To evaluate the impact of the Canadian Association of Radiologists (CAR) guidelines on MRI surveillance burden for incidental pancreatic cystic lesions compared with Fukuoka guidelines. This retrospective single-center study included 1000 asymptomatic patients aged ≥40 years with incidental pancreatic cystic lesions identified on abdominal MRI between January 2010 and March 2025. Patients with high-risk features, cysts ≥3 cm, or a history of pancreatic cancer were excluded. Surveillance recommendations were retrospectively simulated according to CAR and Fukuoka guidelines. The primary outcome was the mean number of recommended MRI examinations over 5- and 10-year follow-up periods. Comparisons were performed using paired t-tests. A total of 1205 consecutive patients were reviewed between January 1, 2010 and March 31, 2025. Of these, 205 patients were excluded based on study criteria, yielding a final cohort of 1000 patients for analysis. At 5 years, the mean number of recommended MRI examinations was lower under CAR guidelines compared with Fukuoka guidelines (1.45 ± 1.5 vs 3.89 ± 0.99; P < .001). At 10 years, the difference further increased (1.45 ± 1.5 vs 6.23 ± 1.64; P < .001). Application of CAR guidelines is associated with a reduction in MRI surveillance utilization over 5- and 10-year follow-up periods compared with Fukuoka guidelines. These findings have important implications in the setting of MRI resource constraints within the Canadian healthcare system.
Background and ObjectivesIllicit prescription painkiller use among university students is a growing concern, influenced by a range of demographic, mental and physical health, academic, and co-substance use factors contributing to the elevated risk. However, Canadian evidence specific to university students remains limited. This study examined correlates of self-reported illicit prescription painkiller use among Canadian university students.MethodA secondary analysis of data from the American College Health Association National College Health Assessment II Canadian university edition was conducted. The dependent variable was past-year illicit prescription painkiller use, defined as a yes or no response to self-reported use of prescription painkillers without a prescription from a healthcare provider in the past 12 months. Descriptive statistics and binary logistic regression were used to examine associated demographic, academic, physical health, mental health, and co-substance use factors.ResultsAmong the analytical sample of 44,508, 5.8% (n = 2,585) reported illicit prescription painkiller use in the past 12 months. Significant predictors included race, sex, sexual identity, international student status, mental health factors, chronic illness, academic factors, and co-substance use. Higher odds of use were observed among West Asian and Black students, international students, students with chronic illness, students reporting hopelessness, feeling overwhelmed, depression with functional impairment, or suicidal ideation, and students reporting tobacco, alcohol, e-cigarette, or cocaine use.ConclusionsIllicit prescription painkiller use among Canadian university students was associated with demographic, mental health, physical health, academic, and co-substance use factors. Findings support campus-based prevention and support strategies that integrate substance use education, mental health services, and equitable access to care. Understanding Prescription Painkiller Use Without a Prescription Among Canadian University Students: The Role of Mental Health, Student Characteristics, Physical Health, Academics, and Substance UsePlain Language SummaryPrescription painkiller use such as opioids is an important concern among university students. This study used Canadian data from the American College Health Association National College Health Assessment II to examine which student characteristics were associated with this behaviour.Among the analytic sample, 5.8% reported using prescription painkillers without a prescription in the past 12 months. Higher odds of use were seen among students with mental health concerns, chronic illness, international student status, and use of other substances such as tobacco, alcohol, e-cigarettes, and cocaine. Differences were also observed by race, sex, sexual identity, academic year, and grade point average.These findings suggest that prescription painkiller use without a prescription is linked to broader health, social, and academic factors. Universities may benefit from prevention strategies that combine substance use education, mental health support, and improved access to care. La consommation illicite d’analgésiques sur ordonnance chez les étudiants universitaires est un sujet de préoccupation croissante. Elle est influencée par un éventail de facteurs démographiques, liés à la santé mentale et physique, scolaires et liés à la consommation concomitante d’autres substances psychoactives qui contribuent à l’accroissement du risque. Cependant, les données canadiennes propres aux étudiants universitaires demeurent limitées. Cette étude a examiné les facteurs associés à la consommation illicite autodéclarée d’analgésiques sur ordonnance chez les étudiants universitaires canadiens. Nous avons réalisé une analyse secondaire des données tirées de l’édition canadienne de l’enquête de l’American College Health Association National College Health Assessment II. La variable dépendante était la consommation illicite d’analgésiques sur ordonnance au cours de la dernière année, définie comme une réponse affirmative ou négative à la question portant sur la consommation autodéclarée d’analgésiques sur ordonnance sans détenir une ordonnance d’un professionnel de la santé au cours des 12 derniers mois. Les facteurs démographiques, scolaires, liés à la santé physique et mentale et liés à la consommation concomitante d’autres substances psychoactives ont été évalués à l’aide de statistiques descriptives et d’une régression logistique binaire. Dans l’échantillon d’analyse de 44 508 personnes, 5,8 % (n = 2 585) d’entre elles ont déclaré avoir consommé de manière illicite des analgésiques sur ordonnance au cours des 12 derniers mois. Les facteurs prédictifs importants comprenaient l’origine ethnique, le sexe, l’identité sexuelle, le statut d’étudiant étranger, les facteurs liés à la santé mentale, la maladie chronique, les facteurs scolaires et la consommation concomitante de substances psychoactives. Un risque plus élevé de consommation a été observé chez les étudiants originaires de l’Asie de l’Ouest et de race noire, les étudiants étrangers, les étudiants atteints d’une maladie chronique, les étudiants ayant déclaré éprouver un sentiment de désespoir ou de surmenage, ceux atteints de dépression s’accompagnant d’altération fonctionnelle ou d’idées suicidaires, et les étudiants qui consomment du tabac, de l’alcool, des cigarettes électroniques ou de la cocaïne. La consommation illicite d’analgésiques sur ordonnance chez les étudiants canadiens a été associée à des facteurs démographiques, liés à la santé mentale et physique, scolaires et liés à la consommation concomitante d’autres substances psychoactives. Les résultats plaident en faveur des stratégies de prévention et de soutien mises en œuvre sur les campus, qui associent l’éducation sur la consommation de substances psychoactives, les services de santé mentale et l’accès équitable aux soins.
