Head and neck cancer (HNC) accounts for nearly 1 million new cases and approximately half a million deaths annually worldwide, representing a substantial global health burden. Despite an overall decline in mortality in many regions, patterns vary across anatomical subsites and countries. To evaluate international and national mortality trends in HNC and its major anatomical subsites from 2001 to 2023. This observational epidemiologic study analyzed population-based mortality data from the World Health Organization (WHO) Mortality Database for 73 countries between 2001 and 2023. Data collection was conducted in May 2025, and the data were analyzed between May and October 2025. Eligible countries had medium- to high-quality vital registration data. Age-standardized mortality rates (ASRs) were calculated using the new WHO World Standard Population. Country-specific trends from 2010 to 2023 were assessed using joinpoint regression among countries with at least 7 years of available data. ASRs and average annual percentage change in HNC mortality overall and by anatomical subsite using population-based analysis. From 2001 to 2023, 2 000 066 HNC-related deaths (450 657 females; 1 549 409 males) were recorded. Internationally, ASRs decreased by 38.9%, with greater reductions among male individuals than among female individuals. Substantial divergence was observed across subsites: laryngeal cancer mortality decreased markedly (-50.1%), whereas increasing trends in oropharyngeal cancer mortality were observed in many countries in recent years, particularly in high-income countries such as the UK (average annual percentage change, 4.30%) and the US (average annual percentage change, 3.26%). Results of this study suggest that, although overall HNC-related ASRs have declined internationally, marked variation across subsites and countries persists. The contrasting trends between laryngeal and oropharyngeal cancers underscore the need for subtype-specific prevention strategies and continued global surveillance.
End-of-life dreams and visions (ELDVs) are vivid, often subjective experiences that occur during the dying process. Even though the patient and family experiences of ELDVs are well documented, there is limited knowledge regarding the perspectives, preparedness, and perceived needs of health care professionals. ELDVs also remain insufficiently addressed in clinical care. To describe how frequently clinicians encounter ELDVs, perceived preparedness/training, and approaches to clinician and family education and communication. We conducted a survey to explore health care professional's perspectives and experiences surrounding ELDVs. The Checklist for Reporting Results of internet E-Surveys was followed. Our survey included 30 items across 7 sections. Professionals that take care of patients with serious or terminal illness were eligible for the study. We utilized a structured multimodal dissemination to achieve maximum diversity in participants. Briefly, 247 participants were eligible for analysis. Frequent encounters for ELDVs were reported by participants. Participants perceived positive effects on patients more frequently than negative effects (W = 446.0, p < 0.001, r = 0.64). Clinical challenges were rated differently across categories (χ2 = 160.97, p < 0.001, Kendall's W = 0.13). The most commonly endorsed clinical challenges were lack of institutional protocols and lack of standardized diagnostic criteria, both rated significantly higher than all other challenges (Bonferroni-corrected Wilcoxon tests: All p < 0.001). Participants endorsed multidisciplinary involvement and formal policy implementation. ELDVs are common, but clinicians feel underprepared to respond to them. There is a need for structured training and institutional protocols. Future studies should include patients and their families and analyze how their experiences are shaped by physician responses.
Background/Objectives: Population aging has increased the demand for comprehensive and coordinated care for older adults, placing primary health care (PHC) nurses at the forefront of comprehensive geriatric assessment (CGA) implementation. However, limited evidence exists regarding nurses' experiences and educational needs related to CGA across different European healthcare contexts. This study aimed to explore the experiences, perceived challenges, and educational needs of PHC nurses regarding the implementation of CGA in five European countries. Methods: A qualitative study design was employed using five focus groups, one in each participating country: Greece, Iceland, Finland, Estonia, and Latvia. A total of 29 PHC nurses participated in semi-structured interviews. Data were analyzed using reflexive thematic analysis. Results: Three overarching themes and nine subthemes were identified in relation to good practices in CGA: (1) embracing the complexity of holistic assessment; (2) balancing consistency with flexibility in clinical practice; and (3) advancing professional expertise through structured learning. Participants highlighted the importance of standardized assessment tools and effective multidisciplinary collaboration. At the same time, they reported significant gaps in formal education, limited organizational resources, and insufficient training in cultural competence, which hinder consistent CGA implementation. Conclusions: PHC nurses recognize the value of a holistic and structured approach to CGA but require clearer educational pathways and evidence-based training to address the complex needs of older adults. Strengthening curricula that emphasize interprofessional collaboration, practical competencies, and contextual adaptability may support more effective and sustainable implementation of CGA in primary care settings across Europe.
