Are We Stepping Back? Findings From an Italian Study on Post-Pandemic Changes in Nursing Education

AIM

To describe (a) recommended changes implemented and their perceived effectiveness at the country level, (b) changes discontinued in the post-pandemic era with reasons, and (c) research priorities in nursing education for the next five years.

BACKGROUND/INTRODUCTION

The COVID-19 pandemic has pushed several nursing education transformations. However, no studies have documented changes still prevalent in the post-pandemic era.

DESIGN

A national cross-sectional study following the STROBE guidelines.

METHODS

All Italian nursing programs (n = 241) were targeted. Eight major and 21 subrecommendations indicating changes expected were included in the online survey to measure their implementation, their perceived effectiveness and status at the time of the survey, discontinuation reasons, and the research priorities. Descriptive and content analyses were used.

RESULTS

113 (45.5%) nursing programs participated reflecting the education received by >70% of Italian nursing students. All recommended changes have been implemented from 60.2% to 100% nursing programs, resulting in a perceived effectiveness from 4.29 (confidence interval [CI] 95%, 4.07-4.51) to 6.37 (CI 95%, 6.19-6.56) out of 7. A few recommendations were still applied at the time of the survey, while several were discontinued (from 4.8% to 61.9%) because, in order, of concern regarding their effectiveness, university/law dispositions, traditional methods reimplemented, technical/logistic difficulties and students' requests. Digital solutions' impact on nursing education was identified as a research priority.

CONCLUSION

After the multifaced changes triggered by the pandemic, the pace of transformation of nursing education seems to have been decelerated.

IMPLICATIONS FOR NURSING

The potential regressive pattern that has emerged, wherein the previous model of nursing education is repristinated, calls for immediate action, which is also in line with the research priorities.

Using Genomics to Develop Personalized Cardiovascular Treatments

Advances in genomic technologies have significantly enhanced our understanding of both monogenic and polygenic etiologies of cardiovascular disease. In this review, we explore how the utilization of genomic information is bringing personalized medicine approaches to the forefront of cardiovascular disease management. We describe how genomic data can resolve diagnostic uncertainty, support cascade screening, and inform treatment strategies. We discuss how genome-wide association studies have identified thousands of genetic variants associated with polygenic cardiovascular diseases, and how integrating these insights into polygenic risk scores can enhance personalized risk prediction beyond traditional clinical algorithms. We detail how pharmacogenomics approaches leverage genotype information to guide drug selection and mitigate adverse events. Finally, we present the paradigm-shifting approach of gene therapy, which holds the promise of being a curative intervention for cardiovascular conditions.

Milk-derived exosomes as functional nanocarriers in wound healing: Mechanisms, applications, and future directions

Wound healing presents a significant challenge in healthcare, imposing substantial physiological and economic burdens. While traditional treatments and stem cell therapies have shown benefits, milk-derived exosomes (MDEs) offer distinct advantages as a cell-free therapeutic approach. MDEs, isolated from mammalian milk, are characterized by their biocompatibility, ease of acquisition, and high yield, making them a promising tool for enhancing wound repair. This review provides a comprehensive analysis of the composition, sources, and extraction methods of MDEs, with a focus on their therapeutic role in both acute and diabetic chronic wounds. MDEs facilitate wound healing through the delivery of bioactive molecules, modulating key processes such as inflammation, angiogenesis, and collagen synthesis. Their ability to regulate complex wound-healing pathways underscores their potential for widespread clinical application. This review highlights the importance of MDEs in advancing wound management and proposes strategies to optimize their use in regenerative medicine.

Yoga in Obesity Management: Reducing cardiovascular risk and enhancing well-being- A review of the current literature

BACKGROUND

Obesity, a global epidemic, significantly increases cardiovascular disease (CVD) risk. Conventional treatments often lack long-term efficacy, emphasizing the need for integrative, sustainable approaches.

OBJECTIVE

This review assesses the role of yoga as a complementary intervention in obesity management and its effectiveness in reducing cardiovascular risk.

METHODS

We systematically reviewed literature up to March 2024 from Medline/PubMed, Scopus, Embase and the Cochrane Central Library. The focus was on randomized controlled trials (RCTs), observational studies, systematic reviews and meta-analyses evaluating the impact of yoga on obesity-related outcomes and cardiovascular risk factors. Studies were reviewed for quality, outcomes, and both physiological and psychological effects of yoga on obese individuals.

RESULTS

Yoga interventions consistently yielded positive results in reducing body mass index (BMI), waist circumference, and body fat. These physical changes correlate with significant improvements in cardiovascular markers, including blood-pressure, cholesterol levels, endothelial and autonomic functions. Yoga also enhances stress management and psychological well-being, addressing both mental and physical facets of obesity. The benefits extend beyond mere weight reduction, affecting systemic inflammation and metabolic health, crucial for mitigating CVD risks.

CONCLUSION

Yoga represents a promising, non-pharmacological approach to obesity management and CVD risk reduction. Its holistic impact on physical and psychological health makes it a viable adjunct therapy in comprehensive obesity management, fostering sustainable lifestyle changes and long-term health benefits.

IMPLICATIONS

Incorporating yoga into standard obesity management protocols could enhance therapeutic outcomes. Future research should standardize yoga interventions to better integrate them into modern healthcare and explore their long-term cardiovascular effects.

Assessment of immune function in individuals without and with obesity and normoglycemia, glucose intolerance, or type 2 diabetes: primary findings of the NutrIMM study, a single-arm controlled feeding trial

BACKGROUND

Obesity and type 2 diabetes (T2D) are associated with immune dysfunction, increasing infection susceptibility and impairing immune responses. However, the independent effects of obesity and hyperglycemia on immune dysregulation remain unclear, particularly under controlled dietary conditions.

OBJECTIVES

The Nutrition and Immunity study investigated the effects of obesity and hyperglycemia on immune cell function, phenotype, and systemic inflammation in individuals with obesity with or without T2D, compared with lean individuals with normoglycemia.

METHODS

This single-arm controlled feeding trial included 112 participants across 4 groups: lean-normoglycemic (Lean-NG), obese-normoglycemic (OB-NG), obese-glucose intolerant (OB-GI), and obese-T2D. Participants followed a standardized isocaloric North American diet for 4 wk. Blood samples were collected at baseline and week 4. One-way and repeated measures analysis of variance assessed group differences and/or dietary effects. Linear regression analyses examined associations between glucose control and immune function.

RESULTS

C-reactive protein levels were higher in the OB-NG group [mean difference (MD): 4.1 mg/L; 95% confidence interval (CI): 1.7, 6.6], OB-GI group (MD: 3.1 mg/L; 95% CI: 0.82, 5.4), and OB-T2D (MD: 2.7 mg/L; 95% CI: 0.3, 5.1) compared with Lean-NG, whereas interleukin (IL)-2 secretion was lower in OB-T2D group (MD: -2086.4 pg/mL; 95% CI: -4375.9, -37.4). OB-T2D also exhibited higher neutrophils (MD: 0.7%; 95% CI: 0.01, 0.12), Systemic Immune-Inflammation Index (MD: 155.3; 95% CI: 0.90, 309.7), and system inflammation response index (MD: 0.58, 95% CI: 0.20, 0.97) compared with Lean-NG, and a lower proportion of naïve CD8+ T cells than OB-NG (MD: -13.7%; 95% CI: -27.3, -0.14). Regression analysis showed an association between hyperglycemia and reduced immune function, particularly for IL-2 (β = -0.296, P = 0.037) and interferon-gamma secretion (β = -0.325, P = 0.017).

CONCLUSIONS

Immune function is compromised in obesity and worsens in T2D, suggesting both obesity and poor glucose control drive immune dysfunction. Addressing metabolic health may help mitigate immune dysfunction and inflammation in obesity-related conditions.

TRIAL REGISTRATION NUMBER

This trial was registered at clinicaltrials.gov as NCT04291391 (https://www.

CLINICALTRIALS

gov/study/NCT04291391?term=NCT04291391&rank=1).

Trends in the incidence and burden of otitis media in children: a global analysis from 1990 to 2021

BACKGROUND

Otitis media (OM) is a prevalent and serious condition in childhood, but comprehensive global studies assessing its burden are lacking.

METHODS

Using data from the 2021 Global Burden of Disease (GBD) study, we analyzed OM incidence cases and disability-adjusted life years (DALYs) in children aged 0-14 from 1990 to 2021. Trends were analyzed across regions, age groups, sexes, and socio-demographic index (SDI) using estimated annual percentage changes (EAPC). Predictive models were used to forecast trends to 2050.

RESULTS

The global number of OM incidence cases in children increased from 256 million in 1990 to 297 million in 2021, a 15.97% rise. The age-standardized incidence rate (ASIR) showed a slight increase (EAPC: 0.12). Despite some variations across age, sex, and regions, the age-standardized DALY rate (ASDR) declined. ASIR and ASDR were highest in children aged < 1 year and gradually decreased with age. The largest burden was observed in low- and middle-low-SDI regions, although these regions showed the greatest declines in EAPC. Correlation analysis indicated that ASDR decreases as the SDI increases. By 2050, the number of global OM incidence cases in children is projected to reach 334 million, with most of the increase concentrated in low-SDI regions, while ASIR is expected to remain stable.

CONCLUSION

Although progress has been made in controlling OM in children over the past 30 years, the ASIR remains high. The sustained high burden and incidence of OM in low-SDI regions, and among young children, pose a significant challenge to children's health.

The changes in global burden of autoimmune diseases two years after the COVID-19 pandemic: a trend analysis based on the Global Burden of Disease Study 2021

Background

Data on the epidemiological changes in the global burden of autoimmune diseases (ADs) after the Coronavirus disease 2019 (COVID-19) pandemic is lacking. This study investigated the impact of the COVID-19 pandemic on the global burden of ADs, including psoriasis (PsO), inflammatory bowel disease (IBD), type 1 diabetes (T1DM), rheumatoid arthritis (RA), and multiple sclerosis (MS).

Methods

Age-standardized rates (ASR), including incidence (ASIR), prevalence (ASPR), disability-adjusted life years (DALYs), and death (ASDR), were extracted from the Global Burden of Disease Study 2021 from 1990 to 2021. The changes in number and ASR of ADs burden were assessed by absolute and relative increases comparing 2021 to 2019. Joinpoint regression analysis was used to determine whether the year 2019 marked the substantial changes in trends of ASR across global, 21 geographical regions, and 204 countries. The correlations between COVID-19 incidence, vaccination and the relative increased ASIR/ASPR of ADs were also evaluated.

