The association between long-term trajectories of insulin resistance and brain structural integrity in middle-aged and older adults

BackgroundThe triglyceride-glucose (TyG) index is considered a robust surrogate for insulin resistance (IR). The relationship between the trajectory patterns of the TyG index and subsequent brain structure changes is still unclear.ObjectiveThis study investigates the relationship between 10-year trajectories of TyG-related indices and brain structural integrity in a 10-year follow-up.MethodsThis prospective study included 898 participants (mean age 55.6 years, 34.4% males) from the community-based Shunyi Study. IR was assessed using the TyG index, TyG-body mass index (BMI) index, TyG-waist circumference index, and TyG-waist-to-height ratio (WHtR) index. The group-based trajectory model was employed to identify the 10-year trajectories. Structural brain measurements included structural changes of the whiter matter (white matter hyperintensities (WMHs), fractional anisotropy, and mean diffusivity) and gray matter (brain parenchymal fraction (BPF), cortical thickness, and hippocampal volume). General linear models were utilized to examine the association between the trajectory patterns of TyG-related indices and brain structure.ResultsThree distinct trajectories of TyG-related indices were identified from 2013 to 2023. The high-level trajectory groups of TyG-related indices exhibited a greater volume of WMHs and were more susceptible to disruptions in white matter microstructural integrity. This association was most significant for the TyG-BMI and TyG-WHtR trajectory groups. No significant correlations were found for BPF and cortical thickness among the different TyG-related indices trajectories.ConclusionsThe findings suggest that long-term IR primarily damages brain white matter rather than causing structural changes in gray matter.

Evaluating the survival and removal of Escherichia coli from surfaces made with traditional and sustainable cement-based materials in field-relevant conditions

Soil household floors are common in low- and middle-income countries (LMICs) and can serve as reservoirs of enteric pathogens. Cement-based floors may interrupt pathogen transmission, but little is known about pathogen survival or removal from cement-based surfaces. This study investigated the survival of Escherichia coli, an indicator of fecal contamination, on cement-based surfaces and evaluated its reduction through common household activities (mopping, sweeping, and walking). We compared E. coli fate on three mixes: (i) ordinary Portland cement (OPC) concrete (used in the United States), (ii) OPC mortar (used in Bangladesh), and (iii) OPC mortar with fly ash (a sustainable alternative to the Bangladesh mix). Additionally, we compared outcomes on cement-based surfaces with and without soil and at two temperatures representing the dry and wet seasons in Bangladesh. After 4 hours on the cement-based surfaces, E. coli decayed more than 1.1 log10(C/Co) under all conditions tested, which is significantly faster than in bulk soils. The higher temperature increased the decay rate constant (P = 5.56 × 10-8) while soil presence decreased it (P = 2.80 × 10-6). Sweeping and mopping resulted in high levels of removal for all mixes, with a mean removal of 71% and 78%, respectively, versus 22% for walking. The concrete and mortar mix designs did not impact E. coli survival or removal (P > 0.20). Cement-based floors made with a fly ash mix performed similarly to traditional cement-based floors, supporting their potential use as a more sustainable intervention to reduce fecal contamination in rural LMIC household settings.

IMPORTANCE

Cement-based surfaces may serve as a health intervention to reduce the fecal-oral transmission of pathogens in household settings, but there is a critical lack of evidence about the fate of indicator organisms on these surfaces, especially in field-relevant conditions. This study provides some of the first insights into Escherichia coli survival on cement-based surfaces and the effectiveness of daily activities for removing E. coli. Additionally, this study explores the fate of E. coli on cement-based surfaces made with fly ash (which contributes fewer CO2 emissions) versus traditional cement mixes. We found that E. coli had similar survival and removal efficiencies across all mix designs, demonstrating that fly ash mixes are feasible for use in household settings (e.g., in floors). The findings enhance understanding of fecal-oral transmission pathways and support the use of fly ash mixes in cement-based flooring in future epidemiologic studies assessing effects on enteric disease burdens.

Six-Axis, Physiological Activity Profiles Create a More Challenging Cellular Environment in the Intervertebral Disc Compared to Single-Axis Loading

Bioreactors provide a valuable way to explore interactions between the mechanical and biological environments of the intervertebral disc (IVD), but the replication of ecologically valid loading protocols is a huge challenge. The aim of this study was to address this through the combination of time use survey data and six-axis load data from in vivo measurements during functional movements and activities of daily living to create population-based activity profiles, which were employed using a unique six-axis bioreactor and a whole-organ bovine tail IVD model. The results of the study show that six-axis activity profiles create a more challenging environment compared to single-axis loading or unloaded controls, resulting in lower cell viability in both the nucleus pulposus and annulus fibrosus regions of the IVD. Additionally, the six-axis activity profile representing a more active lifestyle led to an even lower cell viability in the annulus fibrosus, which may be due to the increased strains in this region of the IVD during activities of daily living. These findings highlight the importance of considering a wide range of activities and lifestyles in the development and evaluation of regenerative therapies and preventative interventions for IVD, if they are to be successfully translated to the clinical setting.

Global, regional and national burden of Parkinson's disease in people over 55 years of age: a systematic analysis of the global burden of disease study, 1991-2021

BACKGROUND

Parkinson's disease (PD) has emerged as a major global public health challenge. However, there is currently a lack of systematic analysis regarding the burden of PD and its long-term trends among people over 55 years of age.

METHODS

This study utilizes data from the Global Burden of Disease 2021 database to analyze the prevalence, incidence, disability-adjusted life years (DALYs), and mortality rates of PD in individuals aged 55 and older from 1990 to 2021. The annual percentage change was calculated to assess the temporal trends of the disease burden. Point estimates and their corresponding ranges were reported with 95% uncertainty intervals.

RESULTS

Globally, the prevalence, incidence, DALYs, and mortality rates of PD in individuals aged 55 and above significantly increased from 1990 to 2021, with all indicators being higher in males than in females. This trend was evident across all five Socio-Demographic Index (SDI) groups and in 21 regions worldwide. The number of prevalent cases, incident cases, DALYs, and deaths all showed significant increases and were positively correlated with SDI (R = 0.645, P < 0.001). Among 185 countries, the incidence rate increased, with DALY rates rising in 74 countries and mortality rates rising in 65 countries. Notably, in the population aged 95 years and older, the prevalence and incidence of PD showed particularly remarkable increases, at 735% and 505%, respectively. Furthermore, the greatest increase in prevalence was observed in the 55-59 age group, especially in countries with Middle SDI and High-middle SDI regions.

CONCLUSIONS

This study indicates that the burden of PD in individuals aged 55 and above has significantly increased over the past three decades. This trend reflects the profound impact of global aging and socioeconomic development levels on the burden of PD, underscoring the urgency of addressing PD as a major global public health challenge.

Health workforce issues and recommended practices in the implementation of Universal Health Coverage in the Philippines: a qualitative study

BACKGROUND

The transition towards Universal Health Coverage (UHC) in a devolved healthcare system such as the Philippines is beset by health workforce issues considering that it is among the world's leading source countries for health workers. This study aims to document health workforce issues and recommended practices in the implementation of UHC in the Philippines.

METHODS

We conducted focus group discussions and key informant interviews with health policymakers and UHC implementers in the national, regional, and local levels. Participants included local chief executives, healthcare facility administrators, and healthcare providers at tertiary, secondary, and primary levels, as well as patients. We transcribed and translated the focus group discussions and key informant interviews and analyzed it thematically.

RESULTS

Workforce factors at entry, current employment, and exit hinder the implementation of UHC. Factors at entry include: poor preparation of graduates in school for implementing UHC; difficulty in recruitment due to restrictive government hiring policies; and government budget caps for personnel services. Factors at the current employment include: poor working conditions; uncompetitive salaries; lack of trained personnel for financial management; exorbitant fees for trainings; lack of job security for nationally deployed personnel; and lack of integration of some barangay health workers and community health volunteers. Factors at exit include the pull of migration overseas and poor crisis management. Some recommended practices to recruit and retain health workforce include scholarships and return service programs; free tuition for dependents of health workers; opportunities for postgraduate degrees and specialist training overseas, and onboarding UHC training for new hires.

CONCLUSIONS

To address the health workforce issues hindering the effective implementation of UHC in the Philippines, there is a need for reforms in the country's healthcare sector and beyond. Specifically, there is a need to revisit the country's Local Government Code, integrate further health professions education institutions and healthcare facilities, implement reforms in its basic, higher, and health education, and the civil service, revisit training costs, and training programs for specialists, and design and implement more sustainable and equitable bilateral labor agreements to keep health workforce in the Philippines and engage them as partners for optimal implementation of UHC in the country.

Prevalence of smoking and smoking cessation and associated factors in diabetes population aged 50 years and over in Europe

The aim of this study was to determine prevalence of smokers and ex-smokers in the older diabetes population in Europe and to evaluate the relationship with various sociodemographic and lifestyle risk factors. This epidemiological study used Wave 8 of the multidisciplinary and cross-national SHARE database, which includes cross-sectional data on health, socio-economic status and social and family networks of individuals aged 50 and over from 27 European countries. Among the 6,903 participants with diabetes, 12.2% were current smokers, 29.9% were former smokers and 57.9% had never smoked. Among countries' diabetes populations, the highest prevalence of ex-smokers (57.6%) with a low prevalence of smokers (9.5%) was seen in the Netherlands. The highest prevalence of never-smokers (84.2%) was found in Latvia, with the lowest prevalence of ex-smokers (7.9%). Austria had the highest prevalence of current smokers (17.9%) along with a below-average prevalence of ex-smokers (26.5%) was seen in Austria. Normal weight, being overweight, lower education, living without a partner, living in larger cities, drinking alcohol in the last 7 days, lower age, and being male were associated with a higher risk of being a current smoker. The study shows high prevalence of smoking among the older diabetes population in Europe and provides data on the association of smoking with several risk factors and country-specific differences in smoking prevalence.

