搜索结果：2000

Severe mental illness (SMI) accounts for over a third of all mental disorders globally, significantly reducing life expectancy and quality of life. Trends in SMI vary, with recent Danish studies reporting both stable and rising rates in the 2000s. This study examines the prevalence (1996-2018) and incidence (2000-2018) of SMI in Denmark, analyzing age- and sex-specific trends using nationwide health registry data. The study included individuals aged ≥18 years with a psychiatric hospital diagnosis of SMI, recorded in the Danish National Patient Registry (1995-2018). SMI was defined as moderate to severe depression, bipolar disorder, or psychotic disorder based on ICD-10 classifications. We estimated five-year prevalence (2000-2018) and one-year incidence (1996-2018), stratified by age and sex. Between 2000 and 2018, the crude prevalence of depression more than doubled, while bipolar and psychotic disorders increased by 89.6% and 35.0%, respectively. All SMIs increased among individuals aged 18-29. From 1996 to 2018, depression and bipolar disorder incidence rose by 137.5% and 45.1%, respectively, while psychotic disorder incidence declined by 9.5%. The largest incidence increase occurred in the 18-29 age group. Bipolar and psychotic disorder prevalence declined in those ≥70 years. Depression was the most prevalent disorder among individuals ≥90 years. SMI prevalence and incidence in Denmark have risen over the past two decades, particularly among younger adults. However, professional, cultural, administrative, and societal factors must be considered before concluding an actual increase in SMI cases.

25-Hydroxyvitamin D3 (25(OH)D3) has been reported to improve production performance and egg quality in ducks during late laying period, but its effects during the peak laying period remain rarely studied. The aim of this study was to investigate the effects of dietary 25(OH)D3 supplementation on the production performance, egg quality, tibia quality and mineral metabolism of ducks during peak laying period in a cage rearing system. A total of 360 Liancheng white laying ducks at 30 weeks (wks) of age were randomly assigned to 5 groups, each consisting of 6 replicates with 12 ducks per replicate. Ducks were fed a basal diet with 25(OH)D3 supplementation at 0, 1000, 2000, 3000, and 4000&#x2009;IU/kg throughout the trial for 8 wks. One-way ANOVA was employed to assess the influence of supplementation level, and linear and quadratic regression analyses were performed for statistical evaluation of dose-dependent effects. 25(OH)D3 supplementation linearly and quadratically increased the laying rate, average egg weight and egg mass and quadratically decreased the feed conversion ratio (FCR). The mean of eggshell strength and thickness at 4 and 8 wks increased linearly and quadratically with increasing 25(OH)D3 levels, and the 4000&#x2009;IU/kg 25(OH)D3 increasing the eggshell thickness by 5.7% (at 4 wks) and 2.9% (mean of those at 4 and 8 wks) relative to those of the non-supplemented group. At the end of wks 4 and 8 of the trial, serum 25(OH)D3, bone glutamyl protein (BGP) and carbonic anhydrase (CA) increased linearly (P < 0.05), and serum parathyroid hormone (PTH) decreased linearly (P < 0.05); the 4000&#x2009;IU/kg group had the highest serum 25(OH)D3 (4.24&#x2009;ng/mL) and BGP (3.11&#x2009;ng/mL) concentrations at 8 wks. Additionally, the tibial breaking strength, trabecular bone number, BGP content, and alkaline phosphatase (ALP) activity and mRNA levels increased linearly with 25(OH)D3 supplementation (P < 0.05). The optimal dietary 25(OH)D3 supplementation levels were approximately 2355, 2347 and 3269&#x2009;IU/kg on the basis of the quadratic model of the laying rate, FCR and eggshell strength, respectively. In summary, 25(OH)D3 supplementation improved the production performance and eggshell quality of ducks during peak laying period by maintaining calcium and phosphorus homeostasis and enhancing tibia quality. A diet that contains 2347-3269&#x2009;IU/kg of 25(OH)D3 displayed beneficial effects on maintaining calcium and phosphorus homeostasis, and improving the tibial quality, which was recommended for ducks during peak laying period in the cage rearing system (30-38 wks of age). 25-Hydroxyvitamin D3 (25(OH)D3) has been demonstrated to improve production performance and egg quality in ducks during late laying period. However, its effects on ducks during peak laying period in the cage rearing system within a cage rearing system remain inadequately explored. The purpose of the present study was to investigate the effects of dietary supplemental levels of 25(OH)D3 on the production performance, egg quality, tibia quality and mineral metabolism of ducks during 30-38 wks of age in a cage rearing system. Ducks were fed a basal diet without 25(OH)D3 supplementation or with 25(OH)D3 supplementation at 1000, 2000, 3000, and 4000&#x2009;IU/kg throughout the trial for 8 wks. The results indicated that dietary 25(OH)D3 supplementation improved the production performance, eggshell and tibia quality and mineral metabolism of ducks during peak laying period. Supplementing the basal diet with 2347-3269&#x2009;IU/kg 25(OH)D3 is recommended for laying ducks during peak laying period of production (30-38 wks of age).