Results

Joinpoint regression analysis identified 2019 as a pivotal year, marking a global increase in the burden of PsO. The global ASR of PsO in 2021 showed an increased incidence, prevalence, and DALYs of 0.78, 5, and 0.33 DALYs per 100,000, respectively, compared to 2019 (194.1 × 103 cases, 1651.3 × 103 cases, and 131.4 × 103 DALYs, respectively). Notable absolute increases in PsO incidence rates in 2021 were observed in regions with a high socio-demographic index, particularly among individuals aged 50 to 54 and among males. Furthermore, 2019 marked a joinpoint with increased ASIR or ASPR of ADs in various regions, notably PsO in High-income North America, Southern Latin America, and South Asia, as well as IBD in Southern and Eastern Sub-Saharan Africa, Central Europe, and East Asia. Regional data from the USA, England, and Japan indicated a positive correlation between COVID-19 incidence and relative increases in the burden of PsO in 2020 (Spearman R 0.35, 0.24, and 0.36, respectively, for incidence; R 0.35, 0.2, and 0.36, respectively, for prevalence; all p < 0.05). Additionally, 2021 state-level vaccination rates in the USA were negatively correlated with the relative increases in the ASIR of PsO and RA (R: 0.27 and -0.54, respectively; p < 0.001 for all), as well as the ASPR of PsO, RA, and MS (R: 0.45, -0.49, and -0.41, respectively; p < 0.01 for all) in 2021.

Conclusions

The year 2019 marked a pivotal point for increased global burden of PsO and regional burdens of other ADs. These observations have important implications for subsequent healthcare planning and resource allocation.

Why some hearts heal and others don't: The phylogenetic landscape of cardiac regenerative capacity

The limited ability of adult humans to replenish lost heart muscle cells after a heart attack has attracted scientists to explore natural heart regeneration capabilities in the animal kingdom. In particular, research has accelerated since the landmark discovery more than twenty years ago that zebrafish can completely regrow myocardial tissue. In this review, we survey heart regeneration studies in diverse model and non-model animals, aiming to gain insights into both the evolutionary trends in cardiac regenerative potential and the variations among closely related species. Differences in cardiomyogenesis, vasculature formation, and the communication between cardiovascular cells and other players have been investigated to understand the cellular basis, although the precise molecular and genetic causes underlying the stark differences in cardiac regenerative potential among certain close cousins remain largely unknown. By studying cardiovascular regeneration and repair in diverse organisms, we may uncover distinct mechanisms, offering new perspectives for advancing regenerative medicine.

Pro-adrenomedullin as an independent predictive biomarker for heart failure in atrial fibrillation and flutter

AIMS

This study aimed to investigate potential biomarkers for predicting incident heart failure (HF) in patients with atrial fibrillation and flutter (AF and AFL), utilizing proteomic data from the UK Biobank Pharma Proteomics Project (UKB-PPP).

METHODS

This study analysed data from AF and AFL patients, split into discovery (n = 1050) and replication (n = 305) cohorts. Plasma biomarkers were screened using a multivariable-adjusted Cox proportional hazards model. Kaplan-Meier survival analysis and area under the receiver operating characteristic (ROC) curve assessments were conducted to evaluate predictive performance.

RESULTS

Over a follow-up of 14.2 years, 222 cases (21.1%) of HF were documented in the discovery cohort, while 117 cases (38.4%) occurred over 13.8 years in the replication cohort. Out of 2923 proteins measured, only pro-adrenomedullin (pro-ADM) consistently showed a significant association with incident HF in both cohorts. In the discovery cohort, each unit increase in pro-ADM was linked to an increased risk of HF (HR = 2.78, 95% CI 1.64-4.71, P < 0.001, FDR = 0.026), which was confirmed in the replication cohort (HR = 3.95, 95% CI 1.97-7.94, P < 0.001, FDR = 0.012). Kaplan-Meier analysis demonstrated that patients with higher pro-ADM levels had significantly shorter time to HF onset, with median times ranging from 2306 to 3183 days across quartiles (P < 0.001). The cumulative incidence of HF ranged from 15.3% to 42.7% across quartiles of pro-ADM (log-rank P < 0.001). Adding pro-ADM to a model with traditional risk factors, including NT-proBNP, significantly improved predictive accuracy for 3-year (AUC = 0.783; integrated discrimination improvement [IDI] = 0.010 and net reclassification index [NRI] = 0.206, both P = 0.002) and 5-year (AUC = 0.749, IDI = 0.013, NRI = 0.179, P = 0.001) risk of HF. In sensitivity analyses, the association between pro-ADM and incident HF remained consistent after excluding participants with self-reported AF and AFL, with each unit increase in pro-ADM being associated with an increased risk of HF (HR = 1.77, 95% CI 1.02-3.04, P = 0.041) and across subgroups of paroxysmal AF (HR = 2.80, 95% CI 1.11-7.07, P = 0.029) and persistent AF (HR = 4.36, 95% CI 1.41-13.43, P = 0.010).

CONCLUSIONS

Pro-ADM is identified as an independent biomarker for predicting incident HF in AF and AFL patients. Its inclusion in risk prediction models enhances the ability to stratify HF risk beyond traditional biomarkers, demonstrating its potential utility in clinical practice.

Lipid-lowering prescription patterns after a non-fatal acute coronary syndrome: A retrospective cohort study

Background

After an acute atherosclerotic cardiovascular event, high-intensity lipid-lowering therapy (LLT) is needed to reduce recurrence risk. This study aimed to describe LLT prescription patterns and LDL-C levels change after non-fatal acute coronary syndrome (ACS) events and to determine if the recommended goals for LDL-C levels were achieved.

Methods

Retrospective cohort study using electronic health records (EHR) of Unidade Local de Saúde de Matosinhos between 2015 and 2023. Participants were adults aged 40-80 years, with a non-fatal ACS hospitalization between 2016 and 2022 (index date); ≥1 general practice appointment in the three years before ACS; and one-year follow-up post-ACS. Sub-analyses focused on gender, age (

Results

Of 544 patients, 270 (49.6 %) were under 65 years, and 164 (30.1 %) were females. Before the ACS, 71.1 % of men and 56.7 % of women had no previous LLT prescription and younger patients showed poorer LDL-C control (132(IQR 64)mg/dL) than older patients (102(IQR 50)mg/dL). One-year post-ACS, only 11.3 % of males and 8.5 % of females met LDL-C target. The proportion of patients without LLT decreased from 66.7 % at baseline to 13.6 % post-ACS. High-intensity LLT prescriptions increased from 2.4 % to 16.5 %, while moderate-intensity LLT remained predominant (65.8 %). Still, 89.5 % of patients had uncontrolled LDL-C levels.

Conclusion

Despite initiating/intensifying LLT, one year after ACS most patients did not achieve LDL-C goals. This indicates a significant gap in guideline implementation in clinical practice.

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Key Words

• Atherosclerosis
• Electronic health records
• Hydroxymethylglutaryl-CoA reductase inhibitors
• Low-density lipoprotein cholesterol

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Affiliation(s)

Cristina Gavina Cardiology Department, Hospital Pedro Hispano–Unidade Local de Saúde Matosinhos, Matosinhos, Portugal Department of Medicine, Faculty of Medicine of University of Porto, Porto, Portugal UNIC, Faculty of Medicine of University of Porto, Porto, Portugal
Daniel Seabra Carvalho Cardiology Department, Hospital Pedro Hispano–Unidade Local de Saúde Matosinhos, Matosinhos, Portugal
Marta Afonso-Silva Real World Evidence Department, Novartis Farma–Produtos Farmacêuticos SA, Porto Salvo, Portugal
Inês Costa Real World Evidence Department, Novartis Farma–Produtos Farmacêuticos SA, Porto Salvo, Portugal
Ana Sofia Freitas Medical Department, Novartis Farma–Produtos Farmacêuticos S.A., Porto Salvo, Portugal
Mariana Canelas-Pais MTG Research and Development Lab, Porto, Portugal Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
Nuno Lourenço-Silva MTG Research and Development Lab, Porto, Portugal Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
Tiago Taveira-Gomes Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal Faculty of Health Sciences, Fernando Pessoa University (FCS-UFP), Portugal CINTESIS@RISE Center for Health Technology and Services Research, Porto, Portugal SIGIL Scientific Enterprises, Dubai, United Arab Emirates
Francisco Araújo Department of Internal Medicine, Hospital Lusíadas, Lisbon, Portugal

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Joint effect of modifiable risk factors and genetic susceptibility on ischaemic stroke

PURPOSE

To investigate the effects of modifiable risk factors and genetic susceptibility on ischaemic stroke (IS).

METHODS

A total of 490365 participants from the UK Biobank, with a 17-year follow-up, were included in this study. Data on 115 modifiable exposures were collected from five domains: early life, environment, lifestyle, socioeconomic status, and physical measures. Additionaly, genetic data were collected. An exposure-wide association analysis was conducted to identify potential risk factors. Risk scores for each domain and genes were calculated. The effect of each domain score on IS and the joint effects among the five domains were analyzed using multi-variate Cox models. The population attributable fraction was estimated to quantize the impact of eliminating unfavorable factors.

RESULTS

Sixty-four of the 115 modifiable exposures were found to be significantly associated with the risk of IS (P < 4.35 × 10-4 for Bonferroni correction). Newly identified factors included maternal smoking and being either overweight or underweight at age 10, which could significantly increase the risk of IS by 4.78 % to 14.74 %, 11.01 % to 23.75 %, and 3.29 % to 12.80 %, respectively. Additionally, exposure to hard water was associated with a decreased risk of IS by 6.96 % to 11.48 % compared to exposure to soft water. The associations varied across domains, with socioeconomic factors accounting for 5.2 % of IS cases, lifestyle accounting for 2.8 %, and physical measures accounting for 2.5 %, representing the top three contributing factors. Overall, it was estimated that 10.6 % to 11.3 % of IS cases could be prevented by eliminating the identified risks.

CONCLUSIONS

Interactions between risk factors and genetic susceptibility elevated the risk of IS. Risk factors from different domains contributed variably to IS, with socioeconomic factors accounting for the largest proportion.

Estimates of submicron particulate matter (PM1) concentrations for 1998-2022 across the contiguous USA: leveraging measurements of PM1 with nationwide PM2·5 component data

BACKGROUND

Excess health risk estimates of exposure per unit mass concentration of fine particulate matter (PM2·5) still exhibit a wide range, potentially due to variations in aerosol size and composition. Submicron particulate matter (PM1) was recently reported to exert stronger health impacts than PM2·5 from studies in China, but an absence of long-term PM1 data in the USA has prohibited such investigations despite a wealth of cohorts. This study aims to fill this data gap and estimate PM1 concentrations over 1998-2022 across the USA.

METHODS

We estimated biweekly gapless ambient PM1 concentrations and their uncertainties at 1 km2 resolution across the contiguous USA over the 25-year period of 1998-2022, from hybrid estimates of PM2·5 chemical composition that merged information from satellite retrievals, air quality modelling, and ground-based monitoring. The mass fractions of PM2·5 components with diameters below 1 μm were constrained by observations for four major components and from established scientific understanding for the other components.

FINDINGS

PM1 concentrations exhibited pronounced spatial variation across the contiguous USA with enhancements observed in the east, major urban and industrial areas, and areas affected by wildfires; low concentrations are prevalent over the arid west. The main components of population-weighted mean (PWM) PM1 in 2022 (6·1 μg/m3) were organic matter (47%), sulphate (22%), nitrate (12%), black carbon (8%), and ammonium (7%). The biweekly PM1 estimates were highly consistent with independent ground-based PM1 measurements (slope=0·96, R2=0·78). The estimated 1-σ uncertainties of annual mean PM1 for the 25 years over more than 8 million land pixels were less than 20% for 98% of data points, while 0·3% of the population of the contiguous USA was associated with uncertainties of more than 30% due to wildfires. The PWM PM1 decreased significantly (p<0·0001) at a rate of -0·23 μg/m3 per year during 1998-2022, accounting for 86% of the overall reduction of PWM PM2·5; the PWM PM1/PM2·5 ratio experienced simultaneous decrease (-0·0013 per year, p<0·0001).

