Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

Respiratory syncytial virus vaccination in older adults and patients with chronic disorders: A position paper from the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine

BACKGROUND

Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract infection, hospitalisation and death in adults.

METHODS

Based on evidence regarding the impact of RSV on adult populations at risk for severe infection and the efficacy and safety of RSV vaccines, the Portuguese Society of Pulmonology, the Portuguese Association of General and Family Medicine, the Portuguese Society of Cardiology, the Portuguese Society of Infectious Diseases and Clinical Microbiology, the Portuguese Society of Endocrinology, Diabetes and Metabolism, and the Portuguese Society of Internal Medicine endorses this position paper with recommendations to prevent RSV-associated disease and its complications in adults through vaccination.

CONCLUSION

The RSV vaccine is recommended for people aged ≥50 years with risk factors (chronic obstructive pulmonary disease, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, chronic liver disease, immunocompromise, frailty, dementia, and residence in a nursing home) and all persons aged ≥60 years. If it cannot be made available to this population, then the vaccine should be prioritised for individuals aged ≥75 years and those aged ≥50 years with risk factors. The vaccine should preferably be given between September and November and can be co-administered with the influenza vaccine. Ongoing studies on RSV vaccines may justify extending these recommendations in the future.

Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

METHODS

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

FINDINGS

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

INTERPRETATION

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

FUNDING

Bill & Melinda Gates Foundation.

Association between methylmalonic acid and prevalence of depression in US adults: evidence from NHANES 2011-2014

Background: Depression is a prevalent mental disorder with high morbidity and mortality globally. Methylmalonic acid (MMA) is involved in the pathogenesis of numerous diseases. However, it is unclear whether there is an association between MMA and the prevalence of depression.Methods: This study enrolled 7866 US adults from the 2011-2014 survey of the National Health and Nutrition Examination Survey (NHANES). Individuals were categorized into depression group and non-depression group based on Patient's Health Questionnaire-9 (PHQ-9) score. The association between MMA concentrations and prevalence of depression was analysed by multivariate logistic and linear regression, restricted cubic spline regression, and subgroup analysis. Mediation analysis was used to explore the role of inflammation in the relationship between MMA and depression.Results: MMA concentrations were higher in participants with depression than those without depression. There was a positive and linear relationship of MMA concentrations with PHQ-9 score and depression risk, respectively. Moreover, the association was stable in most subgroups. Furthermore, inflammatory factors were positively correlated to MMA concentrations and prevalence of depression. In addition, white blood cell, neutrophil and alkaline phosphatase (ALP) mediated the relationship between MMA and depression.Conclusion: Our findings revealed that there was a linear and positive correlation between MMA and the prevalence of depression in US adults, which might be mediated by inflammation.

The real-world impact of cariprazine on short- and long-term disability outcomes among commercially insured patients in the United States

AIM

To compare all-cause and mental health (MH)-related short-term and long-term disability leaves and associated costs among patients in the United States with bipolar disorder (BP), major depressive disorder (MDD), or schizophrenia spectrum disorders (SCZ) before versus after cariprazine initiation.

METHODS

Merative MarketScan Commercial and Health and Productivity Management (HPM) databases (January 2016 to December 2021) were utilized to identify adults diagnosed with BP, MDD, or SCZ with ≥2 pharmacy cariprazine claims (first claim = index), ≥3 months of cariprazine use (adjunctively for MDD), and continuous commercial insurance coverage and HPM eligibility during baseline (12 months pre-index) and ≥3 months post-index. Observation continued until cariprazine discontinuation, insurance or HPM eligibility end, 1 year post-index, or HPM data availability end. All-cause and MH-related disability claims, days, and costs were evaluated. Baseline versus post-index rates of disability claims (events) and days were compared using rate ratios (RR); costs were compared using mean cost differences. Comparisons were calculated from generalized estimating equation models. Analyses were replicated separately across indications.

RESULTS

There were 489 patients overall (BP = 238, MDD = 233, SCZ = 18; mean age = 43.3 years; 60.7% female; mean follow-up = 7.6 months). All-cause rates of disability events and days following cariprazine initiation were 29% (RR = 0.71 [95% CI = 0.57, 0.86]) and 28% (0.72 [0.53, 0.94]) lower than baseline, respectively (both p < .05). MH-related rates of disability events and days were 40% (0.60 [0.43, 0.80]) and 43% (0.57 [0.34, 0.84]) lower, respectively (both p < .01). All-cause disability costs were $2,917 lower and MH-related disability costs were $2,482 lower than baseline (40% and 51% decrease, respectively; both p < .01). Results were similar for indication-specific analyses.

LIMITATIONS

Limited generalizability to patients who are unemployed, uninsured, or have public insurance.

CONCLUSIONS

Rates of disability events, days, and mean costs were significantly lower after versus before cariprazine initiation. These results can help contextualize cariprazine's role in managing disability for these patients.

Global, regional, and national burden of chronic kidney disease among adolescents and emerging adults from 1990 to 2021

BACKGROUND AND AIMS

There are limited studies on the epidemiology of chronic kidney disease (CKD) burden among adolescents and emerging adults. We aimed to assess the global, regional, and national trends in CKD burden among adolescents and emerging adults.

METHODS

The Global Burden of Disease 2021 study was utilized to evaluate the incidence, prevalence, mortality, disability-adjusted life years (DALYs) and average annual percentage changes (AAPC) in CKD among populations aged 15 to 29 years from 1990 to 2021.

RESULTS

From 1990 to 2021, age-standardized incidence (AAPC: 0.85%, 95% uncertainty interval [95% UI]: 0.81%-0.88%), prevalence (AAPC: 0.22%, 95% UI: 0.19%-0.25%), and mortality (AAPC: 0.18%, 95% UI: 0.04%-0.32%) rates of CKD have risen globally among adolescents and emerging adults. In 2021, Southeast Asia had the highest age-standardized prevalence (5370.39 [95% UI: 4060.97-6929.79] per 100,000 population), while Central sub-Saharan Africa had the highest mortality rate (5.05 [95% UI: 3.49-7] per 100,000 population). In 2021, glomerulonephritis and 'other and unspecified causes' accounted for 94% of new cases, 83% of prevalent cases, and 92% of mortality cases. Frontier analyses suggest that regions at varying stages of development still hold substantial potential for further improvements in addressing CKD.

CONCLUSION

Globally, the burden of CKD among adolescents and emerging adults continues to rise, with Southeast Asia and sub-Saharan Africa bearing a disproportionate burden. Nevertheless, there remain substantial opportunities across all levels of the development spectrum to alleviate the CKD burden through enhanced health interventions and resource allocation.

Burden of female infertility in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021

OBJECTIVE

To explore the global burden of female infertility from 1990 to 2021 by examining trends in prevalence and years lived with disability (YLD).

METHODS

Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed with a focus on the prevalence and YLD of female infertility in women aged 15-49 years. Statistical models were used to estimate ASPRs and YLD across regions and countries.

RESULTS

The global prevalence of female infertility was 110.1 million in 2021, with an age-standardized rate of 2,764.6 per 100,000 population. The YLD for infertility in 2021 was 601,134, which represented a 33.1% increase since 1990. Regionally, East Asia and Eastern Europe had the highest rates of infertility, whereas Australasia had the lowest rate.

CONCLUSIONS

The study highlights a significant rise in the burden of female infertility, particularly in high-income regions. Study findings emphasize the need for targeted public health strategies and healthcare interventions to address this growing issue.

Global burden and trends of the Clostridioides difficile infection-associated diseases from 1990 to 2021: an observational trend study

BACKGROUND

This study was aimed to explore the global burden and trends of Clostridioides difficile infections (CDI) associated diseases.

METHODS

Data for this study were obtained from the Global Burden of Disease Study 2021. The burden of CDI was assessed using the age-standardized rates of disability-adjusted life years (ASR-DALYs) and deaths (ASDRs). Trends in the burden of CDI were presented using average annual percentage changes (AAPCs).

RESULTS

The ASR-DALYs for CDI increased from 1.83 (95% UI: 1.53-2.18) per 100,000 in 1990 to 3.46 (95% UI: 3.04-3.96) per 100,000 in 2021, with an AAPC of 2.03% (95% CI: 1.67-2.4%). The ASDRs for CDI rose from 0.10 (95% UI: 0.08-0.11) per 100,000 in 1990 to 0.19 (95% UI: 0.16-0.23) per 100,000 in 2021, with an AAPC of 2.26% (95% CI: 1.74-2.79%). In 2021, higher burdens of ASR-DALYs (10.7 per 100,000) and ASDRs (0.53 per 100,000) were observed in high socio-demographic index (SDI) areas, and among age group over 70 years (31.62/100,000 for ASR-DALYs and 2.45/100,000 for ASDRs). During the COVID-19 pandemic, the global ASR-DALYs and ASDRs slightly decreased. However, in regions with low SDI, low-middle and middle SDI, those rates slightly increased.

CONCLUSION

The global burden of CDI has significantly increased, particularly in regions with high SDI and among individuals aged 70 years and above. During the COVID-19 pandemic period from 2020 to 2021, the burden of CDI further increased in regions with low, low-middle, and middle SDI. These findings underscore the need for increased attention and intervention, especially in specific countries and populations.

Decomposition analysis of lung cancer and COPD mortality attributable to ambient PM2.5 in China (1990-2021)

OBJECTIVE

This study aimed to evaluate the long-term trends in lung cancer (LC) and chronic obstructive pulmonary disease (COPD) mortality attributable to particulate matter (PM2.5) in China and to identify the contributions of population aging and other risk factors to changes in mortality rates.