Erectile dysfunction (ED) is a prevalent condition with important vascular and systemic implications. Although air pollution has been linked to multiple chronic diseases, its association with ED remains insufficiently explored. To investigate the association between long-term exposure to multiple ambient air pollutants and the risk of ED among Taiwanese men. We conducted a retrospective nationwide cohort study using the National Health Insurance Research Database from 2000 to 2013. Ten-year cumulative exposures to 11 pollutants-sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3), particulate matter <10 &#xb5;m (PM10), particulate matter <2.5 &#xb5;m (PM2.5), nitrogen oxides (NOX), nitrogen monoxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), nonmethane hydrocarbons (NMHC), and methane (CH4)-were estimated by linking residential postal codes. The outcome was incident ED (Ninth Revision of the International Classification of Diseases, Clinical Modification 302.72 or 607.84). Cox regression models adjusted for demographics, comorbidities, medications, ambient temperature, season, and short-term pollutant levels were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs). During follow-up, 4936 participants (1.16%) developed ED. Each 1-SD increase in SO2, CO, O3, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 was associated with increased ED risk (adjusted HRs 1.45-2.65; p < 0.001 for all). Conversely, O3 exposure was inversely associated with ED (HR 0.45; 95% CI 0.44-0.46). These associations remained consistent across age strata. Our findings suggest that chronic exposure to most ambient air pollutants may contribute to ED, potentially through vascular, endocrine, and inflammatory pathways, while O3 may exhibit paradoxical protective effects. Long-term exposure to multiple air pollutants is associated with an elevated risk of ED among Taiwanese men, highlighting air pollution as a potential modifiable environmental risk factor for men's sexual health.

Failure of conservative management in patients with initially uncomplicated acute type B aortic dissection (TBAAD) remains clinically relevant. This study evaluated whether commonly cited imaging-based morphologic features are associated with long-term failure of conservative management. This retrospective single-center cohort study included consecutive patients treated for uncomplicated TBAAD between 2000 and 2018 with high-quality baseline computed tomography angiography and &#x2265;1 year of imaging follow-up. Baseline morphologic parameters were assessed with centerline-based analysis and included descending thoracic aortic diameter (DTAD), ascending aortic diameter, true and false lumen dimensions, and primary entry tear (PET) characteristics. Failure of conservative management was defined as the need for surgical or endovascular intervention >3 months after initial presentation. Cox proportional hazards models evaluated associations between morphologic parameters and subsequent intervention. Eighty-nine patients (median age 65 years; 65.2% male) were included with a median follow-up of 7.6 years. During follow-up, 33 patients (37.1%) required aortic intervention, mainly due to aneurysmal degeneration or rapid growth. Baseline DTAD was significantly larger in patients requiring intervention (median 41 mm vs. 37 mm; p=0.026). DTAD &#x2265;40 mm was independently associated with intervention (adjusted hazard ratio [HR] 2.15; 95% confidence interval [CI] 1.05-4.42; p=0.037). DTAD analyzed as a continuous variable remained associated with intervention risk (HR 1.09 per mm; 95% CI 1.02-1.16; p=0.011). Other morphologic features were not associated with aortic growth or need for intervention. Baseline descending thoracic aortic diameter was the only morphologic imaging feature consistently associated with long-term failure of conservative management in uncomplicated TBAAD.