Potential to improve the burden of age-related macular degeneration: results from the Global Burden of Disease Study 2021

BACKGROUND

Age-related macular degeneration (AMD) is a critical public health issue, requiring prioritized public health strategies.

METHODS

Based on the Global Burden of Disease Study 2021, AMD burden and risk factors were analyzed, considering variables such as sex, age, and location. Age-standardized rates (ASR) were employed to evaluate and compare the burdens across different regions. Frontier analysis was used to determine the lowest achievable burden based on the Sociodemographic Index (SDI), while decomposition analysis revealed factors influencing age-related macular degeneration burden change.

RESULTS

Globally, in 2021, ASR of prevalence and disability-adjusted life years (DALYs) were 94.00 (95% UI 78.32, 114.42) per 100,000 and 6.78 (95% UI 4.70, 9.32) per 100,000 respectively. Additionally, a reduction of smoking exposure to its theoretical minimum risk exposure level (TMREL) would lead to an estimated 10.0% decrease in AMD DALYs in 2021. Frontier analysis suggested that Nepal, Iran (Islamic Republic of), and Nigeria were the top three countries with the most substantial potential for reducing disparities. Decomposition analysis indicated that population growth and aging are the primary driving factors for the increase in AMD DALYs.

CONCLUSIONS

We identify countries and territories with potential for improvement and emphasize the importance of equitable, cost-effective control strategies, particularly tobacco control.

Bacterial abundance and antimicrobial resistance prevalence carried by adult house flies (Diptera: Muscidae) at Kansas dairy and beef cattle operations

House flies (Musca domestica L.) are filth-breeding pests of urban and rural environments around the world. Frequenting microbe-rich substrates for nutritional and reproductive needs, house flies pose a risk to human and animal health through their carriage and transmission of pathogenic and antimicrobial resistant bacteria (AMR). Adult house flies were collected from Kansas beef and dairy cattle operations to assess factors influencing bacterial abundance and AMR incidence flies. Aerobic culturable bacteria and suspected coliforms (SC) were enumerated from fly homogenate cultured on nonselective (tryptic soy agar) and selective (violet-red bile agar VRBA) media, respectively. Unique morphotypes of SC isolates were screened for tetracycline resistance and tested for resistance to 4 additional antibiotics to identify multi-drug resistant (MDR) isolates. Female house flies carried greater abundances of both culturable bacteria and SC than male flies. Abiotic factors such as ambient and soil temperatures correlated with culturable bacteria and SC abundances in flies, but farm type correlated only with SC abundance and trends of resistance phenotypes observed in SC isolates. Male and female flies from both farm types carried one or more AMR and MDR SC isolates (73.02% AMR and 31.09% MDR). The majority of AMR and MDR bacteria were Escherichia/Shigella sp., which possessed the widest range of phenotypic resistance variability found in our study. Our results further emphasize the role house flies play in harboring bacteria of risk to human and animal health and identified factors of potential use for the development of strategies to mitigate house fly transmission of bacterial pathogens and AMR within confined cattle operations.

Disease Burden of 30 Cancer Groups in Taiwan from 2000 to 2021

BACKGROUND

Assessment of the morbidity and mortality burden of cancers and their evolving trends is crucial for making informed policy decisions and effective resource allocation. We aimed to examine the burden of cancer in Taiwan from 2000 to 2021 using a national population-based database.

METHODS

Linking data from the Taiwan Cancer Registry and National Death Registry, we calculated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) for 30 specific cancer groups. Our methodology aligns with the Global Burden of Disease Study.

RESULTS

In Taiwan, from 2000 to 2021, the age-standardized cancer mortality rate decreased by 13.8%, while the prevalence rate increased by 80.5%. In 2021, the age-standardized DALYs for total cancer were 3784.2 per 100,000 population. In 2021, in Taiwan, lung, liver, and colorectal cancers were the leading contributors to cancer-related DALYs for men, whereas breast, lung, and colorectal cancers were predominant for women. Life expectancy decomposition analysis revealed distinct patterns by sex, with significant gains for specific cancers from 2000 to 2021: cervical, stomach, and liver cancers in women (0.20, 0.13, and 0.12 years, respectively) and liver, lung, and stomach cancers in men (0.37, 0.17, and 0.17 years, respectively).

CONCLUSION

Our finding of declining cancer DALY rates in Taiwan over the past two decades may reflect improvements in cancer control, particularly the significant decrease in liver and lung cancer burden. However, the rising burden of breast cancer and the sustained impact of colorectal and oral cancers warrant targeted attention in health policies, resource allocation, and research to reduce healthcare costs and improve quality of life.

The burden and trend prediction of ischemic heart disease associated with lead exposure: Insights from the Global Burden of Disease study 2021

AIM

The purpose of this study was to quantify the global burden of ischemic heart disease associated with lead exposure, utilizing data from the Global Burden of Disease (GBD) Study, 2021.

METHODS

Data on the burden of ischemic heart disease (IHD) associated with lead exposure were compiled globally from 1990 to 2021. These data were further stratified by dimensions including gender, age, GBD regions, and countries. Utilizing the Joinpoint regression model, we analyzed long-term trends in the burden of IHD disease associated with lead exposure and derived estimated annual percentage changes (EAPC). For future projections, we used an ARIMA model to predict potential trends in the burden of IHD disease associated with lead exposure over the next decade.

RESULTS

The study's findings reveal that in 2021, there were 590,370 deaths attributed to IHD (95% UI (Uncertainty interval (UI) is derived from the Bayesian school of statistical analysis used in the GBD studies. Unlike the frequency school of thought, which constructs confidence intervals (CI), the Bayesian school of thought views probability as a measure of confidence in an event, and in this approach the actual mean is viewed as a random variable dependent on the data and prior knowledge, with UI indicating that there is a specific probability (e.g., 95%) that the actual mean will fall within the interval.): -83,778 to 1,233,628) and 11,854,661 disability-adjusted life years (DALYs) (95% UI: -1,668,553 to 24,791,275) globally due to lead exposure, reflecting an increasing and then stabilizing trend from 1990 to 2021. Comparative analysis across study regions indicated a higher disease burden for IHD in regions with lower Socio-Demographic Index (SDI) values, contrasting with the lower burden in regions with higher SDI values. Furthermore, IHD mortality and DALYs peak in the 70-80 age cohort, with males exhibiting higher rates compared to females. Decadal projections indicate a downward trend in IHD mortality and DALYs for regions with higher SDI, in contrast to an anticipated upward trend in regions with lower SDI.

CONCLUSION

The global burden of ischemic heart disease associated with lead exposure is increasing, particularly in regions with low SDI values and within the elderly population. Considering the profound threat posed by lead exposure to the global burden of IHD, there is an imperative to consistently reinforce and execute robust prevention strategies to mitigate environmental lead exposure.

Research and predictive analysis of the disease burden of bloodstream infectious diseases in China

BACKGROUND

Bloodstream Infection(BSI) are one of the leading causes of infection-related mortality worldwide. However, epidemiological data related to BSI in China remain very limited.

METHODS

Based on the Global Burden of Disease(GBD) database, a systematic analysis was conducted on the epidemic trends, pathogen spectrum, and the current status of Antimicrobial Resistance(AMR) related to BSI in China for the year 2021. Additionally, an Autoregressive Integrated Moving Average(ARIMA) time series model was constructed to predict the trend of the disease burden associated with BSI in China from 2022 to 2035.

RESULTS

In terms of pathogens, the top five pathogens causing deaths due to BSI in China are as follows: Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. There are significant differences in the pathogens causing BSI across different age groups. The disease burden is heaviest in the elderly population aged 70 and above. Among children under five years old, Staphylococcus aureus, Streptococcus pneumoniae, and Candida species are predominant. From 1990 to 2021, although there has been a gradual decline in mortality rates due to BSI across different age groups (with an approximately 52.4% reduction in age-standardized rates), the disease burden of BSI increases with age. This is especially evident in the population aged 70 and above, where the burden of disease is significantly higher than in other age groups. For instance, in 2021, the mortality rate for individuals aged 70-74 was 149.29 (per 100 K), while for those aged 95 and older, the mortality rate reached as high as 896.71 (per 100 K). On a global scale, the disease burden caused by BSI in China is at a moderate level. According to time series model projections, the mortality burden of BSI in China shows a complex trend toward 2035: the crude mortality rate across all age groups is expected to increase by approximately 14.26%, whereas the age-standardized mortality rate and Disability-Adjusted Life Years(DALYs) are projected to decrease significantly. Notably, the mortality burden is expected to decline most prominently in the 70 + and under 5 age groups, while the 25-44 age group is projected to see minimal change. Conversely, the mortality rates for the 5-49 age group are anticipated to increase slightly.

CONCLUSION

Staphylococcus aureus and Escherichia coli are key pathogens contributing to the high mortality burden of BSI. Additionally, the heavy burden associated with AMR poses significant challenges to clinical treatment. From 1990 to 2021, the age-standardized mortality rate mortality of BSI patients is gradually decreasing, and the change in BSI mortality will be mainly affected by the changes in population size and age structure. The forecast analysis for 2022-2035 finds that the death burden of the elderly will be the heaviest, and the mortality of people aged 5-49 years will increase slightly. BSI and its related health problems are still major challenges and need continuous attention.

CLINICAL TRIAL

Inapplicability.