INTERPRETATION

The dominance of PM1 in PM2·5 reduction and the decreasing PM1/PM2·5 ratio reflect the strong association of PM1 with fossil fuel and other combustion sources and their responses to air quality regulations during the 25-year study period. The gradual coarsening of PM2·5 calls for increasing urgency to separately assess health impacts of PM1 versus PM2·5, as supported by the quality of the derived PM1 estimates. Future particulate matter monitoring programmes, health studies, and regulatory deliberations should consider PM1 in addition to PM2·5.

FUNDING

National Institute of Environmental Health Sciences, National Institutes of Health.

Design, rationale, and characterization of the mobile health based occupational cardiovascular risk intervention study (mHealth-OPEN study)

BACKGROUND

The substantial workforce and suboptimal cardiovascular health highlights the urgent need for workplace interventions. This ongoing cluster-randomized trial aims to evaluate the effectiveness, feasibility, and acceptability of a mobile health (mHealth) based comprehensive intervention program to improve cardiovascular health among employees.

METHODS AND RESULTS

We conducted a 1-year, 2-arm, parallel-group, cluster-randomized controlled multicenter trial involving 10,000 participants (aged 18-65, including 1,600 participants with high cardiovascular risk) across 20 workplaces. Workplaces were randomly assigned in a 1:1 ratio to either the intervention or control group. We established a mHealth based multifaceted cardiovascular risk management system that enables intelligent management. The intervention groups received a mHealth-based management with primary prevention inventions for all participants and additional cardiovascular risk interventions for participants with high cardiovascular risk via the system. The control groups received usual care. Primary outcomes included percentage changes in hypertension, diabetes, and dyslipidemia control rates among participants with high cardiovascular risk, and percentage changes in the rate of regular physical activity among all the participants, from baseline to 12-month follow-up. Secondary outcomes included changes in blood pressure, glucose, lipid, treatment adherence, behavioral factors, questionnaire scores, and incidence of major cardiovascular events. By now, baseline recruitment has been completed, with comparable characteristics between management and control groups.

CONCLUSIONS

This rigorous designed mHealth-based workplace intervention demonstrates potential for nationwide implementation, offering cardiovascular benefits for employees.

CLINICAL TRIAL REGISTRATION

www.chictr.org.cn. Identifier: ChiCTR2200066196.

A randomized controlled Trial of telerehabilitation intervention for acute ischemic stroke patients Post-Discharge

BACKGROUND

The acute ischemic stroke (AIS) represents a significant contributor to global disability and mortality rates. Effective rehabilitation interventions play a critical role in enhancing patients' functional recovery and overall quality of life. With the advancement of telemedicine technology, post-discharge telerehabilitation interventions are becoming increasingly feasible, yet their efficacy requires validation through randomized controlled trials (RCT). This study aimed to evaluate the efficacy of a 12-week telerehabilitation program compared to standard post-discharge care in AIS patients.

METHODS

This study employed a randomized controlled design, enrolling 200 patients who had been discharged after an AIS. Participants were randomly assigned to either the intervention group or the control group in a 1:1 ratio. The intervention group received a 12-week telerehabilitation program, which included a personalized rehabilitation training plan, regular video consultations, and health education. The control group received standard post-discharge care, which consisted of a rehabilitation manual and biweekly outpatient follow-ups for up to 12 weeks. The primary outcome measure was the Barthel Index, assessing patients' ability to perform activities of daily living. Secondary outcome measures included the modified Rankin Scale (mRS, assessing the degree of disability), Hamilton Depression Rating Scale (HAMD, assessing the patients' mental health status), and World Health Organization Quality of Life-BREF (WHOQOL-BREF, assessing the patients' quality of life).

RESULTS

The mean score of the Barthel Index in the intervention group improved significantly from a baseline of 65.4 ± 12.3 to 88.7 ± 9.6, while the control group improved from 65.6 ± 12.1 to 74.9 ± 13.2 (P < 0.001). The mRS showed that 75 patients (75 %) in the intervention group achieved scores of 0-2 (no symptoms or mild disability), compared to 62 patients (62 %) in the control group, with significant improvement in the intervention group (P = 0.003). The HAMD scores indicated a significant reduction from a baseline of 17.5 ± 4.2 to 9.6 ± 3.1 in the intervention group, compared to a reduction from 17.3 ± 4.0 to 13.2 ± 4.5 in the control group (P < 0.001). The WHOQOL-BREF scores in the intervention group were significantly higher than those in the control group across all four domains: physical health, psychological health, social relationships, and environment (P < 0.05).

CONCLUSION

The findings of this study support telerehabilitation interventions as an effective rehabilitation method, significantly improving the rehabilitation outcomes and quality of life of patients discharged after mild AIS, and potentially reducing the risk of recurrence.

Associations between folate intake, serum folate, and stroke risk: The mediating role of dietary inflammatory index from NHANES 2007-2018

BACKGROUND

This study investigates the relationships between folate intake, RBC folate, serum folate levels, and stroke risk, with an emphasis on the mediating roles of the dietary inflammatory index (DII) and systemic immune-inflammation index (SII).

METHODS

A cross-sectional analysis was conducted using 24,106 participants from NHANES (2007-2018). Associations were assessed with weighted multivariate logistic regression, adjusting for key confounders. Propensity score matching (PSM) was applied, yielding 1,838 matched participants, respectively. Nonlinear relationships were analyzed with restricted cubic splines, and mediation analysis was performed for DII and SII.

RESULTS

Post-PSM, folate intake in Q2 (252-350 μg/day), Q3 (350-484 μg/day), and Q4 (> 484 μg/day) was significantly inversely associated with stroke risk (trend P < 0.05), with adjusted ORs of 0.62 (95 % CI: 0.45-0.85), 0.65 (95 % CI: 0.46-0.90), and 0.60 (95 % CI: 0.42-0.86), respectively. Serum folate levels in Q3 (37.0 - 54.8 nmol/L) were also protective (OR: 0.47, 95 % CI: 0.32-0.68, trend P < 0.05). Serum folate levels exhibited a biphasic effect, with the lowest stroke risk at 41.9 nmol/L before PSM and 43.3 nmol/L after PSM. Mediation analysis showed DII mediated 45.2 % of the relationship between folate intake and stroke risk (P = 0.018), while SII's mediation effect was minimal (0.412 %, P = 0.016). No significant interactions were observed between folate intake, serum folate and stratified variables (P > 0.05) after PSM.

CONCLUSION

Higher folate intake lowers stroke risk, with DII playing a significant mediating role, while serum folate presents a biphasic risk pattern. Personalized dietary strategies addressing folate intake and inflammation may be crucial for stroke prevention.

Fetuin-A levels in diabetic retinopathy: a systematic review and meta-analysis

Background

Diabetic retinopathy (DR) is one of the main microvascular complications of diabetes and one of the most common causes of vision loss worldwide. Fetuin-A is a glycoprotein correlated with insulin resistance and has been measured in DR patients. Herein, we aimed to investigate these studies through a systematic review and meta-analysis.

Methods

Four online databases, including PubMed, Embase, Scopus, and the Web of Science were searched comprehensively in order to retrieve relevant studies that compared blood fetuin-A levels in patients with DR vs. non-DR, DR vs. non-diabetic controls, non-DR vs. non-diabetic controls, and proliferative vs. non- proliferative DR. Random-effect meta-analysis was performed for the calculation of the standardized mean difference (SMD) and 95% confidence interval (CI).

Results

From the 186 found results through database search, after eligibility assessment, seven studies were included. A total of 1104 cases with a mean age of 57.24 ± 9.62 years were investigated. Meta-analysis showed that fetuin-A levels were significantly higher in patients with DR compared to both non-DR diabetic patients (SMD 0.41, 95% CI 0.10 to 0.72, P = 0.009), and non-diabetic healthy controls (SMD 0.77, 95% CI 0.47 to 1.07, P < 0.0001). Additionally, patients with proliferative DR had higher fetuin-A levels than those with non-proliferative DR (SMD 0.35, 95% CI 0.11 to 0.59, P = 0.004). However, no significant difference was found between diabetic patients without DR and healthy controls.

Conclusion

Based on our findings, fetuin-A was higher in patients with DR and could be potentially used for measurement in clinical settings if confirmed in future large-scale studies. Moreover, the fact that higher fetuin-A levels were associated with proliferative DR could have clinical implications.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01533-0.

Global variations and socioeconomic inequalities in lifetime risk of lip, oral cavity, and pharyngeal cancer: a population-based systematic analysis of GLOBOCAN 2022

BACKGROUND

In 2021, the World Health Organization (WHO) identified poor oral health as a major health expenditure burden. While lip, oral cavity, and pharyngeal cancers (LOCP) are an important group of diseases threatening oral health, there have been limited studies assessing global variations in lifetime risks (LR) according to socioeconomic inequalities.

MATERIALS AND METHODS

We obtained national incidence and mortality estimates of LOCP in 185 countries from the GLOBOCAN database of the International Agency for Research on Cancer (IARC), corresponding all-cause mortality, population data, and the Human Development Index (HDI, with higher values indicating superior socioeconomic level) through the United Nations, alongside oral health-related data through WHO and INDEXBOX. LR were calculated using the adjusted multiple primary method.

RESULTS

In 2022, the global LR of developing and dying from LOCP were 0.92% (95% CI: 0.92%-0.92%) and 0.48% (95% CI: 0.48%-0.48%), respectively, with the highest burden associated with cancers of the lip and oral cavity. The LR of being diagnosed with LOCP or dying from the disease were 2.24 (95% CI: 2.22-2.25) and 2.30 (95% CI: 2.27-2.33) times higher among males relative to females. The highest LR for lip and oral cavity, salivary gland, oropharynx, and hypopharynx cancers were largely concentrated in Australia/New Zealand, Europe, and North America; whereas nasopharynx cancer was more frequent in parts of Asia and Africa. The LR of developing and dying from LOCP were positively associated with HDI, dental healthcare expenditure, areca nut consumption, the availability of refined sugar, and early screening for oral diseases, and negatively associated with the prevalence of severe periodontal disease. Although the LR of LOCP decreased with age, the rate of decline was relatively slow until the age of 50, and even at age 70, there remained non-negligible risks.

CONCLUSION

Global variations in the LR of developing and dying from LOCP by subsite, sex and age reveal significant disparities by world region, socioeconomic levels and oral healthcare factors.

Global insight of early-onset genitourinary cancers in adolescents and adults from 1990 to 2021: temporal trends and health inequalities analyses

BACKGROUND

Prostate, bladder, and kidney cancers represent the three most prevalent genitourinary malignancies, posing substantial global health burdens. Given the limited epidemiological research on early-onset genitourinary cancers (EOGCs), this study aims to investigate the temporal trends and health disparities in EOGCs from 1990 to 2021.