Alzheimer's is a progressive disorder of the brain that gradually affects memory, personality, behaviour, identity, and interpersonal relationships, particularly among older adults. Alice Munro's novella "The Bear Came Over the Mountain" offers a compelling literary framework for exploring these impacts through narrative gerontology, a lens that emphasizes storytelling's role in shaping identity and relational bonds during ageing and illness. This study applies narrative gerontology to analyze Munro's depiction of Alzheimer's, focusing on the experiences of Fiona and Grant. Through detailed textual analysis, it examines the gerontological concept of "we-narrative" (shared relational identity) to understand how identity, memory loss, and relational dynamics evolve. Munro portrays Alzheimer's as both a medical condition and a social experience, fragmenting Fiona's sense of self and reshaping the couple's shared identity. Fiona's fading memories unravel her narrative, diminishing her autonomy, while Grant's shift from husband to caregiver redefines their relationship. The novella's disjointed structure reflects the cognitive chaos of Alzheimer's, deepening its emotional impact. The gerontological "we-narrative," representing shared relational identity, reveals the enduring strength of their bond, as Grant's selfless actions highlight a transformed expression of love. Dementia narrative features how caregivers' identity gradually forms through the lived experience of supporting a loved one with cognitive decline. These findings align with narrative gerontology's view that stories help individuals and caregivers navigate identity and loss. Munro's work challenges stereotypes about ageing, emphasizing the emotional complexity of caregiving and the resilience of human connections. Munro's novella powerfully illustrates Alzheimer's multifaceted effects, using narrative to explore identity, care, and relational adaptation in the context of ageing and illness.
Mesotherapy (intradermal therapy) is an injection technique involving the administration of small amounts of drugs into the superficial dermis, where micro-deposits are formed and gradually diffuse into underlying tissues. This distinctive local pharmacokinetic profile, together with potential neurobiological and microcirculatory effects related to needle microtrauma and the injected solution, may contribute to analgesic effects in localised pain conditions, particularly of musculoskeletal origin. Across European family medicine, and more broadly within international primary care systems, there is growing interest in therapeutic strategies that are effective, safe, minimally invasive and compatible with longitudinal, patient-centred care pathways. In this context, available clinical evidence, accumulated clinical experience and international consensus recommendations suggest that mesotherapy may provide potential clinical benefits in a range of localised musculoskeletal pain conditions, including acute and chronic low back pain, neck pain, knee osteoarthritis, tendinopathies, myofascial pain syndrome and post-traumatic pain. The use of low drug doses is associated with reduced systemic exposure and a predominantly local, generally mild adverse-event profile, a feature of particular relevance in elderly and polymedicated patients commonly managed in family medicine. International consensus documents support the safe and standardised use of mesotherapy in musculoskeletal medicine and recognise its role as an adjuvant technique in other medical fields. From a primary care perspective, this article examines the clinical and organisational rationale for introducing mesotherapy into family medicine care pathways, highlighting its potential role as a complementary option within a multimodal, patient-centred approach and, in selected cases, as an early local intervention for localised musculoskeletal pain. However, it should be acknowledged that the current evidence base is characterised by a limited number of high-quality, randomised controlled trials, and that the available data do not allow definitive conclusions regarding the clinical effectiveness, cost-effectiveness or system-level impact of mesotherapy across different healthcare settings. At present, the existing evidence supports hypothesis-generating interpretations, suggesting that mesotherapy may be useful and efficient in selected clinical contexts rather than conclusively established. Within these limitations, there is a reasonable likelihood that mesotherapy could be integrated into primary care pathways for specific subgroups of patients, particularly those with well-localised musculoskeletal pain, contraindications to systemic therapies, or a high risk of drug-related adverse events. Further prospective studies, adequately powered randomised controlled trials and real-world evaluations are required to better define its clinical positioning, long-term safety, cost-effectiveness and optimal models of integration within different primary care systems. This article provides a narrative review and a practice-oriented appraisal of the available evidence.