Latent Structure of Past 12-Month Tobacco Use in Wave 6 of the Population Assessment of Tobacco and Health: Examining for Differential Substructure by Generational Status

INTRODUCTION

Tobacco product usage patterns vary significantly across different segments of the population. Combustible tobacco product usage decreased from 19.3% to 12.5%, while electronic cigarette (ECIG) use rose from 1.8% to 3.7% for the US population from 2010 to 2020. However, age-specific estimates differ between younger and older adults. It is possible there are latent subpopulations within American adults.

METHOD

Data from Wave 6 of the Population Assessment of Tobacco and Health survey (PATH, N = 30,516) were analyzed. Participants were classified as a member of Generation Z (N = 10,920), Millennials (N = 10,450), Generation X (N = 6122), or Baby Boomers (N = 3024) via a 6-level ordinal variable collected by PATH. Latent class analysis (LCA) identified distinct groups based on 8 tobacco use variables.

RESULTS

Analysis suggests that a 4-class solution provides the optimal solution for the entire sample. These classes comprised of a low-use class, a high-use class, ECIG Plus (defined as ECIG use with less probability of other tobacco product use), and a conventional user class, defined as high probability on conventional tobacco products. A 4-class solution also provided optimal fit for each generation, though the classes were defined differently.

DISCUSSION

Understanding tobacco use patterns across different classes is crucial for public health interventions. The discovery of a possible class of social users among Generation Z and Millennials suggests that targeted interventions tailored to the social contexts and behaviors of younger generations may be effective while pharmacological treatments may be more efficacious for Baby Boomers.

Disparities in the quality of care for adults with type 2 diabetes according to socioeconomic level and ethnicity in Mexico

BACKGROUND

The quality and equitable accessibility of health services represent basic priorities for health systems. In Mexico, three quarters of patients with diabetes are treated at public health services shown to be heterogeneous as regards the quality of the health-care processes. This notwithstanding, no information has been published on the quality of care provided to patients with diabetes according to their socioeconomic characteristics and ethnicity. Accordingly, the objective of this study was to identify disparities in the quality of care provided to adults medically diagnosed with type 2 diabetes (T2D) according to their socioeconomic levels and ethnicity.

METHODS

Cross-sectional analysis based on data drawn from the 2018-19 National Health and Nutrition Survey. Quality of care was assessed from the patients' perspective. Analysis included a nationally representative sample of 4555 adults aged ≥20 years, with diagnosis of diabetes, and a subsample of 1586 adults with Hb1Ac measurements. Two multiple linear regression models were fitted to assess the relationship between the overall quality of care provided vs. the socioeconomic levels and ethnicity of patients, adjusted for covariates.

RESULTS

Nearly one-third of adults with diabetes belonged to low-socioeconomic levels, 7% were indigenous, 92% were ≥40 years old, and 50% had experienced diabetes-related complications. Respondents had been diagnosed with diabetes for 11 years on average. Patients of low-socioeconomic levels showed a higher frequency of complications and inadequate glycemic control than did those of higher levels. After adjusting for covariates, the quality of care received was poorer among T2D patients of low (-4.8 pp, 95% CI: -6.5, -3.0) and medium (-1.5 pp, 95% CI: -3.1, 0.1) socioeconomic levels compared to those in the high tier, and among indigenous (-2.7 pp, 95% CI -5.3, -0.1) vs. nonindigenous individuals.

CONCLUSIONS

Overall, adults with diabetes received poor-quality health care. Furthermore, disparities exist by socioeconomic level and ethnicity in the quality of care provided. It is essential to strengthen and renew health-care policies with a view to improving outpatient care for individuals with diabetes, one of the most prevalent chronic diseases in Mexico and around the world. It is vital that efforts to ensure the health and well-being of the most socially vulnerable populations be rooted in an equity approach.

Inflammation and Prediction of Death in Type 2 Diabetes. Evidence of an Intertwined Link With Tryptophan Metabolism

CONTEXT

The role of inflammation in shaping death risk in diabetes is still unclear.

OBJECTIVE

To study whether inflammation is associated with and helps predict mortality risk in patients with type 2 diabetes. To explore the intertwined link between inflammation and tryptophan metabolism on death risk.

METHODS

There were 2 prospective cohorts: the aggregate Gargano Mortality Study (1731 individuals; 872 all-cause deaths) as the discovery sample, and the Foggia Mortality Study (490 individuals; 256 deaths) as validation sample. Twenty-seven inflammatory markers were measured. Causal mediation analysis and in vitro studies were carried out to explore the link between inflammatory markers and the kynurenine to tryptophan ratio (KTR) in shaping mortality risk.

RESULTS

Using multivariable stepwise Cox regression analysis, interleukin (IL)-4, IL-6, IL-8, IL-13, RANTES, and interferon gamma-induced protein-10 (IP-10) were independently associated with death. An inflammation score (I score) comprising these 6 molecules is strongly associated with death in both the discovery and the validation cohorts HR (95% CI) 2.13 (1.91-2.37) and 2.20 (1.79-2.72), respectively. The I score improved discrimination and reclassification measures (all P < .01) of 2 mortality prediction models based on clinical variables. The causal mediation analysis showed that 28% of the KTR effect on mortality was mediated by IP-10. Studies in cultured endothelial cells showed that 5-methoxy-tryptophan, an anti-inflammatory metabolite derived from tryptophan, reduces the expression of IP-10, thus providing a functional basis for the observed causal mediation.

CONCLUSION

Adding the I score to clinical prediction models may help identify individuals who are at greater risk of death. Deeply addressing the intertwined relationship between low-grade inflammation and imbalanced tryptophan metabolism in shaping mortality risk may help discover new therapies targeting patients characterized by these abnormalities.

Renal Hyperfiltration as a New Mechanism of Smoking-Related Mortality

INTRODUCTION

Renal hyperfiltration (RHF), an established risk factor for mortality, is prevalent among tobacco smokers. The aim of this study was to assess the mediating role of RHF in the association between smoking and mortality.

AIMS AND METHODS

Data of this study were retrieved from the cohort of the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD), including 2064 males from Finland. Study participants were followed over a 35-year period. Using classic and counterfactual mediation analysis approaches, we estimated the mediative effect of RHF in the association between smoking and each of the following outcomes: All-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality.

RESULTS

The risk of all-cause mortality in smokers was twice that in nonsmokers (hazard ratio [HR], 2.06; 95% confidence interval [CI]: 1.84 to 2.31). Under the counterfactual framework the direct effect of smoking on all-cause mortality, controlled for RHF, corresponded to an HR of 2.00 (95% CI: 1.78 to 2.30). Of the effect of smoking on mortality, 5% (p-value = .016) was mediated by RHF. This finding concerned particularly non-CVD mortality.

CONCLUSIONS

RHF mediated the effect of smoking on non-CVD and all-cause mortality, but not on CVD mortality. The generalizability of our study results is however limited by its focus on a Finnish male cohort, underscoring the need for further investigation into RHF's broader implications across diverse populations.

IMPLICATIONS

This study elucidates the complex interplay between smoking, renal hyperfiltration (RHF), and mortality, offering novel insights into the mediating role of RHF. Our findings demonstrate that RHF significantly mediates the relationship between smoking and non-cardiovascular disease (non-CVD), but not CVD mortality. This distinction underscores the multifaceted role of RHF beyond its established association with cardiovascular events. By highlighting the specific pathways through which RHF mediates some of the smoking-attributed mortality, this research contributes to our understanding of the mechanisms linking smoking to mortality.

Advanced glycation end-product intake predicts insulin resistance in a sex-dependent fashion

PURPOSE

Dietary advanced glycation end products (AGEs) have been implicated in promoting insulin resistance. However, their impact on insulin resistance in a mixed population made up of males and females remains controversial. The aim of this study was to evaluate whether the relationship between dietary AGEs and insulin resistance may be sex-dependent.

METHODS

195 males and 239 females were included in this cross-sectional study. Study participants underwent anthropometric and metabolic assessments. AGE intake was estimated using food frequency questionnaires and databases reporting AGE content in individual food items. The relationship between AGE intake and insulin resistance, estimated using HOMA-IR, was assessed using Pearson correlation test. The predictive power of dietary AGEs towards HOMA-IR was investigated using stepwise linear regression.

RESULTS

AGE intake correlated positively with HOMA-IR in females (p < 0.01) but not in male study participants (p > 0.05). Moreover, AGE intake was able to increase the predictive power of BMI towards insulin resistance in females but not males. Instead, anthropometric variables were the only discriminants able to predict insulin resistance in males.

CONCLUSION

Dietary AGEs exert a sex-dependent effect on insulin resistance as their intake is associated with and able to predict HOMA-IR in females but not males. This suggests that females may be more susceptible to the deleterious impact of these glycotoxins on insulin sensitivity. Nevertheless, considering this study not involving a nutritional intervention to directly elucidate whether the effect of AGEs on insulin resistance is sex-dependent, further studies are warranted to confirm the present findings.

A Stop-Smoking Strategy After Cervical Cancer Screening: Results of a Cluster-Randomized Controlled Trial in Dutch General Practice

INTRODUCTION

This study aimed to assess whether brief stop-smoking advice given to women who smoke and visit their general practice for cervical cancer screening improves smoking cessation outcomes.

AIMS AND METHODS

This two-arm cluster-randomized controlled trial was conducted in 75 Dutch general practices. Participants in the intervention group received brief stop-smoking advice based on the Ask-Advise-Connect method, delivered by a practice assistant. Patient-reported outcomes were measured at 6 months: undertaking a serious quit attempt of at least 24 hours during follow-up (primary outcome), 7-day point prevalence abstinence at 6 months, reduction in number of cigarettes smoked, increase in motivation to quit smoking, exposure to advice or support, and other psychological and behavioral measurements.