METHODS

Based on the Global Burden of Disease Study 2021 (GBD), we extracted data on the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of the three major genitourinary cancers (prostate, bladder, kidney cancer) among individuals aged 15 to 49. We described the distribution of EOGCs at the global, regional and national levels, and analyzed the overall and local time trends through the estimated annual percentage change (EAPC) and joinpoint regression. Spearman's test and health inequality analysis were used to examine the relationship between the disease burden of EOGCs and the Socio-demographic Index (SDI).

RESULTS

In 2021, the incident cases of early-onset kidney cancer (EOKC), early-onset bladder cancer (EOBC), and early-onset prostate cancer (EOPC) were 52,631, 31,054, and 17,865, respectively, with 10,978, 6,328, and 2,861 death cases. The most significant attributable risk factors for EOGC-related deaths and DALYs were smoking and high body mass index. Of particular note, male EOKC consistently demonstrated the highest age-standardized incidence rate (ASIR) and mortality rate (ASMR), with both metrics exhibiting sustained increases from 1990 to 2021, corresponding to EAPCs of 1.33% and 0.3%, respectively. The disease burdens of EOGCs were distributed differently across various regions and countries, and their local trends also varied during the period from 1990 to 2021 globally. The incidence burden of EOGCs was disproportionately concentrated in high-SDI countries, with the concentration indices of EOPC, EOBC and EOKC in 2021 being 0.26, 0.17 and 0.27 respectively. Notably, in regions or countries with a higher SDI, the incidence risk of EOGCs was relatively high, but the mortality risk decreased significantly.

CONCLUSIONS

EOGCs are a major global public health challenge. There is an urgent need for personalized healthcare strategies to alleviate the burden of genitourinary cancers, particularly kidney cancer and prostate cancer, among adolescents and adults.

The impact of dietary interventions on cardiometabolic health

Obesity and cardiometabolic diseases are leading causes of morbidity and mortality among adults worldwide. These conditions significantly contribute to and exacerbate other major causes of illness and death, including cancer, neurodegenerative diseases, and chronic kidney disease. The growing burden of these diseases has increased the interest of modern medicine in understanding metabolic processes and health, with diet emerging as a pivotal modifiable factor, alongside physical inactivity and smoking. In this review, we discuss the pathophysiological and evolutionary foundations of metabolic processes that may link "unhealthy" nutrition to obesity and cardiometabolic diseases and review the current literature to assess the effects of various diet interventions and patterns on cardiometabolic parameters. Special emphasis is placed on summarizing the latest, albeit partially contradictory, evidence to offer balanced dietary recommendations with the ultimate aim to improve cardiometabolic health.

Estimated effect of media use on mothers' vaccination of their children in Sub-Saharan Africa: a quasi-experimental propensity score matching analysis using DHS data

BACKROUND

Media channels are a primary source of health information for mothers/caregivers to enhance their children's vaccination uptake, particularly in Sub-Saharan Africa, where there is a dearth of health workers. WHO set mass media exposure as a potential strategy to increase vaccination uptake. However, estimating the effect of media exposure on child vaccination using observational studies suffers from problems of selection bias. Thus, this study used the propensity score matching (PSM) analysis to estimate the effect of media exposure on childhood vaccinations.

METHODS

We used nationally representative demography and health survey data collected from 2019 to 2024 among 23,194 children aged 12-23 months in SSA countries. A total of 23,194 weighted sample were included in the analysis. We employed PSM analysis with the logit model using the psmatch2 command package in STATA to estimate the causal effect of media exposure on women's uptake of child immunization. The Average Treatment Effect (ATE), average treatment effect on the treated (ATT), and the average treatment on the untreated (ATU) represent the overall effect of media exposure on the entire population, among women who had media exposure, and the hypothetical effect if unexposed women had experienced media exposure, respectively. Radius matching with a caliper width of 0.01 was employed to match the groups. The quality of matching was examined statistically and graphically. Sensitivity analysis was done to test the robustness of the PSM estimate using the Mantel-Haenszel test statistics.

RESULTS

The overall prevalence of full child vaccination was 61.27% (95% CI (60.64%, 61.89%)) in the treatment group. In the PSM analysis, the ATT values in the treatment and control groups were 0.68 and 0.59, respectively, indicating that the childhood immunization uptake increased by 8.76% because of media exposure. The ATU values in the treatment and control groups were 0.51 and 0.62, respectively. This showed that for the women or caregivers who did not have media exposure, the probability of vaccinating their children would have increased by 10.8% if they had media exposure. The final ATE estimate was 0.0828 among the samples. Quality of matching was good, and the estimates were insensitive to hidden bias.

CONCLUSION AND RECOMMENDATIONS

This study finding highlighted that policymakers and planners in SSA countries should give great emphasis to further enhancing media exposure coverage for target groups since it has a substantial impact on improving childhood vaccination uptake. Further research is recommended to examine the cause-effect relationship of media exposure on childhood vaccination by including more proximal variables that were not observed in the present study.

Epigenetic age acceleration mediates the association between low-grade systemic inflammation and cardiovascular diseases: insight from the NHANES 1999-2002

BACKGROUND

Currently, with the global aging of the population, inflammation, recognized as a hallmark in age-related diseases, has been studied and linked to cardiovascular diseases (CVD). However, limited evidence on whether inflammation modifies epigenetic aging and affects CVD risk.

METHODS

This study included 404 CVD patients and 1941 non-CVD individuals from the 1999-2002 National Health and Nutrition Examination Survey cross-sectional data. Low-grade systemic inflammation was assessed using C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and systemic inflammation response index (SIRI). Epigenetic age accelerations (EAAs) were calculated as the residuals between chronological and epigenetic ages: Horvath age acceleration (AgeAccel), AgeAccelHannum, and AgeAccelPheno. Weighted linear and logistic regression analyzed the associations between exposures and outcomes, with mediating effects assessed using the Sobel test.

RESULTS

After adjusting confoundings, the log-transformed NLR and SIRI were positively associated with CVD risk, and the odds ratio (OR) ranges from 1.260 to 1.354 (all P < 0.05). Furthermore, the ln-transformed CRP was positively associated with AgeAccelHannum and AgeAccelPheno, and the coefficient (β) ranges from 0.505 to 1.304 (all P < 0.05); the ln-transformed NLR and SIRI were positively associated with all three EAAs, and the β ranges from 0.392 to 2.212 (all P < 0.005). Additionally, 1-unit increase in AgeAccelHannum and AgeAccelPheno was associated with 2.8% (OR: 1.028, 95% CI 1.007-1.049, P = 0.011) and 3.5% (OR: 1.035, 95% CI 1.014-1.056, P = 0.002) increase in CVD risk, respectively. After adjusting confoundings, mediation analysis showed that AgeAccelHannum mediates 10.44% (P = 0.046) of the association between NLR and CVD risk; and AgeAccelPheno mediates 24.03% (P = 0.009) and 18.16% (P = 0.015) of the NLR-CVD and SIRI-CVD risk associations, respectively.

CONCLUSION

Our results demonstrate that EAAs mediate the association between systemic inflammation and CVD risk, highlighting the potential of a multi-target approach to inflammation and epigenetic modifications for personalized management to reduce CVD risk.

Ambient ammonium exposure is associated with physical dysfunction in older adults in China

The health effects associated with particulate matter (PM) are extensively reported; nevertheless, limited research has explored the exact contributions of its chemical constituents to physical dysfunctional aging. This study assesses the relationships between prolonged exposure to significant ambient air pollutants, especially ammonium (NH4+), and physical dysfunction in a nationally representative cohort of older Chinese adults. We investigated data from 14,641 participants aged 45 years or older in the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS), which was integrated with high-resolution air pollution data from the ChinaHighAirPollutants (CHAP) dataset. Physical dysfunction was evaluated by self-reported challenges in executing routine activities. After controlling for a wide range of confounders, associations among eight air contaminants (averaged from 2013 to 2015) and dysfunction risk were investigated using logistic regression models. Multicollinearity among covariates in the fully adjusted models was assessed using the generalized variance inflation factor (GVIF), with a threshold value of 5 adopted as the criterion to indicate potential collinearity. Sensitivity analyses-including exclusion of high-exposure participants, standardized z-score modeling, stratified subgroup evaluations, and multipollutant adjustments-were performed to assess the robustness of associations. Dose-response relationships were modeled using both quartile-based logistic regression and restricted cubic spline (RCS) models, revealing consistent and complementary trends. To estimate independent effects and address potential collinearity, we further constructed a multipollutant model adjusting for seven co-pollutants. In all and fully adjusted models, ambient ammonium (NH4+) was the only air pollutant that demonstrated a significant and independent association with physical dysfunction (OR: 1.03; 95% CI: 1.01-1.05; p < 0.05); no significant associations were found for the other pollutants. This association remained robust across multiple sensitivity analyses, including exclusion of extreme exposure (OR: 1.13; 95% CI: 1.08-1.17; p < 0.001), z-score standardization (OR: 2.17; 95% CI: 1.57-2.98; p < 0.001), and 5 stratified subgroup models. A significant dose-response relationship was identified both in quartile-based trend tests (p for trend < 0.001) and restricted cubic spline analysis (p for non-linearity < 0.001). Taken together, the monotonic trend from quartile analysis and the non-linear pattern from spline modeling suggest that even moderate exposure to NH4⁺ may contribute to physical dysfunction. Furthermore, multicollinearity diagnostics based on generalized variance inflation factors (GVIFs) indicated no evidence of problematic collinearity among covariates in the fully adjusted models (all GVIF < 5). Besides, the association remained significant and became stronger in a multipollutant model, highlighting the independent effect of NH4+ beyond co-pollutant confounding (OR: 1.49; 95% CI: 1.26-1.76; p < 0.001). Our findings indicate that NH4+, a significant secondary component of PM predominantly sourced from agricultural ammonia emissions, may uniquely contribute to the deterioration of physical function. It may be important to evaluate particle chemical makeup for analyzing health concerns, as there is no association for total PM mass. Long-lasting exposure to ambient NH4+ has been independently associated with increased odds of physical dysfunction across older adults in China. These findings underscore the necessity for specific environmental strategies focused on ammonia reduction to alleviate age-related functional deterioration and foster healthy aging.

Factors influencing the adoption of telemedicine services among middle-aged and older patients with chronic conditions in rural China: a multicentre cross-sectional study

BACKGROUND

In recent years, telemedicine services have significantly improved healthcare quality and access for residents. However, challenges remain, including limited awareness and reluctance to adopt such services, especially among middle-aged and older patients with chronic conditions in remote areas.

OBJECTIVE

This study aimed to investigate the key factors influencing the adoption of telemedicine services among middle-aged and older patients with chronic conditions in rural China.

METHODS

A multicentre cross-sectional study was conducted between November 2023 and February 2024 at five hospitals in western China, targeting middle-aged and older patients (aged ≥ 45 years) with chronic conditions in rural areas. Participants completed the survey in person via QuestionnaireStar, with assistance provided as needed. The questionnaire was structured based on the Health Information Technology Adoption Model (HITAM) and included constructs such as Social Influence (SI), Perceived Usefulness (PU), Perceived Ease of Use (PEU), Perceived Reliability (PR), Perceived Health Threat (PHT), Self-efficacy (SE), Attitude Toward Using (ATU), Adoption Intention (AI) and Usage Behavior (UB). Data analysis was performed using structural equation modeling (SEM) to examine the relationships between these variables and to assess their impact on patients' intention to adopt telemedicine services. Additionally, to further explore the factors influencing telemedicine services adoption, a generalized linear model (GLM) analysis was performed, incorporating variables such as age, gender, education level, monthly income, and health status.