Circulating levels of Cancer Antigen (CA) 15-3 have been associated with distant breast cancer (bc) recurrence; data on bc subtypes is sparse. We examined associations of CA 15-3 with outcomes across immunohistochemically defined bc subtypes in MA.32. 3649 participants with T1-3, N0-1, M0 bc were randomized; 2740 (75.1%) provided blood at entry (mean 278 days post diagnosis) and 6 months later. Prognostic associations of baseline and 6-month change in CA 15-3 with distant recurrence free survival (DRFS) were examined in luminal (ER/PgR positive, HER2 negative), triple negative (ER, PgR, HER2 negative) and HER2 positive (any ER/PgR) bc using Cox proportional hazards models. Mean age was 52 years. bc was luminal in 1589 (58.7%), triple negative in 655 (24.2%) and HER2 positive in 464 (17.1%). Median follow-up was 96 months. CA 15-3 at study entry was not associated with outcome in any subtype. Rising CA 15-3 at 6 months was associated with poor DRFS in luminal and triple negative bc (HR per 25% increase = 1.41, P < 0.0001 and 1.35, P < 0.0001, respectively). New elevations in CA 15-3 at 6 months were adversely associated with DRFS in those with luminal or triple negative bc (HR 4.14, 95% CI 2.69-6.38, P < 0.001 and HR 3.57, 95% CI 1.59-7.99, P = 0.002, respectively). In HER2+ bc, CA15-3 was not associated with DRFS. Rising CA 15-3 was associated with reduced DRFS in luminal and triple negative bc but not in HER2 positive bc. ClinicalTrials.gov NCT01101438.
The publisher regrets that this article has was inadvertently published and has subsequently been temporarily removed. The article will be reinstated as soon as possible. The Publisher apologises for any inconvenience caused. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies-and-standards/article-withdrawal.
Women with HIV are at a significantly increased risk of developing cervical cancer. However, adherence to cervical screening guidelines remains suboptimal.The objective was to assess adherence to Pap test initial screening and follow-up at St. Joseph's Hospital (SJH) in London, Ontario, and to analyze their association with sociodemographic characteristics. A retrospective cohort study was conducted of women with HIV ≥21 years of age who were attending SJH's HIV clinic between 2015 and 2024. Medical records were reviewed to determine Pap test completion at HIV diagnosis, follow-up adherence, and management of abnormal results. Of 235 women identified, 211 were included. Only 29% (n = 62) underwent Pap testing at the time of HIV diagnosis. Among 148 women with normal initial cytology, only 28 (19%) completed three consecutive annual follow-up screenings. Thirty-four women (17%) had atypical squamous cells of undetermined significance (ASC-US) results, of whom 29 (85%) underwent appropriate repeat cytology within 6 to 12 months. Fifty-three women (27%) were diagnosed with low-grade squamous intraepithelial lesion (LSIL) or higher-grade lesions, and 42 (79%) were appropriately referred for colposcopy. Adherence to cervical screening was positively associated with year of HIV diagnosis (p < 0.001); an association with history of injection drug use was observed in unadjusted analyses (p = 0.018), but did not persist in post-hoc analysis. Substantial gaps exist in cervical cancer screening and follow-up among women with HIV. Despite guideline recommendations, less than one-third of patients in our cohort received Pap test at the time of HIV diagnosis, and long-term follow-up adherence was low. Enhanced system-based interventions are required to improve screening continuity and outcomes in this high-risk population. Les femmes atteintes du virus de l'immunodéficience humaine (VIH) courent un risque beaucoup plus élevé de cancer du col de l'utérus. Cependant, l'adhésion aux directives de dépistage du col de l'utérus demeure sous-optimale.L'objectif était d'évaluer l'adhésion au dépistage initial par le test Pap et au suivi au St. Joseph's Hospital (SJH) de London, en Ontario, et analyser leur association avec les caractéristiques sociodémographiques. Les chercheurs ont réalisé une étude rétrospective de cohorte de femmes atteintes du VIH de 21 ans ou plus qui fréquentaient la clinique du VIH du SJH entre 2015 et 2024. Ils ont examiné les dossiers médicaux pour déterminer si le test Pap avait été exécuté au diagnostic du VIH et évaluer l'adhésion au suivi et la prise en charge de résultats anormaux. Des 235 femmes trouvées dans les dossiers, 211 ont été retenues. Seulement 29 % (n = 62) avaient subi un test Pap au moment du diagnostic de VIH. Chez les 148 femmes dont la cytologie initiale était normale, seulement 28 (19 %) ont effectué les trois dépistages de suivi annuels consécutifs. Au total, 34 femmes (17 %) avaient des cellules squameuses atypiques de gravité indéterminée, et 29 (85 %) d'entre elles se sont soumises à la reprise appropriée de la cytologie dans les six à 12 mois. Ainsi, 53 femmes (27 %) se sont fait diagnostiquer une lésion intraépithéliale épidermoïde de bas grade ou des lésions de plus haut grade, et 42 (79 %) ont été orientées en colposcopie comme elles le devaient. L'adhésion au dépistage du col de l'utérus était associée à l'année du diagnostic de VIH (p < 0,001); une association avec une histoire d'utilisation de drogues injectables a été observée dans les analyses non corrigées (p = 0,018), laquelle n'a pas persisté dans l'analyse post-hoc. Il existe des écarts importants sur le plan du dépistage et du suivi du cancer du col de l'utérus chez les femmes atteintes du VIH. Malgré les recommandations contenues dans les directives, moins du tiers des patientes de la cohorte ont subi un test Pap au moment de leur diagnostic de VIH, et leur adhésion au suivi à long terme était faible. De meilleures interventions systémiques s'imposent pour améliorer la continuité du suivi et les résultats cliniques au sein de cette population à haut risque.
