Considering health literacy in communication about medications between nurses and patients with heart failure: A cross sectional observational study

OBJECTIVES

To explore the content, style, and initiation of medication-related discussions between nurses and patients to understand how nurses support patients with heart failure, especially those with inadequate health literacy.

METHODS

A cross-sectional design was conducted to observe medication-related conversations between nurses and patients with heart failure in four Dutch outpatient clinics. Conversations were audio-recorded and analyzed using MEDICODE, focusing on content, communication style (monologue or a dialogue), and initiation of the content themes. Health literacy was assessed using the NVS-D and the SBSQ. Results between health literacy groups were compared with descriptive analyses.

RESULTS

A total of 56 patients and 14 nurses participated in the study. Patients classified by one or both of the instruments as having inadequate health literacy (n = 33; 59 %) were generally older, had lower educational levels, and were more often accompanied by informal caregivers. Key themes discussed in the medication-related conversations included how the medication was identified ('medication designation), its dosage and instruction, main effects, side effects, attitude or emotions and other ('various') themes. The 'medication designation' theme was significantly more frequently discussed in the group with adequate health literacy, whereas 'attitude or emotions' and 'various themes' were more commonly discussed among those with inadequate health literacy. Most conversations were nurse-initiated and tended to be monologues, with nurses mainly serving as information providers.

CONCLUSIONS

Nurses primarily initiated and dominated medication-related discussions with a focus on factual aspects of medication, while patients initiated more discussions about their concerns regarding medication. While there was overlap in the topics discussed, notable differences emerged between patients with adequate and inadequate health literacy.

PRACTICE IMPLICATIONS

Improving communication strategies, such as structuring conversations and adopting dialogic approaches may improve patients' engagement and understanding of medication use, leading to more effective management of their condition, particularly benefiting patients with lower health literacy.

The clinicopathologic and prognostic value of CD44 expression in patients with non-small cell lung cancer: A systematic review and meta-analysis

BACKGROUND

CD44 is a promising target in the prognosis and treatment of non-small cell lung cancer (NSCLC). The study deals with systematic review and meta-analysis to determine the association between CD44 overexpression and survival and clinicopathological characteristics in NSCLC patients.

METHODS

We used the databases Google Scholar, Web of Science, PubMed, Scopus, EMBASE, and Cochrane to conduct a systematic search of English-language literature published up to September 2023. The eligible studies were retrieved on CD44 expression, clinicopathological characteristics in NSCLC patients, and reported survival rates. The Cochran's and Higgins I2 tests were used to measure heterogeneity across the included studies. P < 0.05 was considered statistically significant in all cases. The sources of heterogeneity across the included studies were identified using subgroup analysis on histology (SCC, ADC, and LCC), tumor differentiation (well, moderate, and poor), TMN stage (I/II/III/IV), OS, and lymph node metastasis (negative and positive). All statistical analyses were carried out using meta-analysis (CMA) software.

RESULTS

The final analysis for prognostic significance and clinicopathological features on 3681 participants from 25 eligible studies. The pooled event rate of overexpression CD44 for overall survival in NSCLC was 38 % and was related to SCC with 76.6 %. Furthermore, subgroup analysis revealed a link between CD44 overexpression and moderate tumor differentiation (41.8 %). There was a substantial difference in CD44 overexpression in males, with 69.3 % (95 % CI: 64.3-73.9 %, I2 = 88.25 %) versus 31.5 % (95 % CI: 26.7-36.8 %, I2 = 92.15 %) in females. However, no significant relationship was observed between CD44 overexpression and TMN stages/lymph node metastasis.

CONCLUSION

The meta-analysis demonstrated that CD44 is an effective prognostic factor for NSCLC. Overexpression of CD44 has been linked to moderate tumor differentiation, SCC tumor histology, and a worse survival rate. However, no substantial relationship was found between CD44 and metastasis or TMN stages. Large-scale prospective research is required to validate CD44's clinical value as an unbiased prognostic indicator.

Interaction between opium use and cigarette smoking on bladder cancer: An inverse probability weighting approach based on a multicenter case-control study in Iran

Introduction

Opium and cigarette smoking have been identified as significant cancer risk factors. Recently, the International Agency for Research on Cancer (IARC) classified opium as a Group 1 carcinogen in 2020.

Method

Using data from a multicenter case-control study in Iran called IROPICAN, involving 717 cases of bladder cancer and 3477 controls, we assessed the interactions on the causal additive scale between opium use and cigarette smoking and their attributing effects to evaluate public health relevance and test for different mechanistic interaction forms to provide new insights for developing of bladder cancer. A minimally sufficient set of confounders was identified using a causal directed acyclic graph, and the data were analysed employing multiple logistic regression and the inverse probability-of-treatment weighting estimator of the marginal structural linear odds model.

Results

Our findings indicated a significant increase in the risk of bladder cancer associated with concurrent opium use and cigarette smoking (adjusted OR = 6.34, 95 % CI 5.02-7.99; p < 0.001), demonstrating a super-additive interaction between these exposures (Weighted RERIOR = 2.02, 95 % CI 0.47-3.58; p = 0.005). The presence of a super-additive interaction suggests that interventions targeting opium users who smoke cigarettes would yield greater benefits compared to non-opium users. Furthermore, there was a mechanistic interaction between two exposures (P-value = 0.005) if we assumed two of the exposures have positive monotonic effects, i.e., there must be a sufficient-component cause for developing bladder cancer, which has both opium use and cigarette smoking as components.

Conclusion

There is a causal additive interaction between opium use and cigarette smoking. We observed a super-additive interaction, suggesting the need to focus interventions on specific subgroups. Furthermore, the presence of mechanistic interactions offers profound insights into the mechanisms of cancer induction.

Effects of an artificial intelligence-based exercise program on pain intensity and disability in patients with neck pain compared with group exercise therapy: A cohort study

OBJECTIVES

This study compares the effects of an artificial intelligence app-based exercise program with group exercise therapy on pain intensity and neck-related disability in patients with neck pain.

PARTICIPANTS

84 patients with neck pain. 70 fulfilled the study requirements. 52 were in the intervention and 18 in the comparison group.

INTERVENTION

The intervention group utilized an AI-based exercise program accessible via digital devices. The AI provided 3-5 daily exercises tailored to individual feedback, pain intensity, and well-being. The exercise duration was up to 15 min per day. The comparison group attended up to two 45-min group exercise sessions weekly.

METHODS

Pain intensity and neck-related disability were assessed using an 11-point numerical rating scale and the Neck Disability Index via online questionnaires at baseline, 4 weeks, and 8 weeks. The non-parametric Mann-Whitney U test was used to test for between group differences.

RESULTS

After 8 weeks, the intervention group showed a significantly lower pain intensity than the comparison group (U = 287, Z = -2.447, p = 0.042, r = 0.3). Compared to baseline, the intervention group showed a significant reduction in neck pain (Chi2 (2) = 15.775, p < 0.001, W = 0.15) and an improvement in neck-related disability (Chi2 (2) = 25.094, p < 0.001, W = 0.24). The comparison group showed no significant change over time.

CONCLUSION

The app-based exercise program demonstrated promising results for the reduction of pain intensity and neck-related disability, offering a personalized and mobile alternative to group exercise therapy for patients with neck pain.

Unraveling the prevalence and key influencers of metabolic syndrome in Drug-Naïve, first-episode major depressive disorder patients with psychotic symptoms: A decision tree modeling approach

BACKGROUND

Investigating the relationship between metabolic syndrome (MetS) and first-episode, drug-naïve psychotic major depressive disorders (FEDN-PMD), this study employed decision tree modeling to identify key factors.

METHODS

A cross-sectional study was conducted with 1718 FEDN-PMD patients. Sociodemographic, clinical, and blood biochemical parameters were collected, and the prevalence of MetS was assessed.

RESULTS

MetS was more prevalent in the PMD group (16.96 %) compared to non-PMD (5.95 %) and whole MDD groups (7.04 %). Utilizing decision tree modeling, four key variables were identified: TSH, duration of disease, A-TPO, and age. Specifically, when TSH was less than 6.9 IU/mL, MetS incidence was 2.67 %. Higher TSH levels, in conjunction with other factors, substantially influenced MetS incidence, especially when age was 51.5 years or older, and A-TPO was greater or equal to 763.025 IU/mL.

CONCLUSIONS

MetS is prevalent in FEDN-PMD patients. The decision tree model highlighted the importance of TSH, duration of disease, A-TPO, and age in predicting MetS risk. These insights could lead to personalized interventions, potentially mitigating the risk of MetS and enhancing patient outcomes.

Association between childhood hunger and depression or anxiety in later life: Insights from two case-control studies

OBJECTIVES

Childhood hunger has been found to decelerate the risk of depression and anxiety, which have been reported to influence each other. However, the roles of depression and anxiety in the relationship between childhood hunger and these conditions has not been fully examined. Childhood hunger may increase the risk of depression through anxiety, while it may also increase the risk of anxiety through depression.

METHODS

Two case-control studies were conducted using data from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Depression and anxiety were assessed by using the 10-item Center for Epidemiological Research Depression Scale (CESD-10) and the Generalized Anxiety Disorder 7-item scale (GAD-7). Logistic regression, subgroup and interaction analyses evaluated the associations, while the KHB method estimated the bidirectional mediating effects of anxiety and depression.

RESULTS

A total of 8866 participants were involved in data analysis. After adjusting confounders, logistic regressions and subgroup analyses indicated significant associations between childhood hunger and depression (aOR:1.190, 95 % CI:1.076-1.315, p < 0.001), and the interaction effects of subgroups were significant including residence of birth, father had steady job, father received school education, and mother received school education (p < 0.001). Similarly, childhood hunger and anxiety are significantly associated (aOR:1.309, 95 % CI:1.118-1.534, p < 0.001), particularly in sex, father received school education, mother received school education (p < 0.05). Anxiety partially mediates the relationship between childhood hunger and depression, while depression also partially mediates the relationship between childhood hunger and anxiety.

