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.

Efficacy of superimposing neuromuscular electrical stimulation onto core stability exercise in patients with nonspecific low back pain: A study protocol for a randomized controlled trial

INTRODUCTION

Non-specific low back pain (NSLBP) is a prevalent condition affecting individuals worldwide, leading to significant disability and healthcare costs. Traditional treatment methods have shown limited efficacy, prompting the exploration of innovative approaches. Core stability exercise (CSE) has emerged as a promising rehabilitation strategy, yet optimal activation of local muscle systems remains to be fully understood. This trial aims to assess the efficacy of superimposing neuromuscular electrical stimulation (NMES) onto CSE for improving muscle activation, function, and proprioception in NSLBP patients.

METHODS AND ANALYSIS

A total of 52 participants aged 18-60 years with NSLBP will be randomly allocated into two groups: (1) experimental group receiving NMES superimposed on CSE and (2) control group undergoing the same CSE with sham NMES. Interventions will occur three times per week for six weeks. The primary outcome measures will encompass surface electromyography (sEMG) to assess muscle activity and muscle activation timing. Secondary outcomes will include the evaluation of pain intensity using the Visual Analog Scale (VAS) and disability measured by the Oswestry Disability Index (ODI), as well as proprioception assessed through joint repositioning error (JRE) and muscle thickness evaluated via real-time ultrasound image (RUSI). Data will be collected at baseline, after six weeks, and at a six-month follow-up. A mixed ANOVA will be employed to compare differences among groups and to analyze trends over time as well as interaction effects between treatment and time.

TRIAL REGISTRATION

Trial registration number: Chinese Clinical Trial Registry (ChiCTR2400092409).

Global Burden of Eye Injuries in Children and Adolescents, 1990-2021: A Systematic Analysis from the Global Burden of Disease Study

PURPOSE

Eye injuries are a leading cause of monocular vision impairment and disability in children and adolescents. Unlike adults, eye injuries in children exhibit significant age specificity, with worse visual outcomes due to immature vision, the risk of long-term damage, and amblyopia. However, research on the global distribution and trends of eye injury burdens in this population is limited.

DESIGN

Retrospective population-based trend study.

METHODS

This study analyzes the burden of eye injuries among children and adolescents aged 0 to 19 years globally, regionally, and nationally, using data from the 2021 Global Burden of Disease study. We evaluated the epidemiological characteristics of eye injuries by calculating incidence, years lived with disability (YLD), age-standardized incidence rates (ASIR), and age-standardized YLD rates (ASYR). Temporal trends in ASIR and ASYR from 1990 to 2021 were assessed using joinpoint regression analysis, expressed as average annual percentage changes. The analysis was further stratified by sex, age, and sociodemographic index (SDI) to explore trends in different subgroups.

RESULTS

In 2021, the global ASIR and ASYR for children and adolescents were 434·24 per 100,000 (95% confidence interval [CI], 305·17-603·22) and 3·19 per 100,000 (95% CI, 0·96-6·99), respectively, indicating a decline since 1990. Regions with high SDI showed the highest incidence of eye injuries. Australasia, Southern Latin America, and Western Europe had the highest ASIRs and ASYRs in both 1990 and 2021. From 1990 to 2021, Afghanistan, Yemen, Libya, the Central African Republic, and Chile experienced the most significant increases in pediatric eye injuries. Global data show that boys have an eye injury incidence rate approximately 1·8 times higher than that of girls. In 2021, the incidence of eye injuries among children and adolescents increased with age. The primary causes include foreign bodies, exposure to mechanical forces, and falls.

CONCLUSIONS

Despite observed declines in incidence and YLD, the burden of eye injuries in children and adolescents remains substantial. These findings underscore the urgent need for the development and implementation of targeted preventive education initiatives and ocular protection protocols on a global scale.

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.

Mapping the landscape of neuroscience research trend(s) in South Asia: A bibliometric analysis of 25 years (1995-2019)

In depth analysis of publication trends can help in finding out strengths, weaknesses and areas for improvement. South Asia (SA), with its unique demographic and epidemiological characteristics, is considered a valuable region for health research, particularly in neuroscience. There is a clear need of data which should reflect heterogenous neuroscience research outputs of the SA region and help in devising new trends to boost its research landscape. The present study aimed to analyse the neuroscience research trend in SA during the recent 25 years (1995 to 2019). A total of 85,796 articles were retrieved from PubMed using 7 keywords in combination with the SA country's name. These articles were filtered by removing paper not falling in neurosciences. We compared important metrics of these articles from SA countries. Moreover, data from SA countries were compared with data (extracted similarly) from 4 developed countries i.e., Germany, USA, UK, and Japan (750 articles each). The metrics compared include, journal impact factor (IF), number of authors, citations, funding, collaborations, and research categories. This unique dataset has shown that SA is although, making a lot of progress in neuroscience research, still there is a need for further improvement especially in funding, publications in high IF journals, and the use of advanced cutting-edge technologies. Our study helps in highlighting important gaps and making crucial recommendations to promote neuroscience in the region.

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.

Relationships between atherogenic index of plasma and body mass index with the risk of type 2 diabetes mellitus: insights from CHARLS

BACKGROUND

The complex relationship between obesity and dyslipidemia in type 2 diabetes mellitus (T2DM) remains an area of interest but is not fully understood. This study aimed to evaluate the intricate links between atherogenic index of plasma (AIP), body mass index (BMI), and T2DM risk.

METHODS

Based on data from the China Health and Retirement Longitudinal Study, this analysis comprised 6754 individuals aged 45 and over, free of T2DM in 2011. BMI and AIP were the exposures, with T2DM incidence as the primary focus. Logistic regression models generated odds ratios (ORs), and a thorough decomposition of BMI's impact on T2DM revealed natural indirect and direct effects. The study also examined the complex interactions and combined effects of these two exposures.

RESULTS

By the end of 2018, 972 individuals were diagnosed with T2DM. The AIP played a significant association in the relationship between BMI and T2DM, explaining 21.7% and 18.9% of the association in different BMI ranges. A significant additive effect was observed between BMI and AIP, with a relative excess risk due to interaction of 0.62. BMI ≥ 24.0 kg/m2 and AIP above the median together conferred the highest risk of T2DM, with an OR of 2.31 and a 95% confidence interval (CI) of 1.92-2.79.

CONCLUSION

Exposure to overweight/obesity or high AIP raises T2DM risk among Chinese ≥ 45 years, AIP partly mediates BMI-T2DM link.

Joint associations of diet and physical activity with incident type 2 diabetes and hypertension: an analysis of 144 288 UK Biobank participants

Studies examining the joint associations of lifestyle exposures can reveal novel synergistic and joint effects, but no study has examined the joint association of diet and physical activity (PA) with type 2 diabetes (T2D) and hypertension. The aim of this study is to examine the joint associations of PA and diet with incidence of type T2D and hypertension, as a combined outcome and separately in a large sample of adults in the United Kingdom. This prospective cohort study included 144 288 UK Biobank participants aged 40-69. Moderate to vigorous PA (MVPA) was measured using the International Physical Activity Questionnaire and a wrist accelerometer. We categorized PA and diet indicators (diet quality score [DQS] and energy intake [EI]) based on tertiles and derived joint PA and diet variables. Outcome was major cardiometabolic disease incidence (combination of T2D and hypertension). A total of 14 003 (7.1%) participants developed T2D, 28 075 (19.2%) developed hypertension, and 30 529 (21.2%) developed T2D or hypertension over a mean follow-up of 10.9 (3.7) years. Participants with middle and high self-reported MVPA levels had lower risk of major cardiometabolic disease regardless of diet (eg, among high DQS group, hazard ratios [HRs] in middle and high MVPA group were 0.90; 95% CI, 0.86-0.94), and 0.88 (95% CI, 0.84-0.92), respectively. Participants with jointly high device-measured MVPA and high DQS levels had lower major cardiometabolic disease risk (HR, 0.84; 95% CI, 0.71-0.99). The equivalent joint device-measured MVPA and EI exposure analyses showed no clear pattern of associations with the outcomes. Higher PA is an important component in cardiometabolic disease prevention across all diet quality and total EI groups. The observed lack of association between diet health outcomes may stem from a lower DQS.

Multi-sector determinants of implementation and sustainment for non-specialist treatment of depression and post-traumatic stress disorder in Kenya: a concept mapping study

BACKGROUND

The global shortage of trained mental health workers disproportionately impacts mental health care access in low- and middle-income countries. In Kenya, effective strategies are needed to scale-up the workforce to meet the demand for depression and post-traumatic stress disorder treatment. Task-shifting - delegating specific tasks to non-specialist workers - is one workforce expansion approach. However, non-specialist workers remain underutilized in Kenya due to a paucity of research on how to scale-up and sustain such service models.

METHODS

Purposive sampling was used to recruit experts from policy, healthcare practice, research, and mental health advocacy roles in Kenya (N = 30). Participants completed concept mapping activities to explore factors likely to facilitate or hinder a collaborative Ministry of Health-researcher training of the mental health non-specialist workforce. Participants brainstormed 71 statements describing determinants and implementation strategies, sorted and rated the importance and changeability of each. Multidimensional scaling and hierarchical cluster analysis quantified relationships between statements. The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework guided cluster interpretation activities.