Cardiometabolic conditions remain a major public health concern among Indigenous populations in Canada. Smoking is a recognized risk factor; however, its independent association with conditions, such as hypertension and cardiovascular disease (CVD), among Indigenous populations remains unclear due to the influence of coexisting cardiometabolic factors, variations in exposure patterns, and the limited availability of population-specific evidence. To assess the association between smoking status and cardiometabolic conditions among Indigenous adults in Canada. This cross-sectional study used data from the 2022 Canadian Community Health Survey. The analysis included 1,099 Indigenous adults aged 35 years and older, representing a weighted population of 343,048 individuals. Smoking status was categorized as never, former, or current smoker. Outcomes included hypertension and CVD. Survey-weighted logistic regression models with bootstrap variance estimation were used to estimate adjusted odds ratios controlling for demographic and clinical covariates. Smoking status was not associated with hypertension. Former smokers had an adjusted odds ratio of 1.14 with a 95% confidence interval of 0.51-2.54, and current smokers had an adjusted odds ratio of 1.12 with a 95% confidence interval of 0.45-2.79. Smoking status was also not associated with CVD, with adjusted odds ratios of 0.84 for former smokers and 1.09 for current smokers. Age was strongly associated with hypertension, with individuals aged 50-64 years having an adjusted odds ratio of 2.65 and those aged 65 years and older having an adjusted odds ratio of 4.25. High cholesterol was associated with hypertension at 2.51 and CVD at 4.80.  This study highlights that smoking status was not independently associated with cardiometabolic conditions after adjustment, while age and metabolic factors showed stronger relationships. However, given the cross-sectional design, causal relationships cannot be established, and the findings should be interpreted as associations. These results support integrated risk assessment approaches and highlight the need for further longitudinal research.
Alzheimer's disease (AD) is a heterogeneous syndrome with distinct genetic and clinical profiles between early-onset AD (EOAD) and late-onset AD (LOAD) subtypes. However, specific causal etiologies linking the gut microbiota-immune-metabolic axis to these subtypes remain poorly understood. We employed a comprehensive bidirectional two-sample Mendelian randomization (MR) framework to systematically investigate the causal associations of gut microbiota, immune cell phenotypes, and blood metabolites with EOAD and LOAD. Large-scale genome-wide association study (GWAS) summary statistics were utilized from the MiBioGen consortium, Sardinian cohort, and Canadian Longitudinal Study on Aging, alongside AD outcome data from the FinnGen consortium. Causal estimates were generated using the inverse variance-weighted method, with rigorous sensitivity analyses including false discovery rate (FDR) correction and Steiger directionality tests to ensure robustness. Our analysis revealed divergent multi-omics signatures for AD subtypes. While the genus Veillonella and myeloid dendritic cells emerged as shared protective factors, the risk profiles were distinct. EOAD susceptibility was primarily driven by adaptive immune dysregulation and lipid metabolism disturbances. In contrast, LOAD risk was predominantly associated with innate immune dysfunction and perturbations in amino acid and gut-derived metabolite turnover, such as hippurate. This study provides genetic evidence that EOAD and LOAD are driven by fundamentally different peripheral mechanisms across the gut-immune-metabolic axis. These findings challenge the monolithic view of AD pathogenesis and underscore the critical necessity of stratifying patients by onset age to develop precision therapeutic interventions.