CONCLUSIONS

Our findings suggest that childhood hunger is associated with both depression and anxiety, with each playing a partial mediating role in the relationship between childhood hunger and the other condition, highlighting the importance of addressing early-life hunger to prevent long-term mental health issues.

Interplay between Stressful Life Events and Interleukin-1β on 12-week Antidepressant Response in Depressive Patients

Objective

This study aimed to investigate the moderating effects of interleukin-1β (IL-1β) on the relationship between stressful life events (SLEs) and antidepressant treatment outcomes over 12 weeks in patients with depressive disorders.

Methods

Baseline assessments of SLEs, IL-1β levels, and other covariates were conducted for 1,094 depressive outpatients with 1,086 followed up for 12 weeks. Antidepressant treatment was tailored according to clinician recommendations and patient preferences, with outcomes evaluated at 12 weeks using the Hamilton depression rating scale. Logistic regression analyses explored the individual and interactive effects of SLEs and IL-1β on depression remission.

Results

SLEs alone did not predict 12-week remission (OR = 0.93, 95% CI [0.82, 1.06]). However, IL-1β levels significantly influenced outcomes (OR = 0.67, 95% CI [0.53, 0.87]), particularly in conjunction with high SLE exposure (Wald = 13.29, p < 0.001). Higher IL-1β levels were associated with lower odds of achieving remission in the group with two or more SLEs (OR = 0.46, 95% CI [0.33, 0.65]), whereas in the group with fewer than two SLEs, the odds were not significantly different (OR = 1.13, 95% CI [0.77, 1.65]).

Conclusion

These findings highlight the critical role of both biological markers and environmental stressors in antidepressant treatment. IL-1β could serve as a biomarker for customizing antidepressant strategies, particularly in patients experiencing high SLE exposure, thereby enhancing treatment efficacy and personalized care. Future studies should include longitudinal assessments of IL-1β to further elucidate its dynamic role in depression pathology and treatment response.

Particulate matter 2.5 (PM2.5) - associated cognitive impairment and morbidity in humans and animal models: a systematic review

Particulate matter with an aerodynamic diameter of less than 2.5 µm (PM2.5) is one of the criteria air pollutants that (1) serve as an essential carrier of airborne toxicants arising from combustion-related events including emissions from industries, automobiles, and wildfires and (2) play an important role in transient to long-lasting cognitive dysfunction as well as several other neurological disorders. A systematic review was conducted to address differences in study design and various biochemical and molecular markers employed to elucidate neurological disorders in PM2.5 -exposed humans and animal models. Out of 340,068 scientific publications screened from 7 databases, 312 studies were identified that targeted the relationship between exposure to PM2.5 and cognitive dysfunction. Equivocal evidence was identified from pre-clinical (animal model) and human studies that PM2.5 exposure contributes to dementia, Parkinson disease, multiple sclerosis, stroke, depression, autism spectrum disorder, attention deficit hyperactivity disorder, and neurodevelopment. In addition, there was substantial evidence from human studies that PM2.5 also was associated with Alzheimer's disease, anxiety, neuropathy, and brain tumors. The role of exposome in characterizing neurobehavioral anomalies and opportunities available to leverage the neuroexposome initiative for conducting longitudinal studies is discussed. Our review also provided some areas that warrant consideration, one of which is unraveling the role of microbiome, and the other role of climate change in PM2.5 exposure-induced neurological disorders.

Association Between Type 2 Diabetes Mellitus and Heart Failure: A Retrospective Study from a Tertiary Care Diabetes Centre in India

INTRODUCTION

The study aimed to explore the association between type 2 diabetes (T2D) and heart failure (HF) using echocardiography and NT-proBNP. The study also derived an NT-proBNP cut-off for diagnosing HF by echo in Asian Indians with T2D.

METHODS

A retrospective study was performed using data from individuals with T2D, aged ≥ 18 years, who visited diabetes clinics in India between March 2019 and December 2023. NT-proBNP levels were quantified by chemiluminescence, and left ventricular ejection fraction (LVEF) was assessed from echo using two-dimensional (2D) echocardiography. Heart failure was classified based on the European Society of Cardiology (ESC) guidelines. Receiver operating characteristic (ROC) curve was performed to determine the optimal NT-proBNP cut-off for diagnosing HF by echo.

RESULTS

Among the 1189 study individuals included in the study (714 men and 475 women), 5.9% were identified as having HF with reduced ejection fraction (HFrEF), 5.5% had mildly reduced ejection fraction (HFmrEF), and 14.1% had HF with preserved ejection fraction (HFpEF) while the rest (74.5%) had LVEF > 50%. Elevated NT-proBNP levels were observed in those with reduced ejection fraction. ROC analysis identified an optimal NT-proBNP threshold of 398 pg/mL for diagnosing HF, with 87% sensitivity and 78% specificity. HF prevalence increased with age, peaking at 30.6% in individuals aged 61-70 years. Women with HF had higher NT-proBNP levels than men.

CONCLUSIONS

In this diabetes clinic population, 11.5% of individuals with T2D had moderate to reduced LVEF. Early identification of HF using echocardiography and NT-proBNP in a diabetes clinic could help improve prognosis.

Association of Metabolic Syndrome with Ischemic Changes in Electrocardiogram: Result from a Population-Based Study in the North-East of Iran

Background: Ischemic changes in the electrocardiogram (ECG), along with metabolic syndrome (MetS) and its components, can be utilized to predict cardiovascular diseases (CVDs). However, the exact association between MetS components and ECG abnormalities is not well established. This study was designed to verify this association. Methods: This cross-sectional study was conducted on individuals aged 35-65 years as part of the population-based Mashhad Stroke and Heart Atherosclerotic Disorder (MASHAD) study. Participants were allocated into two groups based on the presence of MetS. ECGs were coded using the Minnesota coding system. The association between each MetS component and every ischemic ECG presentation was analyzed separately. Results: Among the 9,035 available ECG data, the overall prevalence of ischemic ECG presentations was significantly higher in those with MetS than in those without (P < 0.05), except for minor ischemia (P = 0.787). Multiple logistic regression analysis showed that MetS was independently associated with major ischemia presentation in ECG (OR = 1.254, 95% CI 1.103-1.425, P < 0.001), but no association was found with minor ischemia after adjustment for age, sex, smoking, CVD family history, and physical activity level. Among MetS components, triglycerides, fasting blood glucose, waist circumference, and systolic and diastolic blood pressures were significantly associated with ischemic ECG presentations. Elevated high-density lipoprotein cholesterol level had a negative association with ischemic ECG presentations, while it had a significant positive association only with ST-segment elevation (OR = 1.021, 95% CI 1.011-1.031, P < 0.001). Conclusions: MetS and its components showed an association with ischemic ECG presentations, but these associations varied based on each MetS component and ischemic ECG abnormality.

Therapeutic Approaches for COVID-19: A Review of Antiviral Treatments, Immunotherapies, and Emerging Interventions

The coronavirus disease 2019 (COVID-19) global health crisis, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has presented unprecedented challenges to global healthcare systems, leading to rapid advances in treatment development. This review comprehensively examines the current therapeutic approaches for managing COVID-19, including direct-acting antivirals, immunomodulators, anticoagulants, and adjuvant therapies, as well as emerging and experimental approaches. Direct-acting antivirals target various stages of the viral life cycle, offering specific intervention points, while immunomodulators aim to modulate the host's immune response, reducing disease severity. Anticoagulant therapies address the coagulopathy frequently observed in severe cases, and adjuvant treatments provide supportive care to improve overall outcomes. We also explore the challenges and limitations of implementing these treatments, such as drug resistance, variable patient responses, and access to therapies, especially in resource-limited settings. The review also discusses future perspectives, including the potential of next-generation vaccines, personalized medicine, and global collaboration in shaping future COVID-19 treatment paradigms. Continuous innovation, combined with an integrated and adaptable approach, will be crucial to effectively managing COVID-19 and mitigating the impact of future pandemics.

TIM-3 teams up with PD-1 in cancer immunotherapy: mechanisms and perspectives

Immunotherapy using immune checkpoint inhibitors (ICIs) has become a prominent strategy for cancer treatment over the past ten years. However, the efficacy of ICIs remains limited, with certain cancers exhibiting resistance to these therapeutic approaches. Consequently, several immune checkpoint proteins are presently being thoroughly screened and assessed in both preclinical and clinical studies. Among these candidates, T cell immunoglobulin and mucin-domain containing-3 (TIM-3) is considered a promising target. TIM-3 exhibits multiple immunosuppressive effects on various types of immune cells. Given its differential expression levels at distinct stages of T cell dysfunction in the tumor microenvironment (TME), TIM-3, along with programmed cell death protein 1 (PD-1), serves as indicators of T cell exhaustion. Moreover, it is crucial to carefully evaluate the impact of TIM-3 and PD-1 expression in cancer cells on the efficacy of immunotherapy. To increase the effectiveness of anti-TIM-3 and anti-PD-1 therapies, it is proposed to combine the inhibition of TIM-3, PD-1, and programmed death-ligand 1 (PD-L1). The efficacy of TIM-3 inhibition in conjunction with PD-1/PD-L1 inhibitors is being evaluated in a number of ongoing clinical trials for patients with various cancers. This study systematically investigates the fundamental biology of TIM-3 and PD-1, as well as the detailed mechanisms through which TIM-3 and PD-1/PD-L1 axis contribute to cancer immune evasion. Additionally, this article provides a thorough analysis of ongoing clinical trials evaluating the synergistic effects of combining PD-1/PD-L1 and TIM-3 inhibitors in anti-cancer treatment, along with an overview of the current status of TIM-3 and PD-1 antibodies.

Second hand smoke attributable disease burden in 204 countries and territories, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND

We aimed to estimate the changes in, second hand smoke (SHS) and potential drivers of its health outcome from 1990 to 2021 worldwide.

METHODS

The data was derived from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, which covered 204 countries and territories. We reported SHS changes by sex, year and sociodemographic index (SDI) level (a summary measure that identifies where countries or other geographic areas sit on the spectrum of development) from 1990 to 2021. We analyzed the risk-outcome pairs among all age groups to estimate disease burden attributable to SHS exposure and also did a decomposition method to attribute changes in all-cause SHS attributable deaths or disability-adjusted life years (DALYs) to population growth, population aging, and mortality change.