RESULTS

A total of 880 middle-aged and older patients with chronic conditions in rural areas were included in this study, with an average adoption intention score for telemedicine services of 3.94 (standard deviation 1.02). SEM analysis revealed that SI, SE, PR, and PHT were peripheral variables, while PEU, PU and ATU acted as core mediating variables that positively influenced patients' intention to adopt telemedicine services, which in turn impacted their subsequent usage behavior. SI (z = 4.767, P<0.001), PU (z = 2.894, P = 0.004), and ATU (z = 4.545, P<0.001) showed significant direct positive effects on patients' intention to adopt telemedicine services. GLM analysis revealed that education level (β = 0.032, P < 0.001), monthly income (β = 0.009, P = 0.049), required care (β = 0.034, P = 0.007), and cancer diagnosis (β = - 0.147, P < 0.001) were significant predictors of telemedicine adoption intention.

CONCLUSIONS

This study identified key determinants influencing telemedicine services adoption among rural middle-aged and older patients with chronic conditions. The findings offer valuable insights for telemedicine services providers to enhance service design and implementation strategies, thereby promoting greater adoption and sustained use among this target population.

Hypertension and diabetes on cognitive impairment: a case-control study in China

BACKGROUND

Cognitive impairment, hypertension and diabetes are prevalent chronic conditions in populations of older ages. Previous studies have shown that hypertension and diabetes are risk factors for the development of cognitive impairment. However, the impact of hypertension combined with diabetes (HD) and their cumulative effects on cognitive impairment remain unclear. We aimed to investigate whether HD influences development of cognitive impairment and whether the effect is cumulative.

METHODS

A case-control study was conducted. From 40,103 subjects aged 60 years or older, enrolled from 28 representative communities of 9 provinces of China between January 2015 and December 2021 into the Prevention and Intervention on Neurodegenerative Disease for Elderly in China program using multi-stage stratified random sampling, individuals not meeting our propensity score matching criteria were excluded, and 13,252 individuals were finally selected for the study. Exposure factors included hypertension, diabetes and their comorbidity. Odds ratios (ORs) of exposure factors on cognitive impairment were measured using multiple logistic regression.

RESULTS

We found significant impacts of hypertension, diabetes and their comorbidity on cognitive impairment occurrence. The OR values for dementia were 1.18 for individuals with hypertension only, 1.26 for those with diabetes only, and 1.53 for those with HD. Compared to participants without hypertension and diabetes, the OR values for mild cognitive impairment (MCI) were 1.11 for individuals with hypertension only, 1.32 for those with diabetes only, and 1.27 for those with HD. For subjects with HD longer than 5 years, the comorbidity significantly impacted on MCI and dementia, and the degree of impact increased with the duration of comorbidity. For hypertension, the influence of hypertension on dementia were most influential in middle-aged (45-64 years old) people. By contrast, the influence of diabetes on people younger than 45-year-old was most significant, with the middle-age group being the second most impacted subjects.

CONCLUSIONS

The elderly with HD have a heightened risk of developing cognitive impairment, particularly dementia, compared to those with either hypertension or diabetes alone. The study revealed a significant cumulative impact of HD on cognitive impairment.

Cardiovascular Disease Burden among African Migrants

PURPOSE OF REVIEW

To provide an overview of the current available evidence on the burden of cardiovascular diseases (CVD) among African migrants, including its risk factors, underlying mechanisms, and prevention and treatment efforts, while highlighting critical gaps in knowledge.

RECENT FINDINGS

The CVD burden is high among most African migrant populations. Underlying mechanisms for the high CVD burden include various pre- and post-migration factors, genetics, and epigenetics. Studies increasingly show substantial variation in CVD burden among African migrants across factors such as country of origin, host country, reason for migration, duration of stay, sex, and age. This variation is also observed among CVD risk factors and requires tailored prevention and treatment efforts. To fill critical gaps in knowledge, future studies need to recruit among diverse African migrant populations, in various high-income countries, using standardized methodologies with a focus on longitudinal designs, and integrating lifestyle, sociocultural, environmental, and genetic factors.

Interaction between gut microbiota and T cell immunity in colorectal cancer

This review delves into the complex and multi-layered mechanisms that govern the interaction between gut microbiota and T cells in the context of colorectal cancer (CRC), revealing a novel "microbiota-immune regulatory landscape" within the tumor microenvironment. As CRC progresses, the gut microbiota experiences a significant transformation in both its composition and metabolic patterns. On one hand, specific microbial entities within the gut microbiota can directly engage with T cells, functioning as "immunological triggers" that shape T-cell behavior. Simultaneously, microbial metabolites, such as short-chain fatty acids and bile acids, serve as "molecular regulators" that intricately govern T-cell function and differentiation, fine-tuning the immune response. On the other hand, the quorum-sensing mechanism, a recently recognized communication network among bacteria, also plays a pivotal role in orchestrating T-cell immunity. Additionally, the gut microbiota forms an intriguing connection with the neuro-immune regulatory axis, a largely unexplored "territory" in CRC research. Regarding treatment strategies, a diverse array of intervention approaches-including dietary modifications, the utilization of probiotics, bacteriophages, and targeted antibiotic therapies-offer promising prospects for restoring the equilibrium of the gut microbiota, thereby acting as "ecosystem renovators" that impede tumor initiation and progression. Nevertheless, the current research landscape in this field is fraught with challenges. These include significant variations in microbial composition, dietary preferences, and tumor microenvironments among individuals, a lack of large-scale cohort studies, and insufficient research that integrates tumor mutation analysis, gut microbiota investigations, and immune microenvironment evaluations. This review emphasizes the necessity for future research efforts to seamlessly incorporate multiple factors and utilize bioinformatics analysis to construct a more comprehensive "interactive map" of the gut microbiota-T cell relationship in CRC. The aim is to establish a solid theoretical basis for the development of highly effective and personalized treatment regimens, ultimately transforming the therapeutic approach to CRC.

The ratio of blood urea nitrogen to high-density lipoprotein cholesterol: a novel risk-stratifying tool for infective endocarditis

BACKGROUND

Increased blood urea nitrogen (BUN) and decreased high-density lipoprotein cholesterol (HDL) are common in infectious diseases. However, the prognostic significance of the BUN-to-HDL ratio (BHR) in patients with infective endocarditis (IE) is yet unknown.

METHODS

In all, 1441 patients with confirmed IE were included and divided into four groups according to the level of BUN and HDL: BUN > 5.2mmol/L and HDL < 0.7mmol/L (n = 296), BUN > 5.2mmol/L and HDL ≥ 0.7mmol/L (n = 364), BUN ≤ 5.2mmol/L and HDL < 0.7mmol/L (n = 327), and BUN ≤ 5.2mmol/L and HDL ≥ 0.7mmol/L (n = 454). BHR was calculated as BUN/HDL. Multivariable analyses were conducted to determine the association of BHR with adverse events.

RESULTS

The in-hospital mortality was 6.4%. Patients with BUN > 5.2mmol/L and HDL < 0.7mmol/L had a significantly higher risk of in-hospital death than those with BUN ≤ 5.2mmol/L and HDL ≥ 0.7mmol/L (adjusted odds ratio [aOR] = 4.65, 95% confidence interval [CI]: 1.91-11.35, p = 0.001). The decision curve analysis indicated that the combination of BUN and HDL had higher net benefit than either alone. BHR presented a higher predictive value than BUN (AUC: 0.744 vs 0.693, p = 0.01) or HDL (AUC: 0.744 vs 0.648, p < 0.001) for in-hospital mortality, and the optimal cut-off value was 7.4 (sensitivity, 79.3%; specificity, 60.3%). Furthermore, the cumulative 6-month mortality risk was significantly higher in patients with BHR > 7.4 than those with BHR ≤ 7.4 (log-rank = 93.4, p < 0.001). BHR > 7.4 was an independent risk factor for 6-month mortality in IE (adjusted hazard ratio [aHR] = 3.77, 95%CI: 2.32-6.11, p < 0.001).

CONCLUSIONS

BHR offers a high predictive value for short-term mortality in IE, positioning it as a potential stratification tool for critical care triage.

The role of Adiponectin and Leptin in Colorectal Cancer and Adenoma: a systematic review and meta-analysis

BACKGROUND

Colorectal cancer ranks as the third most frequently diagnosed cancer globally. Adipokines, including adiponectin and leptin, are believed to play a vital role in the development and progression of tumors. This study aimed to clarify the association between circulating adiponectin and leptin concentrations and the risk of colorectal cancer and adenoma.

METHODS

A detailed literature review was conducted in different databases, including Google Scholar, Web of Science, Scopus, and PubMed. Articles measuring serum concentrations of adiponectin and leptin in colorectal adenoma or cancer patients were analyzed. Pooled odds ratios (ORs) and their related 95% confidence intervals (CIs) were estimated through a random-effects meta-analysis.

RESULTS

In total, 30 articles were analyzed. According to the meta-analysis, higher adiponectin concentrations were inversely linked to a reduced CRC risk (OR: 0.85, 95% CI: 0.74-0.96), particularly in men. However, no notable connection was detected between higher leptin concentrations and risk of CRC (OR: 1.12, 95% CI: 0.96-1.31). In subgroup analyses, BMI adjustment reinforced the negative association between higher adiponectin levels and risk of CRC, while insulin adjustment yielded non-significant results. Additionally, higher leptin levels revealed a meaningful relationship with colorectal adenoma risk (OR: 1.39, 95% CI: 1.06-1.84), whereas higher levels of adiponectin were not significantly linked to adenoma (OR: 0.79, 95% CI: 0.46-1.36).

CONCLUSION

According to this meta-analysis, elevated adiponectin concentrations may play a protective role against CRC, while leptin could potentially contribute to an elevated colorectal adenoma risk. Further studies are required to explore the potential mechanisms underlying adipokine-mediated colorectal carcinogenesis.

Imo-induced changes in gut hormones and glucose metabolism: A key to improving insulin sensitivity in type 2 diabetes

Isomalto-oligosaccharides (IMO) are prebiotic oligosaccharides that have shown promise in improving insulin sensitivity and glucose metabolism, making them potential therapeutic agents for Type 2 Diabetes (T2D). IMO selectively stimulates beneficial gut microbiota, particularly Bifidobacterium and Lactobacillus, leading to the production of short-chain fatty acids (SCFAs) like acetate, propionate, and butyrate. These SCFAs play a pivotal role in enhancing the release of gut hormones such as GLP-1 (Glucagon-like peptide-1) and PYY (Peptide YY), which improve insulin secretion and promote satiety, thus improving glucose homeostasis. Clinical studies have reported that IMO supplementation can lower HbA1c by 0.5% and reduce postprandial glucose spikes, demonstrating its efficacy in glycemic control. Additionally, IMO promotes insulin sensitivity by reducing inflammation and enhancing adiponectin levels. Although the current findings are promising, further research is needed to determine optimal dosing, long-term safety, and the role of individual gut microbiomes in tailoring IMO interventions. Future studies focusing on personalized nutrition strategies and the synergistic effects of IMO with other lifestyle interventions could enhance its applicability as a key component in T2D management.