Whether sedative prescriptions after hospital admissions are associated with poor patient outcomes is unknown. We sought to determine the incidence and risk of adverse events associated with sedatives in older adults within 30 days after hospital discharge. We conducted a population-based cohort study involving older adults (age ≥ 66 yr) discharged alive from hospital in Ontario (2003 to 2023). We assessed the association of sedative prescriptions (benzodiazepines, antidepressant sedatives, or antipsychotics) filled within 7 days after discharge with falls (with or without fracture), emergency department (ED) visits, and hospital readmission. We used cause-specific proportional hazard regression for outcomes other than death and Cox proportional hazard models for death to assess the association between a sedative prescription filled after discharge and the outcomes. Because of an interaction with prehospital sedative prescription, we stratified results for prehospital sedative-naive and sedative-exposed status. Among 1 868 484 older adults (mean age 77 yr, 52.1% female), 13.2% filled a sedative prescription after discharge; of these patients, 31.0% were sedative naive before hospital admission. Falls occurred in 1.6% (n = 30 626), ED visits in 21.3% (n = 397 402), hospital readmissions in 12.4% (n = 231 191), and death in 3.8% (n = 70 661). The adjusted hazard ratio (HR) for all outcomes was increased among those who filled a sedative prescription after discharge (v. no filled prescription) and were sedative naive before hospital admission (fall: 1.20, 95% confidence interval [CI] 1.13 to 1.26; ED visit 1.20, 95% CI 1.19 to 1.22; hospital readmission: 1.20, 95% CI 1.17 to 1.22; and death: 1.78, 95% CI 1.73 to 1.83). For those who were exposed to sedatives before their hospital admission, there was an increased hazard of death (adjusted HR 1.08, 95% CI 1.05 to 1.11), but not for the other outcomes. For sedative-naive older adults, benzodiazepines were associated with an increased hazard of all outcomes, antipsychotics were associated with an increased hazard of falls and death, and antidepressant sedatives were associated with a decreased hazard of falls. New sedative prescriptions filled within 7 days after discharge were associated with increased hazards of a fall, ED visit, hospital admission, and death within 30 days after discharge, with differences based on the sedative class. These findings have important implications for in-hospital medication review and falls-risk assessment for older adults in Canada.
Multicenter retrospective cohort study of prospectively collected data. Evaluate the impact of EOS-derived thigh muscle measurements as indicators of sarcopenia and their effect on compensatory mechanisms in adult spinal deformity (ASD) patients. ASD patients frequently present with sarcopenia, the progressive loss of muscle strength and mass associated with worse postoperative outcomes. Routine EOS full-body radiographs allow opportunistic thigh muscle measurement without added cost or radiation. This study evaluated EOS-derived thigh and quadriceps thickness against clinical indicators of sarcopenia and their impact on compensatory mechanisms in ASD. We retrospectively analyzed prospectively collected data from 24 U.S. and Canadian spine centers(2019-2024). Sarcopenia was defined using validated sex-specific EOS cutoffs. Patients were classified as sarcopenic only when both AP thigh and LAT quadriceps measurements fell below threshold. Clinical frailty scores, grip strength, 3-meter timed up and go(TUG), and epigenetic age were compared between sarcopenic(SARCO) and non-sarcopenic(NON-SARCO) patients. Multivariate regressions assessed associations between thigh measurements, sarcopenia status, and compensatory radiographic parameters. Among 540 ASD patients (mean age 60, 71% female), 61 (11.3%) were SARCO. SARCO patients had lower BMI(23.6 vs. 27.3 kg/m²), higher clinical frailty scores (3.4 vs. 3.0), and slower TUG (12.2 vs. 10.5s) (all P<0.05). Multivariate analyses showed smaller thigh and quadriceps thickness and sarcopenia status correlated with higher frailty, weaker grip, slower TUG, and older epigenetic age (all P<0.05). Sarcopenia was also associated with greater thoracic kyphosis (β=6.87, P<0.01), cervical lordosis (β=5.84, P=0.01), sagittal vertical axis (β=13.17, P=0.04), and knee flexion angle (β=2.29, P=0.04), but not pelvic tilt, shift, or sacro-femoral angle (all P>0.05). Full-body radiographic derived thigh measurements significantly correlate with frailty, grip strength, TUG, and epigenetic age. Sarcopenic ASD patients demonstrate impaired proximal and increased distal compensations. Incorporating thigh and quadriceps muscle thickness measurements into preoperative assessment may improve surgical planning and patient management in ASD. Prognostic Level III.
The VICTORION-1 PREVENT (V-1P) trial is evaluating the efficacy of inclisiran versus placebo on cardiovascular events in primary prevention patients at high-risk for ASCVD. We assessed whether V-1P eligibility, based on Pooled Cohort Equations (PCE) and Predicting Risk of Cardiovascular Disease Events (PREVENT) equations, was associated with subclinical cardiovascular and inflammatory abnormalities in a healthy European population. We included individuals from the STANISLAS cohort in France aged 40-79 years, LDL-C 70-189 mg/dL and without ASCVD or liver disease. Participants were categorized as V-1P eligible using 10-year ASCVD risk using PCE and PREVENT. Associations with vascular, echocardiographic, and biomarkers were assessed using age- and sex-adjusted linear regression. Among 848 participants (mean age 60 years, 51% female), 16% were eligible per PCE, of which 7% were also eligible with PREVENT. Only one participant was eligible by PREVENT alone. Compared with non-eligible participants, V-1P-eligible individuals, whether by PCE alone or PCE and PREVENT, displayed significant subclinical abnormalities. Compared with V-1P ineligible participants, V-1P eligible participants had increased intima media thickness (+51 µm, p < 0.009 for PCE+PREVENT) and increased mean pulse wave velocity (+0.89 m/s, p < 0.001 for both PCE and PCE+PREVENT) on vascular ultrasound. V-1P eligible participants by PCE+PREVENT also showed signs of subclinical myocardial injury and inflammation, with a 1.3 fold higher troponin (p = 0.015), 1.6-fold higher interleukin-6 (p < 0.001) and a 2-fold higher high sensitivity C-reactive protein (p < 0.001). A large proportion of asymptomatic individuals without known cardiovascular disease would be eligible for the V-1P trial based on both PCE and PREVENT equations. V-1P eligible participants had evidence of subclinical cardiovascular and inflammatory abnormalities.
