Epidemiological and demographic drivers of alcohol-attributable pancreatitis from 1990 to 2021: Findings from the 2021 Global Burden of Disease study

BACKGROUND

Alcohol significantly contributes to pancreatitis, causing high global mortality and health burden. This study examines trends in alcohol-attributable pancreatitis (AAP) from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data, focusing on demographic, temporal, and regional variations to inform policymaking.

METHODS

AAP-related deaths and disability-adjusted life years (DALYs) were analyzed across 204 countries from 1990 to 2021, stratified by Sociodemographic Index (SDI), gender, and age groups. An age-period-cohort model assessed age-standardized DALY rates (ASDR), and decomposition analysis quantified impacts of population growth, aging, and epidemiological changes.

RESULTS

AAP-related DALYs rose from 401,700 in 1990 to 699,300 in 2021, though ASDR and ASMR showed declines globally. Burden increased notably in low and lower-middle SDI regions, especially among those under 40, while high SDI regions achieved better control. Males faced a disproportionately high burden due to alcohol consumption patterns, although some regions saw rising female burdens. Low-SDI areas suffered from limited healthcare, increasing alcohol use, and weak policies, with younger populations contributing significantly to rising burdens. Projections estimate 1.146 million DALYs annually by 2050, with males comprising over 90%. A GBD-AAP visualization platform was developed to present burden data and trends.

CONCLUSIONS

AAP exhibits significant regional and gender disparities. Targeted measures, including alcohol regulation, resource allocation, and public health education, are critical in low-SDI regions and among young males to mitigate AAP burden. The GBD-AAP platform offers valuable tool for targeted interventions.

Unveiling the relationship between heat-resistant structure characteristics and inhibitory activity in colored highland barley proteinaceous α-amylase inhibitors

Natural α-amylase inhibitors (α-AIs) serve as food processing additives, capable of mitigating postprandial blood glucose levels, but heat resistance limits their application in high-temperature processing. This study delved into the correlation between protein structural characteristics and heat-resistance of colored highland barley (CHB) α-AIs and evaluated the inhibitory activity during chemical modification and in vitro digestion. Results demonstrated that CHB α-AIs were glycoproteins, the inhibitory activity retention rate of black highland barley α-AI salted-out with 0-60 % (NH4)2SO4 (BK1 α-AI) was 56.23 % ± 0.64 %. The protein structure analysis revealed that the preservation of three-dimensional structure was attributed to hydrogen bonds and hydrophobic interactions, and disulfide bonds played a crucial role in maintaining protein folding and activity. Succinylation increased the content of disulfide bonds after heating, and the inhibitory activity retention rate of α-AI noodles increased from 37.72 % ± 2.49 % to 42.79 % ± 0.39 %. These findings provide a theoretical foundation for the application of α-AI in thermally processed foods.

Differential inflammation, oxidative stress and cardiovascular damage markers of nano- and micro-particle exposure in mice: Implications for human disease burden

Particulate matter (PM) poses a significant risk to human health; however, it remains uncertain which size fraction is especially harmful and what mechanisms are involved. We investigated the varying effects of particle size on specific organ systems using a custom mouse exposure system and synthetic PM (SPM). Whole-body exposure of mice showed that micrometer-sized fine SPM (2-4 μm) accumulated in the lungs, the primary entry organ, while nanometer-sized SPM (<250 nm) did not accumulate, suggesting a transition into circulation. Mice exposed to micro-SPM exhibited inflammation and NADPH oxidase-derived oxidative stress in the lungs. In contrast, nano-SPM-exposed mice did not display oxidative stress in the lungs but rather at the brain, heart, and vascular levels, supporting the hypothesis that they penetrate the lungs and reach the circulation. Sources of reactive oxygen species from micro-SPM in the lung are NOX1 and NOX2, driven by pulmonary inflammation, while oxidative stress from nano-SPM in the heart is mediated by protein kinase C-dependent p47phox phosphorylation, leading to NOX2 activation in infiltrated monocytes. Endothelial dysfunction and increased blood pressure were more pronounced in nano-SPM-exposed mice, also supported by elevated endothelin-1 and reduced endothelial nitric oxide synthase expression, which enhances constriction and diminishes vasodilation. Further, we estimated the cardiovascular disease burden of nano-particles in humans based on global exposure data and hazard ratios from an epidemiological cohort study. These results provide novel insights into the disease burdens of inhaled nano- and micro-particles (corresponding to fine and ultrafine categories), guiding future studies.

Real-world evidence for an association of vitamin D supplementation with atherosclerotic cardiovascular disease in the UK Biobank

BACKGROUND

Atherosclerotic cardiovascular disease (ASCVD) remains a substantial healthcare burden. The Australian D-Health trial recently showed potential efficacy of vitamin D supplementation (VDS) in reducing major ASCVD events. Whether the efficacy could be translated into real-world effectiveness is unclear.

METHODS

Leveraging data from the UK Biobank, we used Cox regression with competing risk of all-cause mortality to assess the association of self-reported regular VDS (83.3 % from over-the-counter) and serum 25-hydroxyvitamin D (25[OH]D) levels with ASCVD as a composite endpoint and as separate endpoints including ischemic heart disease (IHD), cerebrovascular disease, peripheral arterial disease, and atherosclerotic disease.

RESULTS

Among 409,822 study participants aged 40-69 years, 20.7 % were vitamin D deficient (25[OH]D < 30 nmol/L) and 34.4 % were vitamin D insufficient (25[OH]D 30-<50 nmol/L). Regular VDS was reported by 4.3 % of the study participants. During the follow-up of 15.9 years, 11.6 % of participants developed ASCVD. Compared to vitamin D sufficiency, vitamin D deficiency was associated with a significantly increased risk of the total ASCVD (hazard ratio [95 % confidence interval]: 1.10 [1.07-1.13]) and all separate ASCVD endpoints in the fully adjusted model with 48 covariates. Consistently, compared to non-users, VDS was associated with a reduced total ASCVD risk in the model fully adjusted for the 50 covariates (0.94[0.90-0.98]). Regarding the individual ASCVD disorders, VDS was associated with reduced IHD risk (0.90[0.86-0.96]).

CONCLUSION

Self-reported regular VDS and being vitamin D sufficient were both associated with reduced ASCVD risk in real-world settings. For people with low 25(OH)D levels, regular VDS may be a beneficial strategy for ASCVD prevention.

Neutrophil extracellular traps in cancer: From mechanisms to treatments

Neutrophil extracellular traps (NETs) are reticular ultrastructures released by activated neutrophils. As the reaction products of neutrophils, NETs have been identified as crucial effectors in pathogen defence and autoimmune diseases. Recently, increasing evidence suggest that this process also occurs in cancer. The formation and clearance of NETs are dynamically influenced by the tumour microenvironment, while NETs reciprocally play a dual role in either promoting or inhibiting tumour progression through their DNA scaffold, proteases and other granule-derived proteins. Given the interplay between NETs and tumours, active exploration is currently underway to harness their potential as tumour biomarkers and therapeutic targets. Here, we delve into the biochemical and immunological mechanisms underlying NETs formation within the tumour microenvironment, along with recent advances elucidating their multifaceted roles in tumourigenesis, metastasis and tumour-associated co-morbidities. Furthermore, we present emerging strategies for NETs-based tumour diagnostic approaches and therapeutics, with a special focus on the challenging questions that need to be answered within this field. KEY POINTS: The formation and clearance of NETs are dynamically influenced by the tumor microenvironment. NETs are engaged in tumorigenesis, formation, metastatic spread, and cancer-associated co-morbidities. NETs-based tumor biomarkers and therapeutic strategies warrant significant attention.

Non-Cell-Based Extracorporeal Artificial Liver Systems: Historic Perspectives, Approaches and Mechanisms, Current Applications, and Challenges

BACKGROUND

Liver disease is a growing burden. Transplant organs are scarce. Extracorporeal liver support systems (ELSS) are a bridge to transplantation for eligible patients. For transplant-ineligible patients the objective becomes liver recovery.

METHODS

We review seven decades of non-cell-based ELSS research in humans. Where possible, we emphasize randomized controlled trials (RCTs). When RCTs are not available, we describe the available human clinical data.

RESULTS

There are three broad cell-free approaches to remove protein-bound toxins (PBTs) and treat liver failure. The first is a dialysate binder suspension. A material that binds the PBT (the binder) is added to the dialysate. Binders include albumin, charcoal, and polystyrene sulfonate sodium. The unbound fraction of the PBT crosses the dialyzer membrane along a chemical gradient and binds to the binder. The second approach is using grains of sorbent fixed in a plastic housing to remove PBTs. Toxin-laden blood or plasma flows directly through the column. Toxins are removed by binding to the sorbent. The third approach is exchanging toxin-laden blood, or fractions of blood, for a healthy donor blood product. Most systems lack widespread acceptance, but plasma exchange (PE) is recommended in many guidelines. The large donor plasma requirement of PE creates demand for systems to complement or replace it.

CONCLUSIONS

Now that PE has become recommended in some, but not all, jurisdictions, we discuss the importance of reporting precise PE protocols and dose. Our work provides an overview of promising new systems and lessons from old technologies to enable ELSS improvement.

