More than half of the 700 million people worldwide who lack access to a safe water supply live in sub-Saharan Africa, including Ethiopia. Globally, approximately 2 billion people use drinking water sources that are contaminated with fecal matter. However, little is known about the relationship between fecal coliforms and determinants in drinking water. Therefore, the objective of this study was to investigate the potential for contamination of drinking water and its associated factors in households with children under 5 years of age in Dessie Zuria district in northeastern Ethiopia.p ≤ 0.05. The overall goodness of the model was tested using the Hosmer-Lemeshow test, and the model was fit.The water laboratory was conducted based on the American Public Health Association guidelines for water and wastewater assessment using a membrane filtration technique. A structured and pre-tested questionnaire was used to identify factors associated with the potential for contamination of drinking water in 412 selected households. A binary logistic regression analysis was performed to determine the factors associated with the presence or absence of fecal coliforms in drinking water, with a 95% confidence interval (CI) and a value of A total of 241 (58.5%) households relied on unimproved water supply sources. In addition, approximately two-thirds 272 (66.0%) of the household water samples were positive for fecal coliform bacteria. Water storage duration ≥3 days , dipping method of water withdrawal from a water storage tank , uncovered water storage tank at control , lack of home-based water treatment , and unsafe household liquid waste disposal methods  were factors significantly associated with the presence of fecal contamination in drinking water.Fecal contamination of water was high. The duration of water storage, the method of water withdrawal from the storage container, covering of the water storage container, the presence of home-based water treatment, and the method of liquid waste disposal were factors for fecal contamination in drinking water. Therefore, health professionals should continuously educate the public on proper water use and water quality assessment. Water is the second most important resource for the existence of all living things, including humans . Access E. coli in water sources is responsible for disease outbreaks (Escherichia coli (E. coli)  . In rura of the household-level water samples are positive for fecal-contaminated drinking water, with a 95% confidence interval (CI) and a 5% margin of error.The sample size for the household survey was determined using the single population proportion formula  taking tHence, the sample size was 384 and considering a non-response rate of 10%, the final sample size of the study was 422. Before collecting the water samples, the survey data were collected from the selected households.kth value determined by dividing the study household by the total sample size. The number of participant from each neighborhood was determined by proportional allocation. K = the total number of households’/sample size 3,380/422 = 8.01 = 8.Eight neighborhoods were selected from the total 32 neighborhoods by a simple random sampling technique using a lottery method. Then, the lists of households with children under 5 years of age from each selected neighborhood were obtained from the health extension workers of the selected neighborhoods. Then, the participant household from each neighborhoods was selected using systematic random sampling, using the The questionnaire was developed from the literature that had been published in an international reputable journal , 24 and For the household survey, the data were collected using structured, pretested questionnaires. Initially, the questionnaire was prepared in English and translated into the local language (Amharic) and back-translated into English to assure its consistency. The data were collected through a face-to-face interview and observational. The questionnaire consists of the socio-demographic characteristics of the respondents, water handling practices, hygiene practices, sanitation, and waste management. A total of four Environmental Health professionals and two laboratory technicians were recruited to collect household data and water samples from January 1 to February 30, 2021. The supervision of the data collection process was done by two master’s holders of Environmental Health experts.The outcome variable of the study was the presence of fecal coliform contamination in a drinking water sample, with either (a yes/no) option.The independent variables of the study were Sociodemographic characteristics ; water handling practice; sanitation practices in the immediate area .Fecal coliforms are groups of thermos-tolerant, rod-shaped, non-spore-forming, Gram-negative, oxidase-negative, aerobic or facultative anaerobic bacteria capable of growing in the presence of bile salts or other surface-active substitutes with analogous growth-inhibitory activity and fermenting lactose with gas and acid  production within 48 h at 44 ± 0.5°C .Tap water in home, yard, or property, public tap or standpipe, tube well or borehole, protected dug well, protected springs, and rainwater collection .Flush or drain to the sewer, septic tank or pit latrine, ventilated improved pit latrine (VIP), pit latrine with slab, and composting toilet .Unprotected dug wells, unprotected springs, carts with small tanks or barrels, water supplied by tanker trucks, surface water , and bottled water .Flush or drain elsewhere , pit latrine without slab/open pit, bucket, hanging toilet or hanging latrine, communal facilities of any kind, and no facilities, bush or field .Households with functioning latrines and at least no discernible feces on the premises, discernible fresh feces through the squat hole, and the footpath to the latrine were not covered with grasses .A method of disposal that included burning, burying in a pit, or keeping in a container and disposing of in a designated place .Unsafe disposal of children’s feces: disposal of children’s feces in open areas or not at all; feces is considered unsafe if left in the open, thrown in the trash, placed/washed/flushed down open drains, or buried .Disposing of waste by burning, burying it in a pit or storing it in a container, composting, and disposing of it in a designated location is considered “proper” disposal while disposing of waste in an open field is considered “improper” disposal .It is the practice of disposing excreta through better sanitation technologies such as pit latrine with slab, VIP latrine flush latrine and avoid of open defecation in the family members of the households .It is the practice of disposing human excreta in unsanitary conditions like a pit latrine without slab, bucket, hanging toilet or hanging latrine, the absence of latrine facilities, or having the practice of excreting in bush or field .Data collectors and supervisors received 2 days training on the general aim of the study, the data collection process, and other relevant topics. The questionnaire was pretested on 5% of the sample size in Kalu district, who were excluded from the final study results. Necessary modifications were made based on the feedback from the pre-test before starting the final data collection. Water samples from each household were collected in sterilized glass bottles. All water samples were collected by trained laboratory technicians. Sample bottles were clearly labeled prior to sample collection. Samples were collected according to standardized procedures for collecting drinking water samples. All collected water samples were stored at 4°C prior to analysis. All water samples were analyzed in the laboratory within 4 h of collection. Prior to analysis, the required laboratory equipment and culture media were sterilized. All analytical procedures were carefully performed, and high-quality agar medium was used . Water sA 100 mL volume of a water sample was drawn through a membrane filter (45-micron pore size) through the use of a vacuum pump. The filter was placed on a petri (culture) dish on a pad with lauryl sulfate broth media, which feeds coliform bacteria and inhibits the growth of other bacteria and incubated for 24 h at 44.50°C. This elevated temperature heat-shocks non-fecal bacteria and suppresses their growth. As the fecal coliform colonies grow, they produced an acid (by fermenting lactose) that reacts with the aniline dye in the agar, thus gave the colonies their blue color, and making them easier to count. After 22–26 h, the agar plates were removed from the 44.5°C incubator and counted the colonies that have any blue color. These were taken as positive for fecal coliform bacteria in the investigated water samples , 32.p less than 0.05 at 95% CI were taken as factors significantly associated with the potential for contamination of drinking water by fecal coliforms. Analysis of fecal coliforms in drinking water was based on standard methods for water and wastewater testing adapted from APHA using the membrane filtration technique.Epi Data version 3.1 and SPSS 25.0 were used for data entry and analysis, respectively. The results are presented in tables using frequencies and percentages. The outcome of the study was to measure the presence or absence of fecal coliforms in households stored for drinking water. A binary logistic regression analysis was performed to determine the factors associated with the potential for contamination of drinking water at the 95% confidence interval. Initially, a bivariable analysis was performed using a crude odd ratio (COR), and variables with a cutoff value of less than 0.25 were retained for multivariate analysis with a 95% confidence interval. In the multivariable analysis, the adjusted odds ratio (AOR) with the corresponding 95% confidence interval (CI) was then used to quantify the association between the dependent and independent variables with a 95% confidence interval. Therefore, variables with a value of In this study, 412 participants took part, with a response rate of 97.6%. The majority of participants were between 31 and 40 years old, Muslim, had primary education , were maThe results of this study revealed that a quarter 103 (25.0%) of households used river water as their primary source of drinking water. Generally, unimproved water sources accounted for more than half of 241 (58.5%) of the households. More than half of 234 (56.8%) of the households’ primary sources of water supply water located at a distance of at least 1 km. The study also revealed that nearly two-thirds of 252 (61.2%) households placed their drinking water storage containers on the floor. Additionally, more than one-third [152 (36.9%)] of the households used the dipping method of water withdrawal from storage containers. Furthermore, one-third 162 (39.3%) of the households practiced home-based water treatment. Finally, this study also indicated that less than half of the 194 (47.1%) households had covered their household water storage containers during the inspection period .Less than three-quarters 285 (69.2%) of the households had latrines during the survey time, of whom only 208 (73.0%) households used the latrine properly. Of the households which had latrines, half 143 (50.2%) of the households used pit latrines without slabs. Regarding the cleanliness of latrines, less than half of 129 (45.3%) were clean. This finding also indicated that less than half of 177 (43.0%) households had hand-washing facilities at home, and 127 (30.8%) households used only water for hand washing. Finally, this finding revealed that about two-thirds of 272 (66.0%) of the sampled drinking water was positive for fecal coliform .In multivariable logistic regression analysis, duration of water storage in the