Lung transplantation is the definitive treatment for end-stage pulmonary disease, but ongoing challenges remain in long-term survival. We report our single center experience of 2,000 adult lung transplants over a nearly 35-year period and assess trends in patient demographics, intraoperative management, and in perioperative and long-term outcomes. We retrospectively reviewed 2,000 lung transplants at our center performed between 1988 and 2023. Recipients and donors were separated into 3 eras: Era 1 (1988-2000), Era 2 (2001-2011), and Era 3 (2012-2023). Recipient outcomes were compared between the eras. There were differences in recipient demographics across the eras. Over time, we have increasingly transplanted patients with restrictive lung disease. Overall graft survival has improved, with median graft survival increasing from 5.5 years (Era 1) to 9.0 years (Era 3) (p < 0.0001). We observed similar trends when patients were stratified by transplant indication. The incidence of primary graft dysfunction grade 3 (PGD3) has remained stable at 28.7% in Era 2 and 26.7% in Era 3 (p = 0.4892). The median freedom from chronic lung allograft dysfunction (CLAD) has improved from 3.2 (Era 2) to 3.4 years (Era 3) (p = 0.0001). Lung graft survival has improved over time at our institution due to advances in perioperative and long-term management. However, PGD3 rates have not changed and CLAD is commonly diagnosed within the first 4 years after transplant. Further research is necessary to understand these disease processes and to generate new treatment strategies to address them.

Hypertensive disorders of pregnancy represent a major cause of maternal and fetal morbidity and mortality. Despite primary aldosteronism (PA) being the most common cause of secondary hypertension, there is limited data on pregnancy complications in patients with PA. We conducted an international survey across 5 Hypertension Centers in Europe to gather data on maternal and neonatal complications in women diagnosed with PA from 2000 to 2022. We included 102 women aged 18 to 45 years at PA diagnosis who were pregnant either after or <1-year before the diagnosis of PA. The first eligible pregnancy for each patient was included. Overall, 56% of pregnancies were complicated, with the most frequent complications being maternal preeclampsia (36%), preterm birth (30%), low birth weight (30%), and neonatal intensive care admission (22%). Hypokalemia occurred in 31% of pregnancies. Pregnancies occurring before PA diagnosis presented a poorer blood pressure control and were associated with higher rates of overall, maternal, and fetal/neonatal complications compared with pregnancies in patients with an established PA diagnosis. Independent predictors of complications included uncontrolled blood pressure values during pregnancy (odds ratio [OR], 7.05), undiagnosed PA (OR, 4.37), North/Black African ethnicity (OR, 3.69), a higher body mass index (OR, 1.09), and treatment with a higher number of antihypertensive drugs at PA diagnosis (OR, 2.18). PA is associated with a high rate of pregnancy-related complications, predominantly preeclampsia. Undiagnosed PA during gestation significantly increases the risk of adverse outcomes. Early identification and optimized hypertension control in women with PA are critical to improve maternal and fetal outcomes.