An enhanced harmonic densely connected hybrid transformer network architecture for chronic wound segmentation utilising multi-colour space tensor merging

Chronic wounds and associated complications present ever growing burdens for clinics and hospitals world wide. Venous, arterial, diabetic, and pressure wounds are becoming increasingly common globally. These conditions can result in highly debilitating repercussions for those affected, with limb amputations and increased mortality risk resulting from infection becoming more common. New methods to assist clinicians in chronic wound care are therefore vital to maintain high quality care standards. This paper presents an improved HarDNet segmentation architecture which integrates a contrast-eliminating component in the initial layers of the network to enhance feature learning. We also utilise a multi-colour space tensor merging process and adjust the harmonic shape of the convolution blocks to facilitate these additional features. We train our proposed model using wound images from light skinned patients and test the model on two test sets (one set with ground truth, and one without) comprising only darker skinned cases. Subjective ratings are obtained from clinical wound experts with intraclass correlation coefficient used to determine inter-rater reliability. For the dark skin tone test set with ground truth, when comparing the baseline results (DSC=0.6389, IoU=0.5350) with the results for the proposed model (DSC=0.7610, IoU=0.6620) we demonstrate improvements in terms of Dice similarity coefficient (+0.1221) and intersection over union (+0.1270). Measures from the qualitative analysis also indicate improvements in terms of high expert ratings, with improvements of >3% demonstrated when comparing the baseline model with the proposed model. This paper presents the first study to focus on darker skin tones for chronic wound segmentation using models trained only on wound images exhibiting lighter skin. Diabetes is highly prevalent in countries where patients have darker skin tones, highlighting the need for a greater focus on such cases. Additionally, we conduct the largest qualitative study to date for chronic wound segmentation. All source code for this study is available at: https://github.com/mmu-dermatology-research/hardnet-cws.

Update in the molecular mechanism and biomarkers of diabetic retinopathy

Diabetic retinopathy (DR) is a serious complication of diabetes caused by long-term hyperglycemia that leads to microvascular and neuronal damage in the retina. The molecular mechanisms of DR involve oxidative stress, inflammatory responses, neurodegenerative changes, and vascular dysfunction triggered by hyperglycemia. Oxidative stress activates multiple metabolic pathways, such as the polyol, hexosamine, and protein kinase C (PKC) pathways, resulting in the production of, which in turn promote the formation of advanced glycation end products (AGEs). These pathways exacerbate vascular endothelial damage and the release of inflammatory factors, activating inflammatory signaling pathways such as the NF-κB pathway, leading to retinal cell damage and apoptosis. Additionally, DR involves neurodegenerative changes, including the activation of glial cells, neuronal dysfunction, and cell death. Research on the multiomics molecular markers of DR has revealed complex mechanisms at the genetic, epigenetic, and transcriptional levels. Genome-wide association studies (GWASs) have identified multiple genetic loci associated with DR that are involved in metabolic and inflammatory pathways. Noncoding RNAs, such as miRNAs, circRNAs, and lncRNAs, participate in the development of DR by regulating gene expression. Proteomic, metabolomic and lipidomic analyses have revealed specific proteins, metabolites and lipid changes associated with DR, providing potential biomarkers for the early diagnosis and treatment of this disease. This review provides a comprehensive perspective for understanding the molecular network of DR and facilitates the exploration of innovative therapeutic approaches.

Bioinformatics-led identification of pathophysiological hallmark genes in diabesotension via graph clustering method

Background

Diabesotension, an overlapping triad of diabetes, hypertension, and obesity, remains a diagnostic challenge due to its complex underlying molecular mechanisms. Individuals with diabesotension face twice the risk of microvascular and macrovascular complications compared to those with either condition alone. However, the complexity of diabesotension poses significant diagnostic challenges due to limited knowledge of this disease trifecta.

Methods

The protein network was constructed, and the DPClusOST algorithm was applied to determine the protein clusters with a density ranging from 0.1 to 1.0 and those relevant to the pathophysiology of diabesotension. The significance score (SScore) was computed using the p-value from Fisher's exact test to evaluate each cluster, and the clusters containing proteins associated with diabesotension were classified using receiver operating characteristic (ROC) analysis. The significant density of the cluster, as indicated by the AUC, was determined and subsequently subjected to pathway enrichment analysis using ShinyGO.

Results

At densities of 0.6 and 0.8, 14 proteins (STX3, VAMP2, STX4, SYT1, DNAJC5, HSD17B10, DLD, AIFM1, PDHA1, PDHB, DLAT, PDHX, OGDH, and STAT5A) from clusters 13 and 53 were significantly identified as potential diabesotension-related proteins. Key pathways associated with the tripartite interplay of the three pathologies were found to involve amino acid metabolism, glycolysis/gluconeogenesis, SNARE-mediated vesicle transport, insulin and salivary secretion, and the glucagon and HIF-1 signaling pathways, thus identifying novel candidates for diabesotension biomarkers and therapeutic targets.

Conclusions

This study highlights the use of graph clustering to identify potential biomarkers for the comorbid triad, which could enhance personalized future treatment strategies.

Clinical Application Guideline of Combination With Traditional Chinese Medicine and Western Medicine in the Prevention and Treatment of Chronic Obstructive Pulmonary Disease (2024)

AIM

Chronic Obstructive Pulmonary Disease (COPD) is a common chronic airway disease that can lead to decreased lung function in patients. It places a heavy economic burden on patients and society. Traditional Chinese medicine (TCM) and Western medicine have played important roles in managing COPD. We aimed to develop an evidence-based guideline for treating COPD with Chinese and Western Medicine.

METHODS

We formed a guideline panel of multidisciplinary experts. The clinical questions were identified based on two rounds of issue solicitation and expert demonstration. We searched the literature for direct evidence on the management of COPD and assessed its certainty-generated evidence using the grading of recommendations, assessment, development, and evaluation (GRADE) approach. The recommendations and their strengths were formulated using the Delphi method.

RESULTS

Our guideline covers aspects of the diagnosis and treatment of COPD such as principles and commonly used medications for both traditional Chinese medicine and Western medicine, complications, and the high-risk populations. 9 clinical questions and 35 recommendations were identified, which covered the combinations of YuPingFeng granule, Buzhong Yiqi decoction, Gushen Dingchuan Pill, Bufei Huoxue Capsules, Runfei cream, Bailing Capsule, Tanyin Pills, etc., and nonpharmacological therapy of TCM such as combined acupoint application, electroacupuncture, and Chinese exercise techniques (Tai Chi, Baduanjin), etc. Recommendations were either high or low or in the form of ungraded consensus-based statements.

CONCLUSIONS

This is a comprehensive and systematic evidence-based guideline and we hope it can systematically and effectively guide clinicians in managing COPD and improve overall medical care.

Collaborative Autoethnography of Cancer Patients' Dynamic Sense of Agency

Through collaborative autoethnography, we studied shifts in cancer patients' sense of agency and the meaning of cancer during the diagnostic and treatment phases. This article contributes to the illness management literature by adopting sense of agency perspective that provides new understanding of retrospective interpretation of cancer patients' agency. The authors' experiences of receiving cancer diagnoses and a related, collectively written story illustrate how relational and contextual elements facilitate rapid shifts in cancer patients' sense of agency and illness management. The findings illustrate shifts in the sense of agency as a collaborative and reflexive process between cognitive, emotional, and bodily constraints and adjustments. We demonstrate how shifts in patients' sense of agency and respective changes in meanings attached to cancer were shaped by near ones, healthcare actors, and other cancer patients, as well as the COVID-19 pandemic and the fear of military conflict due to Finland neighbor Russia's war on Ukraine. Furthermore, the study illustrates how shifts in sense of agency shape and are shaped by changes in the understanding of cancer as either a secondary issue, ambiguous stranger, travel companion, or enemy.

The burden of type 2 diabetes in China from 1990 to 2021: A comparative analysis with G20 countries using the global burden of disease study 2021

OBJECTIVES

The study aims to evaluate the burden of Type 2 Diabetes (T2D) in China from 1990 to 2021, and compare to it across G20 countries.

METHODS

We utilized data from the Global Burden of Disease Study 2021 to examine the burden of T2D in China from 1990 to 2021. Prevalence, mortality, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) were calculated. Comparative analyses were conducted with other G20 countries.

RESULTS

T2D prevalence in China increased between 1990 and 2021, with rates rising from 3519.8 (3138.3-3910.1) to 6055.5 (5510.1-6614.3) per 100,000. The death rates slightly decreased from 9.3 (8.2-10.5) per 100,000 to 8.7 (7.3-10.3). The DALYs rate increased from 438.7 (358.5-531.5) to 569.8 (435.4-734.2), with increases observed in YLDs and YLLs. Males had a heavier disease burden in China. Compared to G20 countries, China ranked high in prevalence but had relatively better mortality outcomes in older age groups.

CONCLUSION

This study reveals the enormous burden and remarkable control efforts of T2D in China. Comparative analysis emphasizes the importance of tailored public health interventions to address this growing health crisis.

The burden of cardiovascular disease in Latin America and the Caribbean, 1990-2019: An analysis of the global burden of disease study

INTRODUCTION

Cardiovascular disease (CVD) remains the leading cause of death globally, including the Latin America and the Caribbean (LAC) region. However, limited research has been conducted on the burden of CVD in this region. Our study aims to investigate the burden of CVD and related risk factors (RFs) in the LAC.

METHODS

We used data from the Global Burden of Disease (GBD) 2019 to examine CVD prevalence in 33 LAC countries. Prevalence, mortality, and incidence were analyzed using Bayesian regression tools, demographic methods, and mortality-to-incidence ratios. Disability-adjusted life years (DALYs) were calculated, and RFs were evaluated under the GBD's comparative risk assessment framework.

RESULTS

Between 1990 and 2019, CVD raw rates in the LAC increased by 116.7 %, while age-standardized prevalence decreased (-9.2 %). CVD raw mortality rose by 71.2 %, but age-standardized death rates fell by 69.8 %. Ischemic heart disease remained the most prevalent condition, with higher rates in men, while women had higher rates of stroke. Age-standardized DALYs decreased by 70.9 %. DALY rates varied across countries and were consistently higher in males. Leading RFs included HTN, high LDL, dietary risks, and elevated BMI.

CONCLUSIONS

Despite progress in reducing the CVD burden in the LAC region, the impact on mortality and morbidity, particularly related to ischemic heart disease, remains substantial. Tailored interventions are necessary, considering country-specific variations in socio-economic factors, healthcare infrastructure, and political stability.