house, method of water withdrawal from storage containers, covering of drinking water storage containers during the inspection, practice of household water treatment, and type of human excreta disposal were factors significantly associated with the potential for contamination drinking water at (95% CI). Drinking water stored for more than 3 days was 4,632 times more likely to be positive for fecal coliform than the corresponding groups. Households with the practice of dipping method of water withdrawal from storage containers were 4.377 times more likely to have fecal coliform bacteria than the corresponding groups. Furthermore, households which did not cover the water storage containers during the inspection time were 5.700 times more likely to have fecal coliform bacteria than the corresponding groups. Additionally, households which did not practice home-based water treatment were 4,822 times more likely to test positive for fecal coliform than the corresponding groups. Finally, households which had poor human excreta disposal practice were 3.066 times more likely to have positive for fecal coliform bacteria than the corresponding groups .Access to safe water supply, adequate sanitation, and hygiene facilities are essential necessities of life. Yet, the problem is severe in rural parts of the developing countries, including Ethiopia . More thThe finding of the current study showed that about two-thirds (66.0%) of the water samples taken at the household level indicated the contamination of drinking water were tested positive for fecal coliform, which was matched with the finding in Pakistan . On the The use of improved source of water supply may not be guarantee for safe water quality at the consumption level. Therefore, good water handling practice should be done in addition to utilizing improved sources of water supply to overcome the burden of water related diseases, especially for children under the age of 5 . Less thPoor water handling practices are highly associated with post-contamination of drinking water , 47. TheHousehold water treatment plays an important role in improving drinking water quality. This type of treatment plays a particularly important role for households that depend on unimproved water supply sources, especially in developing countries. It has the potential to reduce the risk of diarrheal diseases by up to 61%. Boiling is the most common method of household water treatment in low-and middle-income countries but is not always practiced effectively . The resImproper disposal of human excreta, such as construction of latrines near water sources and inadequate protection of water at the source, are considered major causes of fecal contamination. In most cases, households with exposed feces have high levels of microbial contamination. Human feces may contain a variety of pathogenic microorganisms, which cause diseases outbreaks such as typhoid fever, dysentery, cholera, and gastroenteritis . The resThis study has certain limitations. Some of the data were collected through interviews and self-report, which means that some of the responses may have social desirability bias. The study used a cross-sectional design, which may make it difficult to establish a cause-and-effect relationship between the dependent and independent variables of the study. Due to the hotspot nature of this study, there may be seasonal variations in the bacteriological quality of the drinking water. Furthermore, since the water samples were taken only from household level, the status of fecal coliform bacterial contamination of drinking water at the sources were ignored which may be a confounding factor for the fecal coliform bacteria at the household level.The results indicate that household drinking water is significantly contaminated with fecal matter. Fecal coliform bacteria were detected in more than two-thirds of the water samples. The length of time water was stored in the household, the method of water withdrawal from storage tanks, the presence of domestic water treatment, and the method of disposal of human excreta were factors significantly related to the potential for contamination of drinking water. Therefore, the district health department should work to improve the quality of drinking water through hygiene education by promoting simple, acceptable, and cost-effective treatment methods and the use of narrow-mouth containers such as jerricans and bottles. In addition, the health and water supply authorities should regularly monitor the bacteriological quality of drinking water at the source, in distribution, and in households. Finally, future research should focus on the quality of drinking water from source to consumption, using other types of bacteria in addition to indicator bacteria.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethics approval was obtained from the institutional ethics committee of Wollo University, University of Medicine and Health Sciences, under ethical reference number CMHS/675/13. The relevant letters were also requested from the district administration. Before the start of data collection, participants were informed of the purpose of the study and confirmed the confidentiality of their information, which would be used exclusively for scientific research purposes. Participation in the study was completely voluntary, and the autonomy of the participants was respected. Participants were also informed that they had the unrestricted right to withdraw from the study at any time.GB, MA, SH, AG, and LB contributed to the conception and design of the study. GB, SH, DT, ZW, and BD conducted the investigation. GB, LB, MA, AK, BD, ZW, BS, and AG performed data management and analysis. GB, MA, DT, AG, LB, ZW, and BS wrote and edited the manuscript. All authors contributed to the article and approved the submitted version.This research project was sponsored by Wollo University with Grant No.: WU/6879 n-05/13.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The objective of this study is to research personality trait differences across generations and the impact of age, gender and self-presentation on these traits.temperament structure scales (TSS) personality questionnaire, which was collected during selection procedures between 1987 and 2019. Generational differences were analysed by ANCOVAs with generation and gender as group factors, controlled by age and self-presentation .A total of 82,147 applicants (aged 17–24) for aviation training , born between 1965 and 2002, were divided into three cohorts . We analysed data from the Age had no significant impact, but we observed slight gender differences in emotional stability, vitality, empathy, and self-presentation across all generations. The generational differences found exhibited extremely small effect sizes, suggesting that applicants have become more extraverted, controlled (with lower aggression and higher rigidity), and inclined to present themselves in a more favourable manner.We discuss the implications of these findings for the aviation industry and the applicability of Generation theory in personality trait research. GeneratGiven the impending mandatory retirement of a significant percentage of pilots, the aviation industry is now interested in the generational shift in the workforce and its implications for training and safety . However1.1.If the environment in the form of historical or social events, influences individuals within a particular age range, they are classified as belonging to a generation . AuthorsGenerational theory not only describes differences between generations, but summarizes environmental factors and predicts their impact on values, attitudes, norms and personality traits. For instance, 1.2.Numerous studies on generational differences focus on workplace behaviour and attitudes. Generation Yers are reported to exhibit higher levels of self-enhancement compared to Generation X , and disNeuroticism is reported to increase over generations as a consequence of less social connectedness and a rise in environmental dangers . For exaSome studies report an increase in self-orientation across generations, with individuals becoming more narcissistic , more in1.3.Differences in certain personality traits between cohorts may be explained by variations in the proportions of men and women within those cohorts. Some findings in generational research suggest, that certain differences hold true only for female cohorts see . It is wAcross the lifespan, changes in values  and trai1.4.Untangling the effects of age, measurement period, career stage, and cohort in contributing to generational differences is challenging . Many fiAnother challenge in exploring generational differences lies in the methodology of questionnaires themselves. It is known that questionnaire results can be influenced by response styles , and soc1.5.In this study, we compared differences between Generation X, Y, and Z in personality traits measured by a personality questionnaire (TSS) that we used during our selection procedures. The TSS, developed by DLR, has its roots in the 1970s prior to the widespread popularity of the Big Five framework . The desSome scales can be recognized as factors  or facets  within the Big Five framework, while other scales were developed specifically for the selection of trainees in aviation jobs. Traits such as being structured yet flexible (Rigidity), adaptability to change (Mobility), maintaining physical fitness and resilience , exhibiting compassionate teamwork (Empathy), or coping with constraints (Spoiltness) reflect the demands necessary during training and on the job. The TSS scale for Openness measures social desirability and self-presentation and should not be confused with the Big Five factor of Openness to experience. The original form of the TSS used in our analysis has remained unchanged over the years and has demonstrated varying but acceptable levels of internal consistency for all scales . Various1.6.Based on the generational theory and empirical findings mentioned above, we expect:H1: Emotional Instability increases from Generation X to Z.H2: Aggressiveness (related to Agreeableness and impulse control) decreases from Generation X to Z.H3: Extraversion shows an increasing trend from Generation X to Z.H4: Mobility increases from Generation X to Z.H5: Physical fitness became more important and Vitality increases from Generation X toY, Z.H6: Achievement increases from Generation X to Y, Z.H7: Rigidity (as a facet of conscientiousness) increases from Generation X to Z.H8: Generation Z is the most egocentric and shows less Empathy then X, Y.H9: Dominance increases from Generation X to Z.H10: Higher levels of narcissism lead to increased levels of Spoiltness from Generation X to Z.H11: Self-presentation is highest in Generation Z with the highest scores in the TSS Openness scale.H12: Women show higher levels of  Instability, Extraversion, Empathy and lower levels of Mobility. In terms of generations, they differ from men in the development of Dominance and Aggressiveness.2.2.1.The sample comprised of 82,147 men and women who were applying for aviation training . The age range was restricted from 17 to 24 years at the time of testing, with applicants born between 1965 and 2002. The testing was conducted at the facilities of the German Aerospace Centre (DLR) in Hamburg, Germany, between 1987 and 2019.All applicants held German citizenship, and only test campaigns conducted in the German language were included in the evaluation. Our data was collected during the initial stage of the selection process, which involved group testing of abilities, knowledge, personality, and English language proficiency. The temperament structure scales (TSS) were integrated into the selection procedure. The sample was limited