METHODS

Using data from 1991 to 2021, we assessed trends in LC and COPD deaths attributable to PM2.5 through linear regression. Decomposition analysis was conducted to determine the extent to which changes in mortality rates were driven by demographic and non-demographic factors.

RESULTS

The crude mortality rates attributable to PM2.5 increased significantly for LC (500.40%) and COPD (85.26%). From 1990 to 2021, LC mortality attributable to PM2.5 increased annually by 4.11% (95% CI: 3.64%, 4.59%), while COPD mortality decreased annually by 1.23% (95% CI: -0.82%, -1.65%). Decomposition analysis revealed that 43.0% of the increase in LC mortality was due to population aging, and 57.0% was attributed to changes in other risk factors. For COPD, population aging contributed to an 18.547/100,000 increase, whereas other risk factors reduced mortality by 10.628/100,000.

CONCLUSIONS

The findings highlight the critical roles of population aging and risk factor modification in LC and COPD mortality trends. Interventions to address aging-related vulnerabilities and air pollution control are essential to mitigate future health burdens.

Causal impact of elevated body mass index on diabetic kidney disease: an integrated Mendelian randomization and Global Burden of Disease Study 2021 analysis

BACKGROUND

Elevated body mass index (BMI) has been implicated in the pathogenesis of diabetic kidney disease among patients with type 2 diabetes mellitus (T2DKD). However, establishing a causal relationship and quantifying the resultant global health impact remain challenging.

METHODS

A two-sample Mendelian randomization (MR) analysis was conducted using summary-level data obtained from the IEU database. Multiple MR approaches, including inverse variance weighted (IVW), MR-Egger regression, weighted median, weighted mode, and simple mode methods, were implemented to ensure robust causal inference. In parallel, Global Burden of Disease Study (GBD) 2021 were analyzed to determine the trends in mortality and disability-adjusted life years (DALYs) in T2DKD attributable to high BMI (HBMI-T2DKD) from 1990 to 2021. Joinpoint regression was used to estimate the average annual percent change (AAPC). Bayesian age-period-cohort (BAPC) models were then applied to project the disease burden through 2049.

RESULTS

MR analyses provided strong evidence for a causal relationship between elevated BMI and T2DKD. The GBD analysis revealed a sustained global increase in HBMI-T2DKD burden over the past three decades. Between 1990 and 2021, the result of AAPC indicated a persistent upward trend. The burden was particularly high among older adults, with the highest impact observed in East Asia and middle Socio-Demographic Index (SDI) region. By 2049, HBMI-T2DKD-related disease burden were projected to continue rising.

CONCLUSIONS

Elevated BMI is a significant causal risk factor for T2DKD. The integration of MR and GBD 2021 data underscores the urgent need for targeted public health interventions to reduce BMI levels, especially in high-risk regions and aging populations.

Determinants of outpatient healthcare-seeking behaviors among the rural poor affected by chronic conditions in India: a population-based cross-sectional study in seven states

BACKGROUND

A rising burden of chronic non-communicable diseases (CNCDs) increases demand for outpatient healthcare. Yet, evidence on preferences and barriers to healthcare services for India's most disadvantaged population, the target of India's largest public health insurance scheme (PM-JAY), is lacking.

OBJECTIVE

We explore determinants of outpatient healthcare-seeking behavior among PM-JAY eligible individuals with CNCDs in rural areas of seven states.

METHODS

Using cross-sectional data from a household survey (conducted between November 2019 and March 2020), we employed multilevel multinomial logistic regression to identify factors associated with seeking care from informal (home treatment, pharmacies, traditional healers), formal public, or formal private providers, compared with no care. Anderson's behavioral model informed the selection of independent variables.

RESULTS

Of 51,820 individuals, 5,061 (9.8%) reported a chronic condition. Despite their disease, 1,168 (23.1%) reported not using regular outpatient care. Another 2,421 individuals (48.0%) used formal private, 922 (18.3%) used formal public, and 535 (10.6%) used informal care. Predictors of formal private care were higher socioeconomic status (RRR = 2.441, 95% CI [1.61, 3.70]) and health insurance coverage (RRR = 1.478, 95% CI [1.12, 1.95]). Residents of Tamil Nadu, Kerala, and Gujarat were more likely to use formal public care (RRR = 23.915, 95% CI [9.01, 63.44]). Suffering from Major CNCDs or experiencing limitations in daily activities increased the probability of using healthcare across all options.

CONCLUSION

Future research should explore the reasons for non-utilization of chronic care and the preference for private providers. Policies to enhance public healthcare utilization and expand insurance for outpatient care could improve access and reduce health inequities.

Global, regional and national burden of pancreatitis in children and adolescents, 1990-2021: a systematic analysis for the global burden of disease study 2021

BACKGROUND

Pancreatitis poses a significant global health burden, disproportionately affecting children and adolescents. This study uses the global burden of disease (GBD) 2021 dataset to evaluate pancreatitis epidemiology in this demographic, focusing on disparities by age, sex, and region.

OBJECTIVE

To assess global trends in pediatric pancreatitis, identify risk factors, and forecast disease burden to 2035.

METHODS

We analysed GBD 2021 data on deaths and disability-adjusted life years (DALYs) for pancreatitis in individuals under 20. The socio-demographic index (SDI) assessed the link between societal development and health outcomes. Bayesian age-period-cohort (BAPC) modelling and Poisson's linear models were applied to project future burdens and estimate annual percentage changes (EAPCs) in age-standardized rates.

RESULTS

In 2021, pancreatitis caused 1120.09 deaths in children and adolescents, comprising 2% of all pancreatitis-related deaths. Age-standardized death rate (ASDR) and DALYs rate declined from 1990 to 2021 (EAPC -0.92 and -0.86, respectively). Low-middle SDI regions, notably Andean and Central Latin America and Eastern Europe, faced the highest burden. Alcohol was a leading risk factor, accounting for 3.51% of related deaths, and males had higher death and DALYs rate.

CONCLUSIONS

Despite declining pancreatitis-related mortality and DALYs, the disease remains a challenge, particularly in low-middle SDI regions. Alcohol consumption is a key risk factor, underscoring the need for targeted public health interventions. Gender-, age-, and region-specific strategies are essential to mitigate pancreatitis impact in children and adolescents.

Fibrosis of the infrapatellar fat pad induces gradual cartilage degeneration in a rat model

Knee osteoarthritis (OA), a degenerative joint disease, causes pain and reduced activity levels, with prevalence increasing with age. Knee OA is recognized as a "joint organ disease," where interactions between the articular cartilage, meniscus, synovium, and infrapatellar fat pad (IFP) are critical. Obesity contributes to OA not only through mechanical stress but also via systemic and local inflammation mediated by adipose tissue. Adiponectin, an adipokine with anti-inflammatory and chondroprotective effects, shows levels negatively correlated with obesity and positively correlated with OA severity. This study explored the role of IFP in OA progression using a rat model of monoiodoacetic acid-induced IFP fibrosis. In vivo, IFP and cartilage degeneration were assessed via histological analysis, real-time PCR, and RNA sequencing. Ex vivo, the effects of conditioned media from synovial cells and IFP on chondrocytes were evaluated. Findings revealed that fibrosis reduced adiponectin expression and accelerated OA progression. Gene sequencing showed significant metabolic pathway changes, particularly in fatty acid β-oxidation, indicating impaired IFP function. Conditioned media from inflamed IFP negatively affected chondrocytes by reducing anabolic factors and increasing cartilage-degrading enzymes. These results suggest that IFP degeneration contributes to OA by promoting inflammation and cartilage degradation. Targeting IFP fibrosis and fatty acid metabolism may offer therapeutic potential to mitigate OA progression.

Global, regional, and national burden of vertebral fractures due to falls from 1990 to 2021 and predictions for the next 15 years: A systematic analysis of the global burden of disease 2021 study

OBJECTIVES

This study utilized the latest data from the 2021 Global Burden of Disease Study to analyze the incidence, prevalence, and years lived with disability due to vertebral fractures from 1990 to 2021, providing information for effective management and prevention strategies.

METHODS

This study describes the trends in incidence, prevalence, and years lived with disability (YLDs) due to vertebral fractures caused by falls. It employs methods such as the Age-Period-Cohort (APC) model, joinpoint regression analysis, and decomposition analysis for further investigation, and calculates the ASIR, ASPR, and ASYR. Finally, it predicts the incidence trend for the next 15 years using the Autoregressive Integrated Moving Average (ARIMA) model.

RESULTS

In 2021, the number of new cases of vertebral fractures due to falls globally reached 4.7 million, with a total prevalence of 3.67 million cases, and years lived with disability (YLDs) amounted to 370,000. Compared to 1990, the estimated annual percentage change (EAPC) was -0.37 (-0.41, -0.32), -0.35 (-0.39, -0.31), and -0.37 (-0.41, -0.33) respectively, indicating a declining trend. There are significant differences in the disease burden among different countries and regions. The APC model, Joinpoint model, and ARIMA forecasting model indicate a global declining trend in the disease burden of vertebral fractures.

CONCLUSIONS

Although the burden of vertebral fractures is on a downward trend, it continues to increase in low and middle SDI regions, as well as among the elderly population. Therefore, targeted preventive measures are still necessary to address the health outcomes related to vertebral fractures.

Knowledge and attitude of pharmacists about Alzheimer's disease: A systematic review

BACKGROUND

To identify studies that explored pharmacists' knowledge and attitudes regarding Alzheimer's Disease (AD).