Artificial intelligence based predictive tools for identifying type 2 diabetes patients at high risk of treatment Non-adherence: A systematic review

AIMS

Several Artificial Intelligence (AI) based predictive tools have been developed to predict non-adherence among patients with type 2 diabetes (T2D). Hence, this study aimed to describe and evaluate the methodological quality of AI based predictive tools for identifying T2D patients at high risk of treatment non-adherence.

METHODS

A systematic search was conducted across multiple databases including, EMBASE, Cochrane Library, MedLine, and Google Scholar search. The Prediction model Risk Of Bias ASsessment Tool (PROBAST) was used to assess the quality of studies. The performances of tools were assessed by Area Under the Curve (AUC), precision, recall, C-index, accuracy, sensitivity, specificity or F1 score.

RESULTS

Most studies measured predictive ability using AUC (75 %), and some only reported precision (25 %), recall (12.5 %), C-index (12.5 %), accuracy (37.5), sensitivity (12.5 %), specificity (12.5 %) or F1 score (25 %). All tools had moderate to high predictive ability (AUC > 0.70). However, only one study conducted external validation. Demographic characteristics, HbA1c, glucose monitoring data, and treatment details were typical factors used in developing tools.

CONCLUSIONS

The existing AI based tools holds significant promise for improving diabetes care. However, future studies should focus on refining the existing tools, validating in other settings, and evaluating the cost-effectiveness of AI-supported interventions.

Association of cardiovascular-kidney-metabolic syndrome with all-cause and cardiovascular mortality: A prospective cohort study

Background

Given evidence on the cardiovascular disease (CVD) risk conferred by comorbidity risk factors, the American Heart Association (AHA) recently introduced a novel staging construct, named cardiovascular-kidney-metabolic (CKM) syndrome. This study examined the association of CKM syndrome stages with all-cause and cardiovascular mortality among US adults.

Methods

Data were from the National Health and Nutrition Examination Survey (NHANES) 1999-2018 at baseline linked to the 2019 National Death Index records. For each participant, the CKM syndrome was classified into five stages: stage 0 (no CKM risk factors), 1 (excess or dysfunctional adiposity), 2 (metabolic risk factors and chronic kidney disease), 3 (subclinical CVD), or 4 (clinical CVD). The main outcomes were all-cause and cardiovascular mortality.

Results

Among 34,809 participants (mean age: 46.7 years; male: 49.2 %), the prevalence of CKM stages 0 to 4 was 13.2 %, 20.8 %, 53.1 %, 5.0 %, and 7.8 %, respectively. During a median follow-up of 8.3 years, compared to participants with CKM stage 0, those with higher stages had increased risks of all-cause mortality (stage 2: HR 1.43, 95 % 1.13-1.80; stage 3, HR 2.75, 95 % CI 2.12-3.57; stage 4, HR 3.02, 95 % CI 2.35-3.89). The corresponding hazard ratios (95 % confidence interval) of cardiovascular mortality risks were 2.96 (1.39-6.30), 7.60 (3.50-16.5), and 10.5 (5.01-22.2). The population-attributable fractions for advanced (stages 3 or 4) vs. CKM syndrome stages (stages 0, 1, or 2) were 25.3 % for all-cause mortality and 45.3 % for cardiovascular mortality.

Conclusion

Higher CKM syndrome stages were associated with increased risks of all-cause and cardiovascular mortality. These findings emphasize that primordial and primary prevention efforts on promoting CKM health should be strengthened to reduce mortality risk.

Factors Associated With Social Participation Among Young and Middle-Aged Patients After Cardiac Surgery: A Cross-Sectional Study

This study aimed to investigate the level of social participation among young and middle-aged patients after cardiac surgery and its influencing factors by using a cross-sectional design. Participants were recruited from the Department of Cardiac Surgery of Guangdong Provincial People's Hospital through convenience sampling, and 237 young and middle-aged patients after cardiac surgery completed the Questionnaire on Participation and Autonomy (IPA). Data were analyzed using descriptive statistics, independent t-test, one-way analysis of variance, Pearson's correlation coefficients, and multiple stepwise linear regression analysis. A total of 237 participants, with a mean (SD) age was 47.2 (9.2). The total score (SD) of social participation among young and middle-aged patients after cardiac surgery was 52.0 (6.7), indicating a moderately low level of social participation. The results of multiple stepwise regression analysis showed that gender, age, number of comorbidities, social support, self-efficacy, kinesiophobia, and pain were the influencing factors of social participation (p < 0.05), which variables accounted for approximately 59.6% of the variance in the social participation. The social participation among young and middle-aged patients after cardiac surgery needs to be improved. TRIAL REGISTRATION: This study has been approved by the Chinese Clinical Trial Registry. (registration number: ChiCTR2400083390).

Attributable risk factors and trends in global burden of falls from 1990 to 2021: A comprehensive analysis based on Global Burden Of Disease Study 2021

BACKGROUND

Falls are a leading cause of disability-adjusted life years (DALYs) and mobility difficulties. Previous estimates have relied on restricted regional scope and lack a thorough global study. This study, for the first time, examines the evolving trends in the global burden of falls from 1990 to 2021, focusing on geographic variation in disease burden and risk factors, predicting the development of burden of falls. Our aim was to provide information for allocating medical resources, taking health policies into action, and making patient management systems operate better.

METHOD

Data on incident cases, deaths, and DALYs were collected for countries, regions, ages, and sexes worldwide from the Global Burden Disease (GBD) 2021 database. Using R (version 4.3.2), we calculated estimated annual percent changes (EAPCs) for assessing trends in age-standardized rates, visualized risk factors, and predicted the global burden of falls. Joinpoint regression (version 4.9.1.0) was used to identify significant temporal trends and change points.

RESULTS

In 2021, 548.8 million people were affected by falls. There were 215 million incidence, 43.8 million DALYs, and 800,000 deaths caused by falls. The incidence rate of falls increases with age, and sex inequalities exist. Compared with 1990, the age-standardized incidence rate (ASIR), death rate (ASDR), and DALY rate (ASDALYsR) declined despite an increase in absolute numbers. The ASDR and ASDALYsR of falls are expected to decline in the future, whereas the ASIR is expected to rise. The fall burden varied significantly according to region and its sociodemographic index (SDI). Both ASIR (R = 0.510, p < 0.001) and ASDALYsR (R = 0.2762, p < 0.001) were positively correlated with SDI. In contrast, ASDR (R=-0.536, p < 0.001) showed a consistently negative association with SDI. Low bone mineral density, occupational injuries, alcohol use, and smoking emerged as the top factors associated with fall-related DALYs and deaths.

CONCLUSIONS

The overall burden of falls declined between 1990 and 2021, but the future incidence is expected to increase. The global burden of falls remains unchanged and shows significant regional and sex-based differences. Effective prevention and strategies against risk factors are imperative for reducing the future burden.

Incidence, Risk and Trends of Multiple Primary Cancers in Patients With Colorectal Cancer: Evidence From the South Australian Cancer Registry

BACKGROUND

Colorectal cancer (CRC) is the fourth most diagnosed cancer in Australia. With advancements in treatment and an increase in survival rates, CRC survivors face an elevated risk of developing multiple primary cancers (MPCs), presenting a clinical challenge. Therefore, this study aimed to estimate the incidence, trend and risk of MPCs after a diagnosis of CRC in the South Australian population.

METHODS

This study analysed South Australian Cancer Registry data on individuals diagnosed with CRC as their first cancer from 1982 to 2017. The incidence of MPCs was assessed using cumulative incidence functions, and age-standardised rates were estimated. Poisson regression was used to determine the risk, and standardised incidence ratios (SIR) and absolute excess risks (AER) were estimated. Trends over time were analysed using Joinpoint regression.

RESULTS

The study included 26,729 CRC survivors. Of the cohort, 15% (3917) developed 4453 MPCs, with 96% diagnosed six or more months after index CRC. The cumulative incidence of MPCs was 22.5% (95% CI: 21.6-23.4). The median follow-up time until MPC diagnosis was 6.4 years. Common MPCs included prostate (18.9%), subsequent CRC (13.1%), lung (10.8%), haematological (10.2%) and breast (8.0%) cancers. The overall risk of MPCs was higher in CRC survivors (SIR: 1.12, 95% CI: 1.09-1.16; AER: 22.6 per 10,000) compared to the incidence in the general South Australian population. The incidence of MPCs has increased over time (annual percentage change = 1.95, 95% CI: 1.33-2.51).

CONCLUSIONS

CRC survivors are at increased risk of subsequent cancers, highlighting the need for targeted surveillance, particularly for prostate, lung, breast and blood cancers, for early detection and treatment.

Outcomes of Elderly Patients With Node-Positive Colon Cancer: A Multicenter Population-Based Cohort Study

BACKGROUND

In this large population-based cohort study, we examined the prognostic significance of various clinical, pathological, and contextual variables for their correlation with survival in elderly patients with stage III colon cancer.

METHODS

Patients aged ≥ 70 years with stage III colon cancer, diagnosed in Saskatchewan during 2012-2018, were evaluated. A Cox proportional multivariate survival analysis was performed to determine factors correlated with overall survival (OS) and disease-free survival.

RESULTS

Overall, 404 eligible patients with a median age of 79 years and a male-to-female ratio of 1:1 were identified. Among them, 48% were aged ≥ 80 years, 66% had ≥ 1 major comorbid illness, 46% had high-risk disease, and 50% had a node-positive to node-harvested (NPNH) ratio of > 0.1. Forty-three percent of patients received adjuvant chemotherapy. The 5-year disease-free survival with chemotherapy was 49% versus 30% without chemotherapy (P < .001). The 5-year OS with adjuvant chemotherapy was 64% versus 49% without chemotherapy (P < .001). On multivariate analysis a past history of cancer, hazard ratio (HR) 1.47 (95% CI, 1.12-1.94); presence of an ostomy, HR 1.53 (1.16-2.03); NPNH ratio > 0.1, HR 1.51 (1.15-1.98); grade III tumor, HR 1.54 (1.16-2.04); WHO performance status > 1, HR 1.42 (1.06-1.90); no adjuvant chemotherapy, HR 1.82 (1.32-2.50); high-risk stage III disease, HR 1.60 (1.22-2.11), and baseline carcinoembryonic antigen > 5, HR 1.98 (1.50-2.61) were independently correlated with OS.

