Connections between the Levant and the Balkans in the late Middle Pleistocene: Archaeological findings from Velika and Mala Balanica Caves (Serbia)

Factors influencing dignity impairment in elderly patients with incontinence-associated dermatitis: A lasso and logistic regression approach

OBJECTIVE

To understand the current status of dignity impairment in elderly patients with incontinence-associated dermatitis and to systematically analyze the factors influencing it.

METHODS

This study employed a cross-sectional survey design. From July 15th to 31st, 2024, a convenience sampling method was used to select elderly patients with incontinence-associated dermatitis (IAD) from 42 tertiary comprehensive medical institutions across 11 provinces and autonomous regions, including Sichuan, Zhejiang, and Guangdong. A general information questionnaire and a dignity assessment scale were used to gather data on participants' demographic characteristics, clinical conditions, and dignity impairment symptoms.

RESULTS

A total of 372 patients were effectively surveyed, of whom 131 exhibited symptoms of dignity impairment, resulting in an incidence rate of 35%. Multifactorial analysis revealed that Employment Status [OR = 4.183, 95% CI (2.233-7.837)], Primary Caregiver [OR = 1.451, 95% CI (1.005-2.095)], Respiratory System Disease [OR = 5.053, 95% CI (2.079-12.279)], and Nervous System Disease [OR = 2.452, 95% CI (1.206-4.985)] were risk factors for dignity impairment symptoms in elderly patients with incontinence-associated dermatitis. Conversely, Gender [OR = 0.488, 95% CI (0.295-0.807)] and Self-Reported Family Harmony [OR = 0.703, 95% CI (0.550-0.898)] were identified as protective factors against dignity impairment symptoms in this patient population.

CONCLUSION

Although the incidence of dignity impairment symptoms in elderly patients with incontinence-associated dermatitis is relatively low, the psychological trauma it causes cannot be overlooked. Healthcare professionals must actively establish and enhance prevention and management systems for this condition.

Facial morphologies of Middle Pleistocene Europe: Morphological mosaicism and the evolution of Homo neanderthalensis

The phylogeny of the Middle Pleistocene hominins is a matter of intense scientific debate. Important phylogenetic and taxonomic uncertainties remain, not least due to conflicting results of phylogenetic analyses when methodologies or morphological focus differ. Geography has been proposed to play a key role in Middle Pleistocene hominin diversity, with a European group potentially ancestral to Neanderthals (Homo neanderthalensis) and an African group possibly ancestral to Homo sapiens, but the evidence is equivocal. In this study, we explore the connection between geography and facial morphology in Middle Pleistocene hominins with a particular emphasis on the potential Neanderthal affinities of the European group. Furthermore, to assess the impact of methodology on the results, we use a multimethod approach in which morphological affinities in both facial shape and discrete facial traits are assessed on a dataset consisting of 38 fossil and 20 recent hominin skulls divided into five groups (European and non-European Middle Pleistocene hominins, H. sapiens, H. neanderthalensis, and Homo erectus/Homo ergaster). Two main conclusions emerge from these analyses. First, methodological approach has a marked impact on the recorded pattern of morphological affinity, which may explain result discrepancies among previous studies. Second, this disparity may be caused by morphological mosaicism and polymorphism in the facial region of Middle Pleistocene hominins. The results provide some support for a closer connection between European Middle Pleistocene hominins and Neanderthals in terms of discrete facial traits, but not in overall facial shape, raising questions about the process of evolution of the Neanderthal facial phenotype. As a consequence of these results, we argue that greater attention needs to be paid to clarifying the broader evolutionary processes guiding hominin evolution during this period.

Early Neanderthals in contact: The Chibanian (Middle Pleistocene) hominin dentition from Velika Balanica Cave, Southern Serbia

Neanderthals are Eurasian fossil hominins whose distinctive morphology developed in the southwestern corner of Europe and later spread throughout the continent, reaching Southwest Asia before the Late Pleistocene and spreading into Central Asia by 59-49 ka. The timing, tempo, and route of the Neanderthal movements eastward are poorly documented. The earliest probable evidence of Neanderthals in Asia comes from Karain E Cave (Anatolia, Turkey), dated to 250-200 ka. We present four Chibanian (Middle Pleistocene) hominin specimens, representing at least two individuals, from Velika Balanica Cave (Serbia): a permanent upper third molar (BH-2), a deciduous upper fourth premolar (BH-3) refitted to a poorly preserved maxillary fragment with the permanent first molar in the alveolus (BH-4), and a permanent upper central incisor (BH-5). We provide descriptions of the teeth, as well as a comparative analysis of the well-preserved M¹ (BH-4), including assessments of cusp angles, relative occlusal polygon area, relative cusp base areas, two- and three-dimensional enamel thickness, and taurodontism. Morphology of both the occlusal surface and the enamel dentine junction of the M¹ indicates that the maxillary fragment and associated dP⁴ belonged to an early Neanderthal child. The heavily worn I¹ and M³ are consistent with the Neanderthal morphology, although they are less distinct taxonomically. These Chibanian remains with provenance from layer 3a are constrained by two thermoluminescence dates: 285 ± 34 ka and 295 ± 74 ka. They represent the earliest current evidence of Neanderthal spread into the Eastern Mediterranean Area. We discuss these findings in light of recent direct evidence for cultural connections between Southwestern Asia and Southeast Europe in the Chibanian.