METHODS

A comprehensive literature search was conducted in Scopus, Medline (via Pubmed), Latin American and Caribbean Literature in Health Sciences (LILACS), and PsycINFO databases until July 2024. Cross-sectional studies that measured pharmacists' knowledge and attitudes toward AD using structure instruments were included. Two reviewers independently performed the selection of studies, data extraction, and methodological assessment.

RESULTS

Ten studies published between 2016 and 2024, involving 7810 participants, were included. Most studies were conducted in Asia (n = 5), in community pharmacies (n = 8), and used the Alzheimer's Disease Knowledge Scale (n = 8). The response rate varied from 8 % to 100 %, while the percentage of correct responses about AD ranged from 50.1 % to 85.3 %. A knowledge gap was identified in areas such as recognizing symptoms, understanding risk factors for AD development, and providing effective patient care. Pharmacists demonstrated greater expertise in the pharmacological management of AD.

IMPLICATIONS

The findings suggest the need for training programs and interventions targeting pharmacists working in services that care for patients with AD.

F-box only protein 10 protects against kidney tubulointerstitial fibrosis by inhibiting ACSL4-mediated lipid peroxidation and ferroptosis

Renal tubular epithelial cell ferroptosis is significantly linked to kidney tubulointerstitial fibrosis, a critical pathological condition in chronic kidney disease. F-box only protein 10 (FBXO10), a newly identified ferroptosis-regulating gene, plays a role in various pathological contexts; however, its involvement in kidney tubulointerstitial fibrosis is not yet fully understood. This research sought to investigate whether FBXO10 regulates ferroptosis in kidney tubular epithelial cells and its relationship with kidney tubulointerstitial fibrosis in both animal and cellular models. We observed a significant decrease in FBXO10 levels in mice with unilateral ureteral obstruction (UUO) and HK-2 cells exposed to TGF-β1. FBXO10 overexpression inhibited the EMT process and counteracted the typical ferroptosis features evoked by TGF-β1 or erastin in HK-2 cells. Compared with those in wild-type (WT) mice, kidney injury, inflammation, and fibrosis are exacerbated in FBXO10-knockout (KO) mice, with elevated ferroptosis levels. Conversely, FBXO10 overexpression reversed these symptoms, alleviating kidney fibrosis and ferroptosis in both WT and FBXO10 KO mice with UUO. Mechanistically, FBXO10 directly interacted with ACSL4 and promoted its ubiquitination and degradation. Overexpression of ACSL4 reversed the inhibitory effect of FBXO10 overexpression on TGF-β1-induced ferroptotic death and fibrosis in HK-2 cells. In summary, FBXO10 mitigates ferroptosis in renal tubular epithelial cells by inhibiting ACSL4-mediated lipid peroxidation, thereby hindering the progression of kidney tubulointerstitial fibrosis. FBXO10 is proposed as a promising target for treating kidney disorders related to tubulointerstitial fibrosis.

Traditional Chinese medicine in cerebral infarction: Integrative strategies and future directions

BACKGROUND

Cerebral infarction is a predominant cause of global disability and mortality, characterized by pathogenesis that includes vascular stenosis, thrombosis, ischemic necrosis, and neuroinflammation. Despite progress in medical science, effective treatments for cerebral infarction are still constrained, prompting the investigation of alternative therapeutic strategies.

PURPOSE

The objective of this review is to assess the efficacy of Traditional Chinese Medicine (TCM) as a treatment for cerebral infarction, emphasizing its mechanisms of action, effectiveness, and clinical relevance.

STUDY DESIGN

An extensive review of the existing literature regarding the role of TCM in the management of cerebral infarction, encompassing investigations on specific remedies, Chinese medicinal formulations, and contemporary advancements in preparation methodologies.

METHODS

This review analyzes diverse TCM remedies recognized for their antioxidant, anti-inflammatory, and neuroprotective properties. Furthermore, it examines the synergistic effects of Chinese medicine formulations in modulating inflammation, enhancing blood circulation, and facilitating neural repair. Contemporary technological advancements that improve the accuracy and efficacy of Chinese medicine are also taken into account.

RESULTS

TCM has shown considerable promise in tackling the complex aspects of cerebral infarction. Specific remedies and formulations have demonstrated potential in modulating inflammatory responses, enhancing cerebral blood flow, and promoting neural repair mechanisms. Contemporary formulations have enhanced these effects, facilitating more precise and effective treatment.

CONCLUSION

While TCM presents a promising multi-faceted and multi-tiered strategy for addressing cerebral infarction, obstacles such as elucidating mechanisms and achieving standardization must be addressed. Continued research and clinical trials are crucial to fully exploit the therapeutic potential of TCM in the management of cerebral infarction.

Food biodiversity and mortality in older Mediterranean adults with high cardiovascular risk

The food system is a key determinant of population and planetary health. As the "one planet, one health" approach gains momentum, evaluating "food biodiversity" and its association with mortality in high-risks populations is increasingly important. Hence, we evaluated the associations of food biodiversity with all-cause and cause-specific mortality in a Spanish cohort of older adults at high cardiovascular risks. Food biodiversity was defined using dietary species richness (DSR), the count of unique plants and animal species consumed by an individual. DSR was cumulatively calculated over the PREDIMED study follow-up, using yearly food frequency questionnaire data. The association of food biodiversity with all-cause and cause-specific mortality was assessed using Cox regression, while controlling for confounders. We analyzed data from 7210 participants (58 % women), with a median age of 67 years. DSR in the cohort ranged between 16 and 57 (median: 48). Over a median follow-up of 6 years, 425 deaths were recorded (103 deaths from cardiovascular diseases (CVD), 169 cancer deaths, and 153 deaths due to other-causes). DSR was only moderately correlated with adherence to the Mediterranean diet. On average, when fully adjusted, every additional species over the follow-up period was associated with a Hazard Ratio (HR (95 % Confidence Interval) of 0.91(0.90,0.93) for all-cause mortality, 0.93(0.90,0.96) for CVD mortality, 0.92 (0.89,0.94) for cancer deaths, and a 0.91(0.89,0.94) for deaths from other causes. Dietary recommendations to improve food biodiversity may increase longevity.

Jian-pi Qu-tan Hua-yu Decoction improves oxidative stress-induced inflammation in endothelial cells in atherosclerotic ApoE-/- mice through the NOX1-ROS-ERK1/2 pathway

BACKGROUND

Atherosclerosis (AS) is a key mechanism in cardiovascular diseases and a major target for interventions. Jian-pi Qu-tan Hua-yu Decoction (JPQTHYD), a herbal formula, has been shown to alleviate AS.

OBJECTIVE

This study aimed to evaluate the therapeutic effect of JPQTHYD on AS and explore its molecular mechanisms.

MATERIALS AND METHODS

In vivo, we established a mouse model through a high-fat diet for 16 weeks combined with a 4-week exhaustive swimming experiment. The body weight and food intake of the mice were measured every 4 weeks. At the end of the 16 weeks, the moisture content of the mice's feces was measured, the morphology of the thoracic aorta and myocardium was observed using HE staining, and lipid deposition in the aorta and myocardium was assessed using Oil Red O staining. The ultrastructure of myocardial tissue was observed via transmission electron microscopy. Levels of TC, TG, and LDL-C were measured using an automatic biochemical analyzer. ELISA was used to detect the levels of ROS, IL-6, IL-10, TNF-α, hs-CRP, VCAM-1, and ICAM-1. In vitro, we induced HUVECs injury using 700 nM of Ang II. Cell viability was assessed using the CCK-8 assay, while ROS levels were measured by a ROS detection kit. NOX1 gene suppression was achieved using a NOX1 inhibitor. Protein expression levels of NOX1, ERK1/2, P-ERK1/2, VCAM-1, and ICAM-1 were measured by Western blot both in vivo and in vitro.

RESULTS

1. JPQTHYD improved fecal water content and exercise capacity in ApoE-/- mice. 2. JPQTHYD reduced TC, TG, LDL-C levels, decreased arterial intimal thickness, and inhibited atherosclerotic plaque formation. 3. JPQTHYD decreased proinflammatory factors and adhesion molecules by inhibiting the NOX1-ROS-ERK1/2 pathway. 4. In vitro, JPQTHYD suppressed endothelial inflammation by reducing NOX1-ROS-ERK1/2 signaling.

CONCLUSION

JPQTHYD reduced blood lipids, inhibited oxidative stress-induced inflammation, and alleviated AS in ApoE-/- mice, likely through the NOX1-ROS-ERK1/2 pathway. This study offers a novel investigation into the mechanisms and regulatory pathways through which traditional Chinese medicine contributes to the prevention and treatment of atherosclerosis.

Systemic inflammation mediates the association between dietary inflammation index and incident anxiety and depression in UK Biobank

BACKGROUND

Evidence on whether systemic inflammation mediates the association between diet and depression and anxiety is lacking.

METHODS

We analyzed 55,799 participants from the UK Biobank, assessing dietary inflammatory index (DII) based on 3 days' 24-hour dietary recall. Systemic inflammation was represented by systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI). Incident depression and anxiety were ascertained through linkage to hospital records, and Cox proportional hazard regression models evaluated the associations, with mediation analysis performed for systemic inflammation.