Bipolar disorder (BD) is a chronic psychiatric illness associated with high rates of medical comorbidities, among which metabolic syndrome (MetS) is particularly prevalent and consequential. Affecting nearly half of individuals with BD, MetS compounds the risk of cardiovascular disease, type 2 diabetes, and premature mortality, while also undermining psychiatric stability and cognitive functioning. Despite these outcomes, metabolic health remains underrecognized and undertreated in psychiatric care. This narrative review aims to examine the bidirectional relationship between BD and metabolic syndrome and to highlight multidisciplinary strategies for metabolic monitoring and clinical management in this population. A targeted literature search was conducted using PubMed (2000-2025), covering studies on the epidemiology, behavioral and biological mechanisms, pharmacologic and lifestyle interventions, and clinical care integration related to BD and MetS. The review followed established quality guidance for narrative synthesis and was structured using the Population-Concept-Context framework to improve transparency in the selection and synthesis of the literature. The comorbidity between BD and MetS is shaped by multiple interacting factors, including shared behavioral risk factors, inflammatory pathways, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and the metabolic effects of psychotropic medications. While pharmacological treatment remains essential for mood stabilization, systematic metabolic monitoring is crucial to mitigate treatment-related risks. Evidence supports the central role of lifestyle interventions, including nutritional strategies and physical activity in reducing cardiometabolic risk. Emerging therapeutic approaches such as GLP-1 receptor agonists and ketogenic metabolic therapy show potential benefits but require careful clinical integration. In selected individuals with severe or refractory obesity, bariatric surgery may be considered. Therapeutic patient education (TPE) represents the cornerstone of care by supporting self-management, treatment adherence, and shared decision-making. Addressing the dual burden of BD and MetS requires a multidisciplinary and patient-centered approach integrating metabolic monitoring, lifestyle interventions, pharmacological strategies, and therapeutic patient education. Strengthening collaboration between psychiatry, primary care, and metabolic specialists is essential to reduce cardiometabolic risk and improve long-term health outcomes in this vulnerable population.

Less women participate in Alzheimer Disease (AD) trials compared to their estimated representation in the global dementia population. We aimed to apply five most commonly used eligibility criteria to a real-world memory clinic population to compare male and female eligibility according to these criteria. Observational. Memory clinic setting. Consecutive patients (2000-2024) from Amsterdam Dementia Cohort with a diagnosis of mild cognitive impairment (MCI) or AD (n = 3835). Free-text eligibility criteria of n = 608 phase II and III AD drug trials were downloaded from ClinicalTrials.gov (March 28, 2025). A machine-learning model was trained and validated to extract all eligibility criteria. Next the criteria were applied on observational real world data from on memory clinic diagnostic work-up. Top 5 most common AD clinical trial eligibility criteria were 1) no other central nervous system disorder related to cognitive impairment (84%), 2) participation of a caregiver (72%), 3) MMSE (66%, range 20-30), 4) no comorbidities, specifically vascular and mental health (62%), 5) no contra-indications for study procedures such as lumbar puncture, MRI and PET (59%). Applying the abovementioned criteria results in 33% of men and 23% of women remaining eligible (p<.001). Main reason for non-eligibility is caretaker absence (applicable for 20% of men and 38% of women) and low MMSE (32% of man and 54% of women). Based on five commonly used eligibility criteria of AD clinical trials, women in our clinic-based cohort are less eligible for participation in AD drug trials than men. This discrepancy was mainly attributed to lack of caregiver presence and lower MMSE at presentation. These results provide clues for trial design to facilitate more equal inclusion of women.