RESULTS

Twelve determinant clusters were identified: 1) Current workforce characteristics, 2) Exploration considerations, 3) Preparation considerations, 4) Sustainment considerations, 5) Inner context implementation processes and tools, 6) Local capacity and partnerships, 7) Financing for community health teams, 8) Outer context resource allocation/policy into action, 9) Workforce characteristics to enhance during implementation, 10) Workforce implementation strategies, 11) Cross-level workforce strategies, and 12) Training and education recommendations. Cluster 8 was rated the most important and changeable.

CONCLUSION

Concept mapping offers a rapid, community-engaged approach for identifying determinants and implementation strategies to address workforce shortages. Organizing results by EPIS phases can help prioritize strategy deployment to achieve implementation goals. Scale-up and sustainment of the non-specialist workforce in Kenya requires formal partnerships between the Ministry of Health and community health worker teams to distribute financial resources and collaboratively standardize training curriculum.

The epidemiological burden of major depressive disorder in women of childbearing age and its relationship with the sociodemographic index: A systematic analysis based on the global burden of disease study from 1990 to 2021

BACKGROUND

The global burden and trends of Major depressive disorder (MDD) among women of childbearing age (WCBA) remain unclear.

METHODS

This study utilized data from the Global Burden of Disease database to extract information on the prevalence, incidence, and disability-adjusted life years (DALYs) related to major depression among WCBA from 1990 to 2021. The study estimated the annual percentage change to assess trends in disease burden and calculated point estimates using 95 % uncertainty intervals.

RESULTS

Between 1990 and 2021, there was a significant increase in the incidence, prevalence, and number of DALYs associated with MDD among WCBA, with increases of 73 %, 73 %, and 72 %, respectively. In low Sociodemographic Index (SDI) regions, WCBA exhibited the highest prevalence, incidence, and DALYs of MDD, whereas high SDI regions had the highest prevalence. East Asia was the only region that reported a decline in the prevalence, incidence, and DALYs associated with MDD. The Central America region experienced the most substantial increases in incidence and DALYs, while East Asia showed the most notable declines in prevalence and DALYs. At the country level, Singapore had the largest global declines in prevalence, incidence, and DALYs, whereas Mexico exhibited the most significant rise. Age group analysis revealed that the most pronounced increase in cases of major depression was observed among women aged 45-49 years.

CONCLUSION

Over the past 32 years, the burden of MDD among WCBA has significantly increased worldwide, particularly in low SDI and high SDI regions, as well as among the 45-49 age group.

Electronic Clinical Decision Support Tools to Manage Patients with Lower Respiratory Tract Infection: Clinicians' Perspectives in Sri Lanka

In low-resource settings, providers often manage lower respiratory tract infections (LRTIs) without diagnostic tests, which may cause antibacterial overuse. Electronic clinical decision support tools (eCDSTs) can support evidence-based decision-making and judicious use of antibacterials. This study aimed to explore the potential of an eCDST to help providers in Sri Lanka effectively manage LRTI. Semi-structured interviews were conducted with 15 clinicians, including 10 males and five females, with an average of 11.6 years (range: 4-25 years) of clinical practice. The interview guide covered clinicians' interest in an eCDST to manage LRTI and their feedback regarding the desired features of such a tool. Interviews were audio-recorded, transcribed, and coded for themes related to: interest in an eCDST for LRTI, desired tool capabilities, development concerns, and tool design characteristics. All expressed interest in incorporating eCDSTs into their practice. However, the majority emphasized that clinical judgment must supersede recommendations from an eCDST. Four themes emerged regarding desired tool capabilities: information about the pathogen, treatment recommendations, severity of the LRTI, and monitoring of patient progress. Six themes emerged regarding tool development considerations: validated algorithms, regional specificity, seasonality, inclusion of patient's risk factors, scalability, and the importance of updated and locally relevant recommendations. Participants stressed that the tool design should be simple, timesaving, and internet-independent. Electronic clinical decision support tools are capable of improving patient care and reduce antibiotic overuse, which may impact downstream antibacterial resistance. Future research should develop an eCDST for LRTI with local input and evaluate its impact on appropriate antibacterial use and patient outcomes.

Stroke-Associated Pneumonia and the Brain-Gut-Lung Axis: A Systematic Literature Review

BACKGROUND

Stroke-associated pneumonia (SAP), a highly lethal complication following stroke, is closely linked to dysregulation of the "brain-gut-lung axis." Accumulating evidence indicates that stroke triggers intestinal alterations through the brain-gut axis, while multiple studies confirm that gut-derived changes can mediate pneumonia through the gut-lung axis. However, the mechanisms connecting stroke-induced intestinal dyshomeostasis to SAP remain incompletely elucidated, and the multiorgan interaction mechanisms of the "brain-gut-lung axis" in SAP pathogenesis require further exploration.

REVIEW SUMMARY

This systematic literature review systematically searched databases, including PubMed, using the keywords "stroke," "gastrointestinal microbiome," and "bacterial pneumonia," incorporating 80 mechanistic studies. Key findings reveal that stroke initiates a cascade of "neuro-microbial-immune" pathway interactions along the brain-gut-lung axis, leading to intestinal dyshomeostasis characterized by microbiota and metabolite alterations, barrier disruption, immune dysregulation, inflammatory responses, and impaired gut motility. These intestinal perturbations ultimately disrupt pulmonary immune homeostasis, promoting SAP development. In addition, stroke directly induces vagus nerve injury through the brain-gut axis, resulting in impaired swallowing and cough reflexes that exacerbate aspiration-related pulmonary infection risks.

CONCLUSIONS

Elucidating the role of the brain-gut-lung axis in SAP pathogenesis provides critical insights into its underlying mechanisms. This paradigm highlights intestinal homeostasis modulation and vagus nerve stimulation as promising therapeutic strategies for SAP prevention and management, advancing a multitargeted approach to mitigate poststroke complications.

Association between NICU intensivist staffing and neonatal outcomes

We aimed to evaluate whether neonatal intensive care unit (NICU) intensivist staffing is associated with improved survival outcomes among neonates admitted to NICUs in South Korea. This nationwide retrospective cohort study included all neonates hospitalized in NICUs between January 1, 2019, and December 31, 2021. Patients were categorized into two groups based on intensivist staffing: the intensivist group, comprising neonates admitted to hospitals with full-time NICU intensivists, and the non-intensivist group, comprising those treated in hospitals without dedicated NICU intensivist coverage. A total of 79,306 neonates were included in the final analysis; among them, 44,330 (56.1%) were admitted to NICUs with registered NICU intensivists. In multivariable logistic regression analysis, the intensivist group had a significantly lower odds of 30-day mortality (odds ratio [OR]: 0.73; 95% confidence interval [CI] 0.58-0.92; P = 0.007) compared to the non-intensivist group. Similarly, in Cox regression analysis, the intensivist group showed a lower risk of 1-year all-cause mortality (hazard ratio: 0.79; 95% CI 0.69-0.91; P = 0.001). These findings suggest that the presence of dedicated NICU intensivists is associated with improved short- and long-term survival outcomes among neonates, supporting policies to enhance specialized staffing in neonatal intensive care settings.

Quantifying the loss of healthy life expectancy due to population ageing: health benefit estimation from a global perspective

STUDY OBJECTIVE

Investing in health to improve healthy life expectancy (HLE) is fundamental to create a demographic dividend. However, how dramatic population ageing affects HLE remains unknown. This study aims to quantify and project the major diseases and injuries attributed to changes in population size and age structure that contributed to substantial losses in HLE.

METHODS

Using data from 188 countries in the Global Burden of Disease Study 2021 and World Population Prospects 2024, we assessed the correlation between HLE and total dependency ratios. Furthermore, we decomposed the mortality and disability burden attributable to changes in population size as well as age structure for 22 disease and injury categories and then quantified the loss of HLE due to the attributable burden. Additionally, we projected the loss of HLE due to priority diseases in 2030, while considering the impact of population ageing.

RESULTS

From 2010 to 2019, globally, the mortality and disability burden attributable to age structure caused 0.40 years and 0.71 years of HLE loss, while for population size, these two estimates were 1.18 years and 1.00 years. By 2030, the mortality and disability burden attributable to age structure may lead to 0.76 years and 0.89 years of HLE loss, while for population size, these two predictions will be 1.21 years and 1.17 years.

DISCUSSION

Population size growth is a consistent and crucial contributor to HLE losses. Reaping the second demographic dividend requires eliminating the double burden of premature death caused by infectious and chronic diseases, whereas gaining the sustainable third demographic dividend requires investments in healthy and successful ageing.

Multifunctional nanocomposite hydrogels: an effective approach to promote diabetic wound healing

Diabetes, a metabolic disease that is becoming increasingly severe globally, presents a significant challenge in the medical field. Diabetic wounds are characterized by their chronicity, difficulty healing, and complex microenvironment that harbors multiple adverse factors, including elevated hyperglycemia, persistent inflammation, susceptibility to infections, and oxidative stress, all of which contribute to the impaired healing process. Nanocomposite hydrogels, as materials with unique physicochemical properties and biocompatibility, have gained growing attention in recent years for their potential applications in diabetic wound healing. These hydrogels provide a moist healing environment for wounds and regulate cellular behavior and signaling pathways, promoting wound repair and healing. By introducing specific functional groups and nanoparticles, nanocomposite hydrogels can respond to pathological features of wounds, enabling adaptive drug release. Owing to their diverse bioactive functions, nanocomposite hydrogels are powerful tools for the treatment of diabetic wounds. Thus, this article provides an overview of recent progress in the use of nanocomposite hydrogels for diabetic wound healing.