Apolipoprotein B (apoB) is a key biomarker for risk assessment and treatment monitoring of atherosclerotic cardiovascular disease (ASCVD). Its clinical value has been validated by multiple studies, and its predictive performance for ASCVD risk is significantly superior to conventional lipid indicators in populations with complex lipid profiles. However, the standardization of apoB detection has long been a core bottleneck restricting its widespread clinical application, as discrepancies in results between different methods and laboratories can biases in clinical decision-making. In recent years, the development of Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) technology has provided a solution for optimizing apoB standardization. Currently, International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) is promoting the development of a primary reference measurement procedure based on mass spectrometry, aiming to achieve apoB standardization traceable to the International System of Units (SI). This review systematically outlines the clinical value of apoB, main detection methods, standardization challenges, and the application and prospects of LC-MS/MS in overcoming these challenges. We aim to provide insights for further optimizing apoB detection standardization.
To establish evidence-based consensus statements on imaging of scaphoid fractures. Nineteen hand surgeons formulated a preliminary list of eleven questions on imaging of scaphoid fractures. Based on this preliminary list, radiologists crafted statements considering literature and their clinical experience, then refined them through an iterative Delphi process to revise the questions and statements. A maximum of three Delphi rounds was scheduled until group consensus was achieved for an individual statement, whichever arose first. Twenty-eight radiologists drafted the statements and acted as Delphi panellists. Panellists rated their level of agreement with each statement on an 11-point numeric rating scale, the score '0' indicated complete disagreement and the score '10' indicated complete agreement, respectively. Group consensus was specified as a score of '8' or higher for ≥ 23/28 panellists. Eight of eleven questions and statements achieved group consensus in the first Delphi round. The remaining three questions and statements achieved group consensus in the second Delphi round, indicating more controversial topics. It was agreed that radiographs are the initial imaging technique of choice for suspected scaphoid fractures. MRI or CT are advocated for suspected radiographically occult scaphoid fractures. CT is the method of choice for assessment of osseous consolidation. Contrast-enhanced MRI is the preferred imaging modality for assessing vascularisation of scaphoid nonunion. CT is the most valuable technique in the postoperative evaluation of scaphoid fractures. Delphi-based consensus statements suggest imaging pathways to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures. Question How can an international and interdisciplinary team of hand surgeons and musculoskeletal radiologists develop practical consensus statements on imaging of scaphoid fractures? Findings All eleven statements achieved group consensus among experts using the Delphi technique for consensus-building. Imaging pathways were suggested to diagnose and assess scaphoid fractures. Clinical relevance statement International, interdisciplinary and evidence-based consensus statements on imaging of scaphoid fractures were achieved using the Delphi technique. The focus of the statements was to diagnose scaphoid fractures, assess osseous fracture consolidation and evaluate pre- and postoperative fractures.
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive disease predominantly affecting older men and is associated with increasing care needs. Previous international studies have reported that, as ATTR-CM progresses, caregivers experience substantial physical and emotional burden, as well as productivity impairment. However, real-world evidence on caregiver burden in Japan remains limited. This study aimed to characterize multidimensional caregiver and patient burden in Japan. Data were drawn from the Adelphi ATTR Disease Specific Programme™, a cross-sectional survey of cardiologists and their consulting patients with ATTR-CM, conducted in Japan between October 2024 and January 2025. Cardiologists completed patient record forms, including patient demographics, clinical characteristics, and caregiving status. Patients and their non-professional caregivers also completed voluntary self-reported questionnaires. Caregiver outcomes included caregiving time, work productivity, and activity impairment (WPAI), and Zarit Burden Interview (ZBI) scores. Patient health status was assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Analyses were descriptive. Twenty-five physicians provided data for 120 patients (mean age 74.7 years; 78.3% male). Over half of patients (55.9%) had a caregiver, most commonly a spouse (72.6%). Caregivers (n = 22; mean age 64.0 years; 95.5% female) primarily lived with the patient (81.8%). Caregivers reported a median (interquartile range) of 20.0 (5.0-40.0) hours/week caregiving, and experienced substantial overall work productivity impairment [36.2% (SD 37.3%)] and daily activity impairment [47.7% (SD 31.5%)]. The mean ZBI score was 38.3 (SD 19.3), with 85% experiencing at least mild burden. This real-world study describes substantial burden among a sample of predominantly female spouses caring for patients with ATTR-CM in Japan. Furthermore, these findings underscore the importance of timely diagnosis and treatment for patients, alongside strengthening support for their caregivers within the Japanese healthcare system.