RESULTS

DII ranged from -6.87 to 4.88 with a median of -0.67. After a median follow-up time of 9.12 years, 1409 were diagnosed with depression and 1806 with anxiety. Higher DII level is associated with the incident risk of depression (HRQ4vsQ1 = 1.20, 1.09-1.32, P < 0.001) and anxiety (HRQ4vsQ1 = 1.10, 1.00-1.21, P < 0.001). SIRI and SII respectively mediate 4.12 % (95 % CI = 1.30 %-23.3 %, P < 0.001) and 4.43 % (95 % CI = 1.89 %-43.75 %, P < 0.001) of the association between DII and depression incidence. As for anxiety, SIRI mediated 8.27 % (95 % CI = 1.44 %-15.31 %, P < 0.001) and SII mediated 4.19 % (95 % CI = 1.58 %-11.47 %, P < 0.001), respectively.

LIMITATIONS

The potential coexistence of anxiety and depression with other psychiatric disorders and limitations in data on changes in DII and inflammation markers over time may bias the findings. The study's generalization is constrained by the demographic of participants.

CONCLUSION

Our findings suggest that DII is positively associated with depression and anxiety, which may be mediated by SII/SIRI.

Depressive disorders attributable to childhood sexual abuse and bullying victimization: Temporal trends and socio-demographic inequalities

BACKGROUND

Childhood sexual abuse and bullying victimization are critical risk factors for depressive disorders, contributing significantly to the global health burden. This study evaluates the global, regional, and national burden of depressive disorders attributable to these factors from 1990 to 2021, focusing on trends, age and sex disparities, and socio-demographic inequalities.

METHODS

Using Global Burden of Disease 2021 data from 204 countries, we measured the burden in disability-adjusted life years (DALYs) with 95 % uncertainty intervals (UI). Temporal trends were assessed via estimated annual percentage change (EAPC), with COVID-19-related changes represented by percentage change. Socio-demographic influences were examined using the Socio-demographic Index and inequality indices. Future trends were forecasted using Bayesian models.

RESULTS

The global age-standardized DALYs rate (ASDR) for depressive disorders attributable to childhood sexual abuse was 18.08 (95 % UI: 8.75-30.97) per 100,000 population, while bullying victimization accounted for 44.32 (95 % UI: 18.72-83.89). From 1990 to 2021, the burden linked to childhood sexual abuse decreased, whereas bullying victimization steadily increased. Females experienced a higher burden from childhood sexual abuse, while bullying-related depressive disorders peaked in males aged 15-24. In 2021, depressive disorders attributable to childhood sexual abuse displayed negative slope index of inequality values (-14.42, 95 % confidence intervals: -19.04 to -9.80). By 2035, ASDRs for both factors are projected to increase by 37-50 %.

CONCLUSIONS

This study highlights the substantial burden of depressive disorders due to childhood trauma, emphasizing the need for tailored interventions, equitable mental health care, and global collaboration to address these challenges.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

ROLE OF THE FUNDING SOURCE

There was no funding source for this study.

Understanding physical aging in relation to biological aging, telomere length: A systematic review

BACKGROUND

Telomere length (TL) serves as a marker for biological aging, influenced by chronological aging but distinct from it. This systematic review aims to synthesize the evidence on the associations between components of physical aging and TL in the elderly population.

METHODS

A comprehensive search was conducted in online databases of PubMed, Web of Science, ProQuest, and ScienceDirect to identify the eligible papers published until 1st August 2024. The authors independently extracted data using the standardized form. The quality of the included studies was evaluated for the risks of biases.

RESULTS

A total of 1080 records were initially identified using the predefined search strategy. A total of 40 eligible records were included in this review. When assessing physical aging, the nature and type of measurements across studies vary, including subjective, objective, and a combination of both approaches. Subjective assessments of general health or physical limitations may be linked with TL, while frailty, whether measured subjectively or objectively, shows associations with TL in less than 35 percent of total studies. In contrast, composite measures of physical performance/ability are consistently associated with TL in the elderly population.

CONCLUSIONS

In conclusion, we demonstrated that the associations between physical aging and TL varies depending on the type and nature of physical aging assessments. Composite measures of physical performance/ability demonstrate a strong and consistent parameter of physical aging to link with TL. Future research should prioritize standardized, multidimensional approaches to measure physical aging to understand better its association with TL to support healthy aging strategies.

Temporal trends in prevalence for depressive disorders among women of childbearing age: Age-period-cohort analysis 2021

BACKGROUND

Depressive disorders (DD) are significant mood disorders with a notable female preference, especially affecting the well-being of women of childbearing age (WCBA). This population with DD was notably associated with severe complications during the perinatal period, leading to unfavourable maternal mortality and morbidity.

METHODS

This study extracted data from the Global Burden of Disease Study (GBD) 2021. We analysed the number of cases, calculated the age-standardized prevalence rate, and performed the age-period-cohort (APC) model to estimate prevalence trends and age, period, and cohort effects from 1992 to 2021.

RESULTS

From 1992 to 2021, the global number of WCBA with DD surged by 59.46 %, reaching 121 million cases up to 2021. India, China, and the USA had over 40 million prevalence cases, accounting for 36.17 % of global prevalence. The global net drift of DD prevalence among WCBA was -0.13 % per year (95 % CI: -0.17 % to -0.09 %). Age effects demonstrated similar patterns that the prevalence risk rose with age. All SDI regions showed unfavourable prevalence risks surging in the period of 2017-2021. The cohort risk of prevalence increased globally in younger generations after the 1987-1996 cohort.

CONCLUSION

Although the overall temporal trend (net drift) presented a downward trend in DD prevalence among WCBA over the past three decades, the prevalence cases had continued to rise with unfavourable period and cohort effects. Since COVID-19 triggered a massive increase in the prevalence of depressive disorders worldwide, there is an urgent need for stakeholders and policy makers to strengthen mental health-care systems.

Dietary factors and cancer outcomes in individuals with type 2 diabetes: A systematic review and meta-analysis of prospective observational studies

INTRODUCTION

Cancer is a major health concern in persons with type 2 diabetes (T2D). Diet plays an important role in progression of diabetes and cancer. We aimed to systematically summarize the evidence on diet and cancer in individuals with T2D.

METHODS

PubMed and Web of Science were searched until August 2023 and followed up via PubMed alert until December 2024. Prospective studies investigating any dietary factor in association with cancer in individuals with T2D were eligible.

RESULTS

We identified 68 studies and conducted 20 meta-analyses. A general low-carbohydrate diet was not associated with cancer outcomes, whereas an inverse association was found for vegetable-based low-carbohydrate diet (HR per 5 points [95 % CI]: 0.90 [0.84, 0.97]; n = 2). We found indications of lower cancer incidence for higher adherence to Dietary Approaches to Stop Hypertension diet, (Alternate) Healthy Eating Index, higher intakes of n-3 fatty acids (0.73 [0.55, 0.98]; n = 2) and higher serum vitamin D (0.95 [0.93, 0.97]; n = 2), as well as a positive association for serum manganese concentrations (1.44 [1.11, 1.87]; n = 2), rated with low to very low certainty of evidence.

CONCLUSION

So far, the certainty of evidence is very limited due to the small numbers of primary studies. There is an indication of a possible association between diet and cancer risk among persons with T2D, but further well-designed prospective cohort studies are warranted.

Epidemiological Dynamics of Burden and Health Inequalities in Metabolic Dysfunction-associated Steatotic Liver Disease in Adolescents at Global, Regional, and National Levels, 1990-2021

Background

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the major causes of chronic liver disease among adolescents. However, epidemiological studies on MASLD in adolescents are still insufficient. In this study, we aim to investigate the global burden and the trend of MASLD in adolescents from 1990 to 2021.

Methods

The age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of MASLD were calculated based on the Global Burden of Disease (GBD) 2021 study and stratified by sex, socio-demographic index (SDI), GBD regions, and countries. The temporal trends were examined using the average annual percentage change (AAPC) and joinpoint regression.

Results

From 1990 to 2021, the global trends of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of MASLD show notable increase, and the male is significantly higher than the female in adolescents. According to the incidence and prevalence, nations with low SDI confront a higher burden of MASLD. Besides, the inequality of incidence and prevalence between different SDI regions have shrunk in 2021, but the inequality of DALYs and mortality are still exacerbated. Decomposition analysis revealed that population growth and epidemiological changes were the main reasons for the increase in the incidence of MASLD.

Conclusion

From 1990 to 2021, there is a significant upward trend in the incidence of MASLD among adolescents worldwide. Of particular note are male adolescents, East Asian regions, and groups living in high SDI countries.

Global trends and burden of age-related hearing loss: 32-year study

BACKGROUND

Age-related hearing loss (ARHL) is a major cause of disability and diminished quality of life in older adults. This study uses data from the 2021 Global Burden of Disease (GBD) study to assess global ARHL.

METHODS

We evaluated ARHL prevalence, DALYs (Disability-Adjusted Life Years), ASPR (Age-Standardized Prevalence Rate), and ASDR (Age-Standardized DALYs Rate). Trend analysis was conducted using Estimated Annual Percentage Change (EAPC), with projections to 2050.

RESULT

From 1990 and 2021, global ARHL prevalence cases and DALYs increased by 109 %, reaching 1.55 billion and 44.45 million, respectively. The ASPR increased from 17,106.88 to 18,070.26, while the crude prevalence rate significantly from 13,890.66 to 19,587.14. Both ASPR and ASDR demonstrated significant age-related increases, particularly for moderate and moderately severe ARHL, with EAPC values of 1.39 and 1.49 for ASDR, respectively. Among individuals aged over 85 years, the ASPR of ARHL is expected to reach 80 %. Prevalence cases peaked in the 55-69 age group, with the highest number of cases (179.43 million) observed in the 55-59 subgroup. High-middle SDI regions and East Asia exhibited the most rapid growth. By 2050, ARHL cases are projected to reach 2.31 billion, with ASPR and ASDR expected to continue rising.