Global Trends and Regional Differences in the Burden of Infective Endocarditis, 1990-2021: An Analysis of the Global Burden of Disease Study 2021

BACKGROUND

The study aimed to offer detailed insights into the global, regional, and national burden of IE in 2021, while also examining the temporal trends of IE from 1990 to 2021.

METHODS

Data on the absolute numbers and age-standardized rates (ASR) of incidence, deaths, and disability-adjusted life years (DALYs) related to IE were sourced from the Global Burden of Disease Study (GBD) 2021. The estimated annual percentage changes (EAPC) of ASR were calculated to quantify the temporal trends. Furthermore, joinpoint regression models were used to identify the temporal trends and the primary joinpoint year of ASR.

RESULTS

Globally, the age-standardized incidence rate (ASIR) for IE increased with an EAPC of 1.00 (95%CI: 0.93-1.08) from 9.35 per 100 000 population in 1990 to 12.61 per 100 000 population in 2021. Despite a rise in the absolute number of death cases and DALYs related to IE, the age-standardized mortality rate (ASMR) has remained stable (EAPC 0.06, 95%CI: -0.10-0.22), and the age-standardized DALYs rate (ASDR) has exhibited a decline (EAPC - 0.34, 95%CI: -0.45-0.24) between 1990 and 2021. Males bore a higher burden of IE compared to females, with the peak burden gradually shifting towards older individuals. In 2021, the ASIR for IE exhibited an increase with the rise in socio-demographic index (SDI) quintiles, with the highest ASIR observed in the high SDI region (15.77 per 100 000 population). Moreover, the highest growth rates of ASIR, ASMR, and ASDR were also noted in the high SDI region. On the other hand, the ASMR (1.34 per 100 000 population) and ASDR (40.71 per 100 000 population) for IE were relatively high in the low SDI region. Joinpoint analysis demonstrated that the ASIR, ASMR, and ASDR did not experience any sudden surges either globally or across different SDI regions after 2007.

CONCLUSIONS

The burden of IE remained relatively high, characterized by a rising ASIR and a stable ASMR on a global scale. This burden was notably prominent among males, the elderly, and in the high and low SDI regions. Region-specific prevention and management strategies might be warranted to reduce the burden of IE.

Weight-neutral interventions for people with obesity and the perspective of patients, carers and healthcare professionals: a mixed methods review

OBJECTIVES

This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To assess the effects of weight-neutral interventions for managing obesity in children and adults (quantitative data). To explore the views, perspectives and experiences of children and adults receiving the intervention, their close family members or, if appropriate, carers, and healthcare personnel who recommend or deliver weight-neutral interventions to determine their feasibility and acceptability and any factors that create barriers and facilitators to optimal implementation (qualitative data). To determine whether the programme theories, components and delivery of interventions take account of the views, perspectives and experiences of intervention recipients and whether patient-centred interventions have greater effects.

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.

Typhoid conjugate vaccines for preventing typhoid fever (enteric fever)

RATIONALE

Typhoid fever is a major cause of enteric disease-related morbidity and mortality. Vaccination reduces disease burden and prevents outbreaks, but policies and programmes should be informed by the most recent evidence as newer vaccines become available.

OBJECTIVES

To assess the benefits and harms of typhoid conjugate vaccines (TCVs) compared to no vaccine, placebo, typhoid-inactive agents (vaccines for another disease) or other typhoid vaccines for preventing morbidity and mortality associated with typhoid fever in adults and children.

SEARCH METHODS

In April 2024, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Global Index Medicus, United States Advisory Committee on Immunization Practices and the World Health Organization vaccine repository for randomised controlled trials (RCTs), with no restrictions. We also searched clinical trial registries for ongoing trials (www.

CLINICALTRIALS

gov and the WHO International Clinical Trials Registry Platform), grey literature, bibliographic citations of reviews and key articles for additional studies. We contacted study authors for information about ongoing studies.

ELIGIBILITY CRITERIA

We included RCTs and cluster-RCTs of children and adults living in typhoid-endemic areas or travelling to typhoid-endemic areas. We included studies comparing TCVs to controls (i.e. no vaccine, placebo or vaccines for another disease), non-conjugated typhoid vaccines or other TCVs.

OUTCOMES

Outcomes included acute typhoid fever, defined by laboratory-confirmed isolation of Salmonella typhi, all-cause mortality, adverse events (AEs) and serious adverse events (SAEs).

RISK OF BIAS

Review authors independently assessed risk of bias for all outcomes, using the Cochrane RoB 2 tools. We resolved disagreements through discussion or adjudication. We assessed the intention-to-treat effect and used the overall RoB judgement to assess the certainty of evidence for each outcome.

SYNTHESIS METHODS

Three review authors independently screened titles and abstracts for eligible studies, followed by full-text assessment. Disagreements were resolved through discussion or adjudication by a fourth author. Four authors independently extracted characteristics of included studies and outcome data using a piloted, standardised data extraction form. We synthesised results for each outcome where possible, using the Mantel-Haenszel statistical method and random-effects analysis model. Where meta-analysis was not possible due to the nature of the data, we planned to synthesise results based on direction of effect. We used GRADE to assess the certainty of evidence for each outcome, assessing risk of bias, inconsistency, indirectness, imprecision and other bias.

INCLUDED STUDIES

We included 19 trials (17 RCTs and two cluster-RCTs). The 19 trials enrolled 395,650 participants, with ages ranging from six weeks to 60 years. Vaccines were delivered as a single dose in 14 studies; two doses, ranging from four to 24 weeks apart, in six studies; and three doses, four weeks apart, in one study. Comparators included: no vaccine, placebo and other vaccines. Seven studies compared TCV with non-conjugated typhoid vaccines. Six studies compared one TCV to another TCV.

SYNTHESIS OF RESULTS

TCV compared to control may result in a large reduction in acute typhoid fever (risk ratio (RR) 0.20, 95% confidence interval (CI) 0.12 to 0.32; I2 = 70%; 6 studies, 101,896 participants; low-certainty evidence) and probably results in little to no difference in all-cause mortality (RR 0.80, 95% CI 0.35 to 1.85; I2 = 52%; 4 studies, 100,337 participants; moderate-certainty evidence). TCV results in little to no difference in AEs when compared to control (RR 0.91, 95% CI 0.76 to 1.09; I2 = 0%; 3 studies, 29,465 participants; high-certainty evidence) and a slight reduction in SAEs compared to control (RR 0.82, 95% CI 0.71 to 0.95; I2 = 0%; 6 studies, 89,625 participants; high-certainty evidence). TCV compared to non-conjugated typhoid vaccines may result in little to no difference in acute typhoid fever (RR 0.90, 95% CI 0.48 to 1.69; 1 study, 78 participants; low-certainty evidence). There were no deaths in the included studies. When compared to non-conjugated typhoid vaccines, TCV likely results in little to no difference in AEs (RR 1.00, 95% CI 0.77 to 1.31; I2 = 0%; 3 studies, 244 participants; moderate-certainty evidence) and likely results in a slight reduction in SAEs (RR 0.30, 95% CI 0.05 to 1.88; I2 = 0%; 2 studies, 732 participants; moderate-certainty evidence). For TCV compared to another TCV, none of the studies reported on acute typhoid fever. Vi tetanus toxoid vaccine (Vi-TT) may result in little to no difference in all-cause mortality compared to a different TCV (RR 5.19, 95% CI 0.54 to 49.80; I2 = 0%; 2 studies, 2422 participants; low-certainty evidence). Vi-TT likely results in little to no difference in AEs compared to another TCV (RR 1.18, 95% CI 0.92 to 1.51; I2 = 39%; 4 studies, 2916 participants; moderate-certainty evidence) and may result in little to no difference in SAEs (RR 2.48, 95% CI 0.74 to 8.36; I2 = 0%; 3 studies, 2866 participants; low-certainty evidence). The certainty of evidence was consistently reduced due to imprecision, indirectness and bias.

AUTHORS' CONCLUSIONS

This review highlights that TCVs, compared to controls, are effective in preventing typhoid fever, and may confer protection for up to four years. TCVs compared to non-conjugated typhoid vaccines may result in little to no difference in acute typhoid fever and AEs, and likely result in a slight reduction in SAEs. Vi-TT compared to another TCV may result in little to no difference in all-cause mortality or SAEs, and likely results in little to no difference in AEs.

FUNDING

NG, TL and TK were partly supported by, and the Cochrane Infectious Diseases Group (CIDG) editorial base is funded by, the Research, Evidence and Development Initiative (READ-It), funded by UK aid for the benefit of low- and middle-income countries (project number 300342-104). The views expressed in this review do not necessarily reflect the official policies of the UK government.

REGISTRATION

Protocol available via doi.org/10.1002/14651858.CD015746.