Alström syndrome (ALMS) is an ultra-rare autosomal recessive disorder caused by mutations in the ALMS1 gene, leading to a complex spectrum of multi-organ failure, including early-onset sensory loss, obesity, and cardiomyopathy. Despite its clinical significance, a systematic overview of the global research landscape and the intellectual evolution of this field over the past 2 decades remains absent. This study was undertaken to conduct a comprehensive bibliometric and visualization analysis of ALMS research from 2000 to 2025, aiming to identify foundational contributions, evaluate international collaboration patterns, and pinpoint emerging research frontiers. Utilizing data from the Web of Science Core Collection, 345 relevant English-language articles and reviews were analyzed using VOSviewer, CiteSpace, and the R-bibliometrix package. Our findings revealed an exponential growth phase in publications post-2020, with developed nations dominating the research output and Jackson Laboratory serving as a critical international hub. Prolific contributors such as Jan D. Marshall and Pietro Maffei have established dense collaboration networks that facilitate the transition of ALMS research from early genetic characterization to contemporary precision medicine. Keyword and co-citation analysis further highlight a thematic shift toward "ciliopathy" contexts, with recent hotspots focusing on "whole exome sequencing" and the management of "cardiomyopathy". These results imply that while our understanding of ALMS pathogenesis is maturing, significant challenges in phenotypic heterogeneity and the lack of targeted therapies persist. Future research should prioritize interdisciplinary resource integration and the application of advanced genomics to optimize clinical management and patient outcomes in this complex rare disease.
Access to essential medicines is a fundamental human right and a critical pillar of effective healthcare. In Africa, armed conflicts severely weaken health systems, disrupting the availability of essential medicine, leading to gaps in patients' treatment and, in turn, posing a serious risk to overall public health. Therefore, this study aimed to identify the impact of armed conflicts on the availability of essential medicines as a cornerstone of healthcare across African regions, and quantify the extent of this disruption over time and by country. In this systematic review and meta-analysis, data were retrieved from published articles accessible in PubMed, Semantic Scholar, and grey literature covering the period from 1985 to 2025 and 2001 to 2024 for system impact and medicines availability studies, respectively. The literature search was conducted from January to May 2025. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, studies were independently screened by two reviewers and included if they contained information on medicine availability or its relation to health systems in conflict zones and were published in English. The quality of studies was evaluated using the Joanna Briggs Institute criteria. Pooled estimates of medicine availability and their 95% CIs were obtained using a random-effects analysis. Heterogeneity was assessed using the I² statistic. The risk of bias and small study effects were assessed with funnel plots and Egger's test. Additionally, the leave-one-out sensitivity test and influence diagnostics test were considered to evaluate study-level impact. The review included data from 1,581 health facilities and 989 essential medicines across eight conflict-affected African countries. The pooled availability of essential medicines calculated from the data obtained from 41 studies conducted in African countries shouldering frequent armed conflict was estimated at 55% (95% CI, 47-63), with substantial heterogeneity across studies (I² = 93%, p < 0.001). Country-level analysis showed the highest availability in the Central African Republic (79%; 95% CI, 49-95) and the lowest in Nigeria (40%; 95% CI, 1-78). A temporal decline in medicine availability was observed, from 76% (2001-2010) to 46% post-2020. No significant publication bias was detected (funnel plot asymmetry p = 0.9560; Egger's test p = 0.494). Additionally, the influence diagnostic test and the leave-one-out sensitivity analysis indicated that observed heterogeneity likely reflects methodological differences and the sample size across the studies rather than bias or outliers. The systematic review revealed that armed conflicts have profoundly compromised health system functionality through the destruction of healthcare infrastructure, closure of medical facilities, displacement of the health workforce, pervasive insecurity and psychological distress among healthcare providers, and disruptions in supply chains and transportation networks, all of which have adversely affected the accessibility of essential medicines. On average, only 