to applicants who were participating in a selection procedure for the first time and held leaving certificates ranging from German secondary school (after 10th grade) to German university entrance level (after 12th or 13th grade). We followed the generational concept (refer to Section 1. Introduction) and categorized the sample into cohorts known as Generation X (born 1965–1980), Y (born 1981–1994), and Z (born 1995–2002).2.2.The TSS had various versions designed to fit the age, language, and cultural background of applicants. For this study, we utilized the German version developed for school leavers without specific aviation experience. The version used consisted of 180 items  and included a social desirability control scale called Openness, which comprised 30 items. The respondents used a forced two-choice (yes/no) answering format for statements provided or selected one of two alternatives for self-descriptions. The items have remained unchanged since 1987, enabling the use of comparable raw scores for each scale.In 2000, the pencil-paper booklet version was transitioned to a computer-based format. The answer schema and items remained identical, and the test administration process was comparable to the booklet version. We examined data from 1 year prior to and after the transition and found no differences between computer-based and pencil-paper presentations.The TSS were naturally not primarily designed for comparing generational differences. However, they are also suitable for this purpose. It encompasses the two temperament factors of the Big Five , facets of Conscientiousness , and additional areas such as Empathy, Mobility, Dominance, and Self-presentation, which are reported on in terms of generational differences.2.3.In each generation, the TSS was presented as part of the selection test battery, with its outcomes influencing the diagnostic decisions. All items were required to be answered, and there was no strict time limit, unlike the ability or knowledge tests. Typically, the test was administered before a lengthy lunch break to allow participants the opportunity to complete the test during the break time.The pencil-paper version was scanned using an optical document reader, while the computerized version was processed using statistical programs. Raw scores for each variable were compiled along with biographical data, testing dates, and other test results in a SQL database in accordance with data protection regulations. Only data where no abnormalities were documented in the test protocol were included in our analysis.We did not have information about the socioeconomic status of our applicants. However, in each generation, the educational background was consistent, as all participants held German citizenship and were German-speaking school leavers seeking training as pilots or air traffic controllers. In our study, we used biographical variables such as date of birth, sex, and citizenship to establish the study cohorts, and age at testing, year of testing, and the Openness scale were used as control variables.2.4.All statistical analyses were conducted using SPSS 21 software.Due to the unavailability of item-level data for pencil-paper and pre-2000 computer data, we were unable to assess structural invariance.The focus of this study was on analyzing differences between three generations rather than general trends. Therefore, we opted against conducting an age-period-cohort analysis and instead chose to directly compare the three groups. To analyze generational differences (H1–H12), we conducted a two-way ANCOVA with generation and gender as group factors, and age and self-presentation (Openness from TSS) as covariates. Since there was confusion between generation and year of testing, we examined the influence of the year of testing variable as a covariate and decided to exclude it from the analysis.ω2) as a conservative measure of effect size , medium effect (0.06–0.139), or large effect (>0.14), and Pearson correlation between the TSS-Openness scale and other scales as small (0.10–0.29), medium (0.30–0.49), or large (>0.50).We examined main effects, interactions, and the impact of each control variable. We also conducted analyses using raw data and found no differences in results compared to stanine scores. Due to the large sample size, all effects were highly significant. Therefore, we used omega square  < 543. 68, ω2 < 0.01] so we will present the results limited to Generation, Gender and Self-presentation.Instability scores decreased, the effect sizes did not reach significance. In line with our hypothesis (H2), Aggressiveness showed a decrease from Generation X to Z. As for the expected increase in Extraversion (H3), it was only true for Generation X and Y . Due to a decrease in Extraversion for Generation Z, there was no substantial effect size between Generation X and Z . Despite the anticipation of higher scores in Mobility (H4) and Vitality (H5) in later generations due to the growing importance of mobility and physical fitness, the effect sizes did not reach significance. While it is suggested in the literature that conscientiousness increases across generations, we did not find a difference in Achievement between generations (H6). However, there was a small effect size for Rigidity, which increased from Generation X with the highest scores in Generation Z (H7). Today’s generations are often described as having higher self-esteem and assertiveness. We expected an increase in Dominance from Generation X to Z , but this was not supported by the data (H9). Generation Z is often characterized as narcissistic with lower levels of empathy. Consequently, we expected Generation Z to be less empathetic (H8) and more demanding (H10), with higher scores in Spoiltness and lower scores in Empathy. However, for both variables, generational differences did not reach significance. Since Generation Z is described as being most familiar with self-presentation, we expected a higher level of impression management through self-presentation in a socially desirable way . Not only did we find self-presentation to be highest in Generation Z (H11), but we also observed decreasing scores of openness from Generation X to Z.Statistics for all the following effect sizes are presented in 3.3.Instability and Empathy . No significant effects were found for the interaction between generation and gender, so we only present the main effects. Across all generations, women showed higher scores in emotional  Empathy . They alTSS-Openness) than men.We also observed a small gender effect in every generation, with women presenting themselves in a more socially desirable way  = 0.50, p < 0.001, followed by Rigidity r = −0.41, p < 0.001 and Instability r = 0.38, p < 0.001. Applicants who described themselves in a socially desirable way (low in TSS Openness), were less aggressive, more rigid and less emotionally stable.Spoiltness r = 0.21, p < 0.001, Achievement r = −0.18, p < 0.001 Mobility r = 0.12, p < 0.001 and Extraversion r = −0.11, p < 0.001. The tendency for higher self-presentation (low in TSS Openness) correlated with a self-description of being less demanding (Spoiltness), more ambitious (Achievement), less prone to risk taking (Mobility) and higher in extraversion. Smaller but still significant correlations showed up for 4.Extraversion increased from Generation X to Y as expected (Aggressiveness decreased from Generation X to Z, in accordance with the results from Our study yielded only a few results in line with generational theory, and even those lacked a clear trend. For example, expected , but theexpected , we onlySome publications suggest that people have become more self-oriented, showing higher scores in narcissism, individualism, and lower empathy , 2012a. Mobility or Vitality and Dominance. While Mobility and Vitality are specific scales of the TSS questionnaire, Dominance is a scale also used in other questionnaires as well. Twenge reported an increase in dominance specifically for women in earlier generations (Contrary to our hypothesis, there were no higher mean scores in erations . AlthougCertain personality traits are linked with gender. If the percentage of men or women changes in a cohort, it might influence the results of generational differences. In our study, women described themselves as less robust, less emotionally stable, and higher in empathy, which is consistent with other studies . These dOne notable result of our study is the importance of self-presentation in personality measurement and indirectly in generational research. We found a high correlation between self-presentation and certain personality scales across all generations. This aligns with the findings of Overall, we did not find substantial differences in personality traits between generations. The effect sizes were extremely small, and trends were sometimes unclear. For the aviation industry, there is no significant concern that applicants from Generation X or Z would differ greatly in emotional stability, conscientiousness, or personality traits related to interpersonal behavior.However, this study has certain limitations. It is important to note that the generalization of findings to young adults in general and to other aspects of personality may be limited. The measures were taken under highly controlled conditions as part of a selection procedure with a highly homogeneous group of individuals. The study focused specifically on personality traits, and differences between generations might arise when considering attitudes, values, norms, beliefs, attention span, or psychomotor abilities. Additionally, structural invariance was not controlled due to the absence of raw scores on an item level.Personality characteristics are a mix within all populations, and cultural influences may account for small differences between them . FurtherFor future research, it is worth questioning whether the generational approach is the most effective way to detect differences in personality traits between cohorts. While we adopted the generational approach due to its predictive nature and popularity in Human Resources (see special issue of the In accordance with other studies , we conc5.Our study identified only minor differences in personality traits between Generations X, Y, and Z. For the aviation industry, we can conclude that generational differences in personality traits do not significantly impact training and safety considerations. However, our study does not provide any insights into differences in values or abilities. We did find consistent gender differences across all generations, and a high impact of self-presentation on our measurement.dirk.stelling@dlr.de.The datasets presented in this article are not readily available because of DLR data protection rules. Data is from selection procedures. Requests to access the datasets should be directed to Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.The author confirms being the sole contributor of this work and has approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The aim of this study was to explore the influential mechanism of the relationship between sleep quality and activities of daily living (ADL) in patients with Parkinson’s disease (PD), we hypothesized disease severity as a mediator and assumed the mediating process was regulated by cognition.194 individuals with PD (95 women and 99 men) were enrolled in study. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality of PD patients. Patients’ ADL, disease severity and cognition were measured by the Unified Parkinson’s Disease Rating Scale-II (UPDRSII), Hoehn-Yahr (H-Y) Scale, and Mini-Mental State Examination (MMSE). We investigated the mediating role of disease severity and the moderating effect of cognition on the association between sleep quality and ADL in PD patients.The score of UPDRSII was positively correlated with the score of PSQI and H-Y stage, while the score of MMSE was negatively correlated with the score of H-Y stage and UPDRSII. Sleep quality predicts disease severity, and disease severity predicts ADL. Disease severity mediated the relationship between sleep quality and ADL, and the mediating effect was 0.179. Cognition alone did not affect ADL, but the interaction between disease severity and cognition was significantly affected ADL, confirming the moderating effect of cognition in PD patients.Disease severity mediated the association between sleep quality and ADL, good cognition significantly reduced disease severity’s mediating influence on the relationship between sleep quality and ADL. Our study indicated a close relationship between ADL and sleep and cognition in PD, and also provided new insights into the overall management of PD and a better quality of life of PD patients. It is estimated will affect about 17 million people in the world by 2040 . In addiActivities of daily living (ADL) refers to the necessary activities that a person performs every day to meet the needs of daily life. It includes basic skills such as dressing, bathing, eating, and other complex activities like social communication, which is closely related to the quality of life. In the PD population, disease severity seriously affects ADL. With the progress of PD, ADL ability decreases .Studies have also shown that PD patients with poorer sleep quality and cognition usually have a lower ability to life . PD itseCognitive impairment can be seen at an early stage in PD. Any types of cognitive impairment are closely related to the severity of PD measured by the Hoehn-Yahr (H-Y) stage and can lead to the deterioration of neuropsychology and quality of life . It was In view of the effect of disease severity, sleep quality, and cognitive function on ADL and clinical manifestations in PD patients, we have no doubt that in PD patients, disease severity, sleep quality, and cognitive function all have an impact on ADL. But how disease severity, sleep quality, and cognitive function overall affect ADL is still unclear.After searching the relevant literature, we did not find any research about the synthetical influence of sleep quality, disease severity, and cognition on the ADL of PD. However, a better understanding of how they interact is very important and will help us to improve the ADL of patients, especially the early PD patients, and eventually to improve the quality of life in PD patients.Therefore, the aim of this study was to explore the interrelationships between sleep quality, disease severity, cognition, and ADL in PD patients. We hypothesized that in the population of PD, sleep quality and disease severity are associated with ADL, and assumed the mediating process is regulated by cognition .2.2.1.A total of 207 patients in the Parkinson’s specialist outpatient departments of Second Affiliated Hospital of Soochow University were enrolled in our study from August 2017 to July 2022. All patients met the inclusion and exclusion criteria, among them, 13 were excluded due to incomplete data, 194 patients ultimately included in the study. Participants were eligible for the study if they met the following conditions: (a) were diagnosed based on the Movement Disorder Society (MDS) Clinical Diagnostic Criteria for PD , (b) reg2.2.Disease severity was evaluated according to the Hoehn and Yahr (H-Y) scale , the H-YThe Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality in patients with PD in a recent month. It consists of 19 items and generates 7 dimensions as follows: subjective sleep quality, sleep duration, medication use, sleep latency, efficiency of sleep, sleep disturbances, daytime dysfunction, and each dimension takes score from zero to three . PSQI waThe Mini-Mental State Examination (MMSE)  was usedADL was accessed according to The Unified Parkinson’s Disease Rating Scale (UPDRS II) , which wAll patients were at “on” stage, and the study was approved by the Ethics Committee of the Second Affiliated Hospital of Soochow University.2.3.t-test or Mann–Whitney U test for continuous variables , and Chi-square test was used for categorical variables. The zero-order correlations between variables were calculated. The models were developed with PSQI as the independent variables, UPDRS II as the dependent variables, and MMSE as a mediator, and then were tested using Hayes’ PROCESS macro 3.5 for SPSS (model 4 and model 58). According to previous studies, there are significant gender differences in ADL and sleep quality in PD patients, so we added gender as a control variable to reduce confounding bias  and 95% confidence intervals (CI), if a 95% bootstrapped CI does not include zero, it means the parameter is statistically significant. A p-values less than 0.05 were considered statistically significant.The mediation and moderation effects were tested using bias-corrected bootstrapping . Besides, according to the study results on validity and reliability of Chinese version , we cate3.2.Pearson correlation analysis was performed on sleep quality, disease severity, ADL, and cognition. 3.3.A moderated mediation model was calculated to test whether cognition would moderate the indirect relationships between sleep quality and ADL via disease severity.3.3.1.B = 0.496, SE = 0.126, p < 0.001, 95% CI ), when the H-Y stage was included as a mediator, the results showed that PSQI still had a significant positive effect on UPDRS II , PSQI positively predicts HY stage , and H-Y stage positively predicts UPDRS II , the indirect effect is 0.034*5.259 = 0.179, 95%CI , which did not include 0. Therefore, PD severity has a mediating role between sleep quality and ADL, and the mediating effect accounted for 36% of the total effects.We used Model 4 of Hayes’s Process first to investigate the mediation effect of disease severity , the res3.3.2.B = 0.280, SE = 0.103, p < 0.01, 95% CI ), disease severity had statistically significant effects on ADL , cognition alone did not affect ADL , but the interaction between disease severity and cognition was significantly affected ADL , which indicates that the association between disease severity and ADL was moderated by cognition. However, another interaction term showed that sleep quality did not interact with cognition to predict disease severity , thus not supporting the moderation effect in this path. Sex was significant when disease severity was a dependent variable, but was insignificant when ADL was analyzed as a dependent variable , indicating that the direct relationship between disease severity and ADL has become weaker with an increase in cognition. Thus, cognition is a protective component that can effectively reduce the harmful consequences of poor sleep quality on ADL.We calculated effects at different levels of cognition , and the mediating effect value of disease severity between sleep quality and ADL is as follows. Under a 95% bootstrapped CI, the indirect effect reached statistical significance for the mean , high (+1 SD)  and low (−1 SD)  cognition values . When co4.In this study, we tested a model of interactions between sleep quality, disease severity, and ADL in PD patients. This study revealed that cognition played a role of moderator which confirmed our hypothesis. Sleep quality directly affected ADL and indirectly affected ADL via disease severity, furthermore, cognition moderated the association between sleep quality and ADL, and the indirect effect gradually decreased as a score of MMSE increased, indicating that better cognition played the role in moderating and palliating between sleep quality and ADL. In other words, patients with poor sleep quality affect ADL by aggravating the severity of the disease, and better cognition plays a role in buffering these negative effects.The evaluation of sleep disorders is increasingly recognized as an important aspect of the health of patients with chronic diseases. Firstly, consistent with recent studies, our results indicated that poor sleep quality could be a risk factor for decreased ADL ability in PD patients . Sleep qSecondly, we found poor sleep quality was associated with more severe PD stages. The connection between sleep and neurodegenerative disorders has been highlighted in many studies . MechaniFinally, our study showed that cognition played a moderating role in the relationship between ADL and PD severity. Cognition deficit is one of the major clinical non-motor symptoms of PD, about 40% of PD patients at an earlier stage have mild cognitive impairment (MCI), and approximately 40% of PD-MCI progress to Parkinson’s disease dementia (PDD) over 3 years . CognitiA recent study showed that cognition decline can mediate the impact of sleep quality on the H-Y stage in PD patients, and was considered to be caused by impairment of the nigrostriatal dopaminergic system . HoweverOur findings have theoretical and practical implications for improving ADL in PD patients. In theory, the model explains the correlation mechanism behind sleep quality, disease severity, ADL, and cognition, and lays a foundation for the next step of research. In practice, the results are instructive for improving ADL in PD, intervention for sleep and cognition decline may be an appropriate choice to alleviate ADL decline.There are several limitations to our study. First, data analysis showed that the mean MMSE score was 24.43 ± 5.06, median H-Y stage was 2 (1.5–3.0), which indicates that most patients have the good cognitive ability and are in the early stage of PD disease. It is difficult to enroll patients of H-Y stage 4–5 due to their limited cognitive and behavioral abilities, so our conclusion may more appropriate for PD patients in an early stage. Second, PSQI has relatively low sensitivity and specificity as a self-report questionnaire, it is necessary to evaluate the sleep quality of patients from the perspective of caregivers. Sometimes the patient said he had a good night, but the caregivers clearly know he had a bad night, which is common in the outpatient clinic. Further studies using more objective methods, such as polysomnography, are needed to investigate the relationship between sleep and ADL. Third, data were cross-sectional and acquired from only one center, the cross-sectional data made making causal inferences between the identified variables and ADL challenging, further longitudinal studies and sample size expansion need to be performed to investigate the causal link between sleep quality and ADL. Finally, we did not have information on variables including depression, anxiety, apathy, all of which could affect ADL, so there may be residual confounding factors that we have not controlled for, additional research is required to identify other potential mechanisms, so as to improve our model.5.Despite the limitations above, our study tested and expanded an intervention perspective model of sleep quality, ADL, disease severity and cognition, indicated a close relationship between ADL and sleep and cognition in PD, and also provided new insights into the overall management of PD and a better quality of life of PD patients.The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding authors.This study was approved by the ethics committee of the Second Affiliated Hospital of Soochow University (JD-LK-2021-132-02) and informed consent was obtained from all participants.YL and CM conceived and designed the study. YL, JL, and DC collected the data, analyzed the data, and drafted the manuscript. ML, YY, JH, JW, and FW collected the data. CM, CL, and JC critically revised it. All authors contributed to the interpretations of the findings and reviewed the manuscript.