TNF induces catabolism in human cartilaginous endplate cells in 3D agarose culture under dynamic compression

Intervertebral disc (IVD) degeneration is the leading cause of low back pain in young adults, and the cartilaginous endplate (CEP) is likely to play a key role in early IVD degeneration. To elucidate the effects of pro-inflammatory cytokines on the mechanobiology of the CEP, human CEP cells were seeded into 2% agarose, dynamically compressed up to 7%, and stimulated with tumor necrosis factor (TNF). It was hypothesized that dynamic compression would be sufficient to induce anabolism, while stimulation with TNF would induce catabolism. TNF was sufficient to induce a catabolic, time-dependent response in human CEP cells through downregulation of anabolic gene expression and increased secretion of pro-inflammatory proteins associated with herniated discs, bacteria inhibition, and pain. However, 7% strain or scaffold material, agarose, may not lead to full activation of integrins and downregulation of pro-inflammatory pathways, demonstrated in part through the unchanged gene expression of integrin subunits α5 and β1.

The epidemiology of asthma and its attributable risk factors from 1990 to 2021: A systematic analysis based on the Global Burden of Disease Study 2021 and Mendelian Randomization Studies

OBJECTIVES

Asthma is a commonly occurring condition due to chronic inflammation of the lower respiratory tract. This study aims to assess the global burden of asthma from 1990 to 2021 and the mortality trends caused by specific risk factors.

STUDY DESIGN

Systematic analysis based on the Global Burden of Disease Study 2021 and Mendelian Randomization studies.

METHODS

Based on a global asthma scale spanning from 1990 to 2021, we performed a secondary analysis to explore the incidence, mortality, and disability-adjusted life-years (DALYs), along with risk factors for asthma. Mendelian randomization (MR) analyses were performed to verify the results.

RESULTS

In 2021, there were 41,555,628 incident cases of asthma worldwide. Cases of asthma decreased by 0.09 % (95 % uncertainty interval [UI]: 0.12,0.06) from 1990 to 2021. Over the past three decades, asthma-associated deaths increased from 374,377 (95 % UI: 304,600-492,653) to 436,192 (95 % UI: 357,795-555,604). The global incidence rate decreased from 736.99 (95 % UI: 615.03-905.18) to 516.70 (95 % UI: 425.36-646.13) per 100,000 population; the asthma-associated mortality rate decreased from 9.64 (95 % UI: 7.76-12.80) to 5.20 (95 % UI: 4.27-6.59) per 100,000 population. Age-specific incidence and prevalence rates peaked in individuals under nine years old. The prevalence and incidence rates of asthma were relatively higher in individuals in countries with higher Socio-demographic Index (SDI); however, mortality and DALYs rates of individuals with asthma showed a reverse trend. Globally, occupational asthmagens, body mass index, smoking, and air pollution were key risk factors for asthma-associated mortality and DALYs in 2021. MR analyses further confirmed the strongly related correlation between body mass index, occupational asthmagens and asthma.

CONCLUSIONS

Although a mild decrease in total incidence cases of asthma was observed from 1990 to 2021, asthma has still continued to pose a life-threatening burden worldwide overall. Generally, asthma frequently occurred at younger ages and is more prevalent in high-SDI countries, indicating that specific periodic and regional features exist. Improved understanding of the epidemiology of asthma could facilitate future interventions to better manage the disease globally and support future investigation on the diagnosis and treatment of asthma.

HbA1c variability and all-cause mortality in type 1 and type 2 diabetes: A population-based cohort study using electronic health records

AIMS

To investigate associations between HbA1c variability and all-cause mortality in individuals with diabetes, accounting for average HbA1c level METHODS: Mean HbA1c and variability score (HVS) were estimated for people aged 31-90 with diabetes (type 1 = 20,347, type 2 = 409,821) with 4 + HbA1c measurements recorded in the Clinical Practice Research Datalink in 2011-14 and alive on 1/1/2015. Cox models estimated hazard ratios (HR) for all-cause mortality, ascertained from national linked mortality data during 2015-17. HbA1c level and variability were mutually adjusted for each other and other measured confounders.

RESULTS

Greater HbA1c variability was associated with younger age, non-white ethnicities (type 1 only), obesity, co-morbidities, and living in deprived areas. During follow-up, 1,043 (5.1 %) individuals with type 1 diabetes and 40,723 (9.9 %) individuals with type 2 diabetes died. In those with the most HbA1c variability compared to the least (HVS = 80-100 vs 0-20), the estimated adjusted HRs for mortality were 2.78(95 %CI 2.15, 3.60) in type 1 diabetes and 1.91(1.83, 1.99) in type 2 diabetes.

CONCLUSIONS

Variability in HbA1c was associated with greater subsequent mortality among people living with diabetes, independent from average HbA1c. Future research should investigate whether reducing HbA1c variability over time in selected patients lowers mortality risk independent of HbA1c level improvements.

Co-Designing, Developing, and Testing a Mental Health Platform for Young People Using a Participatory Design Methodology in Colombia: Mixed Methods Study

BACKGROUND

Globally, mental health (MH) problems increasingly affect young people, contributing significantly to disability and disease. In low- and middle-income countries, such as Colombia, barriers to accessing care exacerbate the treatment gap. In addition, the lack of widespread digital interventions further deepens the digital health divide between the Global North and Global South, limiting equitable access to innovative MH solutions.

OBJECTIVE

This study aims to co-design and develop an MH platform using participatory design methodologies and conduct a 15-month naturalistic observational trial to assess its feasibility among Colombian youth.

METHODS

This study used a mixed methods approach within a structured research and development cycle. To ensure a user-centered design, we began with a series of co-design workshops, where stakeholders collaboratively identified key user needs. Following this, usability testing was conducted in 2 stages, alpha and beta, using the System Usability Scale (SUS) to assess functionality and user experience. To capture real-world interactions, a naturalistic observational trial ran from July 2022 to October 2023, collecting data on user engagement and system performance. This study integrated quantitative and qualitative analyses.

RESULTS

A total of 146 individuals participated in the co-design process, with 110 (75.3%) contributing to the development of platform components and 36 (24.7%) participating in usability testing. The co-designed platform integrated several key features, including social media and advertising, an MH screening tool, registration, targeted psychoeducational resources, automated tailored recommendations, and a "track-as-you-go" feature for continuous MH monitoring. Additional elements included user-friendly follow-up graphs, telecounseling integration, customizable well-being nudges, an emergency button, and gamification components to enhance engagement. During usability testing, the beta prototype received a median SUS score of 85.0 (IQR 80-92.5), indicating high usability. In the subsequent observational trial, which ran from July 2022 to October 2023, a total of 435 users interacted with the platform-314 (72.2%) as registered users and 121 (27.8%) anonymously. Emotional distress was prevalent, with 63.7% (200/314) of the registered users and 61.2% (74/121) of the anonymous users reporting distress, as measured by the 6-item Kessler Psychological Distress Scale. Despite 102 users requesting telecounseling, only 26.5% (27/102) completed a session. While usability scores remained high, engagement challenges emerged, with only 18.8% (59/314) of the users continuing platform use beyond the first day.

CONCLUSIONS

This study explored the development and user experience of a youth MH platform in Colombia, demonstrating that a cocreation approach is both feasible and effective. By actively involving users throughout the design process, the platform achieved high usability and incorporated features that resonated with its target audience. However, sustaining long-term engagement remains a challenge, as does addressing privacy concerns, particularly for younger users. These findings highlight the importance of continuous user-centered refinement to enhance both accessibility and retention in digital MH interventions.

The role of community pharmacists in managing common headache disorders, and their integration within structured headache services: position statement on behalf of the European Headache Federation (EHF) and Lifting The Burden (LTB: the Global Campaign against Headache), with the formal endorsement of the International Pharmaceutical Federation

In the sustainable development goals (SDG) context of seeking universal health coverage, the expanding gap between the supply of specialized and primary health-care providers of headache-related health care and the care needs of the very large number of people affected by headache is a formidable but not insoluble public-health challenge. Structured headache services provide a cost-effective framework wherein controlled patient flows enable the care needs of people with headache to be met at appropriate levels, but these services may still be overwhelmed by inappropriate demand.Community pharmacists are an underutilized resource, potentially well able to provide the solution. To do so, they must, as a profession, be integrated into structured headache services.What remains to be determined is how to achieve this integration in an encouraging climate for change, which recognises the potential for relieving strained health-care systems and meeting a range of health-care needs by expanding pharmacists' scope of practice.This position statement on behalf of the European Headache Federation (EHF) and Lifting The Burden (LTB) is formally endorsed by the International Pharmaceutical Federation (FIP).

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.

The role of the brain-bone axis in skeletal degenerative diseases and psychiatric disorders, A genome-wide pleiotropic analysis

INTRODUCTION

Skeletal degenerative diseases and psychiatric disorders often coexist clinically. However, the genetic correlations and underlying biological mechanisms between these two types of diseases remain unclear.

OBJECTIVES

To investigate the genetic correlations between skeletal degenerative diseases and psychiatric disorders and to identify shared genomic loci, genes, and pathways.

METHODS

This comprehensive genome-wide pleiotropic association study utilized summary statistics from publicly available genome-wide association data. Various statistical genetic correlation methods were employed, including LDSC, HDL, PLACO, Coloc, Hyprcoloc, and Mendelian randomization (MR) analysis, along with immune cell colocalization analysis. The study aimed to identify potential shared genetic factors among three skeletal degenerative diseases (osteoarthritis, intervertebral disc degeneration, and osteoporosis) and three psychiatric disorders (schizophrenia, anxiety disorder, and major depressive disorder).