RESULTS

There was no significant difference in undertaking a serious quit attempt between the intervention (39.8% of n = 266) and control group (36.0% of n = 214), odds ratio 1.18 (95% confidence intervals: 0.80-1.72, p = .41). Neither did the point prevalence abstinence significantly differ between groups: 21.1% versus 16.3%, odds ratio 1.38 (95% confidence interval: 0.83-2.29, p = .21). Although nonsignificant, the direction of effects for the aforementioned outcomes was in favor of the intervention group. The reduction in the number of cigarettes smoked and increase in motivation to quit did not differ between groups. The uptake of cessation counseling was higher in the intervention (14.7%) than in the control group (2.8%).

CONCLUSIONS

A brief stop-smoking strategy after the smear test for cervical screening might encourage women who smoke to attempt quitting and seek cessation counseling, but a significant effect could not be demonstrated in this trial.

IMPLICATIONS

The results of this cluster-randomized trial suggest that brief advice to stop-smoking delivered by a practice assistant after routine cervical screening in general practice might encourage women who smoke to attempt quitting, but a significant effect could not be proven. Also, women who receive advice show a higher uptake of professional cessation counseling compared to their controls. Providing brief advice after the cervical smear might therefore be a useful opportunistic approach to stimulate cessation in women who smoke.

Fine particulate matter exposure and cancer risk: a systematic review and meta-analysis of prospective cohort studies

Studies examining the relationship between fine particulate matter (PM2.5) exposure and cancer risk is inconclusive, with an evident scarcity of comprehensive data on the overall cancer risk. Given the emergence of new evidence, updated meta-analyses is essential. A search was performed on multiple databases including PubMed, Embase, Scopus, Web of Science, and the Cochrane Library up to Jan 2025. Hazard ratios (HRs), relative risks (RRs), or incidence rate ratios (IRRs) with their 95 % confidence intervals (CIs) were extracted and pooled. Moreover, a comprehensive and detailed quality assessment of the included studies was conducted to validate the plausibility of the findings. Overall, 57 original studies were included, covering 36 cancer categories and including overall cancer and malignancies specific to particular anatomical sites. For each increase of 10 μg per cubic meter in PM2.5 concentration, there was an observed pooled HR of 1.07 for overall cancer (95 %CI:1.02-1.13). In the case of site-specific cancers, the pooled HRs were 1.11 (95 %CI:1.07-1.15), 1.06 (95 %CI:1.02-1.11), 1.17 (95 %CI:1.07-1.28), and 1.14 (95 %CI:1.03-1.26) for lung, breast, liver and esophageal cancers, respectively. Furthermore, PM2.5 exposure may potentially correlate with the risk of cancers at other anatomical locations including upper aerodigestive tract, oral cavity, kidney, skin, as well as digestive organs. In light of available evidence, it is inferred that PM2.5 exposure could potentially raise overall cancer risk with moderate certainty. As for site-specific malignancies, there is very low certainty evidence for lung cancer, low certainty evidence for breast cancer, and moderate certainty evidence for both liver and esophageal cancers.

Global, regional and national burden of dietary iron deficiency from 1990 to 2021: a Global Burden of Disease study

Although iron deficiency is well documented, less is known about dietary involvement in symptomatic iron deficiency manifesting in medical conditions. In this study, we quantified the global burden of dietary iron deficiency, focusing on where inadequate dietary iron intake leads to clinical manifestations such as anemia. We analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate dietary iron deficiency prevalence and disability-adjusted life years (DALYs), stratified by age, sex, geography and socio-demographic index (SDI) across 204 countries. In 2021, global age-standardized prevalence and DALY rates were 16,434.4 (95% uncertainty interval (UI), 16,186.2-16,689.0) and 423.7 (285.3-610.8) per 100,000 population, with rates decreasing by 9.8% (8.1-11.3) and 18.2% (15.4-21.1) from 1990 to 2021. A higher burden was observed in female individual (age-standardized prevalence, 21,334.8 (95% UI, 20,984.8-21,697.4); DALYs, 598.0 (402.6-854.4)) than in male individual ((age-standardized prevalence, 11,684.7 (11,374.6-12,008.8); DALYs, 253.0 (167.3-371.0)). High-SDI countries presented greater improvement, with a 25.7% reduction compared to 11.5% in low-SDI countries. Despite global improvements, dietary iron deficiency remains a major health concern with a global prevalence of 16.7%, particularly affecting female individuals, children and residents in low-SDI countries. Urgent interventions through supplementation, food security measures and fortification initiatives are essential.

Development of antibiotic resistome in premature infants

Preterm birth is a major concern in neonatal care, significantly impacting infant survival and long-term health. The gut microbiome, essential for infant development, often becomes imbalanced in preterm infants, making it crucial to understand the effects of antibiotics on its development. Our study analyzed weekly, 6-month, and 1-year stool samples from 100 preterm infants, correlating clinical data on antibiotic use and feeding patterns. Comparing infants who received no antibiotics with those given empirical post-birth treatment, we observed notable alterations in the gut microbiome's composition and an increase in antibiotic resistance gene abundance early in life. Although these effects diminished over time, their long-term clinical impacts remain unclear. Human milk feeding was associated with beneficial microbiota like Actinobacteriota and reduced antibiotic resistance genes, underscoring its protective role. This highlights the importance of judicious antibiotic use and promoting human milk to foster a healthy gut microbiome in preterm infants.

Indirect adjustment of tobacco smoking in occupational studies of lung cancer: A systematic review of the available methods and their applications

Tobacco smoking is an important risk factor and potentially a major confounding factor in occupational lung cancer studies. However, as individual information on tobacco smoking is often not available, indirect adjustment methods may be used to account for potential confounding from smoking. Therefore, we aimed at providing an overview of the available indirect adjustment methods for smoking in studies of occupational exposures and lung cancer risk. We conducted a systematic search of relevant studies that applied statistical methods for indirect adjustment of tobacco smoking and were published between 1-Jan-2000 and 2-Apr-2025 to capture developments in recent decades. Studies were retrieved from Embase, MEDLINE, and Web of Science. Fifteen studies fulfilled our inclusion criteria and were included. We grouped the studies into four methods of indirect smoking adjustment: (1) without distributions for adjusted data; (2) distributions for adjusted data; (3) negative control outcomes; (4) factor analysis models. For studies with an external comparison group, percentage change in estimates from before to after indirect adjustment ranged -36.1 %_to_+ 17.3 %, while the corresponding range for those with internal comparison was -16.2 %_to_+ 47.8 %. The choice of indirect adjustment method depends on the use of reference group (external vs. internal) and the data available. Adjustment methods 1 and 2 use partial cohort data or ancillary data from other similar workers and may be preferable over methods 3 and 4, if such data are available. Methods 3 and 4 may be well suited if such data are lacking but have stronger assumptions.

Bimetallic Metal-Organic Framework Microneedle Array for Wound Healing through Targeted Reactive Oxygen Species Generation and Electron Transfer Disruption

The development of reactive oxygen species (ROS)-based antibacterial strategies that overcome ROS's ultrashort diffusion distance and disrupt bacterial electron transfer represents a promising yet underexplored avenue for nonantibiotic therapies. In this study, we introduce an iron-copper bimetallic metal-organic framework (MOF) with peroxidase (POD)-like enzymatic activity engineered to integrate dual functionalities: bactericidal recognition and electron transfer disruption to synergistically enhance antibacterial efficacy. Mechanistic investigations reveal that boronic-acid-cis-diol interactions enable the MOF to selectively bind to bacterial membranes, where it generates localized ROS, effectively killing bacteria. Concurrently, the alignment of MOF energy levels with the bacterial redox potential facilitates efficient electron transfer from the bacterial membrane to the MOFs, disrupting membrane integrity and inhibiting critical processes such as electron transport and ATP synthesis. When incorporated into biodegradable microneedle patches, the MOF effectively penetrates biofilms and wound exudates, delivering potent antibacterial effects directly to infection sites while simultaneously promoting tissue repair. This strategic combination of bactericidal targeting, electron transfer disruption, and microneedle-mediated delivery highlights the potential of this approach to advance nonantibiotic antibacterial therapies.

Association between diabetes phenotypes with hypertension and cardiovascular diseases, using single-sample confirmatory testing: a national study

AIM

To investigate, for the first time, the association between undiagnosed diabetes-using a single-sample confirmatory definition-and prevalent hypertension and cardiovascular diseases (CVD) in an Iranian national population. A few studies on this topic have been limited to Western populations.

METHODS

The study included 16328 adults aged ≥ 30 years. Diabetes phenotypes were classified as: 1-no diabetes: fasting plasma glucose (FPG) < 7 mmol/L (126 mg/dL) and glycated hemoglobin (HbA1c) < 6.5% (48 mmol/mol), as reference; 2-unconfirmed undiagnosed diabetes: having elevated levels of either FPG or HbA1c; 3-confirmed undiagnosed diabetes: having elevated levels of both tests; 4-known diabetes: self-reported history of glucose-lowering medications. Hypertension was defined using American Heart Association criteria. Self-reported history of CVD is defined as prevalent CVD. Multivariable logistic regression models were applied to estimate the odds ratio (OR) and 95% confidence interval (CI) of the association between diabetes phenotypes with hypertension and CVD.

RESULTS

Prevalence of unconfirmed undiagnosed-, confirmed undiagnosed-, and known -diabetes was calculated as 2.70, 3.10, and 5.64%, respectively. Unconfirmed undiagnosed-, confirmed undiagnosed-, and known -diabetes were associated with hypertension with corresponding OR were, 1.30, 1.37, and 1.62; the related values for CVD were 1.80, 1.61, and 2.38; and for the coexistence of CVD and hypertension were 1.86, 1.79, and 2.80, respectively (all P values < 0.05). Furthermore, isolated HbA1c elevation was significantly associated with prevalent CVD [2.04 (1.20-3.45)], and coexistence of hypertension and CVD [1.89 (1.00-3.55)].