RESULTS

Worldwide, the age-standardized summary exposure values (SEV) of SHS exposure in 2021 was 30.6% (28.9 to 31.6) for males and 38.0% (35.5 to 39.0) for females, with a percentage change of -0.2 (-0.2 to -0.1) and -0.3 (-0.3 to -0.2), respectively, since 1990. Among the top 10 countries with the highest SEV, there were mainly high-middle SDI countries for male and low-middle SDI and middle SDI countries for female, respectively. Secondly, about 1.29 million deaths (0.68-1.90) and 34.90 million DALYs (17.95-52.21) were attributable to SHS exposure, and about half of them took place in two countries (China and India). Ischemic heart disease (IHD) (29.67%), chronic obstructive pulmonary disease (COPD) (19.04%), and lower respiratory infections (LRIs) (10.87%) were the three leading causes of SHS associated deaths. Lastly, since 2010, the number of SHS related death significantly increased due to population growth and population aging, despite a decrease in mortality attributable to SHS exposure.

CONCLUSION

Globally, the age-standardized SEV of SHS exposure decreased from 1990 to 2021. Since 2010, the increased number of deaths attributable to SHS exposure was mainly attributable to population growth and aging.

Effects of Traditional Chinese Exercise Yijinjing on Disability and Muscle Strength Among Patients With Chronic Low Back Pain: Protocol for a Randomized Controlled Trial

BACKGROUND

Chronic low back pain (CLBP) is a common public health problem. Progressive loss of muscle strength leads to long-term chronic pain and disability. Yijinjing exercises, an ancient therapy dating back thousands of years, are widely used in China to treat low back pain. However, little is known about its benefits and scientific evidence for back extensor strength. This trial aimed to assess the efficacy of Yijinjing on disability and dorsal extensor strength in patients with CLBP.

OBJECTIVE

We present a randomized controlled study to evaluate the efficacy of the traditional Chinese exercise Yijinjing on disability and back extensor strength in patients with CLBP.

METHODS

This is a 2-arm, parallel-design, assessor-blinded, and analyst-blinded randomized controlled trial. The 106 participants with CLBP who were recruited will first receive basic traditional Chinese manual therapy to help relieve their physical discomfort. Second, they will be randomly divided into a Yijinjing group (n=53) and a control group with functional exercises (n=53) at a ratio of 1:1. The interventions for both groups will be carried out twice a week for 4 weeks. Patients in both groups will be followed up at 1 and 3 months after the intervention. The primary outcome is disability (measured by the Oswestry Disability Index). The secondary outcomes included pain intensity (assessed by the Numerical Rating Scale), data from isokinetic dynamometry, flexibility (assessed by the fingertip-to-floor test), mood (evaluated by the Pain Catastrophizing Scale and Fear Avoidance Beliefs Questionnaire), and quality of life (measured by the EQ-5D-5L). All adverse effects will be assessed using the Treatment Emerging Symptoms Scale, and data will be analyzed using an intention-to-treat analysis.

RESULTS

The trial was funded in December 2023. The Institutional Ethics Committee of Yueyang Hospital of Integrative Medicine, Shanghai University of Traditional Chinese Medicine, approved this study. The first patient was enrolled in February 2024, and as of August 2024, a total of 106 participants have been recruited. Data analysis has not yet begun and is expected to be published in January 2025. The protocol has been registered with the Chinese Clinical Trial Registry (ChiCTR2400081105).

CONCLUSIONS

If this trial proves effective, it will guide the setup of a randomized controlled trial to demonstrate whether traditional Chinese exercise Yijinjing improves disability in patients with CLBP and is more effective than usual stretching exercises.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2400081105; https://www.chictr.org.cn/showprojEN.html?proj=214425.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/67557.

Trajectories of depressive symptoms and risk of chronic liver disease: evidence from CHARLS

BACKGROUND

It is unclear whether there is a association between the long-term depressive symptoms and chronic liver disease(CLD). The aim of present study was to investigate the relationship between the trajectories of depressive symptoms and CLD in middle-aged and older Chinese adults.

METHODS

The study included data from 7351 Chinese individuals, which from the China Health and Retirement Longitudinal Study (CHARLS). Latent Class Growth Model (LCGM) and Growth Mixture Model (GMM) identified five categories of depressive symptom trajectories from 2011 to 2015. Multiple logistic regression models were used to analyze the relationship between depressive symptom trajectories and CLD in 2015-2020.

RESULTS

We identified five distinct trajectories of depressive symptoms characterized by persistent low CES-D scores throughout follow-up (low-stable; 4621 cases [62.86%]); high starting CES-D scores but then declining (high-decreasing; 824 cases [11.21%]); persistent high CES-D scores during follow-up (high-stable; 508 cases [6.91%]); starting moderate CES-D scores but then increasing (moderate-increasing; 844 cases [11.48%]); and low starting CES-D scores that increased and then remitted through follow-up (remitting; 554 cases [7.54%]). A total of 420 (5.71%) participants developed chronic liver disease during follow-up. The ORs (95% CI) for the risk of developing chronic liver disease in participants on the moderate-increasing trajectory, high-decreasing trajectory, and high-stable trajectory were 1.44 (1.05-1.93), 1.59 (1.17-2.12), and 2.25 (1.62-3.08), respectively, compared with participants on the low-stable trajectory.

CONCLUSION

In Chinese middle-aged and older adults, individuals with moderate-increasing, high-decreasing, and high-stable trajectories of depressive symptoms over time had an increased risk of developing CLD.

Global trends and patterns in cardiovascular disease burden attributable to low physical activity: A systematic analysis for Global Burden of Disease Study from 1990 to 2021

BACKGROUND

This study analyzes the global burden of cardiovascular diseases (CVD) related to low physical activity from 1990 to 2021, focusing on spatiotemporal changes.

METHOD

Using data from the GBD study, we examined trends in CVD burden linked to low physical activity, including mortality counts, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized disability rates (ASDR). Decomposition analysis was used to identify key drivers of these changes, and frontier analysis visualized each country's potential to reduce the burden. An autoregressive integrated moving average model was used to forecast the burden from 2022 to 2036.

RESULTS

In 2021, approximately 370,000 deaths globally were attributed to CVD due to low physical activity. The ASMR and ASDR for CVD were 4.53 per 100,000 (95% uncertainty interval: 1.52 to 8.05) and 85.95 (95% UI: 35.25 to 140.65), respectively. From 1990 to 2021, the global burden increased, particularly in regions with a middle socio-demographic index, driven by aging populations and population growth. The ASMR is projected to decrease to 3.49 per 100,000 by 2036.

CONCLUSIONS

Low physical activity is a major contributor to CVD-related mortality and disability worldwide. Public health interventions aimed at increasing physical activity, especially in regions with rising burdens, are essential to reduce the global CVD burden.

Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019

Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly.

Uncovering bridging diseases in complex multimorbidity pathways: A network science approach

Multimorbidity, the co-occurrence of multiple chronic diseases, represents a significant challenge in healthcare, necessitating advanced analytical methods for a better understanding. Although numerous studies focus on characterizing chronicity profiles across different population groups, there is still a need to identify specific diseases that play a crucial role in shaping multimorbidity patterns. This study applies network science to analyze multimorbidity structures and identify bridging diseases that facilitate the development of complex multimorbidity patterns, using data from a representative sample of 2,200 individuals aged 50 and older residing in southern Spain. Our findings reveal significant gender-based differences in multimorbidity patterns, with women experiencing a higher burden of chronic diseases, resulting in more complex and tightly linked disease networks. The analysis highlights the relevance of specific conditions, such as liver dysfunction in men and depression in women, as key contributors to the formation of complex multimorbidity structures. These findings emphasize the importance of sex/gender-specific healthcare strategies aimed at controlling and preventing diseases that may act as catalysts for multisystem multimorbidity, which have a profound impact on both mortality rates and healthcare utilization.

Association of chronic kidney disease and cardiovascular disease risk with all-cause mortality: an interaction, joint and mediation analysis in Chinese adults

BACKGROUND

Chronic kidney disease (CKD) is a global public health problem. This study aimed to evaluate the complex relationship of CKD and cardiovascular disease (CVD) risk with mortality in different age groups and the mediation effect of CVD risk among Chinese adults.

METHODS

A total of 7533 participants from the 2009 wave of China Health and Nutrition Survey (CHNS) cohort were included in this study and followed up to 2015. CKD was defined as the estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2. Framingham risk score (FRS) was used to assess CVD risk. The interaction, joint association of CVD risk and CKD on mortality, and subsequent mediation effect were evaluated using multivariable Cox regression.

RESULTS

CHNS cohort recorded 266 deaths over a mean follow-up time of 5.04 years. The all-mortality rates among adults with CKD and high CVD risk were significantly higher than healthy controls (22.48 and 21.30 per 1000 person-years). After adjusting for covariates of age, gender, BMI, hypertension, diabetes, hyperuricemia, smoking status, and alcohol consumption, the adjusted hazard ratios (aHR) of CKD and high CVD risk were 1.70 (95% CI 1.27-2.28) and 1.62 (95%CI 1.26-2.09), respectively. Joint effect analysis revealed that mortality hazard was highest in CKD patients with high CVD risk (aHR = 3.15, 95% CI 1.92-5.16). Mediation analysis showed that significant partial mediation by SBP and fasting glucose, accounting for 19.2% (p < 0.001) and 3.52% (p = 0.012) of the total effect of CKD on mortality.

CONCLUSIONS

Comprehensive strategies including lifestyle modifications, diet restrictions, and cardio-nephrology multidisciplinary treatment for mitigating CVD risk in CKD patients should focus on middle-aged people and early disease detection.