RESULTS

Analyses using LDSC, HDL, and Bonferroni corrections revealed significant genetic correlations between intervertebral disc degeneration (IVDD) and anxiety disorder (ANX); fractures, IVDD, and arthritis with major depressive disorder (MDD); and arthritis with schizophrenia (SCZ). Significant genetic correlations were also observed between VDD and ANX, fractures, IVDD, hip osteoarthritis (HipOA), knee osteoarthritis (KneeOA) and MDD, and KneeOA and SCZ. Pleiotropy analysis using PLACO, MAGMA, and multitrait colocalization Hyprcoloc identified 65 pleiotropic loci, 27 shared causal loci, and 9 shared risk loci involving immune cells related to both psychiatric and bone-related diseases. Additionally, tissue-specific enrichment analysis showed that genes mapped to these loci were enriched in brain, cardiovascular, pancreatic, and other tissues. The IVW method demonstrated that MDD increased the risk of IVDD and KneeOA, while IVDD increased the risk of ANX and MDD. Conversely, SCZ was associated with a reduced risk of KneeOA. Multiple sensitivity analyses further supported a positive causal effect of IVDD on MDD.

CONCLUSION

These findings suggest significant genetic correlations between skeletal degenerative diseases and psychiatric disorders, highlighting multiple shared comorbid genes and key immune cell types. Importantly, the study supports the role of the brain-bone axis in the regulation of skeletal degenerative diseases and psychiatric disorders, which could provide valuable insights for potential therapeutic targets and interventions for these conditions.

Effective interventions to reduce sick leave in workers with mental illnesses: A systematic review of randomized controlled trials

OBJECTIVE

Effective interventions to reduce sick leave in people with mental illnesses remain unknown. This systematic review of randomized controlled trials (RCTs) assessed the impact of various interventions on reducing sick leave among individuals with mental illnesses.

METHODS

We conducted searches in PubMed, Cochrane Library, and PsycInfo until February 2024 and included RCTs with parallel designs. Two reviewers assessed the quality of trials using the Cochrane risk of bias tool (ROB-2).

RESULTS

Out of 5109 publications, 75 RCTs were included. Ten RCTs with no serious risk of bias demonstrated that certain interventions could reduce sick leave. Interventions based on cognitive behavioral therapy and problem-solving therapy reduced sick leave within a year, but the effect was not long-lasting. Enhanced care approaches, where physicians and care managers encouraged patients to start and maintain pharmacotherapy or psychotherapy, also decreased absenteeism. Online cognitive behavioral therapy yielded a modest decrease in absenteeism. An intervention involving both employees and supervisors to modify the workplace and address stress reduced long-term sick leave. Involving employees in stressor management initiatives decreased sick leave, and a combination of work-focused and online cognitive behavioral therapy reduced short-term sick leave but did not affect long-term (≥15 days) rates. Group therapy led by a clinical psychologist for stress management also showed benefits in the short term (3 months).

CONCLUSION

Multifaceted approaches that combine individual therapy and workplace adjustments are more effective in managing sick leave for individuals with mental illnesses than either approach alone.

Neuron-Derived Extracellular Vesicles: Emerging Regulators in Central Nervous System Disease Progression

The diagnosis and exploration of central nervous system (CNS) diseases remain challenging due to the blood-brain barrier (BBB), complex signaling pathways, and heterogeneous clinical manifestations. Neurons, as the core functional units of the CNS, play a pivotal role in CNS disease progression. Extracellular vesicles (EVs), capable of crossing the BBB, facilitate intercellular and cell-extracellular matrix (ECM) communication, making neuron-derived extracellular vesicles (NDEVs) a focal point of research. Recent studies reveal that NDEVs, carrying various bioactive substances, can exert either pathogenic or protective effects in numerous CNS diseases. Additionally, NDEVs show significant potential as biomarkers for CNS diseases. This review summarizes the emerging roles of NDEVs in CNS diseases, including Alzheimer's disease, depression, traumatic brain injury, schizophrenia, ischemic stroke, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis. It aims to provide a novel perspective on developing therapeutic and diagnostic strategies for CNS diseases through the study of NDEVs.

Associations of DNA Methylation Algorithms of Aging With Cardiovascular Disease and Mortality Risk Among US Older Adults

BACKGROUND

Several DNA methylation (DNAm) algorithms have recently emerged as robust predictors of aging and adverse health outcomes in older adults, offering valuable insights into cardiovascular disease (CVD) risk stratification. However, their predictive performance for CVD varies significantly. This study aimed to systematically investigate the associations of 12 widely used DNAm algorithms with CVD and mortality risk.

METHODS

Data from the NHANES (National Health and Nutrition Examination Survey) 1999 to 2002 were used to assess 12 DNAm algorithms (eg, HannumAgeacc, PhenoAgeacc, GrimAgeMortacc, GrimAge2Mortacc) in relation to CVD risk and mortality. Two cohorts were analyzed: one for CVD risk (n=1230) and another for CVD mortality risk (n=1606). DNAm was measured using the Infinium Methylation EPIC BeadChip kit (Illumina). Odds ratios (ORs) and hazard ratios (HRs), along with 95% CIs per SD increase of these DNAm algorithms, were calculated.

RESULTS

Significant associations were observed for GrimAgeMortacc and GrimAge2Mortacc with coronary heart disease and heart attack, with multivariable-adjusted ORs per SD increase ranging from 2.15 to 2.76. However, several algorithms exhibited no significant association with self-reported prevalent CVD. For mortality risk, HannumAgeacc, PhenoAgeacc, ZhangAgeacc, GrimAgeMortacc, and GrimAge2Mortacc were significantly associated with CVD mortality. The multivariable-adjusted HRs per SD increase were 1.19 (95% CIs, 1.05-1.34), 1.13 (95% CIs, 1.01-1.26), 1.63 (95% CI, 1.08-2.47), 1.90 (95% CIs, 1.51-2.40), and 1.87 (95% CIs, 1.51-2.32), respectively. These associations were consistent across biological sex, age (≥50 and <65 versus ≥65 years), and race and ethnicity groups.

CONCLUSIONS

DNAm algorithms, particularly GrimAgeMortacc and GrimAge2Mortacc, may serve as valuable tools for CVD risk stratification and mortality risk assessment.

The Asia-Oceania consensus: Definitions and diagnostic criteria for sarcopenic obesity

OBJECTIVE

The aim of this study was to develop consensus definitions and diagnostic criteria for sarcopenic obesity tailored to Asia-Oceania populations, a condition characterized by reduced skeletal muscle mass and function with excess adipose tissue.

METHODS

Experts from various fields formed a working group under the Asia-Oceania Association for the Study of Obesity (AOASO) and the International Association of Gerontology and Geriatrics Asia/Oceania Region (IAGG-AOR). The group convened four meetings, employing the Delphi technique to achieve consensus on diagnostic criteria and management strategies for sarcopenic obesity.

RESULTS

The consensus defines sarcopenic obesity with a 3-step algorithm, including screening, diagnosis, and intervention. The screening criteria included BMI and waist circumference for obesity and calf circumference, the SARC-F, and the Finger Ring test for sarcopenia. The diagnostic criteria for sarcopenia include assessments of muscle mass (using dual-energy X-ray absorptiometry or bioelectrical impedance analysis), muscle strength (handgrip strength), and physical performance (gait speed, Short Physical Performance Battery, or the 5-Times Sit-to-Stand Test). Central obesity is the main concern for the diagnosis of obesity. The working group recommends a combination of dietary consultations, increased physical activity, resistance training, and the potential use of oral nutritional supplements and medications for managing sarcopenic obesity. The primary objective is to increase skeletal muscle mass and reduce adipose tissue mass.

CONCLUSIONS

The established criteria facilitate early recognition and management of sarcopenic obesity, highlighting the need for tailored interventions. Future research should focus on the long-term outcomes of these interventions and the development of pharmacological treatments.

Synthesis, structural insights and bio-evaluation of N-phenoxyethylisatin hydrazones as potent α-glucosidase inhibitors

Effective α-glucosidase inhibitors are vital for managing type 2 diabetes, emphasizing the need for novel and potent compounds. A series of novel N-phenoxyethylisatin hydrazones 1(a-l) have been synthesized and characterized by their spectral data, and in the case of 1l by its single crystal X-ray analysis. All the synthesized compounds were in vitro evaluated for their inhibition potential against the α-glucosidase enzyme. Interestingly, most of these compounds exhibited significant inhibitory activity against the α-glucosidase enzyme, with IC50 values ranging from 3.64 ± 0.13 to 94.89 ± 0.64 μM compared to the standard drug, acarbose (IC50 = 873.34 ± 1.67 μM). The compound 1e was found to be the most active compound of the series having an IC50 value of 3.64 ± 0.13 μM. Molecular docking studies revealed a binding score of -9.7 kcal mol-1 for 1e, slightly surpassing that of acarbose (-9.4 kcal mol-1). Unlike acarbose, which primarily relies on hydrogen bonding, the binding interactions of 1e are dominated by π-interactions. ADMET profiling confirmed favourable pharmacokinetics for these compounds, including good oral bioavailability, balanced hydrophilicity, and minimal predicted toxicity. These findings highlight the potential of these compounds as promising candidates for the development of more effective treatments for hyperglycemia.