CONCLUSIONS

Both unconfirmed- and confirmed- undiagnosed -diabetes were significantly associated with hypertension and CVD, the issue that was mainly attributable to high HbA1c.

6-plex Crystal Digital PCR® for comprehensive surveillance of respiratory and foodborne bacterial pathogens in wastewater

Bacterial wastewater surveillance (WS) is less explored area compared to viral WS despite high burden of bacterial respiratory and gastrointestinal infections worldwide. This study established a 6-plex Crystal Digital PCR® (cdPCR) system, to comprehensively monitor an acute respiratory pathogen - Group A Streptococcus pyogenes, foodborne disease (FBD) pathogens - Clostridium perfringens, Salmonella spp., Campylobacter jejuni, and Campylobacter coli, and an indicator bacterium, Escherichia coli in wastewater. Fifty-two grab influent samples collected weekly from a wastewater treatment plant in Yamanashi Prefecture, Japan, between June 2023 and May 2024 were centrifuged, followed by DNA extraction and cdPCR. cdPCR was performed using the naica® system (Stilla Technologies). The 6-plex cdPCR assays showed strong performance. Among the 52 samples, 100% of samples were positive for C. perfringens, 98% for Salmonella spp., 56% for C. jejuni, 25% for C. coli, and 63% for S. pyogenes, with concentrations ranging between 4.2 ± 0.3 to 7.5 ± 0.2 log10 copies/L. The concentration of C. perfringens was significantly higher than that of other pathogens (One-way ANOVA, p-value < 0.05), indicating its dominance. Salmonella spp. had high detection rate implying increased Salmonella infection in the population. Seaonal variation was not observed in any of FBD pathogens except for the detection rate of C. coli. S. pyogenes concentrations were significantly higher in spring than in other seasons, agreeing with the trend of GAS pharyngitis cases in the catchment. In conclusion, the 6-plex cdPCR system is a valuable tool for comprehensive WS, offering significant implications for public health monitoring.

Evaluation of pre- and in-hospital workflows and time intervals with acute ischemic stroke patients

OBJECTIVE

Stroke is one of the leading causes of death and disability globally. Rapid recanalization therapy for acute ischemic stroke (AIS) patients is critical for improving outcome. While in-hospital time intervals have decreased and treatment methods have improved over the past decade, pre-hospital time intervals have remained unchanged. This study aims to develop a comprehensive understanding of the prognosis of AIS patients based on pre-hospital and in-hospital data.

METHODS

A retrospective study was conducted in Southwest Finland covering the period of 01/01/2022-31/12/2022. The study included a total of 174 AIS patients who were conveyed by the emergency medical services (EMS) to Turku University Hospital (TUH) and given intravenous thrombolysis (IVT) and/or endovascular treatment (EVT). Pre- and in-hospital care records of AIS patients were analyzed to evaluate workflows, time intervals, and the impacts of these time intervals on patient outcome. Binary logistic regression analysis was utilized to identify predictors of on-scene time (OST) and favorable outcome.

RESULTS

The median OST for EMS was 19 minutes. Analysis indicated that the scene of the stroke event being an apartment building, barriers to care such as a locked door, vertigo as a symptom, and EMS taking measurements on-scene were predictive of longer OST. Longer OST was observed to negatively impact patient outcome, along with symptom severity and gender. Using the stroke code as the dispatch code and positive FAST signs were associated with shorter OST. In-hospital median door to needle time (DNT) was 14 minutes in the IVT group and 11 minutes in the IVT+EVT group. EMS prenotification was associated with shorter in-hospital time intervals.

CONCLUSIONS

The presence of vertigo as a symptom poses challenges to identification by EMS. Pre-hospital OST meets national targets, but EMS workflows could be optimized to reduce OST and thereby positively influence patient outcome. These findings underscore the need for targeted interventions in EMS protocols to improve stroke care outcomes.

Fish Oil, Plasma n-3 PUFAs, and Risk of Macro- and Microvascular Complications Among Individuals With Type 2 Diabetes

OBJECTIVE

To evaluate associations of fish oil supplementation and plasma omega 3 polyunsaturated fatty acids (n-3 PUFAs) with risks of macrovascular and microvascular complications among people with type 2 diabetes and to further explore the potential mediating role of metabolism-related biomarkers.

RESEARCH DESIGN AND METHODS

This study included 20 338 participants with type 2 diabetes from the UK Biobank. Diabetic complications were identified through hospital inpatient records.

RESULTS

During 13.2 years of follow-up, 5396 people developed macrovascular complications, and 4868 people developed microvascular complications. After multivariable adjustment, hazard ratios (HRs) and 95% confidence intervals (CIs) for patients with fish oil were 0.90 (0.85, 0.97) for composite macrovascular complications, 0.91 (0.84, 0.98) for coronary heart disease (CHD), 0.72 (0.61, 0.83) for peripheral artery disease and 0.89 (0.83, 0.95) for composite microvascular complications, 0.87 (0.79, 0.95) for diabetic kidney disease, and 0.88 (0.80, 0.97) for diabetic retinopathy. In addition, higher n-3 PUFA levels, especially docosahexaenoic acid (DHA), were associated with lower risks of macrovascular and microvascular complications. Comparing extreme quartiles of plasma DHA, the HRs (95% CIs) were 0.68 (0.57, 0.81) for composite macrovascular complications, 0.63 (0.51, 0.77) for CHD, and 0.59 (0.38, 0.91) for diabetic neuropathy. Moreover, biomarkers including lipid profile and inflammatory markers collectively explained 54.4% and 63.1% of associations of plasma DHA with risks of composite macrovascular complications and CHD.

CONCLUSION

Habitual use of fish oil supplementation and higher plasma n-3 PUFA levels, especially DHA, were associated with lower risks of macrovascular and microvascular complications among individuals with type 2 diabetes, and the favorable associations were partially mediated through improving biomarkers of lipid profile and inflammation.

Tobacco smoking and sarcoidosis revisited - evidence, mechanisms, and clinical implications: a narrative review

Sarcoidosis is a multisystem inflammatory disease with unclear etiology, influenced by genetic predisposition and environmental exposures. Smoking has been widely studied for its potential role in sarcoidosis, with conflicting evidence regarding its impact on disease risk, severity, and treatment response. While some epidemiologic studies suggest that smoking is associated with a lower risk of sarcoidosis, others highlight variations based on geography, ethnicity, and smoking history. Assessing the effects of smoking is particularly challenging because of the complex composition of tobacco smoke, which contains thousands of chemicals with diverse biologic effects. Nicotine, a major component of tobacco, has demonstrated both pro- and anti-inflammatory properties, further complicating its role in sarcoidosis. This narrative review explored the complex relationship between smoking and sarcoidosis by examining smoking's effects on immune modulation, disease presentation and prognosis, and response to immunosuppressive therapy. By summarizing current evidence, this paper aimed to clarify the impact of smoking and nicotine on sarcoidosis and identify key areas for future research, particularly in understanding the mechanisms underlying smoking-related immune modulation and treatment outcomes.

Transitional changes in medication-initiator cohort profiles in persons with chronic kidney disease and type 2 diabetes-A hospital-based cohort study in Japan

AIMS

To describe temporal changes in the characteristics of medication-initiator cohorts in persons with chronic kidney disease (CKD) and type 2 diabetes (T2D).

MATERIALS AND METHODS

Adults with CKD and T2D initiating sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) were identified in the Japan Chronic Kidney Disease Database Extension in each of the two study periods (Period I: 1 January 2014-30 June 2021; Period II: 1 July 2021-31 December 2022). For each cohort, baseline characteristics and the standard mean differences (SMD) between periods I and II were assessed.

RESULTS

During study periods I and II, 1157 and 1122 SGLT-2i, and 329 and 369 GLP-1RA new users were identified, respectively. All four cohorts had similar age, sex and comorbidity patterns, with a mean age spanning 66.1-69.5 years and 60%-70% being male. More than 80% of persons had hypertension and 60% had congestive heart failure. In the SGLT-2i cohorts, we observed a decrease in prior metformin and dipeptidyl peptidase-4 inhibitor use (SMD ≥0.5 and <0.8), and an increase in the number of persons with no T2D medications other than insulin between periods (SMD >0.8). In the GLP-1RA cohorts, there was a medium decrease in persons using insulin.

CONCLUSIONS

With the introduction of new treatments and emerging evidence supporting cardio-renal protective effects in people with CKD and T2D, notable changes in baseline treatment were observed in the medication-initiator cohort characteristics. These findings suggest the earlier use of cardio-renal protective medications in the course of T2D.

Rising global burden of common gynecological diseases in women of childbearing age from 1990 to 2021: an update from the Global Burden of Disease Study 2021

BACKGROUND

Gynecological diseases significantly impact the reproductive health in women of childbearing age (WCBA). However, there is currently a lack of analysis on the specific burden and forecast of common gynecological diseases for this population. The aim of this study was to provide new details for gynecological disorders in WCBA from 1990 to 2021 worldwide based on the Global Burden of Disease (GBD) data.

METHODS

Employing data from the GBD 2021, we analyzed the disability-adjusted life years (DALYs), death, incidence, and prevalence for thirteen types of gynecological disorders by socioeconomic development index (SDI), age, year, and location in WCBA. Age-standardized rates were used to compare the burdens across various time periods and locations. Temporal trends were assessed using Joinpoint regression analysis from 1990 to 2021, the Bayesian age-period-cohort (BAPC) model projected the disease burden through 2031, and the Nordpred model conducted a sensitivity analysis of the prediction results, which validated the findings' reliability.