CONCLUSIONS

This study highlights the prognostic importance of several factors in elderly patients with stage III colon cancer, particularly the benefit of adjuvant chemotherapy on survival. Key predictors of poorer OS include a past history of cancer, presence pf an ostomy, and a higher NPNH ratio. These findings emphasize the need for personalized treatment approaches to improve outcomes in this vulnerable population.

The impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels: A comprehensive analysis for the Global Burden of Disease Study 2021

BACKGROUND

We aim to estimate impact and projection of the COVID-19 pandemic on the burden of stroke at global, regional, and national levels METHODS: Utilizing standardized GBD methodologies, we conducted a comprehensive analysis of the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with stroke across 204 countries and regions spanning the periods from 1990 to 2019, 2019 to 2021, and 1990 to 2021. Our study provides detailed estimates accompanied by corresponding 95% uncertainty intervals (UIs), stratified by age and sex. To elucidate the temporal trends in stroke burden, we calculated the Estimated Annual Percentage Change (EAPC). Additionally, we explored the relationship between stroke burden and sociodemographic index (SDI) levels. The DALYs attributable to various risk factors for stroke were also analyzed. The burden of stroke in the next 20 years was also predicted.

RESULTS

From 2019 to 2021, the age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and DALYs rates for stroke remained stable, diverging from the declining trends observed from 1990 to 2019 and from 1990 to 2021 at global, regional, and national levels, as indicated by both percent change analysis and EAPC analysis. This pattern was similarly reflected in the global burden of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and ischemic stroke (IS). The changes in the burden of stroke, ICH, and IS from 2019 to 2021 were consistent between males and females. Importantly, the impact of COVID-19 on stroke burden remains substantial, irrespective of variations in the SDI. The IS burden increased in the next 20 years, and more attention should be paid on the stroke burden in young people.

CONCLUSIONS

Throughout the COVID-19 pandemic, the burden of stroke exhibited a stable trajectory, in contrast to the declining trend observed from 1990 to 2019 and from 1990 to 2021. The increased burden was observed in IS and young people in the next 20 years. These observations highlight the disparities in stroke burden that exist across different levels of socioeconomic development. The longitudinal epidemiological data presented in this study provide valuable insights into the significant shifts brought about by the COVID-19 pandemic, offering crucial information for researchers, policymakers, healthcare professionals, and other stakeholders.

Timeliness of the second dose of measles-containing vaccine uptake and its determinants among children aged 24-36 months in Gondar City, Northwest Ethiopia, 2023: Community-based cross-sectional study design

Background

Measles remains a global public health concern, despite the availability of effective vaccines. Recent outbreaks highlight the need for strong vaccination programs. Since launching both doses, Ethiopia has been working with global health organizations to increase vaccination coverage. However, focusing solely on coverage overlooks the importance of timely vaccination. In Ethiopia, despite occasional increases in coverage, measles outbreaks persist due to insufficient attention to timeliness. This study aims to assess the timeliness and its determinants of second-dose measles-containing vaccine uptake in Gondar City to inform efforts to strengthen immunization programs and prevent measles infections.

Methods

A community-based cross-sectional study was conducted among 618 children aged 24-36 months. Participants were selected using a two-stage systematic random sampling method from April 25 to May 25. Structured questionnaires were administered through interviews, and data were collected using the Kobo toolbox and then analyzed using Stata version 17. A binary logistic regression model was utilized to determine factors associated with the outcome, with significance declared at a p-value <0.05. Adjusted odds ratios with 95 % confidence intervals were used to assess the direction and strength of associations.

Results

Among the total of 618 children, 523 (84.63 %) (95 % CI: 81.77 %-87.48 %) were vaccinated for MCV2 timely (in the national recommended age). Paternal college and above in their education (AOR: 5.84, 95 % CI: 1.55-8.18), four or more ANC follow-ups (AOR: 5.84, 95 % CI: 1.55-8.18), at least two doses of vitamin An uptake (AOR: 6.39, 95 % CI: 2.92-12.59), mothers having high awareness (AOR: 2.04, 95 % CI: 1.05-3.99), and mothers having positive perception (AOR: 4.81, 95 % CI: 2.13-10.86) to measles vaccination were significant determinants for timely uptake of the second dose measles-containing vaccine.

Conclusion and recommendations

The timely uptake of the second dose of the measles vaccine in the study area was suboptimal, and efforts should be continued to eradicate measles infection. Paternal educational status, ANC follow-ups, repeated vitamin An uptake, maternal awareness, and perception of measles vaccination were statistically significant determinants for the timely uptake of a second dose of measles-containing vaccine. Strengthening maternal and child health services, increasing awareness, and changing mothers' perceptions about measles vaccination may increase the timely uptake of MCV2 among children receiving a second MCV dose.

Current research on mitochondria‑associated membranes in cardiovascular diseases (Review)

The present study aimed to explore the role of mitochondria‑associated membranes (MAMs) as a key interface between mitochondria and the endoplasmic reticulum (ER) and to evaluate their importance in maintaining the physiological functions of these two organelles. MAMs not only act as a structural bridge between mitochondria and the ER but also widely participate in the regulation of mitochondrial biosynthesis and function, Ca2+ signal transduction, lipid metabolism, oxidative stress response and autophagy. In addition, the specific protein composition of MAMs is increasingly being recognized as having a profound impact on their function, and these proteins play a central role in regulating intercellular communication. Recently, the scientific community has accumulated a large amount of evidence supporting MAMs as potential targets for cardiovascular disease treatment. The present review focuses on the fine structure and multifunctional properties of MAMs and their mechanisms in the occurrence and development of cardiovascular diseases. The goal is to explore the mechanism of MAMs, therapeutic intervention points directly related to cardiovascular diseases, and feasibility of incorporating MAMs into the diagnostic strategy and treatment plan of cardiovascular diseases to provide novel insights and theoretical support for clinical practice in this field. MAMs have great potential as therapeutic targets for various cardiovascular diseases. This finding not only deepens the understanding of the interaction between organelles but also opens up a promising research path for the development of new therapeutic strategies for cardiovascular diseases.

Plant proteins and peptides as key contributors to good health: A focus on pulses

The growing interest of the public in healthy food products with adequate nutritional quality has triggered a search for novel sources of protein. This review discusses scientific evidence on the available sources, processing, and biological properties of plant-based protein and bioactive peptides, with a particular emphasis on pulses, as these are some of the most important sources of protein and peptides displaying a wide range of health benefits. Processing plant-based proteins and derived peptides require standardized methods ensuring the improvement of their nutritional quality to counteract limiting factors affecting their evenness to other protein sources. If protein and bioactive peptides can be produced as functional ingredients, the industry releases patents, making them highly marketable to develop functional food products. Current research supports that plant-based food products constitute a nutritious part of a healthy diet by preventing chronic non-communicable diseases, but more studies, particularly clinical trials, are needed to demonstrate these effects fully.

Low-intensity pulsed ultrasound relieved the diabetic peripheral neuropathy in mice via anti-oxidative stress mechanism

Diabetic peripheral neuropathy (DPN), as one of the most prevalent complications of diabetes, leads to significant pain and financial burden to patients. Currently, there was no effective treatment for DPN since the glucose control was just a prevention and the drug therapy only relieved the DPN pain. As a non-invasive physical therapy, low-intensity pulsed ultrasound (LIPUS) is utilized in the musculoskeletal and nerve injuries therapy. Studies revealed that LIPUS could regenerate nerves by the mechanical stimulation via oxidative stress pathway, which was thought as the important factor for DPN, and might have potential in the DPN therapy. This study aimed to identify a new therapeutic strategy for DPN using LIPUS. We analyzed the therapy effect and explored the therapeutic mechanism of LIPUS on DPN in mice. This study involved animal experiments and C57BL/6J mice were randomly assigned to DPN model and Sham groups. The DPN model group was fed a high-fat chow diet and injected with streptozotocin (STZ) for 3 consecutive days (40 mg/kg/d), whereas the Sham group was fed a normal diet and injected with an equal volume of sodium citrate buffer. After the DPN model confirmed with the 84-day modeling process, the DPN mice were randomly allocated into the DPN group and the LIPUS group. The LIPUS group underwent ultrasound treatments with a center frequency of 1 MHz, a duty cycle of 20 %, and a spatial average temporal average intensity (ISATA) of 200 mW/cm2 for 20 min/d, 5 d/w. After the 56-day treatment, all mice were euthanized. LIPUS therapeutic effects were evaluated through measurements of fasting blood glucose (FBG), behavioral tests, oxidative stress tests, morphological analysis, immunofluorescence, and western blot analysis. The results indicated that DPN mice had significantly higher FBG levels (28.77 ± 2.95 mmol/L) compared with sham mice (10.31 ± 1.49 mmol/L). Additionally, DPN mice had significantly lower mechanical threshold (4.13 ± 0.92 g) and higher thermal latency (16.20 ± 2.39 s) compared with the sham mice (7.31 ± 0.83 g, 11.67 ± 1.21 s). After receiving LIPUS treatment, the glucose tolerance tests (GTT) suggested that LIPUS treatment improved glucose tolerance, which was shown by a decrease in the area under the curve (AUC) for glucose in the LIPUS group (AUC = 2452 ± 459.33 min*mmol/L) compared with the DPN group (AUC = 3271 ± 420.90 min*mmol/L). Behavioral tests showed that LIPUS treatment significantly alleviated DPN-induced abnormalities by improving the mechanical threshold from 2.79 ± 0.79 g in the DPN group to 5.50 ± 1.00 g in the LIPUS group, and significantly decreasing thermal latency from 12.38 ± 1.88 s in the DPN group to 9.49 ± 2.31 s in the LIPUS group. Morphological observations revealed that DPN mice had a thinning and irregularly shaped myelin sheath, with 61.04 ± 5.60 % of abnormal nerve fibers in the sciatic nerve in LIPUS group, compared with 49.76 ± 4.88 % of abnormal nerve fibers in the LIPUS-treated group. Additionally, LIPUS treatment increased the mean fluorescence intensity of the associated nerve regeneration protein (i.e., Nf200) from 27.81 ± 0.32 arbitrary units in the DPN group to 37.62 ± 0.36 arbitrary units in the LIPUS group. Western blot and immunofluorescence analysis showed that LIPUS treatment significantly reduced Keap1 expression to 0.04 ± 0.06 relative units, compared with 0.17 ± 0.30 in the DPN group. Furthermore, immunofluorescence analysis revealed that LIPUS treatment promoted the production of its downstream antioxidant protein, heme oxygenase-1 (HO-1), with an increase in the fluorescence intensity from 27.81 ± 0.32 arbitrary units in the DPN group to 37.62 ± 0.36 arbitrary units in the LIPUS-treated group. The fluorescence intensity of Nrf2 was significantly higher in the LIPUS group, increasing from 4.90 ± 0.25 arbitrary units in the DPN group to 15.18 ± 2.13 arbitrary units in the LIPUS-treated group. Additionally, the malondialdehyde (MDA) levels, an indicator of oxidative stress, were significantly reduced in the serum, from 5.40 ± 0.48 nmol/ml in the DPN group to 4.64 ± 0.16 nmol/ml in the LIPUS-treated group, and in the sciatic nerve, from 16.17 ± 5.88 nmol/mg protein to 4.67 ± 2.10 nmol/mg protein, suggesting the oxidative stress was inhibited by LIPUS. This study demonstrated for the first time that LIPUS could relive DPN through anti-oxidative stress process. This study suggests that LIPUS might be a new therapy strategy for DPN.