High Burden and Trend in Nonadherence to Blood Pressure-Lowering Medications: Meta-Analysis of Data From Over 34 000 Adults With Hypertension in Sub-Saharan Africa

BACKGROUND

Nonadherence to blood pressure (BP)-lowering medication is a strong predictor of poor BP control. Sub-Saharan Africa has extremely low BP control rates (~10%), but it is unclear what the burden of medication nonadherence among Africans with hypertension is. This systematic review estimated the prevalence and determinants of nonadherence to BP-lowering medications in Sub-Saharan Africa.

METHODS AND RESULTS

Multiple databases were searched from inception to December 6, 2023. Two reviewers performed independent screening, extraction, and quality assessment of studies. We pooled the prevalence estimates using random effects meta-analyses and summarized the determinants using a narrative synthesis. From the 1307 records identified, we included 95 studies published between 1995 and 2023. The overall prevalence of nonadherence to BP-lowering medication among 34 102 people treated for hypertension in 27 countries was 43.9% (95% CI, 39.2-48.6). There was no change in the prevalence of nonadherence over time. Nonadherence varied by measurement method and by median age (39.4%, ≥57 years versus 47.9%, <57 years). Socioeconomic and patient-related factors were the most frequent factors influencing adherence. Active patient participation in management, accurate perceptions, and knowledge of hypertension and its treatment predicted good medication adherence, whereas high pill burden, medication cost, side effects, and comorbidities predicted poor adherence.

CONCLUSIONS

Two out of every 5 people are nonadherent to their BP treatment. With the African population projected to increase from 1.4 to ~2.5 billion by 2050, targeted strategies are urgently needed to optimize medication adherence in people with hypertension in Sub-Saharan Africa.

Effects of different doses of Ganoderic Acid A on nociceptive behaviour and inflammatory parameters in polyarthritic mice rheumatoid arthritis model

The frequency of autoimmune diseases such as rheumatoid arthritis is increasing annually. Current treatments for these diseases cause new problems due to their side effects. In this study, we investigated the impact of Ganoderic Acid A (GAA), a potent anti-inflammatory herbal molecule, to evaluate the potential efficacy of GAA in alleviating Rheumatoid arthritis (RA)-associated clinical and histopathological manifestations. 40 Balb/c male mice were randomly divided into five groups (n = mice number per each group) as control (C), acetic acid (AA), rheumatoid arthritis (RA), low dose GAA (LGA) and high dose GAA (HGA) groups. Collagen emulsion was applied intra-articularly (ia), and complete Freund's adjuvant (CFA) was applied subcutaneously (sc) to the RA and GA groups to induce an experimental model of rheumatoid arthritis. Other groups were given physiologic saline (PS) or AA at the same dose and in the same way. The procedures were repeated on the 22nd day; however, incomplete Freund's adjuvant was applied to the RA and GA groups instead of CFA. PS was given to groups C, AA and RA for 9 days starting from the 22nd day; GAA was applied to the LGA (20 mg/kg) and HGA (40 mg/kg) groups by gavage. We evaluated body weight, arthritis score, knee temperature, knee circumference, behavioural assessment of pain, gait, tail-flick test, hot plate test, locomotor activity test, lower extremity index, spectrophotometric and histopathological evaluation methods, respectively. Compared to the RA group, the clinical arthritis score was reduced in the HGA group (p < 0.05). GAA significantly reduced knee temperatures and knee circumference, with changes in hot plate scores and tail flip test response. In the GAA groups, serum concentrations of AST, IL-6, TNF-α, NFkB were reduced, and joint damage and arthritis scores were also reduced histologically (p < 0.05). The results of this study suggest that the arthritis regressed with GAA treatment. Edema and inflammation were found to be reduced in the GAA groups compared with the RA group. GAA treatment resulted in significant improvements in behavioural activity, reduced inflammation and the damage to cartilage and bone structure and had an antinociceptive effect.

Role of Maternal Obesity in Offspring Cardiovascular Development and Congenital Heart Defects

BACKGROUND

Congenital heart disease is a leading cause of death in newborns, yet many of its molecular mechanisms remain unknown. Both maternal obesity and diabetes increase the risk of congenital heart disease in offspring, with recent studies suggesting these conditions may have distinct teratogenic mechanisms. The global prevalence of obesity is rising, and while maternal obesity is a known risk factor for fetal congenital heart disease, the specific mechanisms are largely unexplored.

METHODS AND RESULTS

We used a murine model of diet-induced maternal obesity, without diabetes, to produce dams that were overweight but had normal blood glucose levels. Embryos were generated and their developing hearts analyzed. Transcriptome analysis was performed using single-nucleus and bulk RNA sequencing. Global and phospho-enriched proteome analysis was performed using tandem mass tag-mass spectroscopy. Immunobloting and histologic evaluation were also performed. Analysis revealed disrupted oxidative phosphorylation and reactive oxygen species formation, with reduced antioxidant capacity, evidenced by downregulation of genes Sod1 and Gp4x, and disrupted Hif1a signaling. Evidence of oxidative stress, cell death signaling, and alteration in Rho GTPase and actin cytoskeleton signaling was also observed. Genes involved in cardiac morphogenesis, including Hand2, were downregulated, and fewer mature cardiomyocytes were present. Histologic analysis confirmed increased cardiac defects in embryos exposed to maternal obesity.

CONCLUSIONS

These findings demonstrate that maternal obesity alone can result in cardiac defects through mechanisms similar to those associated with maternal hyperglycemia. This study provides valuable insight into the role of maternal obesity, a growing and modifiable risk factor, in the development of the most common birth defect, congenital heart disease.

The global, regional, and national burden and trends of anxiety disorders among women of childbearing age from 1990 to 2021: Estimates from the global burden of disease study 2021

BACKGROUND

Anxiety disorders are prevalent, early-onset mental illnesses that have a major negative impact on society and the economy globally. Comprehensive research on the global prevalence and evolving patterns of anxiety disorders in women of childbearing age (WCBA) is lacking.

METHODS

We computed estimated annual percentage changes (EAPCs) to evaluate trends in the incidence and Disability-Adjusted Life Years (DALYs) rates of anxiety disorders using the three primary WCBA indicators for anxiety disorders: prevalence, incidence, and DALYs, which were taken from the Global Burden of Disease (GBD) database from 1990 to 2021.

RESULTS

The number of prevalent cases increased from 120.2 million in 1990 to 224.8 million in 2021. The number of new cases increased from 17.406 million in 1990 to 30.730 million in 2021. Anxiety disorders is more prevalent in women, particularly those of reproductive age (15-49 years). Over the past 32 years, the global changes of Age-standardized incidence rate (ASIR) and Age-standardized prevalence rate (ASPR) were relatively stable. The results of differential smoothing and ARR model fitting showed that the long term risks showed a fluctuating downward trend in the long run, but showed a significant abnormal increase after 2020.

CONCLUSION

The relative increase in the incidence of anxiety disorders and DALYs in the WCBA over 32 years remains high. Our results can help different countries or regions in the world to develop more reasonable prevention and control measures for anxiety disorders, so as to reduce the serious economic and social burden caused by the disease.

Ketogenic diet attenuates neuroinflammation and restores hippocampal neurogenesis to improve CUMS induced depression-like behavior in mice

The ketogenic diet (KD) has been proposed as a potential treatment for depression. However, the underlying mechanisms remain poorly understood. This study aimed to evaluate further the effects of KD on chronic unpredictable mild stress (CUMS)-induced depression in mice and investigate the underlying mechanisms. The results demonstrated that KD intervention significantly alleviated CUMS-induced depression-like behaviors, as evidenced by a decrease in immobility time in the forced swimming test and tail suspension test, an increase in distance traveled in the open field test, and a greater preference for sucrose in the sucrose preference test. KD alleviated neuroinflammation by reducing the levels of glial cell activation markers Iba-1 and GFAP, inhibiting the expression of inflammatory factors IL-1β, TNF-α, and COX-2, and suppressing the overactivation of the TLR4/MyD88/NF-κB signaling pathway. Furthermore, KD increased the number of DCX-, BrdU-, and PSD95-positive cells in the hippocampus and enhanced the BDNF/TrkB/CREB and Wnt/β-catenin signaling pathways, thereby promoting hippocampal neurogenesis. These findings suggested that KD alleviated CUMS-induced depression-like behaviors in mice by reducing neuroinflammation, enhancing neurotrophic signaling, and promoting hippocampal neurogenesis, thereby providing a mechanistic basis for its potential as a novel dietary antidepressant therapy.

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.

Global burden of ischemic stroke in adults aged 60 years and older from 1990 to 2021: Population-based study

BACKGROUND

Ischemic stroke is an important public health problem. However, comprehensive data on its burden in aging populations is limited. The aim of this study is to provide an up-to-date assessment of the prevalence, incidence, mortality, disability-adjusted life years, and risk factors for ischemic stroke globally in adults aged 60 years and older from 1990 to 2021 based on population changes.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 served as the data source for this study. Average annual percentage changes were estimated over the study period to quantify temporal patterns and assess trends in age-standardized rates of the prevalence, incidence, mortality, and disability-adjusted life-years of ischemic stroke.