Increasing dietary crude glycerin levels did not the influence the metabolic or urinary profiles (p > 0.05). The liver tissue of the goats fed diets containing the highest crude glycerin inclusion levels showed deleterious effects. The inclusion of crude glycerin with approximately 6.6 g/kg methanol caused deleterious effects to the liver tissue of Boer crossbred goats as the glycerin concentrations increased. However, glycerin levels did not cause deleterious effects on the liver tissue or on the serum or urinary profiles. The use of crude glycerin with lower methanol content is recommended for goat diets.Feedlot finishing of goats is a growing practice, but the economic viability of this technology is compromised by the inclusion of ingredients such as corn and soybean. An alternative to minimize this barrier is the use of agroindustry coproducts as substitutes for those ingredients, such as crude glycerol. This study aimed to evaluated the metabolism of crossbred Boer finishing goats fed diets containing crude glycerin from biodiesel production. Thirty-two crossbred, castrated goat of age were distributed in a fully randomized experimental design with four treatments and eight replicates. The experiment lasted 69 days, and goats were fed sorghum silage and concentrate, with the inclusion of crude glycerin in the diet at levels of 0, 50, 100, and 150 g/kg on a dry matter basis. The diets did not have an effect ( An alternative to minimize this barrier is the use of agroindustry coproducts as substitutes for those ingredients, such as crude glycerol , a coproduct from the production of biodiesel.Glycerol is a component of normal animal metabolism found in the bloodstream and in cells and is easily employed by animal bodies , where iIn ruminants, glycerol is completely fermented by ruminal fermentation to volatile fatty acids, especially propionate and butyrate –6, whichAccording to the Brazilian Ministry of Agriculture, Livestock and Supply , the natThe inconsistency in results may be due to the glycerol purity, duration of supplementation, the speed with which glycerol is fermented in the rumen, and the absorption of glycerol, which is metabolized in the liver, in the rumen epithelium . The incDiets rich in substances such as methanol can cause changes in ruminal physiology and, depending on the type of feed, can affect the microorganism population, feed passage rate, nutrient motility, and absorption speed. These factors can cause a series of metabolic disorders that can lead to animal efficiency production losses, particularly to economic losses to farmers , 15.The evaluation of the metabolic profile of goats submitted to new dietary systems using clinical biochemistry, including the determination of serum concentrations of protein and energy profiles and of enzymes related to liver activity  because these indicators help diagnose metabolic disorders and other diseases.In view of the above, this study aimed to assess the effect of the inclusion of crude glycerin in the diet of feedlot-finished goat kids on metabolic, protein, energy, and urinary profiles, as well as to provide a histopathological evaluation of liver tissues.2.Goats were cared for in accordance with the guidelines for the care and use animals presented in the guide issued by the National Institute of Health and by Brazil’s Ministry of Brazil. Federal University of Bahia Animal Use and Care Committee (n. 08/2013).2.1.The experiment was conducted at the Experimental Farm of the School of Veterinary Medicine and Animal Science of the Federal University of Bahia, in the municipality of São Gonçalo dos Campos, state of Bahia, Brazil, between November 2013 and January 2014.Thirty-two Boer crossbred goats with initial weights of 17.8 ± 2.2 kg and ages ranging from three to four months were tested, distributed in a fully randomized design with four treatments and eight replicates. The treatments corresponded to the four levels of crude glycerin  on a dry matter (DM) basis .ad libitum access to water and feed.Animals were vaccinated and dewormed for ectoparasites and endoparasites in the pre-experimental period; then, they were housed in individual stalls in a covered shed with slatted suspended floors and equipped with drinking fountains and feeding troughs to ensure 2 pens in a covered sheds and equipped with feeders and water throughout the trial period, which consisted of 69 days, 15 days of adaptation of the animals to the facilities and diets and 54 days of data collection. At this stage, the animals received sorghum silage as roughage ad libitum and increasing proportions of experimental feeds. Goats were fed twice daily, with half the daily quota delivered at 8:00 and the remainder at 16:00. Feed portions were individually weighed in a roughage:concentrate ratio of 60:40 and subsequently mixed to minimize selective feeding by the animals.The animals were housed in individual 2-mSorghum bicolor (L). Moench] was used as the roughage  from each goat were collected from the jugular vein at the beginning, the middle and the end of the experimental period. The samples were collected before morning feeding (time 0) and 4 h thereafter in nonheparinized vacutainer tubes after local antisepsis. Samples were centrifuged at 3,500 rpm for 15 min to obtain the blood serum, which was transferred to duly labeled Eppendorf tubes and stored in a freezer at −20°C for subsequent analysis.® , alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase MB isoenzyme (CK-MB) were analyzed and quantified in the automatic biochemical analyzer LAB MAX 240 with commercial reagent kits from LABTEST® , 18.Urine samples from each goat were collected at the beginning, the middle and the end of the experimental period. The samples were collected before morning feeding (time 0) and 4 h thereafter on the 68th day of the experimental period, urine samples were collected from the animals at approximately 4 h after the morning feeding. Urine samples were collected in plastic cups from spontaneous urination, filtered with gauze, and a 10 mL aliquot was collected. Subsequently, samples were diluted in 40 mL of 0.036 N sulfuric acid solution , 18. Sam®.Subsequently, samples were sent to the Laboratory of Clinical Pathology, where urinary concentrations of urea, creatinine, urinary proteins, and uric acid were analyzed and quantified in the automatic biochemical analyzer LAB MAX 240 with commercial reagent kits from LABTEST2 were sampled from each goat and transferred to individual containers with 10% buffered formalin.Animals were fasted on the last day of the experimental period; then, they were transferred to a commercial slaughterhouse in the municipality of Feira de Santana, state of Bahia, Brazil, where they were slaughtered in compliance with current regulations of Normative Instruction No. 3 of the Brazilian Ministry of Agriculture and Supply – Secretariat of Agricultural and Livestock Defense . AnimalsSubsequently, the samples were taken to the Laboratory of Histology of the Animal Science Graduate Program of the Federal University of Paraíba, where they were initially processed by inclusion in paraffin. The analyzed area of histological sections was standardized at 4 μm, and sections were subsequently stained with hematoxylin and eosin (HE) for histopathological examination and evaluation of the effect of crude glycerin on liver tissues following . Morphol2.3.The data were subjected to analysis of variance in a completely randomized design with four treatments, named 0, 50, 100, and 150 g/kg inclusion of crude glycerin, and eight repetitions; the initial weight of the goats was considered as a covariate in the statistical model.The results were interpreted through decomposition of the orthogonal polynomials in linear and quadratic using the PROC MIXED function of the SAS software (version 9.1). The homogeneity of variance between treatments was assumed, and the degrees of freedom were estimated using the Kenward-Roger method. The regression models were adjusted according to the significance of the parameters β1 and β2 by using the method of restricted maximum likelihood in PROC MIXED, and the estimation of parameters was obtained through the PROC REG function of the SAS software (version 9.1). All statistical procedures were performed using the value of 0.05 as the critical level of probability for error type I.3.3.1.p > 0.05) on the serum urea levels (p > 0.05) in any samples from any examined diets.The diets did not have an effect  by the diets (p > 0.05) by the diets, showing a mean of 0.38 mg/dL for both sampling times.Serum albumin levels were not affected (he diets . Serum c3.2.p > 0.05) by the diets; only triglycerides were influenced by the inclusion of crude glycerin  by the diets (p > 0.05) from 189.51 to 207.88 μmol/L.Serum concentrations of plasma glucose and fructosamine were not influenced (he diets . Serum f3.3.p > 0.05) by the diets (Serum gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were not affected (he diets .p > 0.05) by the diets  was not affected , alanine aminotransferase (ALT), and aspartate aminotransferase (AST) remained within the normal range for the species according to Kaneko et al. , who preNerium oleander, most commonly known as oleander, whose ingestion by animals leads to several clinical symptoms such as arrhythmia, paralysis, and even death. The authors also observed an effect, where values ranged from 158–206 IU/L to 402–285 IU/L when animals were intoxicated with 0.5 and 1.0 g/kg body weight, and noted areas of extensive hyaline necrosis in the heart papillary muscle. Such findings demonstrate CK-MB also might be indicative of cardiac problems in ruminants.The creatine kinase myocardial isoenzyme (CK-MB) is an isoenzyme found mainly in the heart and whose quantification can be applied reliably in diagnosing acute myocardial infarction in humans. The enzyme has been well-studied in rodents , 27 but 4.4.The different individual responses of the study animals to these characteristics may indicate hepatic overload, as goat kids fed the highest levels of crude glycerin were more often affected by histopathological lesions and with greater occurrence, which was not verified . This heThis response demonstrates that crude glycerin inclusion levels did not lead to any kidney problems in goats, thus reducing the risk of being affected by diseases such as urolithiasis, one of the main diseases that affects the urinary tract of ruminants, and avoiding economic losses related to veterinary treatment expenses, death of affected animals, and carcass condemnation at emergency slaughter.The different diets did not affect the metabolic, protein, or energy profile of the goats examined, with the profiles being within normal limits for the species for most of the evaluated parameters. Although the findings from the histopathological examination of the liver tissue indicates moderate overload, the diets did not significantly affect the body of the study animals. Therefore, during the evaluated period and in the crude glycerin levels studied, this co-product can be recommended as an energy source for the diet of goat kids, given that deleterious effects were not observed.The indicate crude glycerin did not cause deleterious effects on renal tissue or on the protein, energy, or enzymatic serum profiles and resulted in only moderate damage to the liver tissue.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The animal study was approved by Federal University of Bahia Animal Use and Care Committee (n. 08/2013). The study was conducted in accordance with the local legislation and institutional requirements.HB, ES, GC, and JO: conceptualization. GC and JO: data curation. HB and ES: formal analysis. ES and JO: funding acquisition and supervision. HB and MC: investigation. HB, JO, and MC: methodology. ES: project administration. RG, DP, DF, TN, and AZ: resources. FS: software. FS, RG, and DP: validation. HB, ES, GC, JO, FS, MC, RG, DP, DF, TN, and AZ: visualization. HB, ES, and FS: writing – original draft. DP, DF, TN, and AZ: writing – review and editing. All authors contributed to the article and approved the submitted version.This study was supported by Coordination for the Improvement of Higher Education Personnel (CAPES) (Finance code 001), FAPEMA (Maranhão State Research Foundation) and FAPESB (Bahia State Research Foundation) for its financial support.