The Montreal Cognitive Assessment (MoCA) is a validated screening tool for cognitive impairment (CI) in surgical populations that assesses multiple cognitive domains. The primary objective of this report was to characterize preoperative domain-specific performance on the MoCA in older surgical patients. The secondary objectives were to explore preoperative characteristics and adverse outcomes associated with poorer domain-specific performance. This was a post hoc analysis of the Detection of Cognitive Impairment (Detect CI) study. The MoCA was administered preoperatively to assess seven cognitive domains: executive/visuospatial function, naming, attention, language, abstraction, delayed recall, and orientation. It was scored out of 30, with higher education-adjusted MoCA scores indicating better cognitive performance and scores ≤ 25 classifying probable CI. Adverse outcomes were collected in 382 participants at 30 days and 379 participants at 90 days postoperatively. The 382 participants (median age, 73 years [IQR, 68, 77]; 58% female) had a mean MoCA score of 25.9 ± 2.8, with 35% screening positive for CI. Participants with probable CI performed significantly poorer across all seven cognitive domains (executive/visuospatial function, naming, attention, language, abstraction, delayed recall, and orientation) than those without CI. Having ≤ 12 years of education was associated with poorer executive/visuospatial function, naming, language, abstraction, and delayed recall. Of all cognitive domains, exploratory analyses showed that only orientation was associated with 30-day adverse outcomes after adjusting for age, sex, education level, and/or American Society of Anesthesiologists status and within-domain multiplicity. Each one-point decrease in orientation score was associated with a longer length of stay (β = 0.5, 95% confidence interval [95% CI] 0.2-0.8; P  = 0.012) and higher adjusted odds of postoperative delirium (adjusted odds ratio [aOR] = 11.4, 95% CI 2.6-46.8; P  = 0.004), complications (aOR = 3.1, 95% CI 1.3-8.9; P  = 0.035), non-home discharge (aOR = 4.1, 95% CI 1.5-11.4; P  = 0.014), and composite adverse outcomes (aOR = 5.6, 95% CI 1.9-23.9; P  = 0.014). Orientation remained associated with postoperative delirium after adjusting for multiplicity both within and across MoCA domains (aOR = 11.4, 95% CI 2.6-46.8; P  = 0.031). This analysis characterized preoperative domain-specific performance on the MoCA in older adults, with participants screening positive for CI exhibiting poorer performance across all cognitive domains. Exploratory findings suggested that orientation difficulties may be associated with early adverse outcomes, with postoperative delirium showing the most robust association. The online version contains supplementary material available at 10.1007/s44254-026-00181-2.
Hospitalization can disrupt patients' communication and social connections, potentially contributing to social isolation, while the supportive role of family and friends in communication is often underrecognized. This study examines communication access barriers and their association with social isolation among hospitalized patients, based on reports from family and friends. A cross-sectional online survey of family/friends across Canada (N = 179) was conducted to examine patient communication and social isolation. The questionnaire was distributed via Facebook advertisements (Meta Ads Manager) and administered through SurveyMonkey (February 14-28, 2025). Descriptive and inferential analyses were conducted. Most respondents (Family and Friends) were female (78.8%) and were aged 40-49 years. Respondents reported that in-person communication was preferred (67.9%), and 58.5% shared communication responsibilities with patients and hospital staff. However, only 11.2% reported consistent staff communication support, and 5.9% reported reliable device access. Key barriers included lack of independent access to devices (23.5%), poor Wi-Fi (17.5%), and privacy concerns (16.1%). Fewer believed that communication challenges were prioritized equally with physical care (19.1%). Communication gaps were associated with social isolation. Inadequate support increased reported social isolation (odds ratio [OR] = 4.03, 95% confidence interval [CI]: 1.83-8.85), and patients whose communication concerns were not prioritized had greater odds of feeling social isolation (OR = 3.49, 95% CI: 1.12-10.83). Based on family and friends' reports, communication barriers in hospitals are common, despite patients having active social networks. Limited staff support, challenges with independent device use, and Wi-Fi issues highlight modifiable gaps in hospital communication infrastructure.