CONCLUSION

ARHL has increased globally over the past three decades, largely due to population aging. The burden is most severe in middle SDI regions, East Asia, and the 55-69 age group, primarily due to their substantial population bases. Addressing this escalating challenge requires enhanced public awareness, early screening initiatives, and targeted interventions.

Association between inequalities in mental health resources and burdens of mental health disorders in 146 countries and territories: An observational study

BACKGROUND

Mental health disorders impose a substantial social and economic burden. We conducted a comprehensive assessment of global mental health resource allocation and the associated burdens of mental health disorders, examining the relationship between these two factors.

METHODS

We utilized data from the WHO Global Health Observatory and GBD 2021 to encompass 146 countries. We employed spatial autocorrelation analysis and Lorenz curves to characterize the spatial distribution. Additionally, we examined the association between mental health resources and the burdens of mental disorders using a generalized linear regression model (GLM).

RESULTS

Countries and territories with higher income levels were more likely to have greater mental health resources (p < 0.05). Globally, the average mental health resource allocation index (IMRA) was 18.14, and Moran's I was 0.509 (p < 0.001). The Lorenz curve of mental health resources lay below the equality line, suggesting that these resources were more concentrated in countries and territories with higher HDI values. Between 2011 and 2021, the age-standardized incidence rate of all mental health disorders increased significantly (EAPC: 1.41 %, 95 % CI: 0.40 % to 2.53 %, p = 0.011). In multivariable GLM, a negative association was observed between the Index of IMRA and total mental health incidence.

CONCLUSION

Inequalities in mental health resources persist, and the burdens of mental disorders are increasing globally. Our findings underscore the critical need to reduce the overall burden of mental health disorders through enhanced allocation of prevention-oriented resources. Countries at different levels of human development face distinct challenges and priorities in mental health resource allocation.

Inequalities in residential green space and trajectory of cardiometabolic multimorbidity: Different associations by sex and socioeconomic status

Residential green space has the potential to benefit cardiometabolic health. However, little is known about its impacts on cardiometabolic multimorbidity (CMM). Furthermore, the capacity of access to green space to reduce health inequalities during the development of CMM is unclear, and longitudinal evidence is urgently needed. Hence, a large prospective study based on the UK Biobank was conducted. CMM was defined as the coexistence of at least two conditions including type 2 diabetes, ischemic heart disease, and stroke. Multi-state models were used to assess the impacts of green space on the transitions of CMM, from free of cardiometabolic disease to first cardiometabolic disease (FCMD), subsequently to CMM, and finally death. This study included 328,260 participants with a median follow-up of 12.5 years. The benefits of access to green space were observed for transitions from baseline to FCMD, from baseline to death, and from FCMD to death, with HRs of 0.975 (95 % CI: 0.959, 0.991), 0.956 (95 % CI: 0.931, 0.982) and 0.943 (95 % CI: 0.897, 0.990) per IQR increase in the percentage of green space, respectively. Although access to green space benefited early transitions related to FCMD, its protective role was not found in the progression from FCMD to CMM and finally death. Furthermore, access to green space was associated with a reduction in health inequalities influenced by sex and socioeconomic status in the earliest transition from healthy to FCMD. Future policies should prioritize green space investments to sustainably enhance cardiometabolic health and improve health inequalities.

The burden and trends of depressive disorders in adolescent and young adults aged 15-29 in China, 1990-2021 and its prediction to 2030: Findings from the Global Burden of Disease Study 2021

BACKGROUND

Depressive disorders (DDs) are the leading causes of disability among adolescents and young adults (AYAs) in China. This study estimated the trends of DDs burden among AYAs in China over the last 32 years, and further predicted to 2030.

METHODS

Based on the Global Burden of Disease Study 2021, age-standardized incidence, prevalence, and years lived with disability (YLDs) rates were used to describe the DDs burden among AYAs (aged 15-29 years) in China. Estimated annual percentage changes were used to describe the temporal trends from 1990 to 2021. Bayesian age-period-cohort model was used to predict the future burden to 2030.

RESULTS

In 2021, the age-standardized incidence, prevalence, and YLDs rates (per 100,000) for DDs among AYAs in China were 1884.11 (95 % confidence interval [CI]: 1383.84, 2540.68), 1951.57 (95 % CI: 1527.28, 2459.70), and 323.36 (95 % CI: 208.27, 474.88), respectively. The burden was heavier in females and individuals aged 25-29. From 1990 to 2021, all groups showed a downward trend of DDs burden. Males showed an increase in DDs burden (mainly dysthymia) in most groups in 2019-2021, while the increases in DDs burden among females were mainly in 2010-2019. The main attributable risk factor was bullying victimization. Notably, although the DDs burden was predicted to decrease from 2022 to 2030, the dysthymia burden was predicted to increase.

CONCLUSIONS

The DDs burden among AYAs is a significant public health challenge in China. It is crucial to consider the disparities among different demographic characteristics, when formulating and implementing prevention strategies.

Stress hyperglycemia ratio and the risk of new-onset chronic diseases: results of a national prospective longitudinal study

BACKGROUND

The stress hyperglycemia ratio (SHR), a dynamic biomarker of acute glucose dysregulation, has been established as a predictor of adverse acute outcomes. However, its longitudinal associations with chronic disease development, particularly in middle-aged and older populations, remain insufficiently characterized.

METHODS

This nationwide prospective cohort study analyzed data from 8942 adults aged ≥ 45 years in the China Health and Retirement Longitudinal Study (CHARLS). We established 14 disease-specific cohorts to the relationship between SHR and new-onset chronic conditions. Multivariable-adjusted Cox proportional hazards models with restricted cubic splines were utilized to estimate hazard ratios (HRs) per standard deviation (SD) increase in SHR, supported by comprehensive sensitivity analyses and subgroup stratifications.

RESULTS

Elevated SHR levels were significantly associated with increased risks of incident hypertension (HR = 1.30, 95% CI: 1.06-1.60; P < 0.001), dyslipidemia (HR = 1.43, 95% CI: 1.17-1.74; P < 0.001), diabetes (HR = 2.30, 95% CI: 1.82-2.91; P < 0.001), and liver disease (HR = 1.65, 95% CI: 1.21-2.26; P = 0.002). Conversely, elevated SHR levels correlated with a lower risk of lung disease (HR = 0.67, 95% CI: 0.50-0.89; P = 0.006). Restricted cubic spline analyses revealed a nonlinear relationship between SHR and diabetes risk (P-nonlinear = 0.02), while linear associations were observed for other outcomes. Subgroup analyses demonstrated consistency across demographic strata (P-interaction > 0.05).

CONCLUSIONS

SHR demonstrates disease-specific associations with chronic disease development, indicating its potential value as a predictive marker for clinical risk assessment.

Out-of-pocket expenditure and financial risks associated with treatment of chronic kidney disease in Ethiopia: a prospective cohort costing analysis

INTRODUCTION

In Ethiopia, most healthcare expenditures are paid out-of-pocket (OOP), while the burden of kidney disease (KD) is rapidly increasing, posing a major public health challenge in low- and middle-income countries, along with a staggering economic burden. We aimed to quantify the extent of OOP health expenditures and the magnitude of associated catastrophic and impoverishing health expenditures (CHE and IHE) for chronic KD (CKD) care in Ethiopia.

METHODS

We conducted a prospective costing analysis for CKD care from the patient perspective. We collected data on OOP health expenditures (2023 US$) and household consumption expenditures from a cohort of 433 patients that were followed prospectively for 6 months. Patients were recruited from six health facilities from four constituencies in Ethiopia. We estimated the burden of OOP payments as the sum of direct medical expenditures (DMEs) and direct non-medical expenditures (DNMEs). DMEs were calculated by summing OOP payments for consultations, diagnostic workups, procedures, medications and hospital stays. DNMEs were computed by totalling OOP expenses for transportation, food and lodging. Additionally, we estimated the economic value of productivity losses incurred by patients and/or caregivers due to time spent seeking care. We used descriptive statistics to measure the extent of CHE and IHE. We ran a logistic regression model to assess the drivers of CHE.

RESULTS

The mean annual OOP expenditure was US$2337 (95% CI US$2014 to US$2659) and varied by type of care: US$677 (95% CI US$511 to US$825) for outpatient care, US$2759 (95% CI US$1171 to US$4347) for inpatient care and US$5312 (95% CI US$4644 to US$5919) for haemodialysis. DMEs (particularly haemodialysis) were the major drivers of cost, accounting for 76%-85% of the total OOP expenditure. Transportation expenditures were the major contributors among the DNMEs. Among those who sought outpatient, inpatient and haemodialysis care, 36%, 67% and 90% incurred CHE, respectively, at a 10% threshold of annual consumption expenditures. Among all patients, 25.6% of households were impoverished due to OOP medical expenditures, with the rate substantially higher among those requiring haemodialysis (43.4%). Facility type and the type of visit were significantly associated with the odds of incurring CHE (p<0.05), while adjusting for wealth quintile, disease stage, area of residence (urban/rural), family size, patient age and insurance membership status.

CONCLUSIONS

The household economic burden for CKD care is substantial, likely hindering access to necessary treatment and exacerbating the impoverishment, which is prevalent in Ethiopia. This would be an obstacle in achieving universal health coverage and Sustainable Development Goals in Ethiopia.