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Introduction: There are many known risk factors for osteoporosis (OST) among patients with inflammatory bowel disease (IBD), one of which is physical activity. Material and methods: The aim of the study is to assess the frequency and risk factors of OST among 232 patients with IBD compared to a group of 199 patients without IBD. The participants underwent dual-energy X-ray absorptiometry, laboratory tests, and completed a questionnaire about their physical activity. Results: It was found that 7.3% of IBD patients suffered from OST. Male gender, ulcerative colitis, extensive inflammation in the intestine, exacerbation of disease, rare physical activity, other forms of physical activity, past fractures, lower levels of osteocalcin, and higher levels of C-terminal telopeptide of type 1 collagen were risk factors for OST. As many as 70.6% of OST patients were rarely physically active. Conclusions: OST is a common problem in IBD patients. OST risk factors differ significantly between the general population and those with IBD. Modifiable factors can be influenced by patients and by physicians. The key to OST prophylaxis may be regular physical activity, which should be recommended in clinical remission. It may also prove valuable to use markers of bone turnover in diagnostics, which may enable decisions regarding therapy. Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn’s disease (CD) ,2. In thKnown risk factors for OST in IBD include the persistence of chronic inflammation, treatment with glucocorticosteroids, extensive range of the disease, previous resection of the small intestine, arthralgia, and current nutritional deficiencies. Some risk factors are similar to those found in the general population, such as age, smoking, or low physical activity . The golAmong modifiable osteoporosis risk factors specific to IBD, appropriate disease control seems to be a crucial one, especially taking into account the treat-to-target model of treatment . There iWe have irrefutable evidence of the beneficial effects of physical activity for many disease entities. Physical exercise also affects the molecular pathways of bone remodeling, involving all types of bone tissue cells. Unfortunately, we do not have similar data in patients with IBD, although OST is commonly observed in this population. The type and frequency of physical activity, as a modifiable risk factor for OST, needs to be specified in order to make appropriate recommendations for patients. In the general population, multi-component training seems to be the most promising, including aerobic activity and other types of training (resistance and/or strength exercises), because it improves BMD–especially in the elderly and in post-menopausal women .All this indicates the presence of many factors that predispose patients to the development of OST, as well as several factors that have a protective effect on prevention. Nevertheless, some of them still do not have a clearly defined role, which makes the research results inconsistent. The role of physical activity as a protective factor is obvious, though its individual types remain unexplored. In the analysis below, we have included jogging, cycling, gymnastics, swimming or other activities, taking into account the frequency, which seems to be of key importance. In addition, due to the limited number of studies on bone turnover parameters in IBD patients, we examined the values of C-terminal telopeptide of type 1 collagen (CTX), osteocalcin, parathyroid hormone (PTH), and vitamin D.The aim of the study is to assess the frequency and risk factors of OST among patients with IBD compared to a control group without IBD. We conducted a single-center analysis of the frequency of osteoporosis in patients aged 18 and older who had confirmed IBD and in a control group without IBD at the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Poland. All patients in both study groups raised suspicions of OST and were therefore subjected to DXA (2014 Prodigy PRO model) and blood tests to assess bone metabolism with C-terminal telopeptide of CTX, osteocalcin, PTH, and vitamin D levels, and were given an OST risk factor questionnaire. The OST diagnosis was based on the DXA score, which was measured at the femoral neck and lumbar–sacral spine for the following values if the T-score equaled or exceeded −2.5 SD. The study protocol was approved by the Bioethics Committee of the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw. The study lasted two years, from December 2019 to December 2021.n = 232) and the control group (n = 199) separately, and the outcomes were compared. The group characteristics are presented for each study group. Categorical variables are described with the number of observations and the percentage frequency. Numerical variables are described with means and standard deviation or medians and 1st and 3rd quartiles, depending on normality. Normality was tested with the Shapiro–Wilk test and verified with skewness and kurtosis. Homogeneity was tested with Levene’s test. For continuous parameters, differences between groups were assessed with Student’s independent t-test , Welch’s independent t-test , or Mann–Whitney U test . Differences between groups for categorical parameters were assessed with Pearson’s Chi-square test or Fisher’s exact test, depending on whether the assumption for expected counts for Pearson’s Chi-square test was satisfied, and described with Cramer’s V. A logistic 2-step regression approach was used to identify significant predictors of osteoporosis and osteopenia risk (univariate models for each variable in the first step and multivariate models as the second step). Variable selection for multivariate models was based on the p-value produced in the first step being no higher than 0.250. Multivariate models were assessed with Nagelkerke’s R2 and Hosmer–Lemeshow tests. The predictors’ effect is described with an odds ratio (OR) along with 95% confidence intervals. All statistical calculations assumed an alpha value of 0.05. Analysis was run in R software, version R-4.1.2.Statistical analyses were run for patients with IBD , and while there was a roughly equal proportion of men and women within the IBD group , female sex prevailed in the control group (70.4%). The level of correlation between sex and IBD was low, based on Cramer’s V .The group with IBD consisted of 232 patients, 52.2% of whom were women. The average age was 42.09 ± 14.38 years. The control group without IBD consisted of 199 patients, 70.4% of whom were women. The average age was 54.00 ± 12.57 years. The subjects in the two groups demonstrated demographic differences. The patients with IBD were almost 12 years younger . The frequency of physical activity differed between the groups. The correlation between having IBD and the frequency of physical activity was at a moderate level . The main difference lay in patients with daily physical activity  of the control group). There were also more patients exercising once a week in the IBD group (32.8% vs. 23.6% in the control group), while fewer people declared rarely doing physical activity (24.6% vs. 47.7% in the control group). No physical activity was noted for 14.7% of the IBD group and for 25.1% of the control group. In addition, an analysis comparing the performance of resistance exercise  was conducted, finding that 80.1% of IBD patients performed non-resistance exercise (p < 0.001). Supplementation of vitamin D and calcium was significantly more common among patients suffering from IBD (31.0% vs. 17.5% in the control group) with a low strength of association . Fracture history appeared less often among patients with IBD than in the control group (7.8% vs. 19.6%). The association was measured by Cramer’s V was weak . Arthralgia was noted more often within the IBD group than the control group (50.9% vs. 38.2%) and the association between arthralgia and IBD had low strength . The other parameters did not vary between the groups significantly (p > 0.05).Additionally, the proportion of smokers was lower among patients with IBD (11.6% vs. 21.1% in the control group), with a weak association measured by Cramer’s V . These values did not differ significantly from the frequency of osteoporosis  or osteopenia  in the control group . All data are presented in Among patients with IBD, osteoporosis was diagnosed in 17 cases (7.3%). Moreover, osteopenia was found in one-third of patients  among UC patients, exacerbated course of the disease, infrequent physical activity, physical activity other than jogging, cycling, gymnastics or swimming, positive fracture history and abnormalities of certain bone turnover markers: a higher level of C-terminal telopeptide of CTX and a lower level of osteocalcin. All variables had a significant effect, but most were weak . Contrary to previous reports, patients with UC (70.6%) were more likely to suffer from OST, whereas CD was less common . The incidence of pancolitis, as an extensive localization of UC, significantly differed between OST and non-OST groups . Unsurprisingly, exacerbation was observed in all patients with osteoporosis, making disease remission the ultimate goal of OST prevention. Frequency of physical activity differentiated the two subgroups significantly  because the majority of patients with OST were rarely physically active (70.6%). A well-known risk factor—fracture history—was obviously more frequent among patients with OST . Interestingly, there was a lower average osteocalcin value in the OST group , which was unsatisfactory because we hypothesized higher values of the bone formation marker here. However, these discussions were confirmed in CTX . For the other parameters under analysis, no significant difference between the groups was confirmed . Crohn’s disease, compared to UC, lowered the osteoporosis risk by 81% . UC within pancolitis was associated with a tenfold higher risk . Rare physical activity brings a threefold higher risk . Patients with physical activity other than jogging, cycling, gymnastics, or swimming had a fivefold higher risk of osteoporosis . Fracture history increases the risk 18 times . Additionally, a range of numeric parameters influenced the risk level. An osteocalcin level that is one unit higher would cause a 6% lower osteoporosis risk . Statistical significance was not confirmed for other predictor variables (p > 0.05).For patients with IBD, male gender was associated with an almost sixfold higher risk of osteoporosis . Male gender was associated with an almost 6000 times higher risk of osteoporosis . Crohn’s disease, compared to UC, lowered the osteoporosis risk . Rare physical activity brought an almost 380 times higher risk . Performing other physical activity was associated with an almost 140 times higher risk of developing osteoporosis . The other predictors analyzed in the multivariate regression did not have a significant impact on risk. The fit of the multivariate model was assessed with Nagelkerke’s R2, which was found to be 83.6%, indicating a very good fit of the model. The Hosmer–Lemeshow test resulted in a value of p = 0.993, confirming a good model fit.The multivariate regression step identified variables that influence the risk of osteoporosis when working in combination. Significant influences were confirmed for age, gender, Crohn’s disease (vs. UC), rare physical activity (vs. daily), and other physical activity types. Age lowered osteoporosis risk by 24% (p = 0.033). In men with IBD, osteoporosis was found much more often . Physical activity was more often performed by patients with IBD , and among this group, arthralgia was more frequent  and more than one-third of osteopenia (33.6%) in IBD patients can be. There have been some interesting observations regarding risk factors: male gender, ulcerative colitis (UC), location of pancolitis in UC, exacerbation of the disease, infrequent physical activity, other forms of physical activity, history of fractures, lower levels of osteocalcin and higher levels of the C-terminal telopeptide of CTX. Moreover, it is worrying that the average level of vitamin D3 was 16.20 ng/mL, which is far below normal.V = 0.16; p = 0.002). This can be explained by the fact that in our center we strictly follow the recommendations to include vitamin D and calcium supplementation. Unfortunately, as shown by the results of the average vitamin D concentration, it is too low, which was also confirmed in the results of Ratajczak , p = 0.016). Another type of physical activity was not related to OST in this model, which we suspect could be related to the presence