暂无摘要（点击查看详情）
Effective treatment monitoring and treatment decisions in relapsing-remitting multiple sclerosis (RRMS) require accurate and individualized prediction of future disease courses. Guidelines from the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) group and the Canadian Multiple Sclerosis Working Group (CMSWG) frequently cite MRI outcomes as predictive, but the methodological quality of this evidence is uncertain. This study aims to critically assess the methodological standards underlying predictive claims about MRI outcomes in four major relevant MS guidelines. We conducted a content review of citations in the MAGNIMS 2015 and 2021 and the CMSWG 2013 and 2020 guideline publications. Each source was evaluated for whether it reported quantitative predictive evidence: either predictive values with confidence intervals, Kaplan-Meier-based risk estimates, or externally validated models that provide accurate risk estimates (good calibration) and correctly separate high- from low-risk patients (good discrimination); We also checked if measures such as correlations, odds ratios, hazard ratios, Prentice criteria, or likelihood ratio tests were used. Across all four guidelines, most predictive statements relied on secondary citations and association-based measures. Odds ratios, hazard ratios, correlations, or Prentice criteria were commonly reported. Some studies reported predictive values, but confidence intervals were frequently not provided. Only isolated examples of properly validated prediction models were cited, and only one had undergone full external validation. Advanced methods, such as the likelihood reduction factor, were absent. Current guideline statements on MRI prediction in RRMS often rely on associations rather than validated individualized predictions. They do not quantify individual risk or provide evidence for accuracy, calibration, discrimination, or robustness (reliability of predictions across different patients and settings). To ensure trustworthy and actionable evidence, future guidelines should require prospective risk estimates with confidence intervals, externally validated models with calibration and discrimination, predefined thresholds for predictive usefulness, and evaluation of clinical utility (e.g., decision curve analysis). Why was the study done? To effectively treat relapsing-remitting multiple sclerosis (RRMS), reliable individualized prediction of disease worsening based on MRI findings is needed. Four widely used guidelines cite sources that provide such predictive information. However, it is unclear if the presented evidence supports good individual predictions. Thus, this study aims to assess the quality of predictive information in the literature cited by the guidelines on the prediction quality of MRI in RRMS. What did the researchers do? The sources claiming predictive ability of MRI in two guidelines from the Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) group and two guidelines from the Canadian Multiple Sclerosis Working Group (CMSWG) were extracted. The objectives, methodology, and content of the sources were analyzed. The methodologies were then grouped into ten statistical categories, and each category was assessed for its quality in individual prediction. What did the researchers find? In total, 75 sources were identified, which were directly or indirectly cited in the guidelines to show the predictive quality of MRI information. About 80% of sources used association measures to show individual prediction. The cited evidence was mostly insufficient to enable clinically relevant individual predictions. Neither groups report the quality of evidence they used in their guidelines. They also do not report measures for uncertainty of estimates (e.g., confidence intervals). However, one study included an independently tested model, while one other study used a statistically sound prediction model. What do these findings mean? Current guideline statements on MRI prediction in RRMS often rely on associations and rarely employ well-validated methods. There is a need for the Multiple Sclerosis scientific community to set minimum standards for the evidence accepted to support individualized prediction and to rank and assess the contribution of each evidence.
Infertility is a major public health concern, and many individuals face substantial barriers to accessing fertility care. Across jurisdictions, regulations, eligibility criteria and funding frameworks for fertility care vary considerably, particularly in relation to lesbian, gay, bisexual, transgender, intersex and queer/questioning people (LGBTIQ+), as well as unpartnered individuals. Moreover, existing definitions and prevalence estimates of infertility are largely derived from studies of heterosexual couples which may underestimate the need for fertility care among other populations. This protocol describes a systematic review designed to synthesise current evidence on the need for and access to fertility care among LGBTIQ+ populations and unpartnered individuals as well as the policies and regulations that govern such care. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Systematic searches were conducted in MEDLINE (Ovid), Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Global Health, as well as grey literature sources including ProQuest Dissertations & Theses, ECRI Guidelines Trust, Canadian Medical Association Journal (CMAJ) Guidelines, National Institute for Health and Care Excellence, fertility societies guidelines and Google Scholar. Eligible studies will include quantitative, qualitative, mixed-methods, narrative synthesis and typology mapping designs. Two reviewers will independently perform title/abstract and full-text screening, data extraction and quality assessment. The Critical Appraisal Skills Programme checklist will be used for qualitative studies and the Joanna Briggs Institute tools for quantitative studies. Completeness and credibility assessments will be applied to narrative syntheses and typology mappings. The primary outcomes will include measures of fertility care need, indicators of access and policy frameworks influencing service availability. This study does not involve human participants. The protocol received an exemption from Research Ethics Board review by the McGill University Health Centre Research Ethics Board. Findings will be disseminated through peer-reviewed publications, conference presentations and professional networks and shared with the WHO to inform evidence-based policy. CRD420251126056.