RESULTS

The significant increase in the prevalence and incidence of ischemic stroke is mainly related to population ageing and the significant increase in the number of people over 60 years of age, with the significant increase in the population over 60 years of age being the main driving force, while epidemiological changes have had the opposite effect. Critically, using the entire age population for calculations will prompt us to underestimate the burden of ischemic stroke. The burden of ischemic stroke disease is highest in older men than in older women, and the age-standardized prevalence rates, incidence rates, mortality rates, and disability-adjusted life-years rates are 26-35% higher in men than in women. High-middle sociodemographic index and Sub-Saharan Africa regions suffer the heaviest burden. Ischemic stroke health inequities widen, with less developed regions bearing a heavier ischemic stroke burden and the disparity in that burden becoming more pronounced over time.

CONCLUSION

Population aging is the primary driver of the growing burden of ischemic stroke. Our findings indicate that prevention and control of this disease remain critical public health challenges. Targeted interventions addressing modifiable risk factors could significantly reduce the global burden of ischemic stroke.

Trends in liver cancer rehabilitation needs, disease burden, and attributable risk factors in China, 1990-2021

This study investigates trends in liver cancer rehabilitation needs, disease burden, and attributable risk factors in China from 1990 to 2021 using data from the Global Burden of Disease Study 2021. Key metrics included age-standardized prevalence (ASPR), years lived with disability (YLDs), and risk factor attribution. Between 1990 and 2021, the number of liver cancer patients requiring rehabilitation surged by 100.1% (132,779 to 265,539 cases), with YLDs rising by 102.8% (22,981 to 46,602). While ASPR and age-standardized YLD rates (ASYR) showed modest declines (ASPR: - 0.1% annual change; ASYR: - 0.23%), males exhibited a disproportionately higher burden, with 2021 cases and YLDs 2.98- and 2.74-fold greater than females, respectively. Risk factor analysis revealed smoking (14.0%), drug use (11.5%), and alcohol consumption (11.4%) as primary contributors, while metabolic factors like high BMI (7.5%) and fasting plasma glucose (1.9%) demonstrated accelerating impacts (YLDs EAPC: + 4.47% and + 1.31%, respectively). Aging populations and shifting etiologies drove increased rehabilitation demands, particularly among those ≥ 80 years. These findings underscore urgent needs for gender-specific interventions targeting modifiable risks and integrated nursing rehabilitation strategies to mitigate China's growing liver cancer burden.

Emerging trends and disparities in cardiovascular, kidney, and diabetes-related mortality: A retrospective analysis of the wide-ranging online data for epidemiologic research database

INTRODUCTION

Cardiovascular-kidney-metabolic (CKM) syndrome, driven by metabolic risk factors like obesity, type 2 diabetes (DM-2), chronic kidney disease (CKD), and cardiovascular disease (CVD), leads to poorer health outcomes. Despite its rising prevalence and promising new therapies, trends and demographic disparities in CKM-related mortality among adults in the United States remain underexplored.

METHODOLOGY

The study examined CDC WONDER death certificates for individuals aged 25+ who died from 1999 to 2022, with CVD as the main cause, while CKD and DM-2 as contributing factors. Age-adjusted mortality rates (AAMRs) and annual percent change (APC) were calculated by year, sex, age, race/ethnicity, region, and urbanization status.

RESULTS

From 1999 to 2022, 25,980 CKM-related deaths were recorded, with the AAMR decreasing from 5.3 to 0.4 per 1,000,000 population. AAMR rose significantly from 1999 to 2012 (APC: 7.03; p<0.001), sharply declined from 2012 to 2015 (APC: -65.55; p<0.001), and then increased from 2015 to 2022 (APC: 15.98; p = 0.101). Men had higher AAMRs than women (6.9 vs. 4.3), and older adults (65+) had the highest AAMR (23.3), followed by middle-aged adults (2.2). Among racial groups, non-Hispanic (NH) American Indian/Alaska Native had the highest AAMR (11.2), followed by NH Black (8.6), Hispanic (6.6), NH White (4.8), and NH Asian/Pacific Islander (4.7). Rural areas showed the highest AAMRs (6.8), compared to medium-small metro (6.1) and large metro areas (4.4).

CONCLUSIONS

CKM-related mortality trends have varied widely over the past two decades, with men, older adults, American Indian/Alaska Native, and non-metropolitan populations experiencing the highest AAMRs, underscoring the need for targeted interventions.

Laboratory measurement and machine learning-based analysis of driving factors for brake wear particle emissions from light-duty electric vehicles and heavy-duty vehicles

This study investigates brake wear particle (BWP) emissions from light-duty electric vehicles (EVs) and heavy-duty vehicles (HDVs) using a self-developed whole-vehicle testing system and a modified brake dynamometer. The results show that regenerative braking significantly reduces emissions: weak and strong regenerative braking modes reduce brake wear PM2.5 by 75 % and 87 %, and brake wear PM10 by 90 % and 95 %, respectively. HDVs with drum brakes produce lower emissions and higher PM2.5/PM10 ratios than those with disc brakes. A machine learning model (XGBoost) was developed to analyze the relationship between BWP emissions and factors (11 for light-duty EVs and 8 for HDVs, based on kinematic, vehicle, and braking parameters). SHapley Additive exPlanations (SHAP) were used for model interpretation. For light-duty EVs, reducing high kinetic energy losses (Ike > 6500 J) and initial speeds (V > 45 km/h) braking events significantly lowers emissions. Additionally, the emission reduction effect of regenerative braking intensity (BI) stabilizes when BI exceeds 900 J. For HDVs, controlling braking temperature (Avg.T < 200°C) and initial speed (V < 50 km/h) effectively reduces emissions. Our findings provide new insights into the emission characteristics and control strategies for BWPs. SYNOPSIS: The construction and interpretation of a machine learning based model of brake wear emissions provides new insights into the refined assessment and control of non-exhaust emissions.

Puriton attenuates the asthma severity in ovalbumin-induced murine model via balancing Th1/Th2 and inhibiting inflammation

In 2019, 262 million asthma patients were estimated, with 455 thousand deaths caused by asthma. It is an incurable chronic inflammatory respiratory disease and is more severe in the elderly and in the young. Forty BALB/c mice were divided into 5 groups of eight mice each: vehicle group (CON), asthma group (OVA), positive drug group (DEX), and Puriton (700 and 1400 μL/head/day). After animal experiment all mice were narcotized for collecting bronchoalveolar lavage fluid (BALF) and blood and then anesthetized for sampling the lungs. White blood cell (WBC) and differential count in BALF and immunoglobulin E (IgE) in serum were measured. Lung tissues were used for histopathological and immunohistopathological studies. Treatment with Puriton decreased the populations of WBC and neutrophil and the level of IgE. It prevented OVA-induced morphological changes in the lung and increased the expression levels of T helper 2 (Th2) cell-related cytokines such as interleukin- (IL-)4, IL-5, and IL-13. It inhibited inflammatory cytokines such as tumor necrosis factor alpha (TNF-α) and IL-6. The nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB)/ cyclooxygenase-2 (COX-2)/ prostaglandin E2 (PGE2) pathway is a significant inflammatory pathway. Treatment of the subjects with Puriton resulted in the inhibition of the expression of phosphorylated (p)-NF-κB, COX-2, and PGE2 in both the nucleus and cytoplasm. From the results we concluded that Puriton is a promising drug candidate as asthma treatment.

Effects of mindfulness- and acceptance-based interventions for individuals with schizophrenia spectrum disorders: A systematic meta-review

BACKGROUND

Mindfulness- and acceptance-based interventions (MBIs/ABIs) for persons with schizophrenia spectrum disorders (SSD) aim to cultivate purposeful attention, mind-body awareness, and targeted action-taking. This systematic meta-review assessed the current body of evidence regarding the effects of MBIs/ABIs for SSD symptoms.

METHODS

The study was registered with PROSPERO (CRD42024535284) on June 3, 2024. Seven databases were searched between April 18 and April 19, 2024. Meta-analyses investigating the effects of MBIs/ABIs for SSD symptoms were considered. Two authors (AM, AS) independently completed data extraction and analysis. Evidence grading and methodology assessments were conducted using the Ioannidis' criteria, AMSTAR-2, and AMSTAR-Plus Content guidelines.