Predictors of Service Engagement and Disengagement in Community-Based Coordinated Specialty Care for Early Psychosis in Texas

Coordinated specialty care (CSC) is an evidence-based, early intervention approach for individuals with a recent onset of psychosis. This study identifies program and individual characteristics that predict (1) initial engagement in care; (2) the use of peer and family partner services; and (3) time to disengagement. Administrative data representing CSC encounters at 22 community mental health programs were analyzed. Logistic regressions were used to model initial CSC engagement, as well as the use of peer or family partner services, given initial engagement. Cox proportional hazards regression was used to quantify program disengagement, with possible time-varying effects of peer service use. Identified predictors of initial engagement included: race/ethnicity, age, diagnosis, program urbanicity, and program maturity. Identified predictors of disengagement in the first year included: diagnosis, program urbanicity, and program maturity. Peer and family partner services did not significantly predict disengagement. These results suggest equity issues for some individuals, while also highlighting the importance of program characteristics on pathways to care. Future research should include program factors as key predictors for engagement, explore both person-centered and program-centered strategies to maximize engagement, and optimize and examine the role of individual and family peer services in engagement. Such a shift would align with the call to understand pathways to care from a community-level rather than individual lens.

Urban health inequities and healthy longevity: traditional and emerging risk factors across the cities and policy implications

Urbanization is reshaping global health, with over 55% of the world's population residing in urban areas, a figure projected to reach 68% by 2050. This demographic shift presents significant challenges and opportunities for public health, as urban environments exacerbate health disparities rooted in social determinants of health, such as economic stability, education, neighborhood conditions, and access to healthcare. Rapid urban growth, particularly in low- and middle-income countries, has led to the emergence of inequitable living conditions, environmental hazards, and limited access to essential health services, contributing to the early onset of multimorbidity and rising non-communicable disease burdens. Urbanization-driven factors such as obesogenic environments, sedentary lifestyles, air pollution, and inadequate sleep exacerbate cardiovascular and metabolic risks, while social exclusion, overcrowding, and inadequate mental health services heighten vulnerabilities. Emerging risks, including urban heat islands, noise pollution, and exposure to endocrine-disrupting chemicals, further compound urban health inequities. Effective mitigation requires multi-sectoral policies that prioritize health-promoting infrastructure, reduce environmental pollutants, foster equitable healthcare access, and address systemic barriers affecting marginalized groups. This review explores the intersections between urbanization and health inequities, emphasizing the importance of addressing traditional and emerging risk factors across the lifespan. Policy implications include promoting green infrastructure, enhancing urban mobility, expanding mental health care, and leveraging participatory governance to foster resilient and inclusive cities. By adopting an integrated approach that prioritizes social equity and sustainability, cities can mitigate health disparities and create healthier, more inclusive urban environments that support the well-being of all residents.

Alterations in static and dynamic functional network connectivity in chronic low back pain: a resting-state network functional connectivity and machine learning study

Low back pain (LBP) is a prevalent pain condition whose persistence can lead to changes in the brain regions responsible for sensory, cognitive, attentional, and emotional processing. Previous neuroimaging studies have identified various structural and functional abnormalities in patients with LBP; however, how the static and dynamic large-scale functional network connectivity (FNC) of the brain is affected in these patients remains unclear. Forty-one patients with chronic low back pain (cLBP) and 42 healthy controls underwent resting-state functional MRI scanning. The independent component analysis method was employed to extract the resting-state networks. Subsequently, we calculate and compare between groups for static intra- and inter-network functional connectivity. In addition, we investigated the differences between dynamic functional network connectivity and dynamic temporal metrics between cLBP patients and healthy controls. Finally, we tried to distinguish cLBP patients from healthy controls by support vector machine method. The results showed that significant reductions in functional connectivity within the network were found within the DMN,DAN, and ECN in cLBP patients. Significant between-group differences were also found in static FNC and in each state of dynamic FNC. In addition, in terms of dynamic temporal metrics, fraction time and mean dwell time were significantly altered in cLBP patients. In conclusion, our study suggests the existence of static and dynamic large-scale brain network alterations in patients with cLBP. The findings provide insights into the neural mechanisms underlying various brain function abnormalities and altered pain experiences in patients with cLBP.

Global Burden of Cardiovascular Disease Attributable to Sugar-Sweetened Beverages in Middle-Aged Adults: An Age-Period-Cohort Modelling Study

BACKGROUND

Cardiovascular disease (CVD) presents a significant burden among middle-aged adults (aged 35-64). Diet high in sugar-sweetened beverages is a notable CVD risk factor.

METHODS

Using Global Burden of Disease data from 1990 to 2019, age-standardized rates (ASRs) and average annual percentage change of ASRs were used to describe this burden and its changing trend.

RESULTS

In 2019, global CVD-related ASR (per 100 000) of deaths attributable to sugar-sweetened beverages in middle-aged adults reached 1.91 (95% uncertainty interval [UI], 1.07-2.63) compared with 2.75 (95% UI, 1.76-3.59) in 1990. The global ASR of disability-adjusted life years (DALYs) reached 69.71 in 2019 (95% UI, 38.38-96.36) compared with 97.98 (95% UI, 62.29-128.39) in 1990. Men had more than twice the deaths and DALYs as women. Low and low-middle sociodemographic index regions exhibited a higher burden of DALYs and deaths. In 2019, India and China had the highest numbers of deaths and DALYs and the Solomon Islands and Afghanistan recorded the highest ASRs of deaths and DALYs. A negative linear correlation was observed between sociodemographic index and ASRs of deaths (R=-0.10, P=0.010) and DALYs (R=-0.09, P=0.031) across 21 Global Burden of Disease regions. An inequalities analysis indicated that DALYs due to CVD were disproportionately higher in countries with lower sociodemographic index in 2019 (concentration index of inequality=-0.05 [95% CI, -0.1 to -0.01]).

CONCLUSIONS

Globally, sugar-sweetened beverages have contributed to a substantial increase in DALYs and deaths related to CVD in middle-aged adults over the past 30 years, especially among men and in low sociodemographic index countries.

Determining the effects of social-environmental factors on the incidence and mortality of lung cancer in China based on remote sensing and GIS technology during 2007-2016

BACKGROUND

Lung cancer is the leading cause of cancer-related death in China. However, its relationship with social-environmental factors has not been revealed comprehensively. We are the first group to determine cold and hot spots associated with the incidence and mortality of lung cancer (IMLC) in both females and males and their spatiotemporal changes and to explore the social‒environmental burden of lung cancer in China between 2007 and 2016.

METHODS

The explanatory powers of various social-environmental factors for the IMLC were evaluated through correlation analysis and the Geodetector tool. Spatial analysis models were applied to determine the relationships between the IMLC and social-environmental factors.

RESULTS

The results are as follows: (1) The distribution of the IMLC exhibited significant spatial heterogeneity; the Global Moran's index values for incidence ranged from 0.04-0.2 and 0.09-0.33 in males and females, respectively, and the values for mortality ranged from 0.01-0.12 and 0.11-0.32 in males and females, respectively. (2) The IMLC was spatially clustered with an overall positive autocorrelation. Male population-related hot spots were observed in the central-southern region of China, and cold spots were observed in western China. Female population-related hot spots were observed primarily in northeastern China. The cold spots occurred primarily in southern and some western regions of China. (3) The effects of social-environmental factors on the IMLC showed significant spatial and temporal variability: in males, the interaction between terrain undulation and road area exhibited the highest explanatory power for the incidence and mortality, with a value of 0.22 for both; in females, the interaction between O3 and road area and the interaction between O3 and the number of medical beds exhibited the highest explanatory powers for the incidence and mortality, reaching 0.27 and 0.34, respectively. (4) The optimal model capturing the relationships between the IMLC and social-environmental factors was the GTWR model, which relies on reclassified data. The best R2 value is 0.456.

CONCLUSIONS

The influence of each social‒environmental factor on the IMLC showed significant spatiotemporal variability, providing a systematic basis for governments to implement better targeted control of lung cancer.

Safety, efficacy, and compliance of moderate-to-high dose eptinezumab and erenumab in chronic migraine patients with medication-overuse headache: an updated systematic review and meta-analysis

BACKGROUND

The use of monoclonal antibodies targeting Calcitonin Gene-Related Peptide (CGRP) is an established treatment for chronic migraine (CM). However, its efficacy in CM patients with medication overuse headache (MOH) remains underexplored, and data on the safety and patient compliance of standard-to-high doses, especially Eptinezumab and Erenumab, over at least three months are limited.

OBJECTIVE

This study aims to evaluate the efficacy and safety of anti-CGRP therapy (Eptinezumab and Erenumab) in CM and MOH patients. Specifically, it assesses changes in monthly migraine days (MMDs) after 12 weeks, risk of treatment-emergent adverse events (TEAEs) leading to discontinuation, serious TEAEs, common adverse effects, and MOH remission at 6 months.

METHODS

A systematic search of PubMed, Cochrane, and Scopus databases identified randomized controlled trials (RCTs) evaluating standard or high dose anti-CGRP therapy in CM patients strictly with MOH. Studies included were required to report a ≥ 50% reduction in MMDs after ≥ 12 weeks, serious TEAEs, TEAEs leading to discontinuation, common adverse events, and MOH remission at 6 months. Heterogeneity was assessed using I² statistics and a random-effects model.

RESULTS

Three RCTs with 769 patients receiving standard-to-high dose anti-CGRP monoclonal antibodies (Eptinezumab and Erenumab) for ≥ 12 weeks were included. Anti-CGRP therapy significantly increased the likelihood of a ≥ 50% reduction in MMDs compared to placebo (OR: 2.43; 95% CI: 1.68-3.51; p < 0.00001). No substantial differences were found in TEAEs leading to discontinuation, nasopharyngitis, upper respiratory tract infections, or serious TEAEs between the anti-CGRP and placebo groups. The likelihood of MOH remission was approximately double in the anti-CGRP group (OR: 1.97; 95% CI: 1.40-2.78; p = 0.0001).

CONCLUSION

Standard-to-high dose anti-CGRP therapies (eptinezumab, erenumab) effectively reduce monthly migraine days and improve MOH remission rates with minimal adverse effects, showing good tolerability in CM patients with MOH.