Only a limited amount of real-world data are available on the demographic and clinical characteristics of adult patients with obstructive hypertrophic cardiomyopathy (oHCM) treated with mavacamten in Canada. This observational retrospective cohort study included adult patients with symptomatic oHCM enrolled in the mavacamten patient support program in Canada between January 4, 2023 and April 12, 2024. Baseline demographic information, clinical characteristics, medical history, and mavacamten treatment information were collected from the program database. A total of 683 patients met the eligibility criteria for the study. The median age was 65.0 years (interquartile range: 57.0-73.0); 52.1% of the patients were male; and 67.1% were classified as being in New York Heart Association class II at baseline. Most patients were on beta-blocker monotherapy at baseline (63.7%) and the data cutoff point (76.3%). Almost all patients (99.4%) were initiated with 5 mg of mavacamten. The median follow-up time was 27.4 weeks (range: 1.6-70.1), and the median treatment duration was 24.6 weeks (range: 0.4-64.4). At the data cutoff point, 17.1% of patients were on 2.5 mg of mavacamten, 52.6% were on 5 mg, 20.2% were on 10 mg, and 2.2% were on 15 mg. Mavacamten was discontinued by 7.9% of patients, the main reasons being a side effect or adverse event (2.5%; 17 of 683), an undisclosed physician decision (1.8%; 12 of 683), or lack of efficacy (0.9%; 6 of 683). These early results provide the largest dataset on mavacamten utilization in the Canadian oHCM population. Baseline demographic and clinical characteristics and mavacamten dose distributions are comparable to those found in clinical trials and real-world studies. NCT06549608. Il existe peu de données concrètes sur les caractéristiques démographiques et cliniques des patients adultes atteints de cardiomyopathie hypertrophique obstructive (CMHo) traités par mavacamten au Canada. Il s'agit d'une étude de cohorte observationnelle rétrospective portant sur des patients adultes atteints de CMHo symptomatique inscrits au programme de soutien aux patients (PSP) avec prescription de mavacamten, au Canada, entre le 4 janvier 2023 et le 12 avril 2024. Les informations démographiques de base, les caractéristiques cliniques, les antécédents médicaux et les informations relatives au traitement par mavacamten ont été recueillies à partir de la base de données du PSP. Au total, 683 patients répondaient aux critères d'éligibilité de l'étude. L'âge médian était de 65,0 ans (intervalle interquartile [IIQ] : 57,0-73,0), 52,1 % des patients étaient des hommes et 67,1 % étaient classés dans la classe fonctionnelle II de la NYHA au départ. La plupart des patients étaient sous monothérapie par Bêta-bloquant au départ (63,7 %) et à la fin de la collecte des données (76,3 %). Presque tous les patients (99,4 %) ont commencé le traitement avec 5 mg de mavacamten. La durée médiane du suivi était de 27,4 semaines (intervalle : 1,6-70,1) et la durée médiane du traitement était de 24,6 semaines (intervalle : 0,4-64,4). À la date limite de collecte des données, 17,1 % des patients recevaient 2,5 mg de mavacamten, 52,6 % recevaient 5 mg, 20,2 % recevaient 10 mg et 2,2 % recevaient 15 mg. Le mavacamten a été arrêté chez 7,9 % des patients, les principales raisons étant un effet secondaire ou un événement indésirable (2,5 %; 17/683), une décision médicale non précisée (1,8 %; 12/683) ou un manque d'efficacité (0,9 %; 6/683). Ces premiers résultats fournissent le plus grand jeu de données portant sur l'utilisation du mavacamten dans la population canadienne atteinte de CMHo. Les caractéristiques démographiques et cliniques de base et la distribution des doses de mavacamten sont comparables aux résultats des essais cliniques et des études en vie réelle.Numéro d’enregistrement clinique : NCT06549608.
Children with overweight or obesity are at elevated risk for later-life mental health challenges, but the role of accelerometer-derived waking movement behaviors remains uncertain. Thus, we examined longitudinal associations of sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) at age 7 with later-life internalizing and externalizing problems. We used data from the UK Millennium Cohort Study, focusing on children with overweight or obesity at age 7 who had valid accelerometer data and a complete set of predefined analytic variables (N = 858). Exposures were average daily minutes of SB, LPA, and MVPA. Outcomes were parent-reported Strengths and Difficulties Questionnaire-based internalizing and externalizing problems scores at ages 11 and 14. A generalized random forests approach was used to estimate average treatment effects (ATEs) and conditional average treatment effects (CATEs), adjusted for relevant demographic, socioeconomic, body mass index, parental distress, baseline mental health, and co-occurring movement intensities; day-of-week activity-pattern variables were used as exploratory candidate moderators. Estimated ATEs were small. After applying the Benjamini-Hochberg false-discovery-rate (FDR) correction across the 12 primary exposure-outcome tests, only the association between higher SB and lower internalizing problems at age 11 remained statistically significant (ATE = -0.013 SDQ points per additional min/day; 95% CI, -0.019 to -0.007; q < 0.001). No other pathway survived FDR correction, and other nominal or directionally suggestive estimates were interpreted as exploratory. CATE summaries and calibration tests provided limited evidence of reproducible heterogeneity. Accelerometer-derived waking movement behaviors at age 7 were associated with later SDQ problems scores in small and outcome-specific ways among children with overweight or obesity. Since the study is based on observational data and relies on measured-confounder assumptions, the findings should be interpreted cautiously, and as model-based estimates rather than definitive causal evidence.
 Bariatric surgery, also known as metabolic surgery, is known to improve the metabolic profile of morbidly obese patients in many aspects, thereby improving their quality of life. Obesity is typically associated with subtle changes in thyroid homeostasis. Bariatric procedures, particularly sleeve gastrectomy and Roux-en-Y gastric bypass, are associated with reductions in thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and total triiodothyronine (TT3) levels during the first postoperative year. This study aimed to evaluate the impact of bariatric surgery on thyroid function and thyroxine requirements in patients with and without pre-existing hypothyroidism.  This retrospective cross-sectional study was conducted at the Department of General Surgery, Dubai Health, United Arab Emirates. All patients who underwent bariatric surgery between September 2017 and December 2023 were included. Patients were divided into two groups: (1) those with preoperative hypothyroidism controlled on thyroxine therapy and (2) those with normal thyroid function. Patients with hyperthyroidism or a history of total thyroidectomy were excluded. Thyroid function tests and thyroxine requirements were evaluated preoperatively and at one- and two-year follow-up.  A total of 853 patients were included (mean age: 34.4 ± 11.0 years; 71.1% female). Sleeve gastrectomy accounted for 35.3% of procedures, Roux-en-Y gastric bypass for 55.9%, and redo-/mini-gastric bypass for 8.8%. All procedures resulted in significant weight loss at one and two years postoperatively (p < 0.001). Baseline thyroid function was within reference ranges, and postoperative TSH and free T4 levels remained stable. Among the 46 hypothyroid patients receiving thyroxine therapy, only a small proportion required dose adjustments, with no significant association with the type of surgery (χ²(6) = 3.35, p = 0.763). No correlation was found between BMI reduction and changes in thyroid hormone levels.  This study found no significant association between weight loss following bariatric surgery and changes in thyroid hormone function. No significant alterations in thyroxine requirements were observed. Larger multicenter studies with follow-up beyond two years are needed to further evaluate these findings.