Prevalence of macro-vascular complications among type 2 diabetic adults aged 50 and over: results from Ardakan cohort study on aging (ACSA)

Objective

Type 2 diabetes mellitus (T2DM) is a common condition that can lead to adverse macrovascular complications. This study aims to determine the prevalence of macrovascular complications in adults aged ≥ 50 with T2DM in Ardakan city, using data from the Ardakan Cohort Study on Aging (ACSA).

Methods

A cross-sectional investigation involved 5933 participants from the ACSA; of those assessed, 2340 had T2DM. Macrovascular complications, specifically coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease(PAD) were identified through medical records and physician assessment. Logistic regression was used to identify risk factors for these complications.

Results

The prevalence of CAD and CVD were 16.9% (95% CI:16.0-19.0) and 4% (95% CI:3.3-5.0), respectively. risk factors for CAD included age over 60 (OR = 1.47, 95% CI: 1.08-2.01, p = 0.01), male gender (OR = 1.87, 95% CI: 1.33-2.62, p < 0.001), former smoking (OR = 1.96, 95% CI: 1.30-2.95, p = 0.001), hypertension (OR = 3.16, 95% CI: 2.23-4.46, p < 0.001), and over ten years of diabetes duration(OR = 2.04, 95% CI: 1.39-2.99, p < 0.001) and For CVD, significant risk factors included male gender (OR = 2.61, 95% CI: 1.52-4.51, p = 0.001) and hypertension (OR = 2.36, 95% CI: 1.27-4.39, p = 0.006).

Conclusion

This study highlights the high prevalence of macrovascular complications in adults over 50 with T2DM in Ardakan. It emphasizes the importance of managing key risk factors such as hypertension and quitting smoking, especially in older adults and males.

Gaining Recovery in Addiction for Community Elders (GRACE) Project: The Impact of Age-Specific Care on Clinical Outcomes and Health Care Resource Utilization in Older Adults With Substance Use Disorder in an Interprofessional Addiction Clinic

BACKGROUND

The prevalence of substance use disorders (SUDs) in older adults has been increasing, necessitating tailored and effective addiction care for this aging demographic.

AIMS

The purpose of this study was to assess the impact of age-specific, interprofessional addiction care on clinical outcomes and health care resource utilization in older adults with SUD.

METHODS

This quasi-experimental study directly compares patients enrolled in the Gaining Recovery in Addiction for Community Elders (GRACE) Project, an interprofessional age-specific addictions treatment program, with age-matched older adults who received conventional "treatment as usual" (TAU). Through retrospective comparative analysis, substance use outcomes, mental and physical health improvements, and inappropriate use of emergency services were examined among 78 older adults with SUD.

RESULTS

Clinical outcomes and health care resource utilization were superior for older adults who received age-specific addictions care through the GRACE Project, as compared to mixed-age conventional "TAU." GRACE patients had improved treatment adherence, fewer relapses, and longer treatment engagement. While both groups exhibited significant reductions in depression and anxiety scores, GRACE patients showed greater improvements. This group demonstrated superior control of both hypertension and diabetes. Importantly, they had fewer inappropriate emergency department visits and avoidable hospitalizations than conventional "TAU."

CONCLUSIONS

Addiction treatment delivered by an interprofessional team to meet the unique strengths and needs of older adults has the potential to improve treatment adherence and more favorable long-term outcomes in substance use, mental health, and chronic medical conditions. Nurses are poised to lead interprofessional teams to meet the growing demand for specialized addiction treatment and integrated care for older adults.

Reducing premature mortality from cardiovascular diseases in low and middle income countries: The role of Polypill in public health policy

Premature deaths account for about half of all fatalities in developing countries. In low- and middle-income countries, cardiovascular diseases have consistently been the primary cause of premature mortality for men and women during the past three decades. Current evidence indicates that fixed-dose combination therapy, the so-called Polypill, effectively reduces the burden of cardiovascular diseases, with greater benefits observed in combinations that include aspirin. Polypill demonstrates high adherence and an acceptable safety profile, with adverse drug events being comparable between the groups receiving treatment and those in the control group. Therefore, this paper advocates for the broader implementation of Polypill in low and middle-income countries, emphasizing its efficacy in the primary and secondary prevention of cardiovascular diseases. The strategy could also benefit high-risk groups with special conditions, such as non-alcoholic fatty liver disease and chronic kidney disease. The cost-effectiveness of Polypill and its potential to address health inequities in low and middle-income countries underscore its value as a public health strategy. Policymakers are encouraged to consider Polypill as a viable option to enhance cardiovascular health outcomes and reduce premature deaths in low-resource settings.

Satellite data to support air quality assessment and management

Satellite data have long been recognized as valuable for air quality applications. These applications are in a stage of rapid growth: new geostationary satellites provide hourly or sub-hourly data; improvements in algorithms convert measured wavelengths into retrievals of atmospheric constituents; advances in machine learning support improved estimates of near-surface pollution; and growing interest among air quality managers has led to a range of new satellite data applications. Considering mainly activities in the United States under the Clean Air Act, we discuss proven applications relevant to air quality management, including: informing epidemiological studies and health risk assessments for setting regulatory standards; evaluating regulatory models; constraining emissions inventories; supporting Exceptional Event Demonstrations through tracking wildfire plumes and other sources; characterizing emission patterns and ozone-forming chemistry for State Implementation Plans; improving air quality forecasting; and tracking long-term trends to evaluate regulatory impact. Air quality professionals are increasingly using satellite data for these and related analyses, but barriers remain. This review provides a summary of satellite products used in applications for air quality and related health assessments; progress in using satellite observations for deriving surface-level air quality information across scales; and their use in air quality management.Implications: The review covers advancements in satellite data for air quality applications over the last 15 years. Success with satellite applications, especially for PM2.5 and NO2, include use in health risk assessment, constraining emissions inventories, and supporting tracking short- and long-term trends with regulatory relevance. Solutions co-developed between researchers and practitioners show promise for continued improvements in the use and value of satellite data for air quality applications.

Risk stratification of metabolic disorder-associated kidney disease

During the last 20 years, the disease burden attributable to metabolic disorders increased by 49.4%. Metabolic disorders are established risk factors for both chronic kidney disease (CKD) and cardiovascular disease (CVD). A concept of cardiovascular-kidney-metabolic (CKM) syndrome has recently been proposed to underscore the pathophysiological interrelatedness of the metabolic risk factors, CKD, and CVD. Two major adverse outcomes of the metabolic disorder-associated kidney disease are cardiovascular disease and, to a less extent, kidney failure. This review aims to briefly summarize the traditional metabolic risk factors for kidney disease; to introduce the concept of CKM health; to present the methods for risk assessment for CKD progression and CVD, with focus on validated and clinically applicable prediction tools; and to discuss the key gaps in the current tools for the risk stratification. In summary, in general clinical settings, the CKM health and associated risk in patients with the metabolic disorder-associated kidney disease can be assessed by combining the CKM staging model, the CKD Prognosis Consortium equations for CKD progression, and the Predicting Risk of CVD Events (PREVENT) equations for CVD. More efficient risk prediction tools, potentially incorporating multimodal data, are needed for more accurate and early identification of individuals at high risk and better personalized management of the disease.

Global, regional, and national burdens of hip fractures in elderly individuals from 1990 to 2021 and predictions up to 2050: A systematic analysis of the Global Burden of Disease Study 2021

PURPOSE

We aimed to analyse the global, regional, and national burdens of hip fractures in older adults from 1990 to 2021, with projections to 2050, on the basis of data from the GBD 2021 study.

METHODS

We employed a joinpoint model to analyse trends in the burden of hip fractures from 1990‒2021. The estimated annual percentage change (EAPC) was used to quantify temporal trends over this period. We evaluated the relationship between the social development index and the burden of hip fracture in elderly people and conducted a health inequality analysis. Additionally, we applied Long-short Term Memory (LSTM) networks to forecast burden trends of hip fractures up to 2050.