Association between maternal depression and early childhood caries in rural southern Brazil: a population-based cross-sectional study

PURPOSE

The aim of the present study was to investigate the association between maternal depressive symptoms and Early Childhood Caries (ECC) in children residing in rural communities in southern Brazil.

METHODS

A population-based cross-sectional study was conducted with 236 children aged 1-5 years and their mothers. Mothers answered the Patient Health Questionnaire (PHQ-9) addressing depressive symptoms and a structured questionnaire investigating demographic, socioeconomic and behavioural characteristics. The mothers and children underwent oral health examinations using the WHO criteria (DMFT and dmft index, respectively). The outcome was the occurrence of ECC (dmft ≥ 1) and the main exposure was symptoms of maternal depression. Poisson regression with robust variance was used to estimate prevalence ratios and 95% confidence intervals adjusted for potential confounding variables.

RESULTS

Overall, 37.7% of the children had ECC and 21.5% of the mothers had symptoms of depression. The prevalence of ECC was significantly higher among children of mothers with depressive symptoms (52.0%) compared to those of mothers without symptoms (34.6%). The multivariate analysis showed that the likelihood of ECC was nearly 50% higher in children whose mothers presented depressive symptoms (PR = 1.46; 95% CI 1.04-2.05) compared to those with mothers without depressive symptoms.

CONCLUSION

The symptoms of maternal depression increased the likelihood of ECC in preschool children living in a rural area.

Identifying the causes of adolescent malnutrition in Nuwara-Eliya District, Sri Lanka

Malnutrition, a persistent illness, significantly reduces fat, muscle and bone levels, harming internal organs. The economic crisis in Sri Lanka has led to widespread malnutrition among children, including adolescents experiencing growth spurts. This study identifies factors influencing malnutrition in grade 10 pupils in the Nuwara-Eliya District, with the highest rates of malnutrition and also a multicultural area with many estate sector residents. Using a cross-sectional, quantitative approach, the data was collected from 379 respondents via a Likert scale questionnaire. Structural Equation Model (SEM) analysis was conducted using Smart PLS 4.0. Key findings indicate that environmental factors, such as access to clean water and sanitation, significantly influence adolescent malnutrition. A comprehensive strategy incorporating education, healthcare, and environmental improvements is essential for this. Ongoing observation, community engagement, and cooperative tactics are crucial for sustainable solutions. Addressing environmental issues and promoting a holistic approach to health education and infrastructure improvements are vital to combat adolescent malnutrition in vulnerable populations.

Dual Treatment of Chronic Chagasic Cardiomyopathy and Parasitic Burden via Combination Nanotherapy

In chronic Chagas disease, the persistence of the protozoan Trypanosoma cruzi (T. cruzi) is associated with an extensive inflammatory response that impacts cardiac function. The standard treatment, oral benznidazole, effectively targets the parasitic burden but does not address the chronic inflammation nor prevent the progression of severe cardiomyopathies. This presents an inherent immunotherapeutic challenge, as implementing an anti-inflammatory approach can have the unwanted effect of inhibiting beneficial parasite-specific immunity. Here, we investigated a combination therapy approach using benznidazole and immunomodulatory rapamycin-loaded poly(ethylene glycol)-b-poly(propylene sulfide) polymersome nanocarriers in a chronic Chagas disease murine model with cardiac abnormalities. The combined treatment demonstrated effective management of both inflammation and parasitic burden at systemic and local levels. No systemic reactivation of T. cruzi infection was observed, along with cardioprotective immunomodulatory effects through the modulation of cytokines, management of parasitic burden, and improved cardiac function based on electrocardiography assessment. The combination treatment enhanced a protective cytokine response in the heart, characterized by increased anti-inflammatory IL-10 levels, achieving greater effects than standard benznidazole treatment, and normalized TNF-α levels. Localized immunomodulatory effects, along with parasitic burden control, extended to other solid tissues relevant to parasite pathology and reservoirs. These findings highlight the therapeutic potential of modulating the immune response in chronic Chagas disease with rapamycin polymersomes and emphasize the importance of precise treatment timing in the strategy's efficacy.

Burden of Congenital Heart Anomalies in North Africa and the Middle East, 1990 to 2021: A Systematic Analysis for the Global Burden of Disease Study 2021

BACKGROUND

Congenital heart anomalies (CHAs) remain a significant global health burden despite advances in diagnosis and management. Data on CHA burden in North Africa and the Middle East region are scarce. This study aimed to estimate CHA trends from 1990 to 2021.

METHODS AND RESULTS

Using the Global Burden of Disease Research 2021 database, we assessed CHA incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by age, sex, and sociodemographic index (SDI) at regional and national levels. Decomposition analysis was used to evaluate the impact of population growth on CHA incidence. In 2021, CHAs caused 35 272 deaths (95% uncertainty interval [UI], 28 067-43 670) and 3 181 543 DALYs (95% UI, 2 544 864-3 899 408) in the North Africa and the Middle East region. Incidence and prevalence increased by 13% (95% CI, 10-17) and 70% (95% CI, 67-74), respectively, whereas CHA-related deaths and DALYs declined by 63% (95% CI, 28-73). Infants <12 months of age accounted for 74.9% of deaths and DALYs, with half occurring within the first month. High-SDI countries had the lowest CHA-related DALYs, whereas middle-SDI countries showed the most substantial decline in mortality. Decomposition analysis highlighted that the actual CHA incidence is lower than expected despite population growth.

CONCLUSIONS

Although CHA incidence and prevalence increased, mortality and DALYs decreased, particularly in middle-SDI countries. The highest burden was among infants, with better outcomes in higher-SDI nations. More effective strategies are needed to reduce the preventable childhood deaths related to CHAs in the North Africa and the Middle East region.

Association Between Estimated Glucose Disposal Rate and Stroke in Middle-Aged and Older Chinese Adults: A Nationwide Prospective Cohort Study

BACKGROUND

The estimated glucose disposal rate (eGDR) is recognized as a reliable marker of insulin resistance. However, the association between eGDR and the risk of stroke remains unclear.

METHODS AND RESULTS

A total of 13 706 middle-aged and older participants were enrolled from CHARLS (China Health and Retirement Longitudinal Study). The primary end point was the occurrence of stroke events. The Kaplan-Meier curves, Cox proportional hazard models, and restricted cubic spline analysis were applied to explore the association between eGDR and the risk of stroke according to sex, age, and glycemic status. A total of 1101 stroke events were recorded. Our findings revealed a significant nonlinear relationship between eGDR and the occurrence of stroke. The association was similar between men (hazard ratio [HR], 0.83 [95% CI, 0.80-0.87]) and women (HR, 0.86 [95% CI, 0.80-0.87]), as well as among participants with normal glucose tolerance (HR, 0.83 [95% CI, 0.79-0.87]), prediabetes (HR, 0.85 [95% CI, 0.82-0.89]), and diabetes (HR, 0.87 [95% CI, 0.82-0.92]). However, the association was stronger in middle-aged participants (HR, 0.82 [95% CI, 0.78-0.86]) compared with older individuals (HR, 0.87 [95% CI, 0.83-0.90]; P for interaction=0.019).

CONCLUSIONS

This study demonstrates that lower eGDR levels are significantly linked to increased stroke risk. The relationship between eGDR and stroke risk was similar across different sexes and glycemic statuses and was stronger in middle-aged participants compared with older participants.

Confidence in providing primary care to patients with low back pain among physiotherapists

BACKGROUND

Low back pain (LBP) is a common musculoskeletal disorder with distinct clinical features. Direct access to physiotherapy (PT), with physiotherapists (PTs) acting as primary care providers, can improve the management of individuals with LBP. However, clinician confidence may affect their willingness to provide primary care as well as their performance as primary care providers. The objectives of this study were: (1) to develop the Primary Care Confidence Scale (PCCS), and (2) to evaluate PTs' confidence in managing LBP in primary care.

METHODS

The PCCS questionnaire was developed through a seven-stage Delphi process involving experts who modified an existing self-confidence scale. The questionnaire was completed by 314 PTs, 140 of whom completed it again after 2 weeks. Structural validity was evaluated using exploratory and confirmatory factor analysis. Reliability was assessed with Cronbach's alpha for internal consistency and intraclass correlation coefficients (ICC) for test-retest reliability. Spearman tests assessed correlations between background characteristics and PCCS scores. Two independent t-tests estimated the effects of gender and post-graduate education. One-way ANOVA was used to evaluate the impact of the workplace.

RESULTS

The PCCS had a multidimensional structure with three factors demonstrating an acceptable model fit and good reliability (α = 0.83, ICC = 0.78). The mean confidence level was 75% (PCCS = 45 ± 6/60), with moderate positive correlations observed between PCCS scores and both age (r = 0.42, p < 0.001) and years of experience (r = 0.33, p < 0.001). PTs working in public or private outpatient clinics had significantly higher scores (PCCS = 45.3 and 47.0, respectively) compared to PTs working in an inpatient hospital or in rehabilitation centers (PCCS = 40.6 and 40.3, respectively, p < 0.009).

CONCLUSIONS

The newly developed PCCS demonstrated adequate validity and high reliability, suggesting that it is suitable for measuring confidence in treating patients with LBP in primary care settings. PTs demonstrated confidence levels indicative of their perception to manage patients in primary care. Health policy makers and educators could incorporate the PCCS into training and evaluation programs to assess clinicians' confidence and perceived readiness to treat LBP in primary care.

Occupational health literacy and affecting factors on healthcare workers

BACKGROUND

In the realm of occupational accidents, the healthcare sector holds a significant position as it is classified as a highly hazardous workplace, thus bearing a heightened probability of accidents. Consequently, it becomes imperative to assess the occupational Health Literacy (OHL) of healthcare workers and identify the influencing factors.

AIMS

The aim is to determine the OHL levels of healthcare workers and examine their relationship with demographic, socio-cultural characteristics, and variables related to the work environment.