Suicide attempts in childhood and adolescence are common, recurrent, and the strongest predictor of death by suicide; yet their developmental antecedents remain poorly understood, particularly in low- and middle-income countries. We aimed to identify childhood factors associated with incidence, onset timing, and number of suicide attempts and to quantify the population impact of modifiable risk factors. We analyzed data from the Brazilian High-Risk Cohort Study, a community-based cohort of 2511 children aged 6-14 years followed for 15 years. Risk factors across genetic, perinatal, sociodemographic, family, adversity, cognitive, and clinical domains were examined using logistic regression (OR), Cox proportional hazards (HR), and quasi-Poisson models (IRR), were examined for three outcomes (cumulative incidence, onset timing, and number of suicide attempts), with all predictors entered simultaneously and bootstrap resampling. Population attributable fractions were calculated for modifiable factors. Of 2060 participants (48.0% female unweighted, 47.3% weighted), 309 (15.0%) reported suicide attempts over 24,756.5 person-years (mean onset 17.8 years). Female sex (OR 3.06, 95% CI 2.28-4.17; HR 2.88, 2.25-3.69; IRR 3.12, 2.19-4.49) and childhood threat (OR 1.26, 1.08-1.47; HR 1.21, 1.06-1.38; IRR 1.26, 1.05-1.51) were associated with all three outcomes. Caregiver suicide attempt (OR 2.07, 1.40-3.14; HR 1.88, 1.34-2.63) and externalizing disorders (OR 1.52, 1.05-2.15; HR 1.50, 1.07-2.08) were associated with incidence and earlier onset. PRS-depression (IRR 1.39, 1.00-1.94) and gestational diabetes (IRR 2.18, 1.13-3.83) were associated with increased attempt frequency. Child-reported bullying (OR 1.73, 1.22-2.45) and parent-reported physical abuse (OR 1.96, 1.24-3.10) retained association after mutual adjustment in threat-component models. Population attributable fractions were substantial for caregiver suicide attempt (14.1%), caregiver internalizing disorders (11.6%), high childhood threat (>1 SD; 11.5%), and externalizing disorders (10.2%). In lethality analyses, PRS-depression (OR 2.21, 1.09-4.43; HR 1.98, 1.13-3.60; IRR 2.68, 1.43-4.97), childhood threat (HR 1.40, 1.09-1.80; IRR 1.34, 1.03-1.90), and maternal alcohol use in pregnancy (HR 1.92, 1.12-3.26) were associated with medically serious attempts. Prediction models showed modest discrimination (mean area under the curve [AUC] 0.665, SD 0.033, across 200 repeated test splits). These findings highlight three potentially modifiable or clinically actionable domains - childhood threat, caregiver suicidal behaviour history, and childhood externalizing disorders - that may be amenable to prevention even when genetic liability is present. Despite multi-domain predictors, predictive performance remained limited, consistent with a complementary role for population-level prevention alongside efforts to improve risk prediction. CNPq, FAPESP, ERC, UK MRC, and Banco Industrial do Brasil S/A. Full grant details are provided in the manuscript.
Timely follow-up after pediatric hospitalization is critical to support safe discharge, yet many children face barriers to in-person visits. Virtual care may facilitate follow-up; however, its association with follow-up trends remains unknown. To examine whether a system-wide virtual care remuneration policy, characterized by virtual care physician billing codes, was associated with changes in 7-day postdischarge follow-up rates overall and by hospitalization type and equity factors. This population-based, repeated cross-sectional study used administrative data on all children aged 18 years or younger with provincial health insurance in Ontario, Canada, who were discharged home after medical or surgical hospitalization between March 1, 2011, and June 30, 2024. The primary exposure was the implementation of the virtual care remuneration policy (instituted December 1, 2022); effects were stratified by hospitalization type, rurality, and socioeconomic status. The primary outcome was the monthly rate of physician follow-up within 7 days of hospital discharge. The absolute difference in observed vs estimated follow-up visits per 1000 discharges was estimated using an interrupted time series analysis with autoregressive integrated moving average model. The study included 643 156 hospital discharges across 469 066 children (mean [SD] age, 6.3 [5.7] years; 55.1% male). Before the virtual care policy, 42.0% of children received follow-up within 7 days of discharge vs 40.9% thereafter (follow-up provided virtually in 0.2% of postdischarge visits before the virtual care policy vs 11.0% after implementation). After policy implementation, follow-up remained lowest among rural (29.8%) and the most materially deprived populations (39.0%). Accounting for seasonality and autocorrelation, no significant change in slope (0.36; 95% CI, -0.15 to 0.87) or level (-2.70; 95% CI, -7.09 to 1.69) of follow-up rates were observed after policy implementation. Observed follow-up rates did not differ from those estimated (1 fewer visit per 1000 discharges). No clinically meaningful change in slope or level of follow-up rates were observed by hospitalization type, rurality, or socioeconomic status. In this cross-sectional study of Ontario children discharged from the hospital, a virtual care remuneration policy was not associated with an increase in timely follow-up after pediatric hospitalization, nor was it associated with narrowing of geographic and socioeconomic disparities. Virtual care billing policies alone may be insufficient to enhance postdischarge follow-up and may reinforce existing inequities.