When it comes to root canal therapy, the right working length (WL) must be established in order to minimize material extrusion and the resulting post- procedure pain. Although electronic apex locators (EALs) are a radiation-free, time-saving substitute for conventional or digital radiography techniques, but their impact on postoperative pain has been controversial.&#xa0;This systematic review was registered in PROSPERO (CRD420251247626) and adhered to PRISMA 2020 guidelines. Randomized controlled trials (RCTs) comparing EAL versus radiographic WL determination, with postoperative pain as an outcome, were searched in PubMed, Cochrane CENTRAL, and ScienceDirect from January 2000 to November 17, 2025. Only peer-reviewed RCTs involving permanent teeth were considered. Bias risk was evaluated using Cochrane RoB 2.0. Four RCTs (total n&#x2009;=&#x2009;414 patients) met the inclusion criteria.&#xa0;Four RCTs (2014-2024) showed no statistically significant difference in postoperative pain incidence, intensity (measured by VAS or 4-point verbal rating scale), analgesic consumption, or time to pain resolution between EAL and radiographic groups at any time point (4&#xa0;h to 7&#xa0;days). Pain levels were generally low to moderate and resolved within 72&#xa0;h in both groups. One three-arm trial demonstrated significantly lower early pain (6-48&#xa0;h) with a simultaneous/hybrid EAL plus radiographic technique compared with either method alone. No flare-ups or serious adverse events were reported.&#xa0;Based on limited evidence from four RCTs with methodological concerns (including risks in randomization, blinding, and subjective pain assessment) and very low certainty, electronic apex locators and radiographic methods may yield similar postoperative pain outcomes in single-visit root canal treatment of vital teeth. A combined method of both techniques showed preliminary indications of early pain alleviation in one small trial on symptomatic conditions, but this requires confirmation. EALs may represent a radiation free alternative or supplement to radiography that does not appear to increase pain, though the evidence is insufficient to draw firm conclusions.

Historical perspectives remain an underused resource in family medicine research, despite their capacity to explain the development of current challenges and the persistence of certain assumptions in family medicine education. Consequently, many scholars have had little opportunity to engage with historical approaches or the questions they invite. This gap is notable at a time when concern about the family medicine workforce and the effectiveness of educational reform have prompted renewed attention to how the discipline prepares and inspires future practitioners. This manuscript introduces the potential of historical inquiry within family medicine education research and invites readers to consider how a historical lens can expand the ways researchers frame and investigate problems in the field. Although educational strategies are often presented as novel responses to current pressures, many have deeper roots that become visible only when viewed across longer periods. To demonstrate how historians interpret scholarship, context, and sources to construct an account of change over time, we draw on our examination of the Canadian Family Physician journal from 1967 to 2000. The example is intended to clarify methodological principles rather than to present findings. By outlining how historical inquiry operates in practice, this paper gives researchers a starting point for bringing historical perspectives into their own studies and for opening lines of inquiry that fall outside the reach of contemporary data.

Pediatric cancer is an emerging public health priority in Africa, where survival rates remain critically low compared to high-income regions. Malnutrition; specifically wasting and cachexia; is the most prevalent, yet modifiable comorbidity that compromises treatment tolerance and increases mortality. Recent primary studies from 2025 indicate a significant discrepancy between wasting diagnosed via clinical assessment versus anthropometrically defined wasting, suggesting a "hidden burden" of malnutrition in African oncology wards. However, no comprehensive synthesis of data exists regarding the prevalence of wasting across the continent using modern assessment standards, nor its specific impact on clinical outcomes in the current treatment era. We will conduct a systematic review and meta-analysis of observational studies (cross-sectional, cohort, and case-control) published from January 1, 2000, to the present. Data sources will include PubMed/MEDLINE, EMBASE, Web of Science and CINAHL. We will include studies involving children and adolescents (0-19 years) diagnosed with malignancies in African healthcare settings. Two independent reviewers will screen studies, extract data, and assess risk of bias using Covidence systematic review software. The risk of bias will be assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. The primary outcome will be the pooled prevalence of wasting/cachexia. Secondary outcomes will include diagnostic accuracy of assessment methods (such as Mid-Upper Arm Circumference [MUAC] vs. Weight-for-Height vs. clinical assessment) and associations with adverse clinical events (neutropenia, sepsis, treatment abandonment, and mortality). A random-effects meta-analysis will be performed using R software. Heterogeneity will be assessed using the I2 statistic and explored via subgroup analyses (region, tumor type, and assessment tool). Ethical approval is not required as this study relies on secondary data. Findings will be disseminated through a peer-reviewed publication and conference presentations to inform nutritional guidelines for pediatric oncology in resource-limited settings. Registration Number: CRD420251237859.