METHODS

This cross-sectional survey was conducted among 200 healthcare workers employed in healthcare services, administrative services, and support services at an education and research hospital in Niğde, Turkey, from November-December 2023. Data collection involved the utilization of a personal information form encompassing participants' socio-demographic characteristics and occupational health practices, along with the OHL Scale. Descriptive statistics, intergroup difference analyses, and multiple regression analysis were employed for data analysis.

RESULTS

The participants demonstrated an average OHL score of 94.07 ± 11.33. They scored highest in Understanding occupational health and safety (OHS) Information (40.93) and lowest in Evaluating OHS Information (9.57). OHL among healthcare workers varied based on demographics, socio-cultural factors, and work-related variables. Age, education, tenure, vaccination, regular health screenings, workplace accidents and personal protective equipment (PPE) usage positively impacted OHL.

CONCLUSIONS

Findings revealed participants possess a certain level of OHL. Age, education, tenure, vaccination, regular health screenings, workplace accidents and PPE usage accounted for 53% of OHL variance. Enhancing workplace safety measures and improving healthcare workers' OHL are recommended.

Coronary Artery Disease Doubles Excess Mortality in Patients With Heart Failure With Reduced Ejection Fraction

BACKGROUND

Assessment of coronary artery disease (CAD) in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) varies between countries and there are only limited data on the long-term impact of CAD in these patients. We examined the association between CAD and mortality in patients with HFrEF undergoing coronary angiography.

METHODS AND RESULTS

Using Danish registries, we identified patients with HFrEF (EF ≤40%) undergoing coronary angiography from 2003 to 2016. We estimated 10-year cumulative incidence proportions and adjusted hazard ratios (aHR) for all-cause death, comparing patients with HFrEF with CAD with patients with HFrEF without CAD. Both groups were further compared with an age- and sex-matched general population cohort in a 1:5 ratio. We included 3294 patients with HFrEF, of whom 1436 (44%) had CAD, as well as 16 365 matched general population individuals. Median follow-up was 5.3 years. Patients with HFrEF with CAD had higher 10-year mortality than patients with HFrEF without CAD (55% versus 33%; aHR, 1.38 [95% CI, 1.19-1.59]). These estimates were consistent across ages, whereas greater extent of CAD was associated with higher mortality (Ptrend<0.01). Compared with the matched general population, the 10-year excess mortality was 29% for patients with HFrEF with CAD (55% versus 26%; aHR, 2.18 [95% CI, 1.92-2.48]), and 15% for patients with HFrEF without CAD (33% versus 17%; aHR, 1.87 [95% CI, 1.63-2.14]).

CONCLUSIONS

Presence and extent of CAD are strongly associated with all-cause mortality in patients with HFrEF and, when compared with a matched general population, presence of CAD doubles excess mortality. This highlights the importance of CAD assessment for prognostication in patients with HFrEF.

Analysis of factors influencing delayed treatment seeking for dental caries in preschool children: a cross-sectional study

OBJECTIVE

This study investigated the prevalence of treatment delays among preschoolers with dental caries, identified the associated influencing factors, and predicted the risk of delayed treatment. The findings of this study provide an evidence base for future interventions designed to reduce treatment delays in this population.

METHODS

A convenience sample of 264 preschool children with dental caries and their parents who visited the paediatric dental department between October 2023 and May 2024 was surveyed. Data were collected using a general information questionnaire, a medical status questionnaire, the Children's Fear Survey Schedule-Dental Subscale, the Modified Version Dental Anxiety Scale, the Short-Form Health Literacy Dental Scale, and the Illness Perception Questionnaire Revised for Dental. Influencing factors were analysed using univariate analysis and binary logistic regression, whereas the risk of occurrence was predicted using the receiver operating characteristic (ROC) curve.

RESULTS

The prevalence of delayed treatment among preschool children with dental caries was 71.21%, with an average delay of 117.5 days. Binary logistic regression analysis identified several independent factors significantly associated with delayed treatment (P < 0.05), including the primary caregiver, initial symptom recognition, children's dental fear, parental dental anxiety, and parental oral health literacy. Predictive analyses indicated that children's dental fear (AUC: 0.765, 95%CI: 0.707-0.823) and parental oral health literacy (AUC: 0.738, 95%CI: 0.673-0.802) demonstrated relatively high predictive values for delayed treatment.

CONCLUSION

Efforts to reduce delayed treatment should prioritise addressing children's dental fear and improving parental oral health literacy. Targeted and effective strategies in these areas may facilitate early prevention, diagnosis, and intervention, thereby minimising treatment delays, reducing disease burden, and promoting oral health among preschoolers.

CYP4F11, an NRF2 Target Gene, Promotes Hepatocellular Carcinoma Cell Growth

Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, is the third leading cause of cancer-related mortality globally. Current systemic therapies for HCC are limited and often exhibit unsatisfactory efficacy, underscoring the need for novel therapeutic approaches. Nuclear factor erythroid 2-related factor-2 (NRF2), a master transcription factor regulating cellular redox and metabolic homeostasis, is frequently overexpressed in HCC due to mutations in NFE2L2/NRF2 or its negative regulator Kelch-like ECH-associated protein 1 (KEAP1), contributing to tumor progression. In this study, we identify CYP4F11, a member of the Cytochrome P450 family, as a direct target gene of NRF2. CYP4F11, primarily expressed in the liver, is crucial in fatty acid oxidation and eicosanoid metabolism. We demonstrate that CYP4F11 expression is driven by NRF2 and is significantly elevated in HCC patients harboring NFE2L2 gain of function or KEAP1 loss of function mutations. Functionally, CYP4F11 promotes HCC cell growth, and reduced expression of CYP4F11 not only suppresses HCC cell proliferation but also enhances sorafenib-induced HCC cell death. Further, NRF2 inhibition sensitizes HCC to sorafenib through downregulation of CYP4F11. These findings position CYP4F11 as a novel contributor to HCC progression and highlight the potential of targeting the NRF2-CYP4F11 axis for HCC treatment.

[Core competencies of physiotherapists for direct access practice for patients with musculoskeletal disorders in the German healthcare system - A scoping review]

INTRODUCTION

In many countries, direct access to physiotherapy for patients with musculoskeletal disorders (MSKDs) has already been established. It presents an opportunity to optimize healthcare delivery within the German healthcare system, addressing the challenges of demographic changes and staff shortages. This study aims to identify the necessary competencies of physiotherapists for direct access practice, describes them, and compares them with the German Training and Examination Order for Physiotherapy (PhysTh-APrV) and the German Qualifications Framework for Lifelong Learning (DQR).

METHOD

A scoping review was conducted, including a systematic literature review in five databases (Medline, CINAHL, Cochrane Library, PEDro and ScienceDirect), supplemented by a non-systematic search in both Google Scholar and the gray literature. Publications were included if they described the necessary competencies for direct access to physiotherapy for patients with MSKDs in primary or emergency care. Non-German or non-English publications were excluded. Subsequently, content analysis of all included publications was performed. The competencies were analyzed, clustered into five categories, and compared to DQR and PhysTh-APrV.

RESULTS

The literature search yielded 1,283 publications, 61 of which were included. A total of 24 competencies were identified and categorized into five domains: Assessment and Evaluation, Management and Interventions, Communication, Cooperation and Collaboration, Professionalism and Leadership. These competencies are covered by the DQR Level 6 competencies. The PhysTh-APrV does not provide sufficient qualifications for direct access practice.

DISCUSSION AND CONCLUSION

The results highlight the required level of qualification for implementing direct access in the German healthcare system and define the competencies that physiotherapists need in this setting.

Probiotics improve lung function and QOL in participants with exposure to fine particulate matter air pollution: a randomized, double-blind, placebo-controlled clinical trial

Background: Probiotics have been reported to alleviate pulmonary inflammation through the gut-lung axis. However, their effects on PM2.5-induced toxic reactions have not yet been well studied. Objective: This study aims to investigate the effects of probiotics on lung function and quality of life in participants exposed to PM2.5, as well as to explore the potential mechanisms underlying these effects. Methods: 120 volunteers were randomly assigned in a double-blind manner to receive either a placebo or 2.5 × 109 cfu g-1 LGG probiotics once daily for four consecutive weeks, with a follow-up period of 6 months. An analysis of covariance was conducted for data statistics, using PM2.5 exposure and baseline measurements as covariates. Least squares means and their 95% confidence intervals were calculated to explore the effect of PM2.5 exposure on changes in the intestinal microbiota. A mixed linear model analysis was used to construct a model with baseline values and PM2.5 exposure as covariates to analyse the effects of PM2.5 on SF-36, COOP/WONCA charts, and lung function, and the intervention effect of LGG on these parameters. Results: 120 participants were included. Probiotic intervention demonstrated benefits in the Shannon index and β diversity. After the probiotic intervention, the scores of quality-of-life charts increased during the follow-up period. The pulmonary function indicators, including FEV1, FEF50%, and FEF75%, were statistically different from those in the placebo group. Conclusion: Probiotic intervention can reshape the gut microbiota, offering potential benefits for improving the quality of life in participants chronically exposed to PM2.5.

The burden of colorectal cancer attributable to high body mass index in China: findings from 1990 to 2021 and prediction to 2035

BACKGROUND

Colorectal cancer (CRC) incidence and mortality are rising in China, with high body mass index (BMI) established as a significant risk factor. However, comprehensive evidence regarding the BMI-attributable CRC burden in the Chinese population remains limited.

OBJECTIVE

This study aims to analyze the trend of CRC burden attributable to high BMI (BMI ≥ 25 kg/m2) in China from 1990 to 2021 and to predict its development from 2022 to 2035, in order to provide a scientific foundation for the formulation of public health policies.

METHODS

We analyzed data from the Global Burden of Disease Study 2021 (GBD 2021) to assess the BMI-attributable CRC burden in China from 1990 to 2021. Temporal trends were analyzed using Joinpoint regression models. Future projections through 2035 were generated using Bayesian age-period-cohort (BAPC) modeling. The Das Gupta method was used to explore the contribution of population growth, aging, and epidemiologic factors to these burden changes.