Evaluation of a large language model to simplify discharge summaries and provide cardiological lifestyle recommendations

BACKGROUND

Hospital discharge summaries are essential for the continuity of care. However, medical jargon, abbreviations, and technical language often make them too complex for patients to understand, and they frequently omit lifestyle recommendations important for self-management. This study explored using a large language model (LLM) to enhance discharge summary readability and augment it with lifestyle recommendations.

METHODS

We collected 20 anonymized cardiology discharge summaries. GPT-4o was prompted using full-text and segment-wise approaches to simplify each summary and generate lifestyle recommendations. Readability was measured via three standardized metrics (modified Flesch-Reading-Ease, Vienna Non-fiction Text Formula, Lesbarkeitsindex), and multiple quality dimensions were evaluated by 12 medical experts.

RESULTS

LLM-generated summaries from both prompting approaches are significantly more readable compared to the original summaries across all metrics (p < 0.0001). Based on 60 expert ratings for the full-text approach and 60 for the segment-wise approach, experts '(strongly) agree' that LLM-summaries are correct (full-text: 85%; segment-wise: 80%), complete (78%; 92%), harmless (83%; 88%), and comprehensible for patients (88%; 97%). Experts '(strongly) agree' that LLM-generated recommendations are relevant in 92%, evidence-based in 88%, personalized in 70%, complete in 88%, consistent in 93%, and harmless in 88% of 60 ratings.

CONCLUSIONS

LLM-generated summaries achieve a 10th-grade readability level and high-quality ratings. While LLM-generated lifestyle recommendations are generally of high quality, personalization is limited. These findings suggest that LLMs could help create more patient-centric discharge summaries. Further research is needed to confirm clinical utility and address quality assurance, regulatory compliance, and clinical integration challenges.

Systematic analysis of the global, regional, and national burden of subarachnoid hemorrhage from 1990 to 2021

Subarachnoid hemorrhage (SAH) is characterized by high rates of morbidity, mortality, and disability, which imposes a heavy disease burden on society and families. Incidence, mortality, disability-adjusted life years (DALYs) and their corresponding age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs) of subarachnoid hemorrhage were analyzed by using GBD 2021 data in our study. Data were further stratified by age, sex, and region. Globally, in 2021, there were 697486 (95% UI, 614334795785) new cases of subarachnoid hemorrhage, 352,810 (309015401474) deaths, and 10.64 million (9.39 to 12.12) DALYs. The burden of subarachnoid hemorrhage showed substantial decline from 1990 to 2021. However, the decline in the age-standardized incidence rate was significantly smaller than the declines in the age-standardized mortality rate and age-standardized DALY rate, with the most pronounced downward trend in East Asia but an increase in sub-Saharan Africa, indicating that our prevention strategies require further refinement.

Dynamic changes in metabolic syndrome components and chronic kidney disease risk: a population-based prospective cohort study

OBJECTIVE

To investigate the relationships between dynamic changes in metabolic syndrome (MetS) components and chronic kidney disease (CKD) risk.

METHODS

Data from the UK Biobank, including baseline assessments from 2006 to 2010, repeat assessments in 2012-2013, and linked national health records, were analyzed. MetS components consisted of abdominal obesity, elevated blood pressure (BP), fasting blood glucose (FBG), serum uric acid (SUA), and lipid abnormalities. The Kaplan-Meier method and log-rank test were used to analyze CKD incidence and group differences. Cox regression models assessed the association between dynamic changes in MetS components and CKD risk.

RESULTS

The study enrolled 455,060 participants (45.7% male, 18.4% aged 65 years or older) with a median follow-up of 12.68 years. Those with MetS had a significantly higher 10-year CKD cumulative incidence probability of CKD than those without MetS (4.14% VS 1.14%). Multivariate analysis showed all baseline metabolic abnormalities were linked to CKD risk with HRs from 1.40(1.35-1.45) to 1.85 (1.78-1.92), and MetS strongly associated with CKD (HR: 2.31). CKD risk rose with more MetS components and progression stages. Notably, with FBG being the exception, the four MetS components that shifted from normal at baseline to abnormal at follow - up were associated with elevated CKD risk, with HRs (95% CI) ranging from 1.21 (1.00-1.48) to 1.73 (1.34-2.24). Participants with high baseline SUA, even if it normalized at follow - up, still faced a 1.30 - fold higher CKD risk (95% CI: 1.25-1.35), distinct from other components. For those developing one and ≥ 2 new MetS components at follow - up, the CKD risk HRs (95% CI) were 1.49 (1.00-2.35) and 2.26 (1.21-4.24) respectively.

CONCLUSION

MetS and its component changes are significantly associated with CKD risk, in a dose - response pattern. Incorporating SUA into MetS assessments enhances risk identification, especially noting females' higher susceptibility to elevated SUA. Dynamic monitoring of MetS components is crucial for assessing and predicting CKD risk.

CLINICAL TRIAL NUMBER

Not applicable.

Pea and Lentil Flours Increase Postprandial Glycemic Response in Adults with Type 2 Diabetes and Metabolic Syndrome

Pea and lentil flours are added to baked foods, pastas, and snacks to improve nutritional quality and functionality compared to products made solely with refined wheat flour. However, the effect of whole pulses versus their serving size equivalent of flour on blood glucose has not been investigated in persons with altered glycemic response. Health claims for whole pulses are based on a ½ cup amount whereas commercial pulse flour servings are typically a smaller size. The glycemic responses of four treatment meals containing 50 g available carbohydrate as ½ cup whole pulse or the dry weight equivalent of pulse flour were compared with a control beverage (Glucola®). Eleven adults with type 2 diabetes mellitus (T2DM) and eight adults with metabolic syndrome (MetS) completed the study. Venous blood samples were collected at fasting and at 30 min intervals postprandial for three hours. Changes in net difference in plasma glucose over time from baseline and incremental area under the curve (iAUC) segments were analyzed. All four pulse meals attenuated the iAUC compared to the control from 0 to 120 min for T2DM participants and 0-180 min for MetS participants. Whole pulses produced a lower glycemic response than pulse flours in the early postprandial period for persons with T2DM and during the overall test period for those with MetS.

Global, regional, and national burden of opioid use disorder from 1990 to 2021: a statistical analysis of incidence, mortality, and disability-adjusted life years

BACKGROUND

Opioid use disorder (OUD) present significant health challenges globally, especially among adolescents and young adults. This study leverages the Global Burden of Disease (GBD) Study 2021 to assess the burden of OUD from 1990 to 2021.

METHODS

The incidence, mortality, and disability-adjusted life years (DALYs) of OUD from 1990 to 2021 were extracted from the GBD Study 2021 website. The slope index of inequality (SII) and concentration index of inequality (CII) were used to quantify the inequality of OUD burden across countries. We employed frontier analysis to quantify the gap between a country's or territory's current burden and its potential minimum burden.

RESULTS

Globally, in 2021, the number of new cases, deaths, and the DALYs of OUD were 1942.52 thousand [95% uncertainty interval (UI): 1643.34, 2328.36], 99.55 thousand (95% UI: 92.94, 108.04), and 11,218.51 thousand (95% UI: 9188.65, 13,159.55), respectively. The age-standardized rates (ASRs) of incidence, mortality, and DALYs of OUD were 24.54 per 100,000 population (95% UI: 20.74, 29.48), 1.19 per 100,000 population (95% UI: 1.12, 1.29), and 137.15 per 100,000 population (95% UI: 112.29, 161.39), respectively. At the regional level, high-income North America had the most severe burden of OUD. The peak OUD incidence occurred in both males and females aged 20-24 years, and the peak OUD-related mortality occurred in males aged 30-44 years and females aged 30-59 years. Countries with higher SDIs have a heavier burden of OUD, and this trend continues to intensify. Countries with higher SDIs often have greater potential to reduce the burden of OUD.

CONCLUSIONQ

OUD remains an important contributor to the burden of disease and is concentrated mainly among young people, emphasizing the urgency of addressing this public health challenge.

Experienced-based co-design for cardiovascular and chronic disease research

The participatory co-design method has received significant attention recently. Experience-based co-design is an approach that enables patients (service users) and healthcare providers (service delivers) to co-design services and care pathways in partnership to improve health outcomes based on their experience. Traditionally, it was used as a quality improvement technique. Yet, it is a valuable participatory research design that can help improve health outcomes and be applied in nursing research. This paper will discuss its application in research among people living with cardiovascular multimorbidity and its practicalities, usability, and impact on cardiovascular and chronic disease research and models of care.

Association of triglyceride glucose and obesity indices with chronic obstructive pulmonary disease in US adults: data from 2013 to 2018 NHANES

BACKGROUND

The impact of insulin resistance (IR) on chronic obstructive pulmonary disease (COPD) has caught increasing attention, and the triglyceride-glucose (TyG) index and related indices are deemed reliable indicators for evaluating IR. Nevertheless, the potential associations of TyG and obesity-related indexes with COPD are currently understudied. Hence, this paper was to inspect the links of TyG and obesity-related indices with COPD.

METHODS

This was a cross-sectional study based on data from the NHANES 2013-2018. Weighted logistic regression (WLR), restricted cubic sample (RCS), and receiver operating characteristic (ROC) curves were leveraged to examine the links of the TyG index and obesity indices with COPD. The stability of the correlations was also assessed via subgroup analyses.

RESULTS

Data from 6383 participants were finally included, including 583 patients with COPD. WLR discovered positive associations of TyG, TyG-body mass index (TyG-BMI), TyG-waist circumference (TyG-WC), and TyG-waist height ratio (TyG-WHtR) with COPD regardless of covariate adjustment (p-value < 0.05, p for trend test < 0.05). After adjusting for all confounders, RCS analysis signaled notable linear links of TyG and obesity-related indices with COPD (p-value < 0.05, p for nonlinear > 0.05). TyG-WHtR showed the highest association with COPD among the indices tested, albeit with limited discriminative ability (AUC = 0.643, 95% CI: 0.619 ~ 0.665). Subgroup analyses further validated the stability and reliability of the results.

CONCLUSION

TyG and its combination with obesity-related indicators are associated with COPD. Among these, TyG-WHtR showed the strongest association with COPD, although causal relationships cannot be inferred and its discriminative ability remained modest. Further prospective studies are warranted to validate these findings.

CLINICAL TRIAL NUMBER

Not applicable.

Tracheal, bronchus, and lung cancer among older adults: thirty-year global burden trends, precision medicine breakthroughs, and lingering barriers

BACKGROUND

Tracheal, bronchial, and lung (TBL) cancer presents significant health challenges for individuals aged 70 and older. However, comprehensive insights into the epidemiological patterns of and risk factors for TBL cancer in this population remain limited. This study aimed to analyze the global, regional, and national burdens and trends of TBL cancer patients aged ≥ 70 years from 1990-2021.