RESULTS

From 1990 to 2021, the age-standardized DALYs rate (ASDR) and mortality rate (ASMR) of combined gynecological diseases (CGDs) increased by AAPC of 0.28% (95% CI 0.19 to 0.36) and 0.53% (95% CI 0.25 to 0.82) among WCBA. Furthermore, the projections showed a declining trend in the next decade, with ASDR and ASMR dropping by 11.06% and 25.23%, respectively. Notably, HIV/AIDS, polycystic ovary syndrome (PCOS), infertility, premenstrual syndrome (PMS) were the key drivers behind the increased ASDR of CGDs. In 2021, HIV/AIDS (16.38 million), PMS (7.43 million), and cervical cancer (4.18 million) topped the list for the absolute number of DALYs globally among WCBA. CGDs burdens were negatively correlated with and SDI. Women aged 15-24 years showed the most significant rise in CGDs burdens, highlighting its increasingly affecting younger women. The DALYs and death of malignant gynecological tumors are most significant in women aged 40-49 years, the incidence of PCOS predominantly occurs in 15-19 years, and infertility prevalence peaks at 30-39 years.

CONCLUSIONS

The global CGDs burden has increased over the last 32 years, and higher in lower SDI countries. Immediate and effective interventions should be taken to target different types of gynecological disorders, age groups, and countries with high gynecological disease burdens. These findings would provide targeted insights for public health policies and interventions enhancing reproductive health in women of childbearing age.

Progressing towards the 2030 health-related SDGs in ASEAN: A systematic analysis

BACKGROUND

The Sustainable Development Goals (SDGs) articulate an ambitious global agenda and set of targets to achieve by 2030. Among the health-related SDGs, many formidable challenges remain in settings like the Association of Southeast Asian Nations (ASEAN) which face wide-ranging social, economic and health inequalities. In advance of the 2030 horizon, charting the trajectory of the health SDGs is critical for informing policy and programmatic course corrections to advance health and well-being among ASEAN's 10 member countries with its 667 million people.

METHODS AND FINDINGS

We used estimates from the Global Burden of Disease (GBD) Study 2021 and surveillance data to identify 27 health-related SDG indicators. The indicators were classified into 7 thematic areas: (i) nutrition, (ii) maternal, child and reproductive health (MCH), (iii) infectious diseases, (iv) non-communicable diseases (NCDs), (v) environmental health, (vi) universal health coverage (UHC), and (vii) road injuries. We developed an attainment index ranging from 0 to 100 for each SDG indicator by referencing the SDG targets and projected their progress to 2030. We find an overall positive progress towards the health-related SDG targets in ASEAN from 1990 to 2030. At the aggregate level by 2030, 2 member countries, Singapore and Brunei, are projected to achieve their targets (attainment score ≥ 90). At a wider regional level, ASEAN is projected to make substantial progress in nutrition, MCH, and UHC, with a majority of countries projected to come close to or achieve their targets. However, progress is projected to be slower in the areas of reducing the incidence of infectious disease (i.e., HIV and AIDs, hepatitis B, TB, and neglected tropical diseases), NCD-related mortality and its risk factors (i.e., harmful alcohol use and smoking), environment-related mortality and its risk factors (i.e., unsafe water and poor hygiene, and air pollution), and road injuries. Substantial disparities are identified in the region, with Singapore, Brunei, Malaysia and Thailand generally performing better than elsewhere. A limitation of our study was its reliance on historical trends which may not fully capture future political, social, or technological changes.

CONCLUSIONS

As a regional bloc, ASEAN faces persistent challenges in achieving health-related SDG targets by 2030, with unequal progress between countries. Moreover, epidemiological transitions and worsening environmental threats further compound potential gains. At the country level, efforts to enhance health system financing, quality and equity will need to be coupled with wider approaches that address structural drivers of disease. Furthermore, coordinated regional efforts will be essential to effectively respond to emerging threats posed by pollution and environmental risks.

The novel antigen, lipopolysaccharide export protein LptH, protects mice against Pseudomonas aeruginosa acute pneumonia in monovalent and multivalent vaccines

Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that is a leading cause of morbidity and mortality worldwide in susceptible patients, particularly in those with respiratory disorders. The rising prevalence of multidrug-resistant strains and the failure of previous P. aeruginosa vaccine candidates in clinical trials highlight the urgent need to investigate novel vaccine antigens. In this study, we evaluated the protective potential of two antigen candidates, LptH and OprM, previously identified based on their involvement in host-cell attachment in a murine acute pneumonia model. Recombinant Escherichia coli BL21 clones overexpressing these proteins showed 8.8- and 3.5-fold increased attachment to 16HBE14o- cells in vitro, confirming their role in host-cell attachment. Immunisation with rLptH significantly reduced bacterial burden in the lungs by 1.12 log10 CFU and improved animal welfare scores compared to adjuvant-only controls. Serological and immunophenotyping analyses revealed that the monovalent rLptH vaccine stimulated antigen-specific IgG1 and IgG2c isotype production, and enhanced IFN-γ and IL-17 recall responses in the spleen. Moreover, a trivalent vaccine comprising rLptH and two other P. aeruginosa antigens, rFtsZ, and rOpmH, achieved a 2.33 log10 CFU reduction in lung bacterial burden, and 1.85 log10 CFU reduction in dissemination. These encouraging findings support the potential of LptH as a promising antigen for the development of a protective multivalent vaccine against P. aeruginosa infections.

Randomized controlled trials on physical activity, diet, or both for public health through body weight management in 5- to 10-year-old pupils: a systematic review and meta-analysis

Improving the quality of the most basic health behavior among youth may contribute to short-term body composition management with long-term implications for noncommunicable disease regression. This investigation aimed to assess the impact of primary school physical activity (PA), dietary, or dual approach interventions on pupils' body weight (BW) and body mass index (BMI). A systematic review and meta-analysis was completed following a study protocol and a trial registration (PROSPERO: CRD4202347770) with the PRISMA approach. Publications in English or German were included with school-based randomized controlled trials on diet and/or PA. Pupils of primary schools (aged 5-10) with no major nutritional deficiency or unstable health condition were included. The Boolean search strategy revealed a total of 9479 articles, qualifying 39 studies with 20 462 pupils (including 10 211 girls and 10 251 boys) for quantitative synthesis. The interventions were mostly PA (n = 31), several were dietary (n = 6), and some were dual approach (n = 5). Random effects meta-analyses revealed PA intervention (n = 20) to have an effect size of +0.07 kg (95% CI: -0.01 to 0.15) and -0.12 kg/m2 (95% CI: -0.23 to -0.01). Low statistical heterogeneity was found for BW (I2 = 0%; P = 1.000) and BMI (I2 = 0%; P = .9688), respectively. The findings indicate a scarcity of top-quality scientific research performed on healthy diet for body weight management in primary schools. PA intervention for elementary school pupils provides support for a healthier body composition profile amidst the current world health crisis.

CIWARS: a web server for antibiotic resistance surveillance using longitudinal metagenomic data

The rise of antibiotic resistance (AR) poses a substantial threat to human and animal health, food security, and economic stability. Wastewater-based surveillance (WBS) has emerged as a powerful strategy for population-level AR monitoring, providing valuable data to guide public health and policy decisions. Metagenomic sequencing is especially promising, as it can yield comprehensive profiles of antibiotic resistance genes (ARGs) and other genes relevant to AR in a single run. However, online analytical platforms to facilitate analysis of longitudinal metagenomic data are lacking. To address this, we introduce CyberInfrastructure for Waterborne Antibiotic Resistance Surveillance (CIWARS), a web server configured for characterizing key AR trends from longitudinal metagenomic WBS data. CIWARS offers comprehensive profiling of ARGs and taxonomic profiling of pathogen-associated bacterial taxonomic groups, identifies potential associations of ARGs with mobile genetic elements (MGEs) and pathogen-containing taxa, and assesses resistome risk based on the co-occurrence of ARGs, MGEs, and pathogen-like sequences. Additionally, it detects anomalous AR indicators over time, aiding in identifying potential events of concern, such as the emergence of resistant strains or outbreaks. Through interactive temporal data visualization, CIWARS enables AR monitoring and can serve as a tool to inform effective and timely interventions to mitigate the spread and transmission of AR. Here, CIWARS is demonstrated using longitudinal metagenomic data from a wastewater treatment plant (WWTP) influent and effluent, but it can be extended to any environment. CIWARS provides a valuable tool to support global efforts to combat the evolution and spread of AR, while also guiding agricultural and public health efforts aimed at optimizing antibiotic use. The web server is freely available at https://ciwars.cs.vt.edu/.

Modelling transmission thresholds and hypoendemic stability for onchocerciasis elimination

The World Health Organization (WHO) has proposed elimination of onchocerciasis transmission (EOT) in a third of endemic countries by 2030. This requires country-wide verification of EOT. Prior to the shift from morbidity control to EOT, interventions in Africa were mostly targeted at moderate- to high-transmission settings, where morbidity was most severe. Consequently, there remain numerous low transmission (hypoendemic) settings which have hitherto not received mass drug administration (MDA) with ivermectin. The WHO has prioritised the delineation of hypoendemic settings to ascertain treatment needs. However, the stability of transmission at such low levels remains poorly understood. We use the stochastic EPIONCHO-IBM transmission model to characterise the stability of transmission dynamics in hypoendemic settings and identify a range of threshold biting rates (TBRs, the annual vector biting rates below which transmission cannot be sustained). We show how TBRs are dependent on population size, inter-individual exposure heterogeneity and simulation time. In contrast with deterministic expectations, there is no fixed TBR; instead, transmission can persist between 70 and 300 bites/person/year. Using survivorship models on data generated from model simulations, we find that multiple vector biting rates can sustain hypoendemic prevalence for several decades. These findings challenge the assumption that hypoendemic foci would naturally fade out following treatment in nearby higher-endemicity regions. Our modelling suggests that, to achieve EOT, treatment should be extended to all areas where endogenous infection is identified, emphasising the need for improved diagnostic tools suitable for detecting low-prevalence infection and for strategies that allow safe treatment of communities where MDA would not be suitable.