of a weak association (V = 0.22). An interesting relationship concerns past fractures, where the association was moderate (V = 0.41), but it may be an indicator of an unknown variable related with OST. The evaluation of our model shows that it was very well-fitted , which indicates the absence of other unassessed variables.In our multivariable logistic regression model, male sex . Other factors included age, gender, and arthralgia.We also checked whether the factors responsible for OST among IBD patients differed from those presented in the general population. No statistical differences were found in terms of BMI, smoking, calcium in the diet, vitamin D and calcium supplementation, past fractures, and selected indicators of bone turnover. The most striking difference was seen in the case of rare physical activity (p < 0.05). The BMD results of patients with active IBD were comparable to those of the control group (p = 0.151). In the conclusions of the study, it was emphasized that frequent physical activity prevents the long-term effects of the disease [p = 0.0335) [Physical activity is a factor that may improve BMD in the IBD population as well . In 2021 disease . In our  0.0335) . In our The analysis did not confirm a relationship between glucocorticosteroids used in IBD and the presence of OST. In the general population, this relationship has been unequivocally confirmed, while among IBD patients there are still too few studies, so the results are extrapolated here. It is known that the results of bone histology and BMD in patients treated with glucocorticosteroids vary depending on the dosage and duration of treatment. At the beginning of treatment, when higher dosages are usually used, severe resorption predominates; in chronic treatment, the reduction of bone formation predominates. When assessing their impact, one should take into account the fact that glucocorticosteroids are used in inflammatory diseases, which themselves cause osteoporosis, the severity of which depends on their activity. Undoubtedly, they also reduce the absorption of calcium in the intestines and increase its excretion in the urine, but this too was not observed in our results . The absSimilarly, no association with anti-TNFs was demonstrated. Data on the effects of these drugs on OST indicate a protective effect, though it is not known whether this is due to the mucosal healing effect in IBD or the effect against the TNF cytokine itself. Elevated TNF levels may play a role in disturbed bone metabolism in IBD. This cytokine induces osteoclast differentiation, increases bone resorption by osteoclasts, protects these cells from apoptosis, and reduces bone formation. Currently, five studies are available in which the protective effect of anti-TNFs was confirmed in small groups; however, as the authors of these studies themselves emphasize, the duration of treatment is crucial, mainly due to the fact that effective treatment enables the healing of inflammatory lesions ,6. In oup = 0.999).Some limitations of our study should be acknowledged: this is a single-center, observational study and most of the IBD patients were suffering exacerbations, which is an independent risk factor for OST. One strength of the study is the comparison of a group of patients with IBD with a control group, where the risk factors differed significantly. Moreover, to our knowledge, this is the first report to study the importance of not only frequent physical activity, but also the type of activity. Other strengths include the rare analysis of bone turnover markers and the good model fit, which is confirmed by the values of Nagelkerke’s R2 (77.3%) and the Hosmer–Lemeshow test result , and those that can be influenced by the physician . Regular physical activity may be the key to OST prophylaxis, although it should be recommended for appropriate patients . It also seems interesting to use markers of bone turnover in the diagnosis, which may help in deciding on a therapy and may play an auxiliary role in determining the improvement of BMD. It is also crucial to expand the literature with multicenter studies to develop appropriate guidelines for monitoring IBD patients for metabolic bone disease.


The university stage is a good time to promote healthy eating strategies. The sociological and cultural changes experienced by students lead them to skip meals, increase their intake of fast food and energy-dense foods, decreasing adherence to the Mediterranean diet (MD). Professionals related to food such as nutritionists and dietitians are also considered a population at risk of developing eating disorders due to the extensive knowledge they possess, which can be used for both good and bad practice. The objective was to analyze the impact of a 4-month educational program promoting the Mediterranean diet on risky eating behaviors, adherence to the Mediterranean diet, and body composition in nutrition and dietetics students, studying the differences according to the group investigated (control group and educated group). The context of the research was 196 students  from two consecutive years. The control group did not receive any type of intervention, while with the control group (educated) an educational program was carried out. Results showed that women with greater control over energy intake, carbohydrates, and sugar had a lower percentage of fat mass, while in men, the relationship was established with weight. Regarding adherence to the Mediterranean diet, at post, it is adequate in both men (8.25 ± 2.87) and women (7.90 ± 2.89), with no significant differences between the intervention groups. The college years fall during a crucial developmental phase known as emerging adulthood . During This increase in EDs during adolescence could be because during this period of life, the university population is subject to several sociological and cultural changes. In this regard, many students move away from their families, leave home, begin college education, become responsible for their own eating habits, organizing their time, buying food, preparing their meals, and organizing meal schedules ,9. All oAmong the population at risk are students in food-related careers. Freitas et al.  reportedEven considering that nutrition and dietetics is an area prone to a higher prevalence or predisposition to eating disorders, the etiology of this relationship is not yet fully explained . It is uSome studies have analyzed the relationship between EDs and body composition in nutrition and dietetics students, however, the analysis was limited only to body mass index (BMI) or waist/hip ratios, without further consideration of other variables such as percentage (%) of fat mass (FM) or muscle mass (MM) ,18,19,20These circumstances condition the teachers’ need to investigate the current situation of eating habits, body composition, and the risk of suffering from ED in this community. It is vital to transfer to nutrition and dietetics students the importance of good dietary and nutritional education, introducing this knowledge in an innovative way. It will be relevant to integrate within the students an assessment of themselves, making them aware of different aspects and behaviors that can cause ED. This will help the students, who, integrating this problem, will be able to identify and treat it better, preventing the development of eating disorders when in clinical practice. This knowledge can be transformed in an adequate nutritional status, promoting healthy habits in the population with whom they work.The Mediterranean diet (MD) could be a key intervention among nutritional strategies as this eating style is a protective factor against obesity or non-communicable diseases such as type II diabetes mellitus , stroke,The Mediterranean diet is also characterized by using different herbs and plants such as basil, bay leaves, mint, rosemary, and sage to enhance food flavor and taste perception. These have a high capacity to impart distinctive aromas, which can modulate the perception of salty taste by providing proteins, fiber, volatile components , vitamins, minerals, phytochemicals, and contribute significantly to the promotion of human health due to their different beneficial properties  and neurodegenerative diseases .The university stage is a good time to promote healthy eating strategies, since the increase in the consumption of energy-dense and unstable diets shows a low adherence to the MD among students . A studyThe research was conducted during the first semester of the academic years 2021/22 and 2022/23 at the University of Alicante. An intra- and inter-subject quasi-experimental design with a pre- and post-test was conducted to identify the effects of a 4-month educational program promoting healthy eating styles on risky eating behaviors, adherence to the Mediterranean diet, and body composition. For this purpose, a group of students enrolled in the nutrition and dietetics degree was evaluated during an academic year in which they did not receive any educational program and the following year in which they received a specific nutritional educational program.A total of 196 first-year nutrition and dietetics students were recruited through non-probability sampling: 49 males (20.8 ± 6.72 years) and 147 females (19.6 ± 2.90 years). The 2021/22 group participated as a control group , while the 2022/23 group received an educational intervention (EIG). The nutrition degree students who had not attended the practical classes were excluded, therefore, they could not partake in the body composition measurements. The study was conducted in accordance with the Declaration of Helsinki. All procedures were previously approved by the Ethics Committee of the University of Alicante (UA-2021-03-11).®, and adherence to the Mediterranean diet (PREDIMED questionnaire) were analyzed at the baseline and at 4 months in both academic years. Questionnaires were completed by the students as an online survey given their convenient and anonymous format. A qualified nutritionist analyzed both questionnaires and calculated the scores. The analysis of body composition was performed in class, in the practical work of the Fundamentals of Nutrition and Dietetics in the first year of the degree.The risk of developing an eating disorder (EAT-26 questionnaire), composition measured with BiodyxpertIn the CG, in the last practical, they were given a complementary lecture to what they studied in class to increase their awareness of the importance of a good dietetic-nutritional education. In this session, the students were shown the results obtained after performing the tests by themselves (both on the first day of class and after 6 months), making them aware and able to quickly and effectively identify the risk behaviors that can result in an eating disorder. In the EIG, an educational program was designed parallel to the classes they attended, related to diet, lifestyle, and risks of eating disorders. The program included three topics ; each toThe EAT 26 questionnaire was used to screen the potential risk of developing an eating disorder . It cons®  was used to measure body composition. This impedance meter allows for an accurate analysis of body composition with professional hand/foot, multi-frequency, and multi-algorithm technology. It consists of passing a low intensity alternating electric current through the body that measures the opposition of the tissues to the passage of this current. The value of the impedances, phase angle, resistances and reactance collected by the measuring device allow, thanks to algorithms, for the determination of body compartments crossed by the current and provides a detailed body composition. The current used was of very low intensity and completely painless.The BiodyxpertAdherence to MD was assessed using the 14-item questionnaire previously validated for the evaluation of prevention with the Mediterranean diet (PREDIMED) . A score2p) for variance analysis calculated the effect size . Finally, linear relationships between pairs of continuous variables were analyzed using Pearson’s correlation coefficient. In addition, the following cut-off points suggested by Cohen (1988) for correlations were established: 0.10–0.29 small association; 0.30–0.49 moderate correlation, and ≥0.50 strong or large correlation [p  <  0.05 established statistical significance. All analyses were performed using the Mac version of the JAMOVI statistical program .Descriptive statistics including the means and standard deviations (SD) were