RESULTS

From 1990 to 2021, China's BMI-attributable CRC burden increased substantially, with ASMR and ASDR rising at annual rates of 2.393% (95% CI 2.306-2.481) and 2.305% (95% CI 2.188-2.422), respectively. The mortality and disability-adjusted life years (DALYs) rate both increased with age. Males showed higher burden rates in most age groups. Projections indicate continued increases in ASMR (2.43% annually) and ASDR (2.44% annually) through 2035. Epidemiological factors were the primary drivers, contributing 99.73% to mortality changes and 44.81% to DALYs changes.

CONCLUSIONS

The BMI-attributable CRC burden in China shows a concerning upward trajectory that is predicted to continue, with epidemiologic factors playing a major role. Urgent public health interventions targeting obesity prevention, lifestyle modification, and expanded CRC screening are needed to mitigate this growing burden.

Gamma oscillations as correlates of depression: updating Fitzgerald and Watson (2018)

Depression remains one of the most common and debilitating neuropsychiatric conditions, with little consistency in treatment efficacy. Some of the lack of success in developing effective treatments has been the absence of a reliable biomarker of depression, despite many attempts. One such potential biomarker is the electrical activity of the brain that occurs in the gamma band (30-200 Hz). To evaluate the state of research into gamma as a biomarker of depression, a review of recent research literature was conducted. A total of 31 relevant papers was identified, 22 of which used resting-state studies, and nine included a stimulus-task. These studies were examined here in terms of their definition of gamma, sample sizes, research focus, brain region examined, and EEG methodologies used. Due to the range of methodologies, some inconsistent results emerged but several valuable findings remained, including that depressed patients usually had higher gamma power than their healthy controls (HC), that the imposition of a perceptual task into the research protocol also introduced a strong element of confound to the results, and that studies that sought to evaluate the role of gamma in treatment were yet to be established as reliable. Key issues for future research are discussed, and the potential for gamma as a biomarker of depression is evaluated as emerging.

The fall-dementia connection: Synergistic effects of falls with genetic and health risk factors

BackgroundFew studies have examined the inverse relationship between dementia and falls, i.e., whether falls before dementia are a herald of dementia.ObjectiveWe aimed to explore the relationship between fall experiences and risk of dementia, assessing how factors like APOE ε4 allele, family history of dementia, comorbidities, traumatic brain injury (TBI), and frailty modify this association.MethodsWe used data from the UK Biobank. We used Cox proportional hazards models to estimate the HRs and 95% CIs for the association between falls and all-cause dementia, Alzheimer's disease (AD), vascular dementia (VaD), and non-Alzheimer/non-vascular dementia (NAVD). The synergistic effects of fall experiences and APOE, dementia family history, cardiovascular disease (CVD), diabetes, TBI, frailty on dementia were also investigated.ResultsTotally, 403,502 participants were included. 99,832 people experienced at least one fall, and 4143 dementia cases were observed. People who experienced falls had a higher risk of all-cause dementia, AD, VaD, and NAVD, with HRs (95% CIs) of 1.71(1.61, 1.83), 1.33 (1.20, 1.47), 2.00 (1.74, 2.29), and 2.03 (1.84, 2.24), respectively. The risk of dementia increased with the number of falls and with falls occurring later in life (after age 60). Fall experiences had a synergistic effect with dementia risk factors (APOE ε4 allele, family history of dementia and comorbidities), TBI, and frailty, collectively increasing the risk of dementia.ConclusionsFalls before dementia were linked to a higher risk of dementia. The risk escalated with more falls and falls after age 60. Combining falls with risk factors further amplified dementia risk.

Big picture thinking of global PM2.5-related COPD: Spatiotemporal trend, driving force, minimal burden and economic loss

Chronic obstructive pulmonary disease (COPD) is a leading global cause of morbidity and mortality, with increasing evidence linking long-term exposure to ambient fine particulate matter (PM2.5) to accelerated lung function decline and exacerbation of COPD symptoms. This study aimed to assess the global burden of PM2.5-related COPD from 1990 to 2021 and project future health and economic impacts. Using Mendelian randomization, the causal relationship between PM2.5 exposure and COPD was confirmed. Data from the Global Burden of Disease 2021 dataset was analyzed across 204 countries, considering age, gender, region, and socio-demographic index (SDI). A significant positive correlation between PM2.5 exposure and COPD was observed. In 2021, COPD deaths due to ambient PM2.5 exposure reached 841,466 globally, with an age-standardized mortality rate (ASR) of 10.23 per 100,000 people. DALYs were 17,683,776, with an ASR of 208.27 per 100,000. Both the number of deaths and DALYs significant increased since 1990, primarily driven by population aging and growth. Regional analysis revealed that Asia, especially China and India, bore the highest burden, high SDI regions managed to maintain relatively stable and lower rates, and there are large health inequities. Projections indicate a continued rise in COPD burden, with substantial economic implications, estimating global economic losses of approximately $1.246 trillion by 2050. These findings highlighted the urgent need for public health interventions to mitigate future health and economic impacts of PM2.5 exposure.

Association between risk of mortality among children and twin birth in India: an econometric analysis of live births between 1993-2021

Background

Twin births present unique challenges for child survival, particularly in low- and middle-income countries. Despite the high burden of global child mortality, there has been no comprehensive assessment of twin births and deaths in India. We analysed the trends and patterns in twin births and deaths in India between 1993 and 2021, examining mortality risks across different phases of early childhood, including the late neonatal phase.

Methods

We analysed data on 659 175 births from five rounds of India's National Family Health Survey (NFHS) (1992-93 to 2019-21). We calculated age-specific mortality rates using a synthetic cohort life table approach for early neonatal (0-7 days), late neonatal (8-28 days), post-neonatal (29 days to 11 months), and child (12-59 months) periods. The analysis employed logistic regression models (both adjusted and unadjusted) to estimate phase-specific mortality risks and coarsened exact matching to establish causal relationships while adjusting for demographic and socioeconomic covariates.

Results

Twinning rates in India increased from 0.9% in 1992-93 to 1.5% in 2019-21. Despite this small share in births, twins accounted for 7.7% of under-five deaths in 2019-21. Twin under-five mortality rate was 179.8 (95% confidence interval (CI) = 162.2, 197.4) per 1000 live births in 2019-21, declining from 447.5 (95% CI = 405.6, 489.3) in 1992-93. Twins faced 7.5 times higher risk of early neonatal death and 10 times higher risk of late neonatal death compared to singletons. Twins from the poorest wealth quintile experienced 9.8 (95% CI = 8.43, 11.44) times higher early neonatal mortality risk compared to those from the highest quintile. The coarsened exact matching analysis confirmed twin birth as an independent risk factor for neonatal and infant mortality.

Conclusions

Despite general improvements in child survival, twin mortality rates continue to be high, particularly during the neonatal period. The persistent socioeconomic gradient in twin survival necessitates strengthening health care delivery for vulnerable populations. Establishing twin registries and including twin mortality in global monitoring frameworks could accelerate progress toward achieving Sustainable Development Goal targets for child survival.

Barriers and facilitators to self-management in people with back-related leg pain: a qualitative secondary analysis

BACKGROUND

Back related leg pain (BRLP) is a problematic subset of low back pain, leading to greater pain, loss of function and health related care costs. While evidence suggests self-management is effective, patient implementation can be sub-optimal. The purpose of this study is to identify barriers and facilitators to self-management for persons experiencing BRLP within the context of a controlled clinical trial and to map these to theory-informed intervention elements that can be addressed by front-line healthcare providers, informing the design and implementation of future theory-driven self-management interventions for this population.

METHODS

This study was a qualitative secondary analysis of a 2-site, pragmatic, parallel group, randomized clinical trial (participants enrolled 2007-10) of spinal manipulative therapy (SMT) and home exercise and advice (HEA) compared to HEA alone for persons with subacute or chronic BRLP. We used deductive and inductive content analysis, to describe self-management facilitators and barriers among trial participants, map these to behavior change elements in the Behavior Change Wheel (BCW) Framework, and identify potentially modifiable, theory-intervention elements which may be addressed with guidance by healthcare providers. Baseline characteristics of participants were descriptively analyzed using SAS (University Edition).

RESULTS

Of 40 participants, the majority identified as white (n = 24, 85%) and of non-Hispanic or Latino ethnicity (n = 38, 95%). Average participant age was 57 years old (range 29-80). Frequent facilitators included ease of exercises, knowing how to manage condition, atmosphere created by staff, therapeutic alliance, effectiveness of exercises or treatment, goal of reducing pain, and intentions of continuing exercises. Frequent barriers included time constraints, pain, and lacking confidence in treatment. Barriers were mapped to all 9 Intervention Functions, most common being modelling and education. Frequently identified Behavior Change Techniques included information, feedback, self-monitoring, graded tasks, restructuring, social support, goal setting, reviewing goals, and action planning.

CONCLUSION

This study identified barriers and facilitators to engaging in self-management for participants in a pragmatic, randomized clinical trial. A rigorous systematic intervention mapping process utilizing the BCW was used for describing what participants need and how their needs may be met. These findings may support the design of future self-management interventions for persons experiencing BRLP.

A description of serious adverse events following spinal manipulative therapy for adults with history of spine surgery: a single institution retrospective chart review

OBJECTIVES

The purpose of this study was to describe patient demographics and medical history, clinical care characteristics, and short-term serious adverse events associated with SMT in adults with prior spine surgery.

METHODS

This study was a retrospective chart review of adult (at least 18 years of age) patients with any prior spine surgery who underwent SMT between January 2010 and December 2021 at an academic medical center in the United States. Eligible charts were reviewed, and data were extracted and transcribed onto an a priori Microsoft Excel data extraction tool. Adverse events were defined as vertebral artery dissection, cauda equina syndrome, fracture in the location of SMT, or spine surgery hardware failure in the same spinal region of SMT within 10-days following SMT.

RESULTS

A total of 418 unique patient's charts were eligible for review. The mean patient age was 50.6 years. The majority of patients were female (52.6%), White (90.7%), and non-Hispanic (97.8%). The most common types of spine surgeries were lumbar fusion (28.7%), cervical fusion (27.8%), and lumbar discectomy with laminectomy/foraminotomy (34.7%). The median time after surgery to first SMT was 311 days. There were no short-term incidents of vertebrobasilar/cervical artery injury, acute cauda equina, fractures in the same region of SMT application, or hardware failure.