RESULTS

The global age-standardized incidence rate (ASIR) for hip fractures in older adults rose from 781.56 per 100,000 in 1990 to 948.81 in 2021. The 2021 age-standardized prevalence rate (ASPR) was 1,894.07, and the age-standardized YLD rate (ASDR) was 173.52. From 1990 to 2021, the incidence and prevalence increased by 168.71 % and 173.07 %, respectively, while the burden of DALYs decreased. Future trends were projected via the LSTM. The burden and risk factors for hip fractures varied significantly by sex, country, and region. Population and aging are primary contributors to the rising incidence of elderly hip fractures, with falls being the leading direct cause.

CONCLUSION

From 1990 to 2021, the global burden of hip fractures in the elderly population, especially among older women, steadily increased. Population ageing highlights the urgent need for targeted public health interventions and resource allocation, including early diagnosis, effective prevention strategies, and region-specific management approaches.

Vision transformer-based stratification of pre/diabetic and pre/hypertensive patients from retinal photographs for 3PM applications

Objective

Diabetes and hypertension pose significant health risks, especially when poorly managed. Retinal evaluation though fundus photography can provide non-invasive assessment of these diseases, yet prior studies focused on disease presence, overlooking control statuses. This study evaluated vision transformer (ViT)-based models for assessing the presence and control statuses of diabetes and hypertension from retinal images.

Methods

ViT-based models with ResNet-50 for patch projection were trained on images from the UK Biobank (n = 113,713) and Singapore Epidemiology of Eye Diseases study (n = 17,783), and externally validated on the Singapore Prospective Study Programme (n = 7,793) and the Beijing Eye Study (n = 6064). Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC) for multiple tasks: detecting disease, identifying poorly controlled and well-controlled cases, distinguishing between poorly and well-controlled cases, and detecting pre-diabetes or pre-hypertension.

Results

The models demonstrated strong performance in detecting disease presence, with AUROC values of 0.820 for diabetes and 0.781 for hypertension in internal testing. External validation showed AUROCs ranging from 0.635 to 0.755 for diabetes, and 0.727 to 0.832 for hypertension. For identifying poorly controlled cases, the performance remained high with AUROCs of 0.871 (internal) and 0.655-0.851 (external) for diabetes, and 0.853 (internal) and 0.792-0.915 (external) for hypertension. Detection of well-controlled cases also yielded promising results for diabetes (0.802 [internal]; 0.675-0.838 [external]), and hypertension (0.740 [internal] and 0.675-0.807 [external]). In distinguishing between poorly and well-controlled disease, AUROCs were more modest with 0.630 (internal) and 0.512-0.547 (external) for diabetes, and 0.651 (internal) and 0.639-0.683 (external) for hypertension. For pre-disease detection, the models achieved AUROCs of 0.746 (internal) and 0.523-0.590 (external) for pre-diabetes, and 0.669 (internal) and 0.645-0.679 (external) for pre-hypertension.

Conclusion

ViT-based models show promise in classifying the presence and control statuses of diabetes and hypertension from retinal images. These findings support the potential of retinal imaging as a tool in primary care for opportunistic detection of diabetes and hypertension, risk stratification, and individualised treatment planning. Further validation in diverse clinical settings is warranted to confirm practical utility.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-025-00412-9.

Large-Scale Proteomics Improve Risk Prediction for Type 2 Diabetes

OBJECTIVE

This study evaluated the incremental predictive value of proteomic biomarkers in assessing 10-year type 2 diabetes risk when added to the clinical Cambridge Diabetes Risk Score (CDRS).

RESEARCH DESIGN AND METHODS

Data from 21,898 UK Biobank participants were used for model derivation and internal validation, and 4,454 Epidemiologische Studie zu Chancen der Verhütung, Früherkennung und optimierten Therapie chronischer Erkrankungen in der älteren Bevölkerung (ESTHER) cohort (Germany) participants were used for external validation. Proteomic profiling included the Olink Explore (2,085 proteins) and Olink Target 96 Inflammation panel (73 proteins).

RESULTS

Adding 15 proteins from Olink Explore or 6 proteins from the Olink Inflammation panel improved the C-index of the CDRS by 0.029 or 0.016 in internal validation with net reclassification of 23.0% and 29.0%, respectively. External validation was only conducted for the six-protein-extended model, and the C-index improved by 0.014.

CONCLUSIONS

The Olink Explore-based 15-protein model enhanced the CDRS model performance most, and this promising prediction model should be externally validated. Our successful external validation of the Olink Inflammation panel-based six-protein model shows that this is a promising endeavor.

Shen-fu Injection Modulates HIF- 1α/BNIP3-Mediated Mitophagy to Alleviate Myocardial Ischemia-Reperfusion Injury

Coronary reperfusion therapy is the most common surgical treatment for myocardial infarction, but it can further induce myocardial ischemia-reperfusion injury (MIRI). Therefore, MIRI following coronary intervention is a challenging clinical issue. This study aims to investigate the involvement of HIF- 1α/BNIP3-mediated mitophagy in the protective effects of Shen-fu Injection (SFI) on MIRI in rats. Key targets and signaling pathways of myocardial MIRI were analyzed using high-throughput transcriptome data from the GSE240842 dataset in the GEO database.To establish the MIRI rat model, the left anterior descending coronary artery was ligated for 30 min, followed by reperfusion for 120 min. Hypoxia/reoxygenation (H/R) in neonatal rat primary cardiomyocytes was induced by oxygen-glucose deprivation for 4 h, followed by reoxygenation for 2 h. Two hours after reperfusion, assessments included myocardial infarction area, CK-MB, CTnI, HE staining, TUNEL, mitochondrial ultrastructure and autophagosomes, HIF- 1α, BNIP3, LC3B-II, LC3B-I protein expression, immunofluorescence, and qRT-PCR. Cardiac function was also evaluated using M-mode ultrasound 2 h after reperfusion. In cardiomyocytes, CCK- 8, EdU cell proliferation levels, scratch assay, mitochondrial membrane potential, ROS levels, cardiomyocyte apoptosis, protein expression levels, and immunofluorescence were assessed 2 h after reoxygenation. Our results indicate that HIF- 1α and BNIP3 are key targets in MIRI. SFI upregulates HIF- 1α expression, promoting moderate mitophagy. This process clears excessively damaged mitochondria, reduces cardiomyocyte apoptosis, and decreases myocardial injury. Additionally, SFI reduces autophagosome accumulation, lowers ROS production, and stabilizes membrane potential. Consequently, the area of myocardial infarction is reduced, and cardiac function is improved. SFI activates the HIF- 1α/BNIP3 pathway to mediate moderate mitophagy, effectively reducing cardiomyocyte apoptosis and alleviating myocardial ischemia-reperfusion injury, thereby protecting cardiomyocytes.

Chronic meningitis: diagnostic and therapeutic challenges

PURPOSE OF REVIEW

We review recent advances in diagnosis and treatment of chronic meningitis, focusing on tuberculous meningitis (TBM), cryptococcal meningitis (CM), syphilitic meningitis, neuroborreliosis, and recurrent chronic meningitis. Noninfectious causes and unique challenges faced in resource-limited settings are also considered.

RECENT FINDINGS

Novel biomarkers are being identified that may be useful for the diagnosis of TBM [i.e. monokine induced by interferon-γ (MIG), plasminogen binding proteins] and syphilitic meningitis (i.e. CXCL13, neurofilament light protein, etc.) but require more validation. Much progress has been made regarding diagnosis and treatment of CM, with a new semiquantitative lateral flow assay showing high diagnostic and prognostic utility and clinical trials demonstrating that regimens of oral lipid nanocrystal formulation and a single dose of liposomal formulation of amphotericin B maintain clinical efficacy with improved side effect profiles. An ongoing clinical trial of ceftriaxone for treatment of syphilitic meningitis and early stage studies of linezolid for TBM treatment may also lead to changes in recommended treatment regimens for these conditions in the near future.

SUMMARY

Diagnosis and management of chronic meningitis remains a significant challenge, and further research is needed to improve our diagnostic and therapeutic armamentariums. However, emergence of potential new biomarkers for diagnosis and disease course is cause for optimism.

Universal alcohol prevention in the workplaces - does it matter?

BackgroundHarmful alcohol consumption has significant negative implications for the workplace. The workplace offers a strategic opportunity for alcohol prevention due to the substantial time employees spend at work.ObjectiveUtilizing a social-ecological framework, this study aims to investigate whether universal alcohol prevention strategies in the workplace are associated with employees' alcohol-related perceptions or behaviorsMethodsA cross-sectional survey study was conducted in December 2019 using a web-based questionnaire distributed through the Laboratory of Opinion Research Citizen Panel. Participants included 2771 employed adults aged 16-80 in Sweden. Multiple- and logistic regressions were used to investigate significant explanatory factors.ResultsHaving alcohol procedures, as well as having received information from a supervisor regarding how to act on concerns, were associated with a higher probability of being comfortable informing a supervisor of concerns. A restrictive alcohol culture was associated with lower threshold for perceived risk-free alcohol consumption. Having an alcohol policy only was not associated with any of the examined alcohol-related perceptions or behaviors when controlling for other factors.ConclusionsAlcohol preventive measures can significantly influence employee perceptions of responsibility to act on concerns, and the feeling of being comfortable doing so. The findings support the integration of alcohol preventive measures at multiple levels within the workplace, as well as having a restrictive alcohol culture.

A nomograph model for predicting the risk of diabetes nephropathy

OBJECTIVE

Using machine learning to construct a prediction model for the risk of diabetes kidney disease (DKD) in the American diabetes population and evaluate its effect.

METHODS

First, a dataset of five cycles from 2009 to 2018 was obtained from the National Health and Nutrition Examination Survey (NHANES) database, weighted and then standardized (with the study population in the United States), and the data were processed and randomly grouped using R software. Next, variable selection for DKD patients was conducted using Lasso regression, two-way stepwise iterative regression, and random forest methods. A nomogram model was constructed for the risk prediction of DKD. Finally, the predictive performance, predictive value, calibration, and clinical effectiveness of the model were evaluated through the receipt of ROC curves, Brier score values, calibration curves (CC), and decision curves (DCA). In addition, we will visualize it.