55% of essential medicines were available in conflict-affected regions of Africa, which was below the WHO benchmark of 80%. This finding underscores the severe threat that armed conflict poses to medicine availability and, consequently, to increased indirect morbidity and mortality. Additionally, the conflict undermines medicine availability through multiple, often interconnected mechanisms, indicating the need for a coordinated, multisectoral approach to ensure continuous access to essential medicines. Therefore, strengthening healthcare infrastructure in conflict settings is critical. Furthermore, the international community should enforce accountability mechanisms for violations affecting healthcare services, while donors and regional humanitarian assistance and emergency response mechanisms should increase investment and medicine supply in resilient medicine supply systems capable of maintaining availability during periods of armed conflict. The study protocol was registered in PROSPERO (CRD420251154811), the International Prospective Register of Systematic Reviews, maintained by the National Institute for Health and Care Research (NIHR).
Swallowing dysfunction poses significant health risks for older adults. Early detection is crucial to prevent complications such as aspiration pneumonia and sarcopenia. Acoustic analysis of voice, speech, and cough provides a promising, noninvasive method for screening for swallowing dysfunction. Here, we present an Expert Consensus Statement (ECS) on the use of select acoustic metrics for bedside screening of swallowing dysfunction in older adults (>65 years). A multidisciplinary panel of 17 experts, spanning speech-language pathology, otolaryngology, geriatrics, neurology, nursing, emergency medicine, engineering, and computer science, developed this ECS using a modified Delphi method. Consensus discussions were guided by working definitions of swallowing dysfunction, aspiration, frailty, and dementia. After three iterative Delphi survey rounds and four conference calls, nine items reached consensus. These statements emphasized the clinical relevance of "wet voice" as an indicator of airway invasion, the requirement for screening tasks to be feasible for alert older adults, and the necessity of instrumental validation (videofluoroscopic swallowing studies/flexible endoscopic evaluation of swallowing) as a reference standard. Furthermore, the panel reached consensus on artificial intelligence's potential to enhance screening, while stressing the importance of addressing algorithmic bias and ensuring equitable access across diverse populations. The consensus highlights the potential of auditory-perceptual assessment and acoustic metrics to inform screening for swallowing dysfunction in older adults and offers expert insights for clinical investigators who aim to analyze voice, speech, and/or cough sounds as clinically meaningful indicators of laryngeal function to improve early detection and intervention, thereby enhancing patient outcomes.
Inflammatory rheumatic diseases (IRDs) present substantial risks of infection-related comorbidities during pregnancy. This study evaluates the knowledge, experience, and perceptions of healthcare professionals concerning the prevention of these risks. An international, cross-sectional survey was administered using the SurveyMonkey platform. The survey was disseminated to healthcare professionals specializing in rheumatology, obstetrics, infectious diseases, internal medicine, general practice, and related disciplines through social media channels. Developed in accordance with European Alliance of Associations for Rheumatology (EULAR) recommendations, this survey comprised 30 questions, including multiple-choice, Likert-type, and open-ended formats. A total of 201 healthcare professionals from thirty-six countries participated in the study, with rheumatologists comprising the majority (n = 145, 72.1%). Systemic lupus erythematosus (n = 183), systemic vasculitis (n = 141), and rheumatoid arthritis (n = 86) were identified as the diseases associated with the highest risk of infection-related comorbidities. The most frequently recommended infectious conditions for screening included Hepatitis B (n = 142), urinary tract infections (n = 141), and Hepatitis C (n = 129). The primary risk factors were uncontrolled disease activity (n = 176), high-dose corticosteroid use (n = 164), and high disease severity (n = 162). The most significant systemic barriers were insufficient number of specialists (n = 156), and absence of multidisciplinary teams (n = 155). This study identifies structural and educational deficiencies in the management of infection-related comorbidities among pregnant patients with IRD. The results underscore the need for targeted clinical guidelines, enhanced multidisciplinary care models, and expanded pre-pregnancy counseling.