FINDINGS

A total of 18 meta-analyses with up to 2572 participants were considered; 14 studies were eligible for analysis. Results were classified according to Ioannidis' criteria; the effect size of the highest ranked study with the largest number of primary studies is presented. Percentages indicate the number of studies reporting significant results. Significant evidence was found at end of treatment for overall symptomatology (MBIs: 100 %, n = 9, g = -0·7 (total range: -0·417 to -1·152), 95% CI: [-1·052, -0·347], I2 = 95·36; ABIs: 25 %, n = 29, g = -1·065 (total range: -0·1 to -1·065) [-1·371, -0·759], I2 = 85·1), positive (MBIs: 50 %, n = 6, g = -0·296 (total range: -0·155 to -0·416) [-0·528, -0·064], I2 = 34·69; ABIs: 33·33 %, n = 3, g = -0·602 (total range: -0·602 to 0·147) [-1·014, -0·191], I2 = 0), negative (MBIs: 100 %, n = 8, g = -0·94 (total range: -0·384 to -0.98) [-1·466, -0·413], I2 = 86·42; ABIs: 25 %, n = 2, g = -0·631 (total range: -0·028 to -0.631) [-1·108, -1·154], I2 = 0), affective symptoms (MBIs: 50 %, n = 9, g = -0·971 (total range: -0·275 to -0·971) [-1·413, -0·529], I2 = 91·32; ABIs: 33·33 %, n = 3, g = -0·854 (total range: -0·472 to -0·854) [-1·255, -0·453, I2 = 0), social functioning (MBIs: 100 %, n = 7, g = -1·368 (total range: -0·452 to -1·368) [-2·194, -0·542], I2 = 94·3; ABIs: g total range: -0·878 to 0·625), mindfulness (MBIs: 66·66 %, n = 5, g = -0·805 (total range: -0·488 to -1·429) [-1·16, -0·45], I2 = 0; ABIs: 66·66 %, n = 1, g = -0·959 (total range: -0·391 to -0·959) [-1·788, -0·129], I2 = NA), and acceptance (MBIs: g total range: -0·381 to 0·381; ABIs: 50 %, n = 4, g = -0·393 (total range: -0·393 to 0·398) [-0·673, -0·113], I2 = 0). Possible explanations for the differences in effect sizes for MBIs and ABIs are explored. Methodological assessments ranked 'low' or 'critically low' for all meta-analyses.

INTERPRETATION

Although subject to several limitations, significant small to large effect sizes were evident for overall symptomatology, mindfulness, and social functioning. Small to large effect sizes were found for positive, negative, and affective symptoms. Future research should incorporate additional risk of bias assessments, increased sample sizes, and consider cultural contexts (as the largest effect sizes were reported by studies with a majority of samples from Mainland China and Hong Kong) regarding the therapeutic benefits of MBIs/ABIs.

ROLE OF THE FUNDING SOURCE

There was no funding source for this study.

Low back pain among the working-age population: from the global burden of disease study 2021

BACKGROUND

The burden of low back pain in the global working-age population (WAP) is substantial and exhibits unique characteristics. This study aimed to evaluate global, regional, and national trends in low back pain prevalence among the WAP over a 32-year period.

METHODS

We utilized data from the 2021 Global Burden of Disease (GBD) study to evaluate the global impact of low back pain in the WAP from 1990 to 2021. A secondary analysis focused on temporal trends and a decomposition analysis of low back pain.

RESULTS

From 1990 to 2021, there was a continuous decrease in the rate of low back pain among the global WAP. The age-standardized incidence rate (ASIR) decreased from 4,111 (95% uncertainty interval [UI]: 2,682-5,619) to 3,676 (95% UI: 2,563-5,021), with an annual average percentage change (AAPC) of -0.36. The age-standardized prevalence rate (ASPR) decreased from 9,731 (95% UI: 7,061-12,970) to 8,632 (95% UI: 6,296-11,517), with an AAPC of -0.39. The age-standardized disability-adjusted life years (DALYs) rate (ASDR) decreased from 1,108 (95% UI: 686-1,650) to 982 (95% UI: 608-1,460), with an AAPC of -0.39. However, the number of low back pain cases in the global WAP continued to increase. Regions with a middle Socio-demographic Index (SDI), South Asia, China, and India carried a heavier burden of low back pain in the WAP. The burden was also greater among females, with the gender gap continuing to widen. Decomposition analysis revealed that population growth and population aging were the predominant driving factors.

CONCLUSIONS

Despite the overall reduction in the ASIR, ASPR, and ASDR of low back pain among WAP, it remained a leading cause of disability worldwide. More attention needs to be paid to the low back pain burden among WAP in middle-SDI regions, countries with a large population base, and females. Significant gender and regional disparities persist within WAP, highlighting the necessity for targeted preventive and therapeutic interventions to alleviate the burden of low back pain and reduce the risks of disability.

Assessing Alzheimer's disease knowledge among Egyptian medical students in the context of recent educational reforms

BACKGROUND

Medical students are the future doctors and play an essential role in the management of health issues. Their understanding of Alzheimer's disease (AD) is not only required but also necessary to provide the best possible care to patients. The present study aimed to assess medical students' knowledge about AD within the context of the recent reform of the Egyptian medical educational system, which switched to competency-based instead of outcome-based education since 2017.

METHODS

A descriptive cross-sectional study was conducted among medical students in public and private Egyptian medical schools. Between August and November 2024, an anonymous self-administered questionnaire was uploaded to Google Forms and distributed online through commonly used social media platforms. The Alzheimer's Disease Knowledge Scale (ADKS), a validated and reliable tool, was used for the measurement of AD-related knowledge. Univariate and multivariable logistic regression models were used to determine the factors associated with having good or poor knowledge about AD among participants.

RESULTS

In total, 1100 medical students were included through convenience and snowball sampling methods; their mean age was 20.9 ± 1.9 years, 55.5% were males, 59.6% were in their clinical years, and 15.6% had a positive family history of AD. The students' mean knowledge score was 19.10 ± 2.96 out of 30, representing 63.7% of answers correct, with a range of scores between 9 and 29. About 70.8% of the sample had good knowledge. The highest percentage of correct answers was for the treatment and management domain (76.5%), while the lowest percentage was for the caregiving domain (52.2%). Predictors of good knowledge were females [adjusted odds ratio (aOR) = 1.33 (95% confidence interval (CI): 1.01-1.76, p = 0.043], attending a public university [aOR = 1.62 (95% CI: 1.09-2.41), p = 0.015), clinical year students [aOR = 1.53 (95% CI: 1.07-2.16), p = 0.018], living in an urban area [(aOR = 1.67 (95% CI: 1.23-2.25), p < 0.001], and having higher family monthly income [aOR = 1.75 (95% CI: 1.13-2.72), p = 0.012].

CONCLUSIONS

The study highlights gaps in Egyptian medical students' knowledge of AD. Knowledge gaps were found in domains of caregiving and risk factors, urging educators and policymakers to enhance curricula, particularly preclinical curricula, with a specific focus on some socio-economic determinants.

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.

Paediatric anaemia prevalence trends in the Eastern Mediterranean Region: a 20-year analysis by income level

Background

Anaemia is a significant global public health issue, especially in low-income countries, where it influences children's mental and physical development. Anaemia is a common public health problem in the Eastern Mediterranean Region (EMR), although long-term, income-stratified analyses at the regional level are scarce. This study investigated trends in anaemia prevalence among children aged 6-59 months from 21 countries in the EMR between 2000 and 2019, correlating differences in these trends with each country's national income.

Methods

We analysed data collected by the World Health Organization (WHO) on the prevalence of anaemia in children aged 6-59 months between 2000 and 2019 in 21 EMR countries at five-year intervals. Data on national income classifications were taken from the World Bank. The data were subject to statistical analysis using SPSS, Excel and GraphPad Prism to determine the associations between anaemia prevalence and income groups.

Results

The average anaemia prevalence among children in the EMR decreased from 40.56% in 2000 to 34.25% in 2019 - an absolute change of -6.3%. The number of countries with a prevalence above 40% fell from seven in 2000 to six in 2019. Oman, Yemen and Sudan had some of the highest prevalences, and the UAE witnessed a slight increase, despite being a high-income country. Anaemia prevalence was significantly associated with national income (P < 0.001), but outliers suggest that income alone does not fully explain the observed trends. In 2019, the prevalence of anaemia in the EMR remained greater than the global average.

Conclusions

Between 2000 and 2019, the prevalence of anaemia in children aged 6-59 months decreased significantly in the EMR. Despite this progress, there are still disparities between the prevalence of anaemia in low-income and high-income countries. Therefore, income is not the only factor associated with declines in anaemia prevalence. The fact that reduction rates plateaued after 2015 reinforces the significance of implementing new, innovative health programmes to minimise anaemia.

Indoor concentrations and exposure levels of CO, SO₂, NO₂, and O₃ in Chinese residences, schools, and offices (2000-2021): A systematic review

This systematic review addressed critical knowledge gaps regarding the spatiotemporal patterns and human exposure to indoor gaseous pollutants (CO, SO₂, NO₂, O₃) in Chinese civil buildings (residences, schools, offices) from 2000 to 2021. A total of 108 field measurement studies revealed divergent temporal trends: a decline in indoor CO, SO2, and NO2 concentrations over the past two decades in China, alongside a rise in indoor O3 concentrations. The highest CO (8.4 mg/m3), SO2 (1473.6 μg/m³), and NO2 (217.0 μg/m³) concentrations were observed in northwest China. Time-weighted exposure assessments indicated elevated levels in children compared to adults (office workers) for CO (3.1 vs. 1.7 mg/m³), SO2 (248.4 vs. 239.5 μg/m³), and NO2 (50.5 vs. 42.3 μg/m³), while higher O₃ exposure was identified among office workers (25.0 vs. 21.1 μg/m³ in children). These findings underscore the urgency of implementing population-specific interventions, such as solid fuel replacement programs in high-burden rural regions and reducing the use of ozone-releasing appliances in office environments. Future efforts should prioritize formulating more stringent indoor air quality standards and establishing comprehensive long-term monitoring systems across different indoor environments, which would provide a robust foundation for refining population exposure models and developing targeted mitigation strategies aligned with spatiotemporal pollutant dynamics.