Portable ultra-low-field MRI in acute stroke care: A pilot study

INTRODUCTION

Neuroimaging is a prerequisite for treatment of stroke patients, but it is not available all over the globe. Portable ultra-low field (pULF) MRI has the potential to improve access to neuroimaging and thus stroke care worldwide. In a pilot study, we were the first to utilise pULF-MRI in a European tertiary stroke centre and to evaluate its diagnostic value compared to high-field (HF) MRI.

PATIENTS AND METHODS

Consecutive patients admitted for suspected ischaemic stroke underwent pULF-MRI using the 0.064 Tesla Swoop® portable MR imaging system in addition to standard imaging. HF-MRI and pULF-MRI scans were blindly assessed to compare the diagnostic accuracy and imaging-based therapeutic decisions based on pULF-MRI to HF-MRI.

RESULTS

Seventeen patients underwent pULF-MRI, 12 of whom had ischaemic lesions on HF-MRI. Ischaemic lesions were detected on pULF-MRI in 8/12 cases. The four infarcts not identified on pULF-MRI were all smaller than 6 mm in diameter. In all cases, a virtual treatment decision based on pULF-MRI by a blinded team matched the actual clinical decisions.

CONCLUSION

This single-centre study demonstrates that pULF-MRI is a promising tool in acute stroke care, providing reliable imaging for treatment decision and follow-up monitoring. pULF-MRI may support acute stroke care if HF-MRI is unavailable and may be particularly helpful in resource-limited settings. Limitations of pULF-MRI include long acquisition times and the lack of vessel imaging and haemorrhage-sensitive sequences.

Global, regional and national level burden of bulimia nervosa from 1990 to 2021 and their projections to 2030: analysis of the global burden of disease study

Background

Bulimia nervosa (BN) is increasingly recognized as a significant public health issue worldwide. This study aims to explore the effects of BN on global, regional, and national scales by analyzing data from the Global Burden of Disease (GBD) Study 2021.

Methods

We obtained the age-standardized rates (ASRs) of prevalence, incidence, and disability-adjusted life years rates (DALYs), along with their 95% uncertainty intervals (UIs) for BN from the GBD 2021 dataset, covering the period from 1990 to 2021. And estimated annual percentage changes (EAPCs) was used to represent the changing trend of BN burden. The Long-term trends of the burden of BN were quantified by Age-period-cohort (APC) analysis. Furthermore, an evaluation of inequality and a prospective prediction concerning the worldwide impact of BN is performed.

Results

From 1990 to 2021, the global burden of BN showed a continuous increase. In 2021, the highest burden of BN was observed in regions with a high socio-demographic index (SDI), particularly in Australasia (ASPR was 811.9 per 100,000 individuals; 95% UI: 629.68 to 1041.59). The most substantial increase in the burden of BN was observed in Asia. In the national level, Equatorial Guinea experienced the most significant increase in the burden of BN from 1990 to 2021 (EAPC of ASPR was 3.48; 2.86 to 4.11). In contrast, burden of BN in High-income North America recorded a substantial decrease from 1990 to 2021 (EAPC of ASPRs was − 0.26; -0.39 to -0.13). The growth rate of male BN burden was higher than that of female. The relative inequality of the BN burden decreased between 1990 and 2021. Further forecasts from the GBD indicated that the global burden of BN would continue to rise by 2030.

Conclusion

These results can help governments across the globe in developing suitable health and medical policies focused on the prevention and early intervention of BN. Moreover, the differences in BN burden should be analyzed based on region, nation, gender, and year when setting international health goals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40337-025-01289-9.

Analyses of prevalence, incidence, and disability-adjusted life years (DALYs) for bulimia nervosa (BN) revealed a sustained increase in BN’s global burden from the year of 1990 to 2021. Regionally and nationally, BN burden correlated positively with socioeconomic development levels, with Australia exhibiting the highest burden in 2021. The most pronounced growth occurred in East and South Asia, while high-income North America experienced a decline. Notably, although females bore a higher burden, males demonstrated faster growth rates in BN cases. Inequality analyses showed widening absolute disparities in BN burden between high- and low-income nations, whereas relative inequality decreased due to accelerated burden growth in lower-income regions. Projections indicate a continuing global rise in BN burden through 2030, underscoring the need for targeted interventions.

Immunogenicity and Safety of Influenza and COVID-19 Multicomponent Vaccine in Adults ≥50 Years: A Randomized Clinical Trial

Importance

Uptake of recommended seasonal influenza and COVID-19 vaccines remains suboptimal.

Objective

To assess the immunogenicity and safety of an investigational mRNA-1083 vaccine against seasonal influenza and SARS-CoV-2 in adults 50 years and older.

Design, Setting, and Participants

This phase 3, randomized, observer-blinded trial was conducted across 146 US sites in adults 50 years and older enrolled between October 19, 2023, and November 21, 2023. Data extraction was complete on April 9, 2024.

Interventions

Participants in 2 age cohorts (≥65 years and 50-64 years) were randomly assigned (1:1) to receive mRNA-1083 plus placebo or coadministered licensed quadrivalent seasonal influenza (≥65 years: high-dose quadrivalent inactivated influenza vaccine [HD-IIV4]; 50-64 years: standard-dose IIV4 [SD-IIV4]) and COVID-19 (all ages: mRNA-1273) vaccines.

Main Outcomes and Measures

The primary objectives were to demonstrate the noninferiority of humoral immune responses following mRNA-1083 vs comparators against vaccine-matched strains at day 29 and to evaluate the reactogenicity and safety of mRNA-1083. Secondary objectives included demonstration of superiority of humoral immune responses elicited by mRNA-1083 relative to comparators at day 29.

Results

Overall, 8015 participants were enrolled and vaccinated (4017 aged ≥65 y and 3998 aged 50-64 y). Among adults 65 years and older and 50 to 64 years, the median age was 70 and 58 years, 54.2% and 58.8% were female, 18.4% and 26.7% were Black or African American, and 13.9% and 19.3% were Hispanic or Latino, respectively. Noninferior immunogenicity of mRNA-1083 was demonstrated against all vaccine-matched influenza and SARS-CoV-2 strains based on lower bound of the 97.5% CI of the geometric mean ratio greater than 0.667 and lower bound of the 97.5% CI of the seroconversion/seroresponse rate difference greater than -10%. mRNA-1083 elicited higher immune responses than SD-IIV4 (50-64 years) for all 4 influenza strains and HD-IIV4 (≥65 years) for 3 influenza strains (A/H1N1, A/H3N2, B/Victoria) and against SARS-CoV-2 (all ages). Solicited adverse reactions were numerically higher in frequency and severity after mRNA-1083 vaccination than comparators in both age cohorts (≥65 y: 83.5% and 78.1%; 50-64 y: 85.2% and 81.8%); most were grade 1 or 2 in severity and of short duration. No safety concerns were identified.

Conclusions and Relevance

In this study, mRNA-1083 met noninferiority criteria and induced higher immune responses than recommended standard care influenza (standard and high dose) and COVID-19 vaccines against all 4 influenza strains (among those ages 50-64 y), the 3 clinically relevant influenza strains (among those aged ≥65 y), and SARS-CoV-2 (all ages), with an acceptable tolerability and safety profile.

Trial Registration

ClinicalTrials.gov Identifier: NCT06097273.

Global Changes in Ischemic Stroke Burden Attributable to Ambient PM2.5: Trends From 1990 to 2020 and Projections to 2050

BACKGROUND AND OBJECTIVES

Ischemic stroke (IS) is a leading cause of disability and mortality worldwide, with ambient fine particulate matter (PM2.5) exposure being a significant modifiable risk factor. While PM2.5 concentrations have declined in some regions, global assessments examining how these changes affect the IS burden remain limited. The aim of this study was to quantify changes in IS burden attributable to PM2.5 from 1990 to 2020 and project future trends to 2050.

METHODS

We used data from the 2021 Global Burden of Disease study, including population estimates, IS incidence rates, and PM2.5 concentrations, for 204 countries and World Bank regions. The Environmental Benefits Mapping and Analysis Program algorithm was applied to estimate IS cases attributable to PM2.5. Future projections were calculated using an autoregressive integrated moving average model.

RESULTS

Between 1990 and 2020, global PM2.5 concentrations decreased by 8.18 μg/m3. This reduction was associated with approximately 920,245 avoided IS cases, equivalent to 12.11% of the global IS incidence in 2020. The East Asia and Pacific region experienced the greatest benefit, with 699,218 IS cases avoided (19.09% of the region's IS incidence in 2020). By 2050, PM2.5 concentrations are projected to decline by 33.64 μg/m3 relative to 1990, potentially preventing an additional 6,004,854 IS cases. However, significant disparities persist, particularly in low-income regions where PM2.5 exposure and limited health care infrastructure continue to pose challenges.

DISCUSSION

Our findings highlight the substantial public health benefits of PM2.5 reductions in mitigating the IS burden. While high-income regions have seen substantial gains due to stringent air quality regulations, low-income regions remain disproportionately affected. Addressing these disparities requires targeted pollution control policies and equitable health care resource allocation. Sustained efforts in air quality management are critical to reducing the global IS burden and improving health outcomes, particularly in vulnerable populations.

Global and regional trends in the burden of surgically confirmed endometriosis from 1990 to 2021

BACKGROUND

endometriosis as a common gynecologic finding significantly affects the quality of life of many women. An accurate understanding of the epidemiological characteristics of endometriosis is essential for disease control and prevention. We aimed to use the latest data from the Global Burden of Disease (GBD) 2021 to comprehensively analyze the various epidemiological indicators of surgically confirmed endometriosis and their changing trends to better measure the disease burden and help improve health management.