Age at menarche (AAM) is a key indicator of female pubertal development. A secular decline in AAM has been observed globally, but data from indigenous populations of Northeast India remain limited. This study documents the secular trend in AAM among Mizo ethnic women over five decades and examines its association with pre-menarcheal residential setting. A cross-sectional retrospective study was conducted among 2,178 Mizo women currently residing in Aizawl and born between 1960 and 2007, classified into five birth-decade cohorts. AAM was obtained through structured bilingual questionnaires. Pre-menarcheal residential setting (rural or urban) was based on self-reported childhood residence. Linear regression was the primary analysis; one-way ANOVA and nonparametric tests served as confirmatory analyses. Multivariable regression and bootstrap resampling were used to test sensitivity to confounding and unequal cohort sizes. The overall mean AAM was 13.50&#xb1;1.49 years. A significant declining trend was observed across cohorts (F(4,2173)=54.587, p<0.001, &#x3b7;&#xb2;=0.091): mean AAM decreased from 14.67&#xb1;1.19 years (1960-1969) to 13.09&#xb1;1.45 years (2000-2007), a decline of approximately 0.40 years per decade. When restricted to the three most recent cohorts (1980-2007), where recall intervals were shorter, the decline remained significant (0.30 years per decade). Women with rural pre-menarcheal residence had later AAM than those with urban residence (13.76 vs. 13.34 years; Cohen's d=0.280), though the effect was small. In multivariable regression, the year-of-birth effect remained significant after covariate adjustment (B=-0.034, p<0.001). The prevalence of early menarche (&#x2264;12 years) increased from 4.0% to 35.2% across cohorts (p<0.001). A significant secular decline in AAM has occurred among Mizo women in Aizawl over five decades, consistent across analytical approaches and residential strata. The concurrent rise in early menarche prevalence carries public health relevance given Mizoram's high noncommunicable disease burden. Although generalizability to rural Mizoram is limited, these findings add to the limited evidence on menarcheal timing among indigenous ethnic groups in Northeast India and underscore the need for prospective studies linking pubertal timing to later-life disease outcomes.

Breast cancer is a global health concern. Hormone replacement therapy (HRT) prior to breast cancer diagnosis is of particular interest due to the hormone sensitivity of the breasts. Previous evidence has altered the perception of HRT by highlighting that certain risks could outweigh the benefits. As a result, the popularity of HRT for menopausal symptom relief and disease prevention decreased. To investigate the relationship between pre-diagnosis HRT use and breast cancer survival, a meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search across MEDLINE, Cochrane and Web of Science databases up to August 2025 identified 33 studies. These studies evaluated the impact of HRT on breast cancer survival utilizing various study designs. Quality assessment was performed using the Newcastle Ottawa Scale, while the Risk of Bias in Non-Randomized Studies of Exposures tool was used to evaluate the risk of bias. The pooled analysis revealed that HRT use prior to breast cancer diagnosis was associated with reduced breast cancer mortality (odds ratio, 0.86; 95% CI, 0.79-0.94). Subgroup analyses based on duration and timing of HRT use at diagnosis revealed heterogeneous associations with survival. Shorter duration of use (<5 years) appeared to be associated with lower breast cancer mortality; however, these subgroup analyses were based on a limited number of studies and should be interpreted with caution. Longer duration of use (>10 years) showed no clear association. Studies recruiting after 2000 showed an inverse association between HRT use and breast cancer mortality, a trend more pronounced than in earlier years, although evidence remains limited. In conclusion, pre-diagnosis HRT use was associated with improved breast cancer survival, influenced by treatment duration, timing and temporal factors. It is necessary to note that subgroup findings based on the treatment duration and recruitment period were limited by the low number of contributing studies and should be interpreted with caution. Despite methodological differences among the included studies, the present findings provide valuable insights into the complex relationship between HRT and breast cancer prognosis.