Nano-Infrared Detection and Identification of Bacteria at the Single-Cell Level

Every year, bacterial infections are responsible for over 7 million deaths globally. Timely detection and identification of these pathogens enable timely administration of antimicrobial agents, which can save thousands of lives. Most of the currently known approaches that can address these needs are time- and labor consuming. In this study, we examine the potential of innovative nano-infrared spectroscopy, also known as atomic force microscopy infrared (AFM-IR) spectroscopy, and machine learning in the identification of different bacteria. We demonstrate that a single bacteria cell is sufficient to identify Borreliella burgdorferi, Escherichia coli, Mycobacterium smegmatis, and two strains of Acinetobacter baumannii with 100% accuracy. The identification is based on the vibrational bands that originate from the components of the cell wall as well as the interior biomolecules of the bacterial cell. These results indicate that nano-IR spectroscopy can be used for the nondestructive, confirmatory, and label-free identification of pathogenic microorganisms at the single-cell level.

Identification and validation of SLC16A8 as a prognostic biomarker in clear cell renal cell carcinoma: a six-gene solute carrier signature

Solute carrier (SLC) proteins are essential for nutrient transport, influencing tumor metabolism and growth while preserving cellular homeostasis. Despite the critical biological functions of these transporters, their applicability as therapeutic targets in clear cell renal cell carcinoma (ccRCC) remains largely unexplored. In the current study, we analyzed transcriptomic data and discovered 77 differentially expressed SLC genes in ccRCC, with 24 demonstrating predictive potential. Using Lasso regression, we developed a prognostic signature comprising six key genes: SLC2A3, SLC11A1, SLC14A1, SLC16A8, SLC22A6, and SLC28A1. This signature demonstrated strong diagnostic performance and served as an independent predictor of patient survival. Further analysis integrating clinical variables and risk scores enabled the construction of nomograms, which exhibited high predictive accuracy for patient outcomes. Immune profiling revealed distinct infiltration patterns between risk groups: high-risk patients showed elevated levels of memory B cells, activated CD4+ T cells, regulatory T cells (Tregs), M0 macrophages, and neutrophils. In contrast, their low-risk counterparts showed M1 macrophages, resting dendritic cells, and resting mast cells. Validation experiments confirmed that SLC16A8 was significantly overexpressed in ccRCC tissues compared to normal samples, correlating with poor prognosis. Functional studies demonstrated that SLC16A8 knockdown impaired tumor progression in vitro. Consistent with these findings, in vivo experiments demonstrated reduced tumor growth upon SLC16A8 knockdown. Mechanistically, decreased SLC16A8 attenuated PI3K/AKT signaling, suggesting a potential regulatory pathway in ccRCC progression. In summary, we established a six-gene SLC signature with significant prognostic value in ccRCC. Among these genes, SLC16A8 emerged as a promising biomarker and therapeutic target, warranting further investigation.

Dilemmas in Secondary Stroke Prevention

Secondary stroke prevention encompasses many approaches, including antithrombotic therapy, risk factor management, and a healthy lifestyle. Recommendations are typically based on the results of randomized clinical trials that provide evidence of benefit. However, in some situations, clinicians extrapolate the results of clinical trials into everyday practice, or trials have not provided sufficient information to make treatment decisions. This review will discuss 4 scenarios: dual-antiplatelet therapy, the perils of combining antiplatelet and anticoagulation, indications for statin therapy, and therapeutic considerations for patients with paroxysmal atrial fibrillation.

Disparities in residential PM2.5 and disease burden across urban and peri-urban: A 2018-2019 multicenter on-site survey in China

Residential fine particulate matter (PM2.5) poses a substantial health hazard, yet disparities across urban and peri-urban areas remain unclear in China due to the absence of systematic monitoring data. Key knowledge gaps persist regarding the characteristics, influencing factors, and health burdens of residential PM2.5 pollution, particularly in peri-urban regions. Between 2018 and 2019, 746 urban and 339 peri-urban households in 15 typical Chinese cities were randomly selected through the Chinese Indoor Environment and Health Surveillance Project (CIEHS). The relationships between influencing factors and residential PM2.5 were assessed using a general linear model (GLM), and factors importance was identified using the Boruta algorithm with 10-fold cross-validation and 100 replications. Disability-adjusted life-years (DALYs) attributable to the residential PM2.5 were estimated using the population-attributable fraction method. The mean residential PM2.5 concentration was 62.2 μg/m3, with higher levels in peri-urban (Odds ratio [OR] = 1.0705 95 % Confidence interval [95 % CI]: 1.0615, 1.0795) and during cold seasons (OR = 1.3499 95 %CI: 1.3388, 1.3610). Environmental factors, building conditions, family-related information, and lifestyle behaviors were all associated with residential PM2.5, notably, with the five most influential factors remaining consistent across urban and peri-urban areas. The mean DALY rate was 2160 per 100,000 in urban areas, slightly higher at 2186 per 100,000 in peri-urban areas. According to China's seventh national census, residential PM2.5 exposure accounted for 19.48 million urban and 11.14 million peri-urban DALYs nationally. These findings underscore the urgency for differentiated environmental management and targeted mitigation policies to address the disproportionate health burden in peri-urban areas.

Bioinspired Membrane-Based Cancer Vaccines for Immunotherapy: Progress and Perspectives

Cancer vaccines hold promise for tumor immunotherapy, with their success hinging on effective systems to boost anti-tumor immunity. Biological membranes are not only a delivery vehicle but also a source of antigens and adjuvants, garnering growing interest in vaccine research. This review starts with an introduction to the composition and mechanisms of cancer vaccines and describes the sources, advantages/disadvantages, engineering strategies, and applications of these membrane-based platforms for cancer vaccine development. This review also offers a critical analysis and discusses the further direction of the vaccine platform in view of clinical translation for tumor immunotherapy.

Anemia in Asian children: trends in the prevalence, etiology and analysis of geographic inequalities

BACKGROUND

Pediatric anemia is a pervasive public health issue in Asia, significantly impairing children's growth, cognitive development, and future potential. This study evaluates trends, prevalence, and socio-economic disparities of pediatric anemia across Asia from 1990 to 2021, leveraging data from the Global Burden of Disease Study (GBD) 2021 study.

METHODS

Using estimated annual percentage change (EAPC) and Pearson's correlation coefficient, geographic variations and temporal trends were analysed alongside associations between prevalence, years lived with disability (YLDs), and Socio-demographic index (SDI).

RESULTS

The study reveals a modest overall decline in anemia prevalence by 11.9%, from 464.53 million cases in 1990 to 409.07 million in 2021. High-SDI regions such as East Asia achieved significant reductions (- 71.36%), with countries like Singapore, the Republic of Korea, Seychelles, Qatar, and the United Arab Emirates (UAE) showing substantial progress. In stark contrast, low-SDI countries, including Yemen (108.34%) and Afghanistan (130.28%), along with Cambodia, India, and Pakistan, experienced alarming increases. Dietary iron deficiency was the dominant cause, followed by hemoglobinopathies and neglected tropical diseases. Females, particularly adolescents, and children under five faced disproportionate burdens, with prevalence rates in low-SDI regions exceeding 47,000 per 100,000 compared to < 10,000 per 100,000 in high-SDI areas.

CONCLUSIONS

These findings emphasize profound regional and socio-economic inequalities in anemia burden. Urgent, evidence-based interventions are imperative, focusing on enhancing nutrition, expanding healthcare access, and integrating sex-sensitive strategies to address this multifaceted issue. Strengthened policies and targeted actions are critical to mitigating the burden and fostering health equity, particularly in vulnerable low-SDI regions.

A SpA+LukAB vaccine targeting Staphylococcus aureus evasion factors restricts infection in two minipig infection models

Staphylococcus aureus is a major cause of bacterial infection-related deaths. Increasing antimicrobial resistance highlights the urgent need for effective preventative strategies. Antibody-mediated opsonophagocytosis, the key mechanism for protection against S. aureus, is disabled by critical virulence factors such as Staphylococcal protein A (SpA) and leukocidin AB (LukAB). In our study, we combined genetically detoxified vaccine candidates SpA* and LukAB RARPR-33 with a TH1 adjuvant aiming to restore host antibody functionality. To evaluate these vaccine candidates, we developed both surgical site infection (SSI) and superficial wound infection (SWI) models in minipigs. Our results showed a significant reduction in bacterial load and systemic dissemination in the SSI model, while skin infection severity was markedly decreased after intradermal immunization in the SWI model. This study introduces a novel S. aureus vaccine strategy by targeting immune evasion factors SpA and LukAB, utilizing potent TH1 adjuvants, and employing minipig challenge models.

The lack of a biorepository during vaccine trials: A lost opportunity to understand staphylococcal immunity

Development of a vaccine against Staphylococcus aureus has proven to be difficult, in no small measure due to our lack of understanding of the human immune response to this pathogen. Because the human immune response is distinct from other species often used for pre-clinical animal models, including non-human primates, it will be necessary to perform studies in humans to guide vaccine development. One can view the staphylococcal vaccine clinical trials as an opportunity to study human immune response to S. aureus infections, which of course provide outcome data. In order to gain maximal information from these clinical trials, biological materials should be taken during the trial. In this commentary article, we explore a mechanism for such collection.

METTL3-mediated m6A modification in sepsis: current evidence and future perspectives

Sepsis, a severe systemic inflammatory condition triggered by infection, is associated with high morbidity and mortality worldwide. While medical diagnosis and treatment have advanced in recent years, a specific therapy remains unavailable. Recently, significant progress has been made in studying the epigenetic RNA modification N6-methyladenosine (m6A) and its core methyltransferase METTL3. The role of m6A in sepsis has also been increasingly elucidated. This review aims to explore the pathological mechanisms of sepsis and its relationship with m6A, focusing on the role of the key m6A writer, METTL3, in sepsis.