METHODS

The incidence, mortality, and disability-adjusted life years (DALYs) for TBL cancer patients aged ≥ 70 years from 1990-2021 were obtained from the 2021 Global Burden of Disease study. Global trends were stratified age, sex, and sociodemographic index (SDI). Decomposition analysis identified the primary drivers of burden changes, and a global risk attribution analysis was conducted. The Bayesian Age‒Period‒Cohort (BAPC) model forecasted trends over the next 14 years. The analyses were performed with Joinpoint software and the R software.

RESULTS

From 1990-2021, the ASIRs, ASMRs, and ASDRs of TBL cancer among patients ≥ 70 years increase significantly, mainly due to aging and population growth. In the precision medicine era (2015-2021), these indicators for both sexes and males have declined, but the burden among females has increased. The burden varies across regions, with the incidence of TBL cancer increasing more severely in middle-SDI regions, East Asia, and western sub-Saharan Africa, whereas high-SDI regions have shown a decline after peaking. Although the DALY proportion of smoking decreased, it was still the main cause of TBL cancer. However, the burden of environmental particulate pollution has increased. The BAPC model predicted that in the future, the ASIR, ASMR, and ASDR for males and both sexes would decrease, whereas these indicators would either remain stable or increase among females.

CONCLUSIONS

The burden of TBL cancer is increasing significantly among patients aged ≥ 70 years. Despite new hopes and approaches from precision medicine, environmental and behavioral factors still critically influence the TBL cancer burden. Future strategies could enhance subgroup-specific management and promote effective control of known risk factors.

Multi-Scale Vision Transformer with Optimized Feature Fusion for Mammographic Breast Cancer Classification

Background: Breast cancer remains one of the leading causes of mortality among women worldwide, highlighting the critical need for accurate and efficient diagnostic methods. Methods: Traditional deep learning models often struggle with feature redundancy, suboptimal feature fusion, and inefficient selection of discriminative features, leading to limitations in classification performance. To address these challenges, we propose a new deep learning framework that leverages MAX-ViT for multi-scale feature extraction, ensuring robust and hierarchical representation learning. A gated attention fusion module (GAFM) is introduced to dynamically integrate the extracted features, enhancing the discriminative power of the fused representation. Additionally, we employ Harris Hawks optimization (HHO) for feature selection, reducing redundancy and improving classification efficiency. Finally, XGBoost is utilized for classification, taking advantage of its strong generalization capabilities. Results: We evaluate our model on the King Abdulaziz University Mammogram Dataset, categorized based on BI-RADS classifications. Experimental results demonstrate the effectiveness of our approach, achieving 98.2% for accuracy, 98.0% for precision, 98.1% for recall, 98.0% for F1-score, 98.9% for the area under the curve (AUC), and 95% for the Matthews correlation coefficient (MCC), outperforming existing state-of-the-art models. Conclusions: These results validate the robustness of our fusion-based framework in improving breast cancer diagnosis and classification.

Barriers and facilitators to accessing Non-Communicable Disease services among children, adolescents and young people with Type 1 Diabetes in Mozambique: a quantitative content analysis using the COM-B framework

BACKGROUND

Non-communicable diseases (NCDs), and diabetes in particular, are on the rise even in sub-Saharan African countries. Despite this, access to care is still poor. This study aimed to assess barriers/facilitators to access NCDs services for children, adolescents and young people with Type 1 Diabetes (T1DM) in Mozambique.

METHODS

A qualitative cross-sectional study using focus groups (FG) and key-informant interviews was conducted between September and October 2023, involving patients (16-30 years), caregivers of child and adolescent patients and health care staff of 5 health facilities. A deductive approach was adopted using the Capability-Opportunity-Motivation-Behaviour (COM-B) framework to classify themes referring to barriers/facilitators to access. Two researchers carried out quantitative content analysis independently, assessing the inter-rater agreement through Cohen's K.

RESULTS

Four FGs were conducted with 26 patients (61.5% female, 16-24 years), three with 18 caregivers (83.3% female) and 16 interviews with healthcare workers. A total of 455 themes were identified, with a predominance of barriers (67.3%) compared to facilitators (32.7%) in accessing T1DM services. The area ''Capability'' was labelled significantly more often as a barrier (89.5%) than ''Motivation'' and ''Opportunities'' (60.2% and 62.6%, p < 0.001). The most frequent barriers were related to the psychological ability to accept and manage the disease in the absence of professional psychological support, inadequate interactions with healthcare personnel, long waits in the outpatient clinic and stigma towards diabetes in the community. Social support from family and friends appears to be an important facilitator. Social opportunities emerge more often as facilitators (76/105, 72.4%) than physical opportunities, which were 79.0% (n = 139/176) of the barriers in the 'Opportunities' area (p < 0.001).

CONCLUSIONS

The study highlights the difficulties of patients suffering from T1DM, in particular due to the lack of psychological support and inadequacies of the health services. It also points out the need to improve the training of healthcare personnel and to strengthen the health literacy of patients to improve recognition and management of the disease, respectively. Increased awareness by the community, supported by structured interventions, could also contribute to reducing stigma towards patients and improving the quality of care.

Relationship between tobacco use and body mass index- a propensity score matching analysis of an indian National Survey

BACKGROUND

Tobacco and obesity control is among the major health priorities. Previous studies have mixed opinions about their association. The present study was done to investigate the association between Body Mass Index (BMI) and tobacco use (smokers, smokeless tobacco users and dual users) among Indian adults.

METHODS

Secondary analysis of the fifth National Family Health Survey (2019-21) was conducted that included 724,115 women (15-49 years) and 101,839 men (15-54 years). Nutritional status (BMI) was dependent variable. Current tobacco use was primary independent variable. Using sampling weights, bivariate analysis assessed the association, the determinants were explored using the binary logistic multinomial regression. Propensity Score Matching (PSM) was employed using STATA software to control for potential confounding and strengthen causal inference.

RESULTS

Weighted prevalence of overweight/obesity and underweight was 38.17%, and 18.05%. Underweight prevalence was highest in smokeless tobacco users (17.09%). Overweight/obesity was highest among smokers (41.62%). Compared to non-users, tobacco users had higher odds of being underweight (AOR: 1.2; 95% CI: 1.2-1.2) and lower odds of being overweight (0.9; 0.9-0.9). PSM confirmed the BMI lower effect of Tobacco (ATT: 0.159), with a non-significant impact on overweight/obesity (ATT: -0.360).

CONCLUSIONS

We present clear evidence that tobacco use, especially smokeless forms, is significantly associated with undernutrition among Indian adults, while its impact on overweight/obesity remains minimal, which otherwise was more common in smokers. The findings clarify the previously mixed evidence and highlight the nutritional impact of tobacco, reinforcing the need for integrated interventions targeting both tobacco cessation and nutritional improvement.

Absorption and metabolic transformation mechanisms of the interaction between salvianolic acids and tanshinones in DKD rats

ETHNOPHARMACOLOGICAL RELEVANCE

Salviae Miltiorrhizae Radix Et Rhizoma (SM) (The plant name has been checked with http://www.theplantlist.org) mainly contains water-soluble salvianolic acids and fat-soluble tanshinone components, which are often used to treat diabetic kidney disease (DKD) in clinical settings.

AIM OF THE STUDY

To investigate the absorption and metabolism regulation of salvianolic acid B and tanshinone IIA combination (Comb1) along with fraction of salvianolic acids and tanshinones combination (Comb2) in DKD rats.

METHODS

Plasma concentrations of 11 salvianolic acids and tanshinone compounds of Comb2 were determined using ultra-performance liquid chromatography in rats with DKD. The Caco-2 cell monolayer model was used to study the transmembrane transport of salvianolic acids and tanshinones and compatibility of the two compounds. Finally, we assessed the effects of cytochrome P450 (CYP450) enzyme on the metabolism of salvianolic acids and tanshinones as well as the compatibility of their components in normal and DKD rats using in vitro incubation of liver microsomes.

RESULTS

The results showed that danshensu, protocatechualdehyde, dihydrotanshinone I, cryptotanshinone, tanshinone I, and tanshinone IIA were well-absorbed in vivo. Salvianolic acid B and salvianolic acids promoted the absorption of tanshinone IIA, whereas tanshinones promoted the absorption of danshensu and inhibited the absorption of protocatechualdehyde. In vitro incubation of liver microsomes showed that salvianolic acids may not undergo phase I metabolism. The pathological status of DKD affected the metabolic rates of tanshinones not the content of total CYP450 enzymes.

CONCLUSION

The molecular compatibility of salvianolic acid B and tanshinone IIA as well as of salvianolic acids and tanshinones act synergistically to improve DKD by affecting drug absorption and metabolism. This study provides an experimental basis for research and development of new drugs related to salvianolic acids and tanshinones.

Burden of smoking-related stroke in Saudi Arabia: trends from 1990 to 2021

BACKGROUND

Stroke ranks among the top causes of death and disability globally, with smoking being a significant risk factor for its development. This study aims to assess the impact of smoking-related strokes in Saudi Arabia from 1990 to 2021.

METHODS

The data was extracted from the Global Burden of Disease (GBD) 2021 database. We assessed the burden of smoking-related stroke by estimating the age-standardized rate (ASR) of years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs) and deaths related to this disease.

RESULTS

From 1990 to 2021, there was a respective 22.37% and 24.15% absolute decrease in the ASR of DALYs and ASR of YLLs, with average annual percentage changes (AAPCs) of -0.85 (-0.88, -0.83) and -0.92 (-0.94, -0.89) attributable to smoking-related stroke in Saudi Arabia. The ASR of death fell absolutely by 28.48%, with AAPC of -1.08 (-1.11, -1.05) between 1990 and 2021. In contrast, the ASR of YLDs absolutely increased by 5.17% during the same period, with an APCC of 0.15 (0.14, 0.17). Further, the decline in AAPCs of ASR of DALYs (-1.99), ASR of YLLs (-1.79), and ASR of deaths (-1.90) was primarily influenced by the reduction in the female population, p < 0.001, except ASR of YLDs, where the increase in the AAPC was attributed to a rise in the male population, p < 0.001. In 2021, YLLs contributed 93% (157.81/179.02) of total DALYs from smoking-related strokes in Saudi Arabia. Death rates rose in all age groups in 2021, with the most significant increases seen in the younger and middle-aged groups (30-59 years).

CONCLUSION

While the rates of deaths, DALYs, and YLLs attributable to smoking-related stroke decreased in Saudi Arabia between 1990 and 2021, YLDs significantly increased, mainly in males during the same period. This emphasizes the need for targeted intervention focused mainly on the younger and middle-aged males.

Barriers and facilitators of pap-smear test uptake in Asia: a systematic review

BACKGROUND

In addition to the establishment of screening procedures, it is important to identify the barriers and facilitators for promoting preventive behavior. Many studies have been conducted in the field of investigating the factors affecting Pap smear test uptake and the barriers related to it. However, a systematic approach is still needed. Therefore, this present study was conducted with the aim of systematically reviewing the barriers and facilitators of Pap smear test uptake in Asia.

METHODS

To collect the data, searches were performed in PubMed, WOS, ProQuest, Scopus and Cochrane databases from January 1, 2018 to January 15, 2025. Two people separately and independently evaluated the quality of the studies by Newcastle-Ottawa Scale. To conceptualize influential factors, barriers and facilitators of Pap-smear test uptake among Asian women, a theoretical thematic analysis was applied.