CONCLUSION

There were no incidents of serious adverse events in the short-term following SMT in individuals with prior spine surgery in this study. Findings from this study aid in evaluating the safety profile of SMT for patients with prior spine surgery. In addition, findings contribute to the development of future high-quality study designs for investigating the clinical effectiveness of SMT in this patient population.

Predictors of Mortality in Patients With Multiple Endocrine Neoplasia Type 1

OBJECTIVE

Multiple Endocrine Neoplasia Type 1 (MEN 1) is an autosomal dominant disease predisposing to hyperplasia and neoplasia in diverse endocrine tissues. Patients typically present with endocrine abnormalities before the age of 30 years and have reduced life expectancy. Our objective was to determine predictors of premature mortality in MEN 1.

DESIGN

Tertiary hospital based retrospective cohort study.

PATIENTS

One hundred and thirty patients with a common MEN1 genotype.

MEASUREMENTS

Kaplan-Meier survival analysis of median life expectancy (MLE).

RESULTS

The overall cohort MLE was 70.8 years. Sex and year of birth were not predictive of survival. A diagnosis before age 45 years of adrenal nodularity (MLE 51.8 years), hypergastrinaemia (MLE 66.2 years), or liver lesions (MLE 38.6) were associated with a significant reduction in survival (26.2 years, p < 0.01, 6.4 years, p = 0.03, and 30.3 years, p < 0.01 respectively) compared to being diagnosed with these conditions later in life. In contrast, diagnosis before age 45 years of pancreatic nodularity (MLE 68.9 years) and primary hyperparathyroidism (MLE 68.9 years) were not predictive of survival.

CONCLUSION

Patients with MEN 1 diagnosed before age 45 with adrenal nodularity, hypergastrinaemia or liver lesions had significantly reduced survival. The explanation for non-secretory and benign adrenal macronodular hyperplasia being associated with diminished life expectancy is unclear.

Joint BrEast CAncer & CardiOvascular ScreeniNg: BEACON Study to Assess Opportunistic Cardiovascular Screening Using Breast Arterial Calcification on Mammography

Purpose: Breast arterial calcifications (BAC) are not routinely reported on mammography but are linked to coronary artery calcification (CAC) and cardiovascular disease (CVD) events. We sought to assess primary care provider (PCP) follow-up after BAC and CAC notification and the association between BAC on mammography and CAC on CT. Methods: Participants without known CVD undergoing mammography at a single centre were prospectively recruited over 18 months. BAC were qualitatively scored (none/mild/moderate/severe) by 2 breast radiologists. All participants had research cardiac CT for CAC within 6 months, scored using the Agatston method. Questionnaires collected baseline demographics, risk factors, and follow-up data. Results: 286 participants were included (median age 62 ± 10). Prevalence of BAC was 13% (38/286), 248 had none, 18 mild, 16 moderate, and 4 severe. For CAC: 180 had none, 70 had mild (CAC 1-99), 28 had moderate (CAC 100-399), and 8 had severe (CAC >400). For detecting CAC, BAC presence had 92% specificity (166/180), 23% sensitivity (24/106), and 67% negative predictive value (166/248). Most participants with BAC and CAC (71%, 17/24) were not on lipid-lowering therapy and 63% (15/24) did not believe they had elevated CVD risk. At follow-up (median 202 days), 46% (11/24) with BAC and CAC implemented lifestyle modifications, 92% (22/24) scheduled PCP follow-up, and 56% (10/18) underwent further CV risk assessment following their appointment. One participant with BAC and CAC had a stroke during follow-up. Conclusion: In a prospective cohort without known CVD undergoing mammography, notification of BAC and CAC status prompted high follow-up rates with PCPs and lifestyle modifications.

Insights into the complexities of symptom management for hemodialysis patients: a systematic review of qualitative studies

Patients undergoing hemodialysis experience a broad spectrum of symptoms that impact their physical, psychological, and social well-being. Traditional qualitative studies often focus on isolated aspects of patient experiences and offer limited insights into the interconnected nature of symptom management. This systematic review and meta-ethnography aims to synthesise qualitative studies and develop a comprehensive model that elucidates interrelations between patient experiences and symptom management practices in hemodialysis. Our analysis integrated findings from 30 qualitative studies using a meta-ethnographic approach. The results revealed critical psychological and social dynamics influencing symptom management. The model highlights how supportive factors, such as family involvement and effective healthcare interactions, enhance coping mechanisms, improving emotional resilience and treatment adherence. Conversely, it identifies significant barriers, including chronic self-regulatory burnout and systemic inefficiencies, that hinder symptom management and exacerbate psychological distress. By integrating diverse qualitative findings, this study proposes a shift towards patient-centred, culturally sensitive care strategies that prioritise psychological support. This shift aims to transform hemodialysis care by addressing the complex interplay of medical, psychological, and social factors. The developed framework not only facilitates deeper understanding of the psychological impacts of symptom management and offers a structured approach for future research and interventions in this domain[Q1].

Policy models for preventative interventions in cardiometabolic diseases: a systematic review

BACKGROUND

Cardiometabolic diseases (CMDs), including cardiovascular disease (CVD) and type 2 diabetes (T2DM), are major contributors to morbidity, mortality, and rising healthcare costs. Effective disease prevention programs rely on robust mathematical models to generate long-term evidence regarding the effectiveness, cost-effectiveness, and policy implications of interventions in the population. Population-level interventions, such as dietary policies, are recognised as essential prevention strategies, yet there is limited syntheis of policy models assessing their impact. This study systematically reviews existing CMD policy models to provide: (i) a comprehensive overview of current models, and (ii) a critical appraisal of their application, particularly in the context of primordial prevention programmes.

METHODS

A systematic search was conducted across MEDLINE (Ovid), EMBASE (Ovid), CINAHL, Google Scholar, and Open Grey. The search focused on publications from 1st January 2000, to 31st May 2024, using Medical Subject Headings (MeSH) for "cardiovascular," "diabetes," "decision model," and "policy model." Full-text articles were independently appraised independently by three reviewers using the Phillips et al. checklist, and the review process adhered to PRISMA guidelines.

RESULTS

Thirty-two articles met the inclusion criteria and were critically appraised. Policy models were assessed across three domains: structure, data, and consistency. Most models (79%) demonstrated well-defined structures, aligning inputs and objectives with the stated perspective and initial justifications. However, fewer than 60% of studies clearly reported the quality of their data sources and provided clear information in terms of consistency. The reviewed studies employed diverse methodologies, including parameter incorporation, simulation modelling, and outcome analysis.

CONCLUSION

The review highlights substantial heterogeneity in the quality, structure, and data use of policy models evaluating dietary interventions for CMD prevention. To advance CMD policy modeling, this study provides recommendations for improving conceptualisation, methodological rigor, and applicability to prevention programmes.

TRIAL REGISTRATION

Registered protocol at PROSPERO: CRD42022354399.

Comparison of mental health networks across different educational stages

Mental health concerns are growing more prevalent among students of school age. This study employed network analysis to view mental health problems as a network of interconnected symptoms, and to compare how these networks vary across different stages of school age. A sum of 60, 465 Chinese students in Grades 4 through 12 were selected to participate in the Middle School Student Mental Health Inventory (MMHI-60). The mental health network and bridge centrality were assessed through network analysis. Network comparison tests were performed to compare the networks among elementary, junior high, and senior high school students. 12.2% of elementary school students, 22.1% of junior high school students, and 24.9% of senior high school students exceeded the threshold for overall mental health issues as defined by the MMHI-60. The network analysis indicated that anxiety emerged consistently as a central dimension of mental health issues across all educational levels; paranoid ideation was prevalent in both junior and senior high school, whereas emotional disturbance was particularly characteristic of elementary school. Upon comparing the network structures, it was found that the mental health network connectivity was more pronounced among senior high school students, indicating closer associations between dimensions in this group. Identifying core mental health dimensions and their unique connections in school-aged students at each stage, especially the strong links between dimensions in senior high school students, is crucial for creating successful mental health dimension prevention and intervention strategies for students in educational settings.

The use of glycoprotein IIb/IIIa inhibitors in elective PCI - A systematic review and meta-analysis of randomised trials

BACKGROUND

Glycoprotein IIb/IIIa inhibitors (GPIs) improve 30-day outcomes when used as an adjunct to percutaneous coronary intervention (PCI) in acute coronary syndromes, but their role in stable coronary artery disease (CAD) remains uncertain in the context of modern stents and oral antiplatelet therapy.

METHODOLOGY

A systematic search of PubMed, EMBASE, Central and clinicaltrials.gov databases was conducted from inception to October 2022. Randomised trials comparing GPI to placebo in elective PCI were included. Outcomes included target vessel revascularisation (TVR), stent thrombosis (ST) and a composite of TVR, myocardial infarction and death (MACE) at 30-days and 6-12 months. Bleeding was assessed using Thrombolysis In Myocardial Infarction bleeding score or equivalent. A random-effects model was used for all analyses.

RESULTS

Of 2375 abstracts screened, 16 studies (6428 patients) were included. GPIs significantly reduced 30-day MACE (risk ratio [RR] 0.58, 95 % CI, 0.39-0.86, p < 0.01; number needed to treat = 33), intermediate-term MACE at 6-12 months (RR 0.67; 95 % CI, 0.49-0.92; p = 0.01) and ST (RR 0.29, 95 % CI, 0.10-0.83, p = 0.02). There was no significant difference in TVR or major bleeding, although minor bleeding was increased (RR 1.72, 95 % CI, 1.14-2.61, p = 0.01, number needed to harm = 77). Meta-regression suggested that the benefit of GPIs has diminished over time.

CONCLUSION

GPI use during elective PCI reduces MACE and ST whilst increasing minor bleeding. The observed benefit appears to have waned over time, highlighting the importance of selective use in patients at low bleeding risk.