RESULTS

A total of 4371 participants were selected and included in this study. Patients were randomly divided into a training set (n = 3066 people) and a validation set (n = 1305 people) in a 7:3 ratio. Using machine learning algorithms and drawing Venn diagrams, five variables significantly correlated with DKD risk were identified, namely Age, Hba1c, ALB, Scr, and TP. The area under the ROC curve (AUC) of the training set evaluation index for this model is 0.735, the net benefit rate of DCA is 2%-90%, and the Brier score is 0.172. The area under the ROC curve of the validation set (AUC) is 0.717, and the DCA curve shows a good net benefit rate. The Brier score is 0.177, and the calibration curve results of the validation set and training set are almost consistent.

CONCLUSION

The DKD risk nomogram model constructed in this study has good predictive performance, which helps to evaluate the risk of DKD as early as possible in clinical practice and formulate relevant intervention and treatment measures. The visual result can be used by doctors or individuals to estimate the probability of DKD risk, as a reference to help make better treatment decisions.

Burden of cardiometabolic disease attributable to sugar sweetened beverages consumption in North Africa and the Middle East from 1990 to 2021

Objectives

The consumption of sugar-sweetened beverages (SSBs) is recognized as a significant risk factor for chronic non-communicable diseases (NCDs). Accurate estimates of the burden of SSBs are crucial for preventing, controlling, and treating associated diseases to achieve the Third United Nations Sustainable Development Goal of reducing premature mortality from NCDs by one-third by 2030. In this study, we aim to systematically assess the regional patterns and trends in the burden of SSBs in the North Africa and the Middle East (NAME) region. By analyzing regional differences, the study identifies specific areas where SSBs consumption has a more significant impact on public health.

Methods

The study data were retrieved from the Global Burden of Disease (GBD) study 2021. This study analyzed the impact of SSBs on mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 21 countries in the NAME region from 1990 to 2021. Our analysis considered various factors, including sex, age, region, and socio-demographic index.

Results

In 2021, DALYs attributable to SSBs there were 315,312 (95% uncertainty interval, 140,854 to 503,347) in absolute terms reflecting 518.3% (424.9 to 642.2) increase over three decades. From 1990 to 2021, the age-standardized rate of DALYs attributable to SSBs increased by 118.5%, from 27.9 (11.4 to 43.9) to 61.0 (27.6 to 97.0) per 100,000 population. Qatar (246.7 [113.1 to 404.5]), Saudi Arabia (201.2 [87.1 to 314.2]), and Bahrain (180.1 [78.4 to 295.8]) had the highest age-standardized rate of DALYs. The highest attributable DALYs and mortality from SSBs consumption were due to diabetes mellitus in all countries in 1990 and 2021. In 2021, Qatar (224.7 [104.9 to 365.5]), Bahrain (167.0 [74.8 to 274.8]), and Saudi Arabia (153.1 [75.3 to 230.4]) had the three highest age-standardized rates of DALYs from diabetes mellitus attributed to SSBs.

Conclusions

NAME witnessed a substantial increase in the burden attributable to SSBs. Alarmingly, exposure to SSBs has principally contributed to the increased burden of diabetes mellitus and chronic kidney disease. Among the region's countries, exposure and attributable burden trends vary considerably. It is imperative that governments and health authorities within the NAME region work together to combat SSBs' detrimental effects. Local, socioeconomic, and educational factors need to be considered when developing prevention and treatment strategies at the individual, community, and national levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01578-9.

Road traffic noise and incident ischemic heart disease, myocardial infarction, and stroke: A systematic review and meta-analysis

Background

This systematic review aimed to estimate relative risks for incident ischemic heart disease (IHD), myocardial infarction (MI), and stroke in relation to long-term road traffic noise exposure and to evaluate exposure-response functions.

Methods

We systematically searched databases for longitudinal studies in humans on incident IHD, MI, and/or stroke, including quantitative estimates on individual exposure to residential road traffic noise based on validated models or measurements. Risk of bias was evaluated in each study based on predefined criteria. Pooled linear exposure-response functions were generated from random-effect models in meta-analyses of study-specific risk estimates. Restricted cubic spline models were used to capture potential nonlinear associations.

Results

Twenty eligible studies were identified based on more than 8.4 million individuals, mostly from Europe, including between 160,000 and 240,000 cases for each of the outcomes. Pooled relative risk estimates were 1.017 (95% confidence interval [CI]: 0.990, 1.044) for IHD, 1.029 (95% CI: 1.011, 1.048) for MI, and 1.025 (95% CI: 1.009, 1.041) for stroke per 10 dB Lden in road traffic noise exposure. Risk estimates appeared higher in combined analyses of studies with a low risk of exposure assessment bias. Restricted cubic spline analyses of these studies showed clear risk increases with exposure for all three cardiovascular outcomes.

Conclusions

The evidence indicates that long-term exposure to road traffic noise increases the incidence of IHD, including MI, and stroke. Given the abundant exposure, traffic noise is a cardiovascular risk factor of public health importance. High-quality assessment of noise exposure appears essential for the risk estimation.

Mapping the Burden of Conduct Disorder in the Middle East and North Africa: Global Burden of Disease Study 2021

This study aims to investigate the prevalence, incidence, and Years Lived with a Disability (YLDs) caused by conduct disorder in 21 countries of the Middle East and North Africa (MENA). Sex and age differences in conduct disorder were investigated as well as the trend of conduct disorder from 1990 to 2021. Data from the MENA were used for this study. This super region includes 21 countries. All-age count estimates and age-standardized rate (Per 100,000) were calculated for prevalence, incidence, and YLDs. Each of the disease burden indicators was examined in the period of 1990-2021, stratified by sex, age, and location, and the % change between 1990 and 2021 was reported. The 95% uncertainty interval was reported for each of the reported estimates. In 2021, there were 41 million cases of conduct disorder, globally. In 2021, there were 3.5 million cases of conduct disorder in MENA; the conduct disorder count had a significant growth from 1990. At the national level, the highest conduct disorder was in Iran. The lowest age-standardized prevalence rate (ASPR) per 100,000 conduct disorder was in Syria. Of the total cases of conduct disorder in the MENA, 2.350 million were males and 1.100 million were females. The findings of this study showed an increase in the burden of conduct disorder over the past three decades in the MENA. Considering the demographic changes and population increase compared to three decades ago, as well as social, health, and economic developments, it is necessary to pay more attention to the health of children and adolescents in health-related policies.

Real-time cardiomyocyte contraction sensing via a neo-flexible magnetic sensor

Assessing heart disease and evaluating drug-induced cardiotoxicity require a deep understanding of the contractile properties of cardiac tissue, particularly at the level of individual cardiomyocytes. Traditional methods for measuring cardiomyocyte contractility present several challenges, including limitations in real-time detection, complex and costly sensing platforms, and biocompatibility issues. To address these challenges, we introduce an innovative magnetic sensor that utilizes a flexible coil cantilever, pioneering the application of electromagnetic induction for detecting cardiomyocyte contractility. This marks the first time such technology has been deployed in typical laboratory settings with straightforward configurations. When cardiomyocytes are cultured on these coils and subjected to a static magnetic field, their contractions induce oscillations in the coils, generating an electromotive force that converts mechanical pulsations into electrical signals. This advanced platform enables long-term, real-time monitoring of cardiac functional characteristics, including contractility, beating rate, and rhythm. It also enables the quantitative assessment of cardiovascular dynamics, such as in response to drugs like isoproterenol and verapamil. Offering a uniquely simple, stable, and efficient method for evaluating drug-induced cardiotoxicity, this novel detection platform underscores the transformative potential of flexible magnetic sensors in real-time cellular detection applications.

The fraction of cancer attributable to modifiable risk factors in Turkey in 2018

Cancer is the second leading cause of death in Turkey, with nearly one in six deaths attributed to the disease. In 2018, Turkey recorded 211,273 new cancer cases. Many cancers are linked to modifiable lifestyle risk factors, such as tobacco use, alcohol consumption, obesity, and inadequate diet and physical activity. Modifying these risk factors could potentially prevent 30%-50% of cancer cases and deaths. This study aims to estimate the population attributable fraction (PAF) of cancer cases and deaths due to various modifiable risk factors in Turkey. Modifiable cancer risk factors were identified as smoking, infections, obesity, physical inactivity, alcohol consumption, inadequate intake of fruits, vegetables, fiber, and calcium. Data on exposure prevalence and cancer incidence were sourced from national surveys and reports. Relative risks (RRs) were obtained from global studies. PAFs were calculated using Levin's equation, accounting for overlaps between risk factors. In 2018, 32% of the cancer cases were attributable to lifestyle risk factors. Smoking was the most significant factor, accounting for 28.4% of cases in men, while high BMI was the leading factor in women, contributing to 11.5% of cases. Lifestyle risk factors were responsible for 41.6% of cancer deaths, with smoking being the leading cause. Lifestyle risk factors contribute significantly to cancer incidence and mortality in Turkey. Prioritizing interventions to reduce tobacco use and obesity could substantially lower the cancer burden. These results are crucial for developing effective cancer prevention strategies and informing public health policies.

Comparative Efficacy of Non-Pharmacological Interventions on Anxiety, Depression, Sleep Disorder, and Quality of Life in Patients With Liver Transplantation: A Systematic Review and Network Meta-Analysis

AIMS

To compare and rank the efficacy of different non-pharmacological interventions on anxiety, depression, sleep disorders, and the quality of life in liver transplantation patients.

BACKGROUND

In recent years, numerous non-pharmacological interventions have been developed to address anxiety, depression, sleep disorders, and the quality of life in liver transplantation patients. However, it remains unclear which non-pharmacological intervention serves as the most effective and preferred approach.

DESIGN

A systematic review and network meta-analysis in accordance with the PRISMA guidelines.