Association of ApoB/apoA1 ratio with stenosis of intracranial and extracranial arteries in patients with ischaemic stroke

Despite the well-established association between the apolipoprotein B/apolipoprotein A1 (apoB/apoA1) ratio and ischemic stroke, its specific relationship with the underlying vascular pathologies contributing to stroke remains poorly understood. This study aims to investigate the association between the apoB/apoA1 ratio and intracranial or extracranial atherosclerosis. We enrolled 408 patients with acute ischemic stroke who had never been treated with statins or fibrates. Based on the images from computed tomography angiography (CTA), the patients were categorized into four groups: intracranial atherosclerosis stenosis (ICAS, n = 136), extracranial carotid atherosclerosis stenosis (ECAS, n = 45), combined intracranial and extracranial atherosclerosis stenosis (COAS, n = 73), and non-cerebral atherosclerosis stenosis (NCAS, n = 154). Demographic characteristics, clinical factors, and serum lipid levels were collected and then compared across groups. The apoB/apoA1 ratio was significantly higher in patients with ICAS, ECAS and COAS compared to those in the NCAS group. Multivariable logistic regression analysis demonstrated that the ApoB/ApoA1 ratio was independently associated with ICAS, but not with ECAS. ROC curve analysis showed that the ApoB/ApoA1 ratio had a good diagnostic ability for ICAS, with an area under the curve (AUC) of 0.764, an optimal cut-off value of 0.8122, a sensitivity of 81.3%, and a specificity of 59.8%. An higher apoB/apoA1 ratio is associated with ICAS in ischemic stroke patients.

An Updated Systematic Review on Asthma Exacerbation Risk Prediction Models Between 2017 and 2023: Risk of Bias and Applicability

Background

Accurate risk prediction of exacerbations in asthma patients promotes personalized asthma management.

Objective

This systematic review aimed to provide an update and critically appraise the quality and usability of asthma exacerbation prediction models which were developed since 2017.

Methods

In the Embase and PubMed databases, we performed a systematic search for studies published in English between May 2017 and August 2023, and identified peer-reviewed publications regarding the development of prognostic prediction models for the risk of asthma exacerbations in adult patients with asthma. We then applied the Prediction Risk of Bias Assessment tool (PROBAST) to assess the risk of bias and applicability of the included models.

Results

Of 415 studies screened, 10 met eligibility criteria, comprising 41 prediction models. Among them, 7 (70%) studies used real-world data (RWD) and 3 (30%) were based on trial data to derive the models, 7 (70%) studies applied machine learning algorithms, and 2 (20%) studies included biomarkers like blood eosinophil count and fractional exhaled nitric oxide in the model. PROBAST indicated a generally high risk of bias (80%) in these models, which mainly originated from the sample selection ("Participant" domain, 6 studies) and statistical analysis ("Analysis" domain, 7 studies). Meanwhile, 5 (50%) studies were rated as having a high concern in applicability due to model complexity.

Conclusion

Despite the use of big health data and advanced ML, asthma risk prediction models from 2017-2023 had high risk of bias and limited practical use. Future efforts should enhance generalizability and practicality for real-world implementation.

Biliverdin alleviates cerebral ischemia-reperfusion injury by regulating the P4hb/MAPK/mTOR pathway to inhibit autophagy

BACKGROUND

Biliverdin (BV) exhibits anti-inflammatory and antioxidative effects. Autophagy activation is crucial in the pathogenesis of cerebral ischemia-reperfusion injury (CIRI). This study aimed to investigate whether BV could ameliorate CIRI by regulating autophagy.

METHODS

A middle cerebral artery occlusion-reperfusion (MCAO/R) model in Sprague-Dawley (SD) rats and an oxygen-glucose deprivation/reoxygenation (OGD/R) model in PC12 cells were employed to explore the neuroprotective effects of BV and its underlying mechanisms. In these rats, once BV was administered post-MCAO/R, its treatment efficacy and underlying mechanisms were evaluated through behavioral, morphological, and molecular analyses. Alternatively, for PC12 cells, following successful OGD/R modeling, BV, autophagy activator rapamycin, prolyl 4-hydroxylase beta (P4hb) knockdown or overexpression, and the specific inhibitors of three classic autophagy pathways were applied. Cell viability (using CCK8 assay), Calcein/PI staining, autophagosome staining (using MDC assay), reverse transcription quantitative polymerase chain reaction, and western blot were subsequently carried out to investigate the mechanisms by which BV ameliorates CIRI.

RESULTS

BV alleviated CIRI by inhibiting autophagy. Further investigation suggested that BV downregulated P4hb expression. In vitro experiments showed that P4hb knockdown reduced autophagy in post-CIRI cells, while its overexpression reversed the effects of BV. Rescue experiments indicated that MAPK pathway inhibitors counteracted the effects of P4hb overexpression on autophagy post-CIRI.

CONCLUSION

BV improves CIRI by regulating the P4hb/MAPK/mTOR signaling pathway to inhibit autophagy, offering a novel therapeutic strategy for ischemic stroke.

Global burden trends and forecasts for MAFLD in adolescents and young adults from 1990 to 2021

Metabolic-dysfunction associated fatty liver disease (MAFLD) is a widespread chronic liver condition that has been steadily increasing among adolescents and young adults in recent years, posing a major global public health concern. This study aims to conduct an in-depth analysis of the Global Burden of Disease (GBD) 2021 data on MAFLD, focusing on prevalence, incidence, and disability-adjusted life years (DALY) for individuals aged 15-39, spanning the period from 1990 to 2021. This research examines data from the GBD study covering 1990 to 2021 to assess the prevalence, incidence, and DALYs associated with of MAFLD in adolescents and young adults aged 15-39. The analysis is broken down by socioeconomic status, geographic regions, and specific countries. Advanced statistical methods, including the estimated annual percentage change (EAPC) and Bayesian age-period-cohort (BAPC) modeling, were used to deliver the most current and thorough epidemiological assessment of MAFLD in this demographic. In 2021, the estimated global cases of non-alcoholic fatty liver disease among adolescents and young adults reached approximately 423 million, representing a 75.31% increase from 1990. The age-standardized prevalence rate (ASPR) was 14,221.32 cases per 100,000 population, and the age-standardized incidence rate (ASIR) was 977.61 cases per 100,000 population in 2021. Between 1990 and 2021, the ASPR, ASIR, age-standardized DALY rate, and age-standardized mortality rate showed a continuous upward trend, with EAPC of 0.84, 0.79, 0.65, and 0.81, respectively. Regions with Middle and Low-middle Socio-Demographic Index (SDI), as well as High-middle SDI, emerged as "hotspots" for MAFLD prevalence, particularly in North Africa, the Middle East, East Asia, and South Asia. Males exhibited higher prevalence rates compared to females, and the rates continued to increase across all adolescents and young adult age groups. By 2050, the ASPR for MAFLD among this population is projected to reach 16,101 cases per 100,000, signaling an alarming trend. Over the last 30 years, the burden of metabolic-dysfunction associated fatty liver disease has significantly increased among adolescents and young adults worldwide. To counter this rising global health concern, it is crucial to develop and implement targeted and effective interventions tailored to socio-economic settings.

Improving Care for People with Chronic Respiratory Diseases: Taking a Policy Lens

Chronic respiratory diseases (CRDs) affect almost 470 million people worldwide, and this number is growing. CRDs take a significant toll on the capacity of health systems and economies, and their effect on people's lives can be devastating. Despite high rates of prevalence and mortality, CRDs are underprioritised by policymakers and governments. Tackling these conditions will require a holistic, multisectoral approach, including government-led strategies for prevention, diagnosis, management and investment in research. In this article, we provide a clear rationale for prioritising CRDs to advance population health. Proactive steps in countries of all income levels must be taken promptly to limit the growing prevalence and impact of CRDs both now and in the future.

Cancer screening and its associated factors in hypertensive individuals: new insights from the 2021 STEPs national study in Iran

BACKGROUND

Cancer continues to be a major cause of death worldwide with almost 10 million deaths from cancer each year and a significant financial burden on healthcare systems. Hypertension can increase the risk of developing certain cancers and their complications, necessitating higher screening rates in the hypertensive population. Although screening for cancer can reduce mortality rates and help with early diagnosis, the screening rates in Iran are far below the optimal level. This study aimed to identify factors associated with cancer screening participation among hypertensive individuals.

METHODS

We utilized data from the STEPs 2021 survey, a large-scale nation-wide cross-sectional study conducted in Iran to assess non-communicable disease (NCD) risk factors. The survey followed the WHO's STEPwise approach and included adults aged 18 and older from both urban and rural areas of 31 provinces of Iran. The effect of each covariate on different types of cancer screening was determined using odds ratios (ORs) which were estimated using univariate and multivariate logistic regression models.

RESULTS

We found that screening rates were significantly influenced by age, marital status, employment, wealth, and residential area. Middle-aged women were more likely to participate in breast and cervical cancer screenings, whereas prostate cancer screening was more common among men aged 70 and older. Furthermore, awareness and control of hypertension, a history of cancer, comorbid chronic diseases, and receiving lifestyle advice were all associated with increased screening participation. Lifestyle scores, BMI, education level, and insurance coverage were all linked to higher screening rates for most cancer types.

CONCLUSION

Despite these findings, cancer screening rates in Iran remain alarmingly low, particularly among high-risk groups such as hypertensive individuals. Urgent reforms and targeted strategies are required to increase screening uptake and enhance early detection efforts in populations at risk.