used. The Shapiro–Wilk test was performed to evaluate the normality of the descriptive statistics. To calculate the effect of the educational program, analysis of variance (ANOVA) was used. Post hoc tests (Bonferroni) were performed when significant interaction (group × time) effects were observed. Eta squared partial  and 62 women , and the EIG included 26 men (21.4 ± 6.35 years) and 65 women . The analysis of the differences in the different subscales of the EAT-26, and total sum showed no significant differences in either the women  or men .p = 0.001), BMI (p < 0.001), fat mass at constant hydration (FMCH) (p = 0.001), and crude fat mas (CFM) (p < 0.001). However, there has also been an increase in skeletal muscle mass (SMM) (p < 0.001), appendicular skeletal muscle mass (ASMM) (p < 0.001), hydration without grass (HWG) (p = 0.001), and total water (p = 0.002). In addition, it showed differences between CG and EIG in the post moment for CFM (p < 0.001), SMM (p < 0.001), ASMM (p < 0.001), and water (p = 0.003).For women , the maip < 0.005). After performing the post hoc analysis, a trend was observed in the CFM variable (p = 0.052) between the pre and post of the educated group. Regarding SMM, in the educated group, the post results were significantly higher than the pre (p = 0.034). However, there are differences both at the beginning (p < 0.001) and at the end (p < 0.001) between both groups, with the control group having higher SMM and ASMM values.In men , there wp < 0.001) and in the educated group (p < 0.001), with the pre values significantly lower than the post in both cases.As for the PREDIMED , signifip = 0.002) and between the dieting subscale (p = 0.030) and total score of the EAT-26 with FMCH (p = 0.049).The correlations of the different variables included in the research are presented in p = 0.001), BMI (p < 0.001), FMCH (p = 0.014), and CFM (p = 0.004). Regarding the EAT-26 questionnaire, moderate negative correlations were found between the dieting scale with respect to weight (p = 0.033) and BMI (p = 0.005) and between the total score and BMI (p = 0.011).In men, moderate negative correlations were observed between the different body composition variables and the PREDIMED results: weight , body composition, and adherence to the Mediterranean diet (PREDIMED), in addition to establishing correlations between these variables.From the total number of nutrition and dietetics students who participated, one student in each group was at high risk for eating disorders (EAT ≥ 20) . Initially, of the total number of students who participated in the research, 19.3% had scores higher than 15 points in the total sum, 58% were female, and 42% were male. These percentages can be compared with what has been found in previous studies, where the risk ranged from 9% to 15% among both male and female university students .It has recently been reported that there has been an increase in body dissatisfaction within the population, particularly among university students in non-Western civilizations . In addiPrevious research has shown that nutrition and dietetics students did not have a higher risk of eating disorders and did not differ in the scores of the subscales compared to students from other majors . HoweverOther factors attributed to this struggle include daily dealings with food , guilt, Harrer et al. (2019) , in theip < 0.001). Therefore, it can be assumed that young adults in the educated group experienced favorable changes in body composition in terms of weight loss.Regarding the analysis of body composition, the prevalence of underweight was 13.10%, overweight 13.13%, type I obesity 3.04%, and type II obesity 3.5%. The remaining 78% of students had an adequate weight for their height. It should be noted that the educated group had significantly improved BMI values . The mean body fat percentage was higher in females than in males, as seen in previous research [As the BMI has an unhealthily low specificity , approprresearch . After tresearch  observedIt was observed that the women with the lowest percentage of FM had higher scores on the total punctuation of EAT-26 and dieting scale. This scale is characterized by scrutiny of calorie content, carbohydrates, and sugar content, which is motivated by a desire to be thinner. Therefore, women with a lower percentage of fat mass have greater self-control of food intake and environmental pressure to lose weight. In men, something similar occurs, since the dieting variable and the total sum are significantly and negatively correlated with the BMI variable.With respect to student nutrition, adherence to DM was adequate in men in both groups. However, women obtained slightly lower scores. It should be noted that in all groups, there were significant improvements. The possible reason for this fact is that in addition to the educational intervention designed, the students attended their corresponding classes, increasing, although in a more indirect and not so specific way, their knowledge of food quality and nutritional habits related to adherence to the Mediterranean diet.Among men, significant negative correlations were found between the PREDIMED questionnaire and different body composition variables such as weight, BMI, % fat in constant hydration, and kg fat. Therefore, adult young men who are more adherent to the Mediterranean diet have lower body weight and body fat values.It has been observed that adherence to MD has also been decreasing over the years toward a Western diet model in university students, as indicated by some authors ,47. In pTherefore, disease prevention requires systematizing and incorporating the contributions of the social sciences such as education. This implies integrating the knowledge on the development of subjectivity accumulated by different scientific disciplines, specially psychology, sociology, and pedagogy .It is necessary to define the mechanisms of the emergence of diseases and the participation that the subjective, the social, and the biological aspects have in them. Moreover, it is essential that the social sciences actively participate in the understanding, definition, and stimulation of disease prevention as much as the medical sciences do. In this way, it is possible to speak of psychosocial disease prevention .The results of this study should be interpreted considering some limitations. First, the study sample was limited; students from other specialties/graduates are required to compare the results. In addition, the results were collected within the population of Alicante. To learn the impact of these programs in other cities, it would be necessary to carry out more studies in different provinces with different eating habits. Future research should consider the analysis of other psychological aspects such as the perception of body image using the body shape questionnaire (BSQ). Possible factors associated with the study variables such as dietary intake and physical exercise were also not considered; therefore, it is recommended that they be included in future research to have a better understanding of the behavior of these variables.The educational intervention produced significant improvements in all body composition variables in the women and in the SMM variable in the case of the men; however, it did not produce significant changes in the results of the EAT-26 questionnaire. The results of adherence to the Mediterranean diet improved in both the control and experimental groups. The results obtained were average, with males presenting a higher score, both before and after the intervention. It should be noted that the students with greater control of caloric intake and consumption of carbohydrates and sugars were those with less fat in women, and less weight and BMI in men. In addition, moderate correlations between Mediterranean diet adherence and EAT-26 questionnaire with body composition variables were observed in men. However, in women, the associations observed were small. More social science interventions are needed including measures to assess the impact of nutrition education interventions. In addition, different programs should be made according to the sex of the students, since, as seen in the literature, their interests are not the same.


Local recurrence occurred in 25 patients in the non-TT group and 10 patients in the TT group. The disease-free interval did not differ between groups. Neurological deterioration was observed in three patients in the non-TT group and no patients in the TT group. The ability to walk was preserved in 97.6% of patients in the TT group and 88% of patients in the non-TT group (p = 0.12). In conclusion, molecularly targeted drugs improve survival in patients with spinal metastasis but do not alter local control of metastatic tumors.The aim of this study was to investigate outcomes of molecularly targeted therapy after surgical treatment of spinal metastasis. Participants comprised 164 patients who underwent surgical treatment of spinal metastasis, divided according to whether molecularly targeted therapy was performed. We compared survival, local recurrence of metastasis detected by imaging, the disease-free interval, relapses of neurological deterioration, and the ability to walk between groups. Molecularly targeted drugs were administered to 39 patients after surgery (TT group) and were not administered to 125 patients (non-TT group). Median survival was significantly longer in the TT group (1027 days) than in the non-TT group (439 days,  Metastatic spinal disease is a clinically challenging condition affecting approximately 30% of all cancer patients ,2. Of thIn particular, the introduction of molecularly targeted therapy (MTT) has dramatically improved patients’ prognoses ,6,7. AddThe combination of surgery and radiotherapy has been considered standard treatment for a spinal metastasis . HoweverThe aim of this present study was to clarify the outcomes of MTT after surgical treatment of a spinal metastasis, especially from the viewpoints of life prognosis and local control.The participants were 164 patients who underwent surgery for a spinal metastasis at our hospital between January 2004 and December 2017. All the patients received posterior fusion surgery (with or without decompression) and radiotherapy for their spinal metastasis. Radiotherapy was performed intraoperatively with a dosage of 20 Gy . The patt-test for continuous variables and the chi-square test for categorical variables, as appropriate; p < 0.05 was considered to indicate statistical significance.All statistical analyses were performed using EZR , a graphical user interface for R . More precisely, EZR is a modified version of R Commander designed to add statistical functions frequently used in biostatistics . Descripp < 0.01) (p = 0.5). The disease-free interval did not differ significantly between the groups, with both groups showing relatively good local control (p = 1.0). In total, 97.6% of the patients in the TT group and 88% in the non-TT group retained or regained the ability to walk  than in the non-TT group  , Table 2 control . NeuroloA subgroup analysis was done to compare overall survival and disease-free survival by primary tumor type. Survival time was significantly longer in patients with lung cancer, renal cell carcinoma, and colon cancer with MTT, but no significant difference was seen for breast cancer , Table 3In the present study, the life expectancy of patients with a spinal metastasis was longer with MTT than without MTT. However, local control of spinal metastasis did not differ between the groups, with both groups showing relatively good local control.In general, the life expectancy of patients with a spinal metastasis has significantly improved with the emergence of MTT ,6. A recThe combination of surgery and radiotherapy has been considered standard treatment for a spinal metastasis . In our The present study has several limitations. First, MTT administration was not randomly assigned. Instead, allocation depended on the general status and genetic type of the carcinoma in each patient, thus introducing selection bias. However, no significant difference in preoperative neurological status or life expectancy was evident between the groups . Second,Based on these findings, we concluded that MTT was found to improve survival in patients with a spinal metastasis but did not alter local control of metastatic tumors. Administration of MTT as an alternative to surgical intervention for spinal metastases is not recommended.