METHODS

Relevant randomised controlled trials were extracted from eight electronic databases. A network meta-analysis was then performed to evaluate the relative efficacy of the non-pharmacological interventions for liver transplantation patients. The quality of the data was assessed using the Cochrane Risk of Bias tool. We registered this study in PROSPERO, number CRD42023450346.

RESULTS

A total of 25 randomised controlled trials were included. Spouse support education combined with mindfulness training, individualised psychological intervention, and cognitive behavioural therapy were found to be significantly effective for both anxiety and depression. The top three interventions against anxiety were spouse support education combined with mindfulness training, individualised psychological intervention, and exercise rehabilitation training. Meanwhile, individualised psychological intervention, spouse support education combined with mindfulness training, and cognitive behavioural therapy were the top-ranked three interventions for reducing depression. Sleep hygiene education was the most effective to improve sleep disorders. Continuous care based on a mobile medical platform emerged as the most effective intervention in improving the quality of life.

CONCLUSION

Several non-pharmacological interventions appeared to be effective in treating anxiety, depression, sleep disorders, and improving the quality of life among liver transplantation patients. More high-quality clinical trials should be incorporated in the future to investigate the reliability of existing findings.

RELEVANCE TO CLINICAL PRACTICE

Healthcare professionals should be encouraged to apply these promising non-pharmacological interventions during clinical care.

NO PATIENT OR PUBLIC CONTRIBUTION

This study did not directly involve patients or public contributions to the manuscript.

N-acetyl-L-cysteine mitigates diabetes-induced impairments in sciatic nerve

Diabetic neuropathy is a consequence of long-term hyperglycemia. The emergence of neuronal condition is a result of hyperglycemia-induced oxidative stress. In the present study, streptozotocin-induced diabetes exhibited notable decrease in the levels of phospholipids, glycolipids, gangliosides, and triglycerides in the sciatic nerve. The alterations in lipids resulted in increase in cholesterol to phospholipid ratio in sciatic nerve of diabetic animals. This ratio is crucial and determines the rheological properties of membranes and resulted in substantial reduction in the activity of membrane-bound enzymes; Ca2 + ATPase and acetylcholinesterase. Histological examination of the cross-section of the sciatic nerve in diabetic mice revealed axonal atrophy and disarrayed myelin sheath. The potential therapeutic impact of N-acetyl Cysteine (NAC), a powerful antioxidant, on a rat model of diabetic neuropathy was evaluated. NAC was administered to rats in drinking water for a period of 8 weeks. The results indicate that administration of NAC restored lipid composition; ratio of cholesterol to phospholipids, the activity of membrane linked enzymes, and improved the structural defects in sciatic nerve. NAC plays protective role against diabetes-induced alterations in lipid composition in sciatic nerve membranes leading to improvement in structure and function of membranes. Overall, the findings suggest NAC as a potential therapeutic strategy in preventing diabetic neuropathy and other diabetic complications.

The role of branched chain aminotransferase in the interrelated pathways of type 2 diabetes mellitus and Alzheimer's disease

Objectives

This review assessed the role of Branched-Chain Amino Acid Transaminase (BCAT) enzymes in human metabolism, and their involvement in the catabolism of branched-chain amino acids (BCAAs) and exploring the association between Type 2 Diabetes Mellitus (T2DM) and Alzheimer's disease (AD) through insulin resistance.

Methods

The analysis involves a comprehensive literature review of recent research findings related to BCAT enzymes, BCAA metabolism, T2DM, and AD. Relevant studies and articles were identified through systematic searches in databases such as PubMed, ScienceDirect, and other scholarly resources. Inclusion criteria encompassed research articles, reviews, and studies published in peer-reviewed journals, with a focus on human metabolism, BCAT enzymes, and the interplay between BCAA metabolism, T2DM, and AD.

Results

The association between T2DM and AD suggests a potential metabolic link, particularly through dysregulated BCAA metabolism leading to insulin resistance. The impact of impaired insulin signaling is implicated in brain function and the accumulation of amyloid plaques facilitated by BCAT.

Conclusion

The identified link between BCAT, BCAA metabolism, T2DM, and AD suggests that disruptions in BCAT levels could serve as valuable indicators for early detection of insulin resistance and cognitive impairment as observed in Type 3 Diabetes which may present a promising therapeutic target.

Accuracy and interpretability of smartwatch electrocardiogram for early detection of atrial fibrillation: A systematic review and meta-analysis

Background

The prevalence of atrial fibrillation (AFib) continues to increase globally, posing a significant risk for serious cardiovascular complications, such as ischemic stroke and thromboembolism. Smartwatch single-lead electrocardiogram (ECG) can be a practical and accurate early detection tool for AFib.

Objective

The aim of this study was to fill the research gap in evaluating the accuracy and interpretability of smartwatch ECG for early AFib detection.

Methods

Data derived from indexed literature in the Scopus, Scilit, PubMed, Google Scholar, Web of Science, IEEE, and Cochrane Library databases (as of June 1, 2024) were systematically screened and extracted. The quantitative synthesis was performed using a two-level mixed-effects logistic regression model, as well as a proportional analysis with Freeman-Tukey double transformation on a restricted maximum-likelihood model.

Results

The sensitivity and specificity of smartwatch ECG in algorithmic readings were 86% and 94%, respectively. In manual readings, the sensitivity and specificity reached 96% and 95%, respectively. In a brand-specific subgroup analysis, the algorithmic reading reached a summary area under the curve (sAUC) of 96%, while another brand achieved the highest sAUC of 98% in manual reading. The level of manual interpretability was relatively high with Cohen's Kappa of 0.83, but 3% of ECG results were difficult to read manually.

Conclusion

This study shows that smartwatch ECG is able to detect AFib with high accuracy, especially through manual reading by trained medical personnel.

PROSPERO Registration

CRD42024548537 (May 29, 2024).

Global burden and national health inequity of ischemic heart disease attributed to kidney dysfunction from 1990 to 2021: Findings from the global burden of disease study 2021

BACKGROUND AND AIMS

To estimate the global disease burden and cross-national inequalities in the distribution of ischemic heart disease attributable to kidney dysfunction (KI-IHD) from 1990 to 2021.

METHODS

The estimates for age-standardized death rates (ASDR) and age-standardized disability-adjusted life-years rates (ASDAR) of KI-IHD were obtained from the Global Burden of Disease Study (GBD) 2021. Data for gross domestic product (GDP) and GDP growth rates were extracted from World Bank database. The average annual percent change (AAPC) was calculated to analyze temporal trends of ASDR and ASDAR by Joinpoint regression model. Slope index of inequality and concentration index were generated to quantify the cross-national socioeconomic inequality of KI-IHD burden.

RESULTS

From 1990 to 2021, the ASDR and ASDAR of KI-IHD has shown downward trend globally; with AAPC values of -1.384 % and -1.204 %. The ASDR and ASDAR of KI-IHD was higher in males than females, with increasing age, the burden gradually increased. The concentration index showed 0.02 (95%CI: 0.02, 0.06) in 1990 and -0.11 (95%CI: 0.15, -0.07) in 2021. The slope index of inequality showed that an excess of 170 ASDR per 100,000 existed between countries with the lowest and the highest SDI in 1990, however, in 2021, the results are reversed, a reduction of 159 per 100,000. GDP growth rate and GDP per capita might be associated with the health inequality of KI-IHD.

CONCLUSION

The burden of KI-IHD has decreased in almost 70 % of countries over the past three decades. Disproportional distribution of health inequalities was concentrated in poor countries.

Age- and sex-specific analysis of the impact of bipolar disorder in Iran and its provinces: Prevalence, incidence, and disability-adjusted life years: Global burden of disease 2021

OBJECTIVES

This study sought to deliver a prevalence, incidence, and Disability-Adjusted Life Years (DALYs) of bipolar disorder in Iran, covering both national and subnational scales. The results were broken down by age group and sex, alongside an analysis of trends in bipolar disorder from 1990 to 2021. The estimates gathered were further compared to global averages to offer deeper insights into the prevalence and impact of bipolar disorder in Iran.

METHODS

This study analyzed data from the Global Burden of Disease 2021 framework to assess various health metrics. Key indicators such as prevalence, incidence, and Disability-Adjusted Life Years (DALYs) were examined using all-age count estimates and age-standardized rates per 100,000 individuals. The analysis spanned the years 1990 to 2021, with results categorized by sex, age group, and geographic location. Furthermore, percentage changes over this period were calculated. To enhance the reliability of the findings, all reported estimates included a 95 % uncertainty interval.

RESULTS

In 1990, the age-standardized prevalence rate of bipolar disorder in Iran was 770.09 per 100,000 individuals [95 % UI: 657 to 902], and by 2021, it slightly increased to 780 per 100,000 [95 % UI: 667 to 915]. The percentage change over the period from 1990 to 2021 was 0.01 %. In 2021, the total number of bipolar disorder cases in Iran was reported at 724,891, with a 95 % uncertainty interval ranging from 614,626 to 848,263. Among these cases, 376,813 were observed in females and 348,077 in males. Notably, individuals aged 10 to 24 accounted for 127,388 of the overall cases, making this age group the most affected. The age-standardized incidence rate (per 100,000) of bipolar disorder was estimated to be 52 [95 % UI: 44 to 61] in 1990 and 53 [95 % UI: 45 to 62] in 2021, reflecting a minimal change of 0.01 % over this period. Similarly, the age-standardized disability-adjusted life years (DALYs) rate (per 100,000) for bipolar disorder was recorded at 164 [95 % UI: 107 to 240] in 1990 and 166 [95 % UI: 109 to 241] in 2021, with an equivalent negligible change of 0.01 % from 1990 to 2021.

DISCUSSION

In Iran, the burden of bipolar disorder has been found to exceed global averages, and due to demographic changes, young population, regional stressors this burden has grown significantly over the past three decades. Therefore, it remains crucial to focus increasing access to mental health care by increasing mental health care infrastructure in the country, especially in densely populated areas.