METHODS

We delineated incidence, prevalence, and years lived with disability (YLDs) of surgically confirmed endometriosis at the global, regional, and national levels. The estimated annual percentage change (EAPC) was calculated to assess temporal trends in the age-standardized rate (ASR). In addition, we used joinpoint regression models to describe local trends in these indicators, assessed the correlation between disease burden and Socio-demographic index (SDI) levels, and used decomposition analysis to quantitatively analyze the driving factors leading to changes in disease burden.

RESULTS

Globally, the age-standardized rate of incidence, prevalence, and YLDs of surgically confirmed endometriosis all showed a decreasing trend from 1990 to 2021. The burden of surgically confirmed endometriosis is mainly concentrated in women aged 20-30 years and declines with increasing SDI levels. The results of the decomposition analysis indicated that population growth is the main driving factor for the upward in the number of incidence, prevalence, and YLDs cases of endometriosis worldwide.

CONCLUSIONS

The overall burden of endometriosis has decreased globally from 1990 to 2021, but there are regional disparities. Managing this condition remains a major challenge, and more refined policies and interventions are needed to effectively address the burden of endometriosis.

Global, regional, and national burden of breast cancer in young women from 1990 to 2021: findings from the global burden of disease study 2021

AIM

The issue of breast cancer in young women (BCYW) has gained increasing attention over the past few decades. However, a notable gap exists in the literature concerning the comparison of the disease burden of BCYW with that of other age groups. This study presents a comprehensive analysis of the disparities in global, regional, and national burden between BCYW and their middle-aged and elderly counterparts.

METHODS

The breast cancer data in this study were collected from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021). The age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized disability-adjusted life years rate (ASDR), and the Average Annual Percent Change (AAPC) were employed to assess the disease burden of BCYW. The Bayesian Age-Period-Cohort model was used to forecast disease burden from 2022 to 2030.

RESULTS

The AAPC of ASIR of BCYW from 1990 to 2021 was 0.91 (95% CI: 0.77 to 1.05), exceeding the global average (0.49, 95% CI: 0.40 to 0.58) as well as both middle-aged (0.60, 95% CI: 0.47 to 0.73) and elderly groups (0.30, 95% CI: 0.21 to 0.39). The AAPC for ASMR of BCYW experienced a marginal increase of 0.02 (95%CI: -0.07 to 0.11) from 1990 to 2021, surpassing the rates observed in both the middle-aged group (-0.40, 95%CI: -0.47 to -0.32) and the elderly group (-0.50, 95%CI: -0.62 to -0.38). The ASIR in BCYW significantly increased in regions with low (AAPC = 1.87), low-middle (AAPC = 2.32), middle (AAPC = 1.84), and high-middle SDI (AAPC = 0.98), while it remained unchanged in regions with high SDI (AAPC = -0.02). This trend was also observed among middle-aged and older groups. The ASMR in BCYW significantly increased in regions with low (AAPC = 1.01) and low-middle SDI (AAPC = 1.25), but remained unchanged in regions with middle SDI (AAPC = 0.02), while it decreased in regions with high-middle (AAPC = -1.10) and high SDI (AAPC = -1.60). Among the middle-aged and elderly populations, there was an increase in ASMR rates observed in regions with low, low-middle, and middle SDI groups (all AAPC > 0), whereas a decrease was noted in the regions with high-middle and high SDI (all AAPC < 0). The BAPC predicts a consistent annual increase in ASIR, ASMR, ASPR, and ASDR of BCYW globally and in China from 2022 to 2030. Notably, China has higher ASIR and ASPR rates compared to the global average, while its ASMR and ASDR rates are lower.

CONCLUSION

The burden of BCYW was particularly significant in regions with low-SDI, low-middle SDI, and middle SDI. Despite the progress made, China still faces considerable challenges in effectively addressing this issue. The prevention and control of BCYW must remain a priority. Different countries and regions should develop personalized, targeted intervention strategies for this population and establish public health policies tailored to the specific needs of each region.

Burden of pulmonary arterial hypertension in Asia from 1990 to 2021: Findings from Global Burden of Disease Study 2021

BACKGROUND

Pulmonary arterial hypertension (PAH) presents a significant health burden in Asia and remains a critical challenge. This study aims to delineate the PAH burden in Asia from 1990 to 2021.

METHODS

Using the latest data from the Global Burden of Disease 2021, we evaluated and analyzed the distributions and patterns of PAH disease burden among various age groups, sexes, regions, and countries in Asia. Additionally, we examined the associations between PAH disease burden and key health system indicators, including the socio-demographic index (SDI) and the universal health coverage (UHC) index.

RESULTS

In 2021, there were 25,989 new PAH cases, 103,382 existing cases, 13,909 PAH-associated deaths, and 385,755 DALYs attributed to PAH in Asia, which accounted for approximately 60% of global PAH cases. The age-standardized rates (ASRs) for prevalence and deaths were 2.05 (95% uncertainty interval [UI]: 1.66-2.52) per 100,000 population and 0.31 (95% UI: 0.23-0.38) per 100,000 population, respectively. From 1990 to 2021, Asia reported the lowest ASRs for PAH prevalence but the highest ASRs for deaths compared to other continents. While the ASRs for prevalence increased slightly, ASRs for mortality and DALYs decreased over time. This increasing burden of PAH was primarily driven by population growth and aging. The burden was especially pronounced among individuals aged ≥60 years and <9 years, who collectively accounted for the majority of deaths and DALYs. Moreover, higher SDI and UHC levels were linked to reduced incidence, but higher prevalence rates.

CONCLUSIONS

Although progress has been made in reducing PAH-related mortality and DALYs, the disease continues to impose a substantial burden in Asia, particularly among older adults and young children. Region-specific health policies should focus on improving early diagnosis, expanding access to treatment, and effectively addressing the growing PAH burden in the region.

Comparison of triglyceride-glucose related indices in prediction of cardiometabolic disease incidence among US midlife women

The effects of triglyceride-glucose (TyG) related indices on cardiometabolic disease (CMD) are still unclear. Our study aimed to investigate the relationship between the TyG-related indices and CMD risk among midlife women. This retrospective observational cohort study utilized data from the 2020 SWAN participants. The TyG index was computed as Ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Modified TyG indices were created by integrating TyG with body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR). Multivariate Cox proportional hazards regression and receiver operating characteristic (ROC) analyses were conducted to assess the associations and predictive capacities of TyG and its related indices with CMD incidences. The mean age of participants was 45.7 years, comprising 420 (20.8%) Black, 184 (9.1%) Chinese, 225 (11.1%) Japanese, and 1191 (58.9%) Caucasian or Hispanic women. Over a 10-year follow-up, 837 women (41.4%) developed CMD. Compared to the lowest quartile, the adjusted hazard ratios (95% confidence intervals) for incident CMD in the highest quartile for TyG, TyG-BMI, TyG-WC, and TyG-WHtR were 1.78 (1.41-2.25), 3.26 (2.51-4.24), 3.13 (2.41-4.06), and 3.19 (2.47-4.12), respectively. The area under the ROC curve for modified TyG indices was significantly higher than that for the TyG index alone. Both the TyG and modified TyG indices were significantly associated with new-onset CMD, with modified TyG indices showing superior performance in identifying individuals at risk for CMD.

Can we cure rheumatoid arthritis?

Rheumatoid arthritis (RA) persists as a chronically progressive autoimmune disorder, notwithstanding significant advancements in early intervention and precision-targeted therapeutics. While treat-to-target paradigms and disease-modifying antirheumatic drugs ameliorate clinical outcomes, sustained drug-free remission (SDFR) or even cure remains elusive, underscoring the need for innovative strategies addressing underlying immunopathogenic mechanisms. Prolonged SDFR implies cure or eradication of disease, but there is no consensus definition of cure because it has rarely been contemplated in RA. Pathogenic immune circuit resilience, stromal hyperactivation, persistent structural abnormalities, and genetic susceptibilities constitute multifactorial barriers to a cure. Emerging therapies - including novel biologics, cellular interventions, and gene editing - aim to reprogram pathogenic immune responses rather than suppress symptoms and may have the potential for both SDFR and possibly cure. Whereas preclinical and early clinical data suggest the potential to modify disease trajectories, durable resetting of the RA immune system toward normal has not yet been conclusively demonstrated or uniformly achieved in RA. The 'window of opportunity' paradigm postulates that early-stage immunomodulatory interventions may alter the disease trajectory. However, the optimal therapeutic approaches for capitalizing on this temporal window remain debated, particularly regarding the integration of personalized biomarkers and mechanistic targets. This review summarizes advancements in RA therapeutics, evaluating whether emerging modalities can pivot the clinical paradigm from symptomatic management to the induction of persistent immunological normalization and cure. Although definitive cure remains on the far horizon, the rapid convergence of precision medicine, next-generation immunotherapy, and translational research underscores a paradigm shift toward curative strategies.

Bidirectional associations between adiposity and mental health: a prospective cohort study of the UK Biobank

OBJECTIVE

This study aimed to examine the bidirectional associations between indicators of adiposity and mental health.

METHODS

Using longitudinal data from 60,319 UK Biobank participants, we explored the bidirectional associations between mental health (including neuroticism, recent depressive symptoms, probable depression status, stress, mania, life satisfaction, and happiness) and adiposity indicators (including BMI, waist circumference, body fat percentage, and different obesity types).