RESULTS

A search yielded 4057 records, of which 44 documents discussing the determinants, barriers, and facilitators of Pap smear uptake were included in the review. There were economic, social, awareness, test and provider characteristics, and lifestyle and health behaviors dimensions in both categories of barriers and facilitators. In addition, two religious and psychological dimensions were included in the barriers category. In total, 55 components representing barriers and 51 components representing facilitators were identified.

CONCLUSION

To improve Pap smear uptake, implement financial assistance and comprehensive insurance coverage. Enhance community engagement through outreach and support groups, provide counseling, and create positive messaging. Increase accessibility with mobile clinics, flexible hours, and train providers. Promote health education and offer incentives to motivate women to participate in screenings.

A village doctor-led mobile health intervention for cardiovascular risk reduction in rural China: cluster randomised controlled trial

OBJECTIVE

To assess the effectiveness of a village doctor-led mobile health intervention on cardiovascular risk reduction among residents in rural China.

DESIGN

Cluster randomised controlled trial.

SETTING

127 villages from five provinces and autonomous regions in China.

PARTICIPANTS

4533 participants from 127 villages: 2297 (64 villages) were randomly assigned to the intervention group and 2236 (63 villages) to the control group. Participants were aged ≥35 years, had no established atherosclerotic cardiovascular disease (ASCVD) but a predicted 10 year risk of ≥10%, had contracted a family doctor service with the local village doctor, and owned a smart phone.

INTERVENTIONS

In addition to usual clinical care and basic public health services provided for the control group, the intervention led by village doctors included five components: assessing risk factors to identify individualised intervention targets, setting gradual goals based on doctor-participant communication, providing targeted short videos on health education, conducting health monitoring with periodic feedback, and providing motivation to reduce risk based on gamification.

MAIN OUTCOME MEASURE

Mean change in predicted 10 year risk of ASCVD from baseline to 12 months.

RESULTS

Enrolment took place between March 2023 and May 2023. During the 12 month follow-up (completion rate 99.4%), the 10 year risk of ASCVD decreased from 18.0% to 11.7% in the intervention group and from 17.8% to 13.6% in the control group (absolute difference -1.88% (95% confidence interval (CI) -2.57% to -1.19%; P<0.001). Compared with the control group, the intervention group showed larger reductions in lifetime ASCVD risk (-15.9% v -11.0%; difference -4.59%; P<0.001), systolic blood pressure (-23.2 mm Hg v -15.2 mm Hg; difference -7.64 mm Hg; P<0.001), diastolic blood pressure (-10.9 mm Hg v -6.9 mm Hg; difference: -3.59 mm Hg; P<0.001), fasting blood glucose (-0.9 mmol/L v -0.5 mmol/L; difference -0.30 mmol/L; P=0.008), proportion of daily smokers (-3.1% v -0.6%; odds ratio 0.60, 95% CI 0.43 to 0.84; P=0.003), and insufficient physical activity (-3.0% v 1.3%; odds ratio 0.63, 0.42 to 0.95; P=0.03). No significant differences were observed for change in non-high density lipoprotein cholesterol or proportion of participants with obesity.

CONCLUSIONS

The village doctor-led mobile health intervention was effective at reducing cardiovascular risk and improving control of behavioural and metabolic risk factors. This feasible approach could be scaled up in rural China and other under-resourced settings to improve health management based on the local primary healthcare system.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05645640.

Community burden of acute respiratory infections in Shanghai, a longitudinal cohort study in respiratory pathogens, China, 2024-2027

PURPOSE

We are conducting a longitudinal cohort study-the Community Burden of Acute Respiratory Infections in Shanghai-to assess age-stratified incidence, healthcare utilisation and risk factors of influenza virus, respiratory syncytial virus (RSV) and SARS-CoV-2 associated acute respiratory infections (ARIs) in Shanghai, China.

PARTICIPANTS

Study participants were enrolled by family doctors in all 47 community health services centres in Pudong New Area District, Shanghai, China. All permanent residents 6 months and older living in Pudong for at least 6 months were eligible for enrolment; residents who planned to leave Pudong for more than 1 month in the first study year were excluded. During enrolment, study staff conducted baseline assessments of sociodemographics, underlying medical conditions, vaccination history and household and self-rated health status. Study participants are being followed for ARIs for 3 years. Nasopharyngeal and oropharyngeal swab specimens are being obtained from suspected ARI cases. Influenza virus, RSV, SARS-CoV-2 and other respiratory pathogens are tested for by multiplex respiratory pathogen real-time quantitative PCR assays. Illness courses and clinical recoveries of ARI cases are assessed through weekly contact with ARI cases for 28 days post ascertainment.

FINDINGS TO DATE

Between 14 October 2024 and 22 November 2024, we enrolled 5387 community residents into the cohort, including 233 children aged from 6 months to 2 years, 278 preschool children aged 3-6 years, 575 school-age children aged 7-18 years, 2150 adults aged 19-64 years and 2151 older adults aged 65+years. All finished baseline assessment and started follow-up. Surveillance of ARI symptoms, collection of specimens and laboratory testing are ongoing.

FUTURE PLANS

Findings from this study will be used to provide valuable scientific data to inform ongoing control efforts and future pandemic preparedness for respiratory diseases in China. Planned analyses include analysis of annual pathogen-specific incidence by age group and exploration of healthcare seeking behaviour and factors associated with ARIs and severe ARIs. We will also assess transmission dynamics of common respiratory pathogens in a household transmission subcohort.

How people with type 2 diabetes in Kuwait manage the condition: A thematic analysis and conceptual framework

BACKGROUND

Type 2 diabetes is a growing non-communicable disease burden across the Eastern Mediterranean region, particularly in Kuwait. The methods that patients adopt to manage the condition following diagnosis is poorly understood. This study aimed to explore these methods using a qualitative approach, and develop a conceptual framework characterising the phases that patients transition through.

METHODS

This was a qualitative, thematic evaluation of a grounded theory methodology investigating the methods that patients with type 2 diabetes employ to manage their condition. Qualitative coding of semi-structured interview transcripts with 22 patients, over three phases: initial, focused and theoretical, enabled categorical themes and phases to be identified. The findings were synthesised into a conceptual framework that represented the transitional journey.

RESULTS

The development of conceptual framework revealed five transitional categorical phases that characterised the journey: (1) experiencing unusual symptoms; (2) accepting the diagnosis; (3) adopting management strategies; (4) adherence and relapse; and (5) adaptation.

CONCLUSION

In Kuwait, patients with type 2 diabetes appear to transition through relatively predictable stages in learning to manage their condition. Clinical consideration of this transition could improve the quality of diabetes care provision for these patients.

Cervical cancer screening uptake and its associated factor in Sub-Sharan Africa: a machine learning approach

INTRODUCTION

Cervical cancer, which includes squamous cell carcinoma and adenocarcinoma, is a leading cause of cancer-related deaths globally, particularly in low- and middle-income countries (LMICs). It is preventable through early screening, but incidence and mortality rates are significantly higher in LMICs, with 94% of deaths occurring in these regions. Poor implementation of screening programs, in addition to multiple health system barriers, leads to a high burden from cervical cancer in these countries. Projections show increasing cases and deaths due to the disease by 2030. Using machine learning instead of the usual statistical tests will incorporate the complex and non-linear relationship of factors in predicting the outcome variable.

METHOD

The secondary data for ten Sub-Saharan African countries were utilized from the Demographic and Health Survey, DHS, to evaluate cervical cancer screening uptake among women aged 25-49 years. During cleaning missing values and outliers were removed. Class balancing by Synthetic minority oversampling techniques (SMOT) was done and tuning hyperparameters via grid search was used in the models before splitting into training and validation sets containing 89% and 20%, respectively. The following machine learning classification algorithms were used in the study: Logistic Regression, Decision Tree Classifier, Random Forest, K-Nearest Neighbor, Gradient Boosting, AdaBoost, and Extra Trees. These algorithms were employed to predict cervical cancer screening uptake. The performance of the models was evaluated using accuracy, precision, recall, and F1 score.

RESULT

In this study, a cervical cancer screening uptake was predicted among 75,360 weighted samples of women from an African country, aged 25-49 with the final data for model formulation of 53,461, where the Extra Trees Classifier obtained an accuracy of 94.13%, a precision of 95.76%, recall of 94.12%, F1-score of 93.80%. Then followed Random Forest: accuracy = 93.87, precision = 99.18%. Health visits, proximity to health care, using contraceptives, residing in urban settings, and exposure to media were its most crucial predictors. The ensemble methods, such as Extra Trees and Random Forest, showed the best generalization, indicating that this work well on complex datasets and can help devise targeted intervention strategies.

CONCLUSION

This study demonstrates that the ensemble machine learning models, such as Extra Trees Classifier and Random Forest, are promising in predicting cervical cancer screening uptake among African women with accuracies of 94.13% and 93.87%, respectively. Key predictors include healthcare access, sociocultural factors, media exposure, residence in urban areas, and contraceptive use. The findings emphasize the need for a reduction in care barriers and the use of family planning visits and mass media in promoting screening. These results will be validated in different populations in order to find the clinical integration via decision support systems.

Lipoprotein (a) levels and clinical decision-making: data from a Mexican cohort at a tertiary medical institution

BACKGROUND AND OBJECTIVE

Approximately 20% of the global population has a Lp(a) concentrations above 50 mg/dL (> 125nmol/L), yet many remain unaware of the associated cardiovascular risks. In Mexico, routine measurement of Lp(a) is uncommon. This study aimed to investigate the frequency of Lp(a) testing, and the clinical actions taken by physicians upon detecting elevated Lp(a) concentrations in patients at a tertiary medical institution.

METHODS

Using an algorithm-based screening system, we reviewed the clinical and biochemical data of patients with Lp(a) measurements from 2019 to 2024. Data were retrieved from the laboratory information system and electronic health records. Complementary assessment data were obtained from the radiology and cardiology departments.

RESULTS

Of the 150,083 individuals evaluated at the institution, only 830 (0.5%) underwent Lp(a) testing, with testing rates increasing from 0.037% in 2019 to 0.24% in 2023. Elevated Lp(a) concentrations (> 50 mg/dL) were found in 21% of patients, and 2.2% had concentrations > 180 mg/dL. Patients with elevated Lp(a) had significantly higher rates of atherosclerotic cardiovascular disease (ASCVD) (p < 0.001) and familial hypercholesterolemia (p < 0.004) than those with lower Lp(a) levels. Interestingly, diabetes prevalence was higher in those with Lp(a) < 4 mg/dL (51.5% vs. 33.4%, p < 0.001). Despite the cardiovascular risk, only 26% of patients with elevated Lp(a) levels received interventions to modify risk factors.

CONCLUSIONS

Lp(a) testing was infrequent in a tertiary medical setting. Clinical interventions to modify cardiovascular risk factors were insufficient among patients with elevated Lp(a). These findings highlight the need for greater awareness among healthcare providers and the development of comprehensive screening and management algorithms to mitigate Lp(a) -related cardiovascular risk.