Since 2016, the Alzheimer's Association and the Fondation Alzheimer have hosted Global Alzheimer's Leadership Series (GoALS) global think tanks, with world-leading experts for innovative discussions to advance Alzheimer's disease (AD) research and care. The second GoALS think tank, held in June 2024 in Paris, focused on the relationship between biological changes and clinical manifestations of AD in the context of the evolving therapeutic landscape. Discussions spanned real-world experiences of providers, patients, and their families, theoretical considerations, and health system challenges. The lived experience perspective was central to these discussions. The importance of shared decision-making, clear and transparent communication, and the need for real-world data to holistically support patients during their experiences were highlighted. This manuscript shares key insights from both the think tank meeting in Paris and a featured research session at the 2024 Alzheimer's Association International Conference that expanded the discussion themes for broader dissemination with the community.
Introduction Individual health and life expectancy, rather than age, should drive management decisions for patients with prostate cancer. There is limited available data regarding treatment outcomes and tolerance for older adults where health status warranted treatment with curative intent. Herein, we report treatment outcomes for patients 80 years and older who received definitive radiation therapy (RT) for localized prostate cancer. Methods This retrospective study includes 41 patients who received RT for localized prostate cancer at the age of 80 years or older between 2004 and 2022. The median age was 83. Baseline details and outcomes, including treatment toxicity, symptom scores, biochemical recurrence (BR), distant metastases (DM), and overall survival (OS), were collected in a secure database and analyzed with Graphpad Prism (GraphPad Software, Boston, MA, USA) and R software (version 4.5; R Foundation for Statistical Computing, Vienna, Austria). Results No patients experienced adverse events that were Common Terminology Criteria for Adverse Events (CTCAE) grade 4 or higher. One patient (2.4%) experienced late CTCAE grade 3 proctitis, seven patients (17.1%) experienced acute CTCAE grade 2 genitourinary adverse events (GU AE), and five patients (12.2%) experienced late grade 2 GU AEs. Mean urinary symptom scores improved after RT (with the International Prostate Symptom Score (IPSS) decreasing from 12.1 pre-RT to 8.2 post-RT). The estimated four-year cumulative incidence of metastases was 6.7% (95% CI 0-16.1%). There were trends in outcomes based on risk group, but no statistically significant differences between intermediate risk cancer (IR) and high or very high-risk cancer (HR/VHR) regarding BF (15% vs. 20%, p=0.17), DM (0% vs. 10%, p=0.20), or OS (94% vs. 96%, p=0.38). Conclusions Definitive RT for patients 80 years or older was generally well tolerated and effective in this small cohort. These findings may indicate a favorable risk/benefit ratio for definitive prostate cancer treatment for select patients 80 years or older. Decision-making for prostate cancer treatment should involve a comprehensive approach, accounting for each individual patient's life expectancy and overall health rather than avoidance of treatment based simply on age.
Comprehensive geriatric assessment and resilience evaluation are central to modern geriatric care. While geriatricians strongly advocate healthy ageing and prevention, little is known about their own resilience profiles. During an international meeting of the European Academy for Medicine of Ageing (EAMA) held in July 2025 in Zeist, the Netherlands, and the 21st EuGMS Congress in Reykjavik, Iceland, we conducted a cross-sectional survey paired with standardized physical and cognitive performance tests. A composite resilience score was derived from standardized handgrip strength (sex-specific), chair stand performance, reaction time, and optimism and was associated with several person- and work-related characteristics in regression models. Ninety-four geriatricians (mean age 45.4 years; 66% women) participated. In age- and sex-adjusted analyses, resilience was lower among geriatricians working in Western and Southern Europe compared with Northern Europe. Poorer electronic health record availability and unbalanced work-life conditions were independently associated with lower resilience. Even among physicians highly aware of