RESULTS

The multivariate logistic regressions and mixed-effects models revealed the following: 1) BMI and general obesity were bidirectionally associated with recent depressive symptoms, having probable depression status, experiencing at least one type of stress (especially stress from serious illness, injury, or assault to oneself or financial difficulties), and life satisfaction (especially health satisfaction and financial situation satisfaction); 2) waist circumference and abdominal obesity were bidirectionally associated with recent depressive symptoms and financial situation satisfaction; and 3) body fat percentage and high body fat percentage were bidirectionally associated with recent depressive symptoms, experiencing stress from financial difficulties, health satisfaction, and financial situation satisfaction.

CONCLUSIONS

The bidirectional associations between specific indicators of adiposity and mental health depend on the types of adiposity.

Contribution of Posttuberculosis Sequelae to Life-Years Lost from Tuberculosis Disease in the United States, 2015-2019

Rationale: Individuals surviving tuberculosis (TB) disease may experience chronic sequelae that reduce survival and quality of life. These post-TB sequalae are not generally considered in estimates of the health impact of TB disease. Objectives: To estimate the TB-attributable reductions in life expectancy and quality-adjusted life expectancy for individuals developing TB disease in the United States, including post-TB sequelae. Methods: We extracted national surveillance data on individuals with diagnoses of TB from 2015 to 2019, including demographics, vital status at diagnosis, treatment duration, treatment outcome, and coprevalent conditions. Using a mathematical model, we simulated life expectancy and quality-adjusted life-years (QALYs) for the TB cohort compared with a no-TB counterfactual (with the same distributions of age, sex, race/ethnicity, and coprevalent conditions as the TB cohort but without TB-attributable mortality and disutility). We disaggregated results to report the proportions of QALYs and life-years lost from TB due to post-TB sequelae and stratified outcomes by age, sex, and race. Measurements and Main Results: Estimated life expectancy after TB diagnosis was 30.3 (95% uncertainty interval, 29.9-30.7) years for the TB cohort versus 32.3 (31.9-32.7) years without TB, a difference of 2.03 (1.84-2.21) years and 1.93 (1.69-2.18) QALYs. Life-years lost were greatest for individuals 65-74 years of age versus other age groups, for men versus women, and for American Indian or Alaska Native individuals versus persons from other races/ethnicities. Overall, 41% (35-46%) of life-years and 48% (42-54%) of QALYs lost were estimated to result from post-TB sequelae. Conclusions: In the United States, a substantial fraction of life-years and QALYs lost from TB are attributable to post-TB sequelae. Evidence is needed on approaches to prevent and repair post-TB lung damage in the context of frequent coprevalent health conditions.

The burden and trends of road injuries in Afghanistan (1990-2021): A joinpoint analysis of data from the global burden of diseases, 2021 study

Objective

Road injuries pose a major public health challenge, particularly in low-income, conflict-affected regions like Afghanistan. Despite issues like poor infrastructure and weak traffic regulations, no national study has assessed the road injury burden. This study examines Afghanistan's road injury burden from 1990 to 2021.

Method

This epidemiological study utilized the global burden of diseases (GBD) 2021 data. Key metrics included age-standardized mortality rate (ASMR), age-standardized disability-adjusted life-years rate (ASDR), years of life lost (YLL), and years lived with disability (YLD) per 100,000 population. Trends were analyzed using joinpoint analysis to determine annual and average annual percent changes (APC and AAPC). Estimates were presented with a 95 % uncertainty Interval, and statistical significance was assessed via permutation tests (p < 0.05).

Results

Between 1990 and 2021, Afghanistan's road injury burden declined across all indicators (ASMR: -1.2 %, ASDR, YLL, YLD). Males (1.2 %) and children (AAPC: -3.1 %) saw the steepest declines, while the elderly (-0.7 %) had the slowest. Motor vehicle injuries dropped most (1.3 %), followed by pedestrian (1.0 %) and motorcyclist (0.9 %) injuries.Period-specific trends showed fluctuations: ASMR, ASDR, and YLL rose (1990-1997), then declined, except YLD, which increased post-2018 (+0.5 %). From 2017 to 2021, YLD rose across all age groups (except 0-14 years). Post-2014, motorcycle-related ASMR increased (+0.3 % APC), while from 2017 to 2021, ASDR and YLD increased across all injury types (+0.4 % to +1.3 % APC).

Conclusion

Despite progress, rising DALYs and YLDs, especially from 2017 onward, highlight a growing disability road injury burden, necessitating targeted interventions to address long-term disability and mitigate its public health impact.

A National Cross-Sectional Survey on Real-World Experiences of Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibody Use in Adults with Migraine in Finland

INTRODUCTION

Calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs) were the first preventive migraine treatment group to target the underlying cause of migraine. This survey evaluated real-life experiences of adults with migraine in Finland before and after using their current subcutaneous CGRP mAb treatment.

METHODS

Adult users of a subcutaneous CGRP mAb for migraine prevention were recruited for an electronic cross-sectional survey by Finnish community pharmacies and Migraine Finland (a patient advocacy group) in 2023. The survey included questions regarding monthly migraine headache days, absenteeism, general disability, pain intensity, treatment patterns, and a validated Migraine-Specific Quality of Life (MSQoL) questionnaire.

RESULTS

The survey was completed by 383 users of subcutaneous CGRP mAb medication, of whom 78 (20.4%) were receiving galcanezumab. Users of galcanezumab, the latest CGRP mAb to be reimbursed in Finland, had more previous CGRP mAb treatment switches than users of other CGRP mAbs. Following any subcutaneous CGRP mAb use, changes were observed in the number of monthly migraine headache days (0-7 experienced by 17/379 participants [4.5%] with data before, versus 302/379 [79.7%] after using treatment; ≥ 12 experienced by 279/379 [73.6%] before, versus 34/379 [9.0%] after), monthly sick leave days (from 139/376 [37.0%] to 15/376 [4.0%] with ≥ 4 monthly sick leave days), overall ability to work or study (from 180/377 [47.7%] to 287/377 [76.1%] able to work or study full time) and average intensity of migraine pain (median [lower-upper quartile] from 8.0 [7.0-9.0] before to 6.0 [4.0-8.0] after). No differences were observed between total MSQoL scores for new (0-6 months CGRP mAb use) versus persistent (≥ 6 months use) users of any CGRP mAb.

CONCLUSIONS

Patient experiences of using subcutaneous CGRP mAbs in Finland showed improvements in several migraine-related factors, supporting the potential for CGRP mAbs to improve the quality of life of adults with migraine.

Optimal blood pressure target for patients with prior stroke: A systematic review and meta-analysis

In this systematic review of randomized controlled trials, we examined the optimal blood pressure (BP) target for patients with prior stroke, comparing intensive BP control (systolic BP [SBP] <130 mmHg) with standard BP control (SBP < 140 mmHg). Literature searches of PubMed/MEDLINE, the Cochrane Database, and Ichu-shi identified seven randomized controlled trials for quantitative analysis. Meta-analyses were performed using random-effects models, with most included trials assessed as having low risks of bias. The meta-analysis showed significant reductions in recurrent stroke (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.65-0.96) and major cardiovascular events (RR, 0.86; 95% CI, 0.76-0.97) in the intensive BP control arm. Intensive BP control was more effective in reducing recurrent hemorrhagic stroke (RR, 0.33; 95% CI, 0.15-0.74) than ischemic stroke (RR, 0.87; 95% CI, 0.71-1.08). However, adverse events such as syncope or dizziness were significantly more frequent in the intensive BP control arm (RR, 1.30; 95% CI, 1.00-1.68). Absolute risk reductions (per 1,000 persons) for recurrent stroke (-14; 95% CI, -24 to -4) and major cardiovascular events (-17; 95% CI, -28 to -6) outweighed the absolute increase in syncope or dizziness (4; 95% CI, 0-9). We recommend a lower SBP target of <130 mmHg, with careful monitoring for hypotension-related symptoms, to prevent recurrent stroke and major cardiovascular events in patients with prior stroke.

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

Background

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

Methods

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

Results

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

Conclusion

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

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

RESULTS

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

CONCLUSIONS

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

Oral Cancer Knowledge and Screening Practices Among Dental Professionals in Yemen: a Web-Based Survey

BACKGROUND

Good knowledge and screening practices of dental professionals for oral cancer (OC) will inevitably improve its prognosis. The present study sought to evaluate OC knowledge and practices among dental professionals in Yemen.

METHODS

This study was conducted among Yemeni dentists. The used tool was a prevalidated online questionnaire composed of items on the knowledge, practices, and barriers of OC screening and early detection. The data were managed and analysed using SPSS Version 28.0.

RESULTS

A total of 506 dental professionals completed the questionnaire. The participants showed moderate levels of knowledge on risk factors and clinical signs of OC. While the majority reported tobacco (89.9%) as a potential risk factor, only 76.7% and 57.5% of the subjects reported a potential role for alcohol consumption and old age. Regarding clinical signs, the majority reported that OC can present as nonhealing ulcer (90.3%) or white/red patch (87.2%), yet only 73.7% reported that it can present as swelling/lump, and around 32% reported that teeth attrition is one of its clinical signs. Concerning practices, most of the participants reported asking their patients about their tobacco habits (84%), routinely examine patients' oral mucosa (81.4%), and refer suspicious lesions to specialists (91.3%). Only 44.9% reported feeling confident regarding their knowledge and training on OC. Specialists and those who attended educational courses on OC were more knowledgeable, more confident, and showed better practices than their counterparts. Inadequate knowledge/training, lack of time, and lack of financial compensation were the most reported barriers to OC screening and early detection.

CONCLUSION

The present study indicates marked gaps in the knowledge and screening practices of OC among Yemeni dentists. Therefore, conducting periodic continuing courses along with interventional trainings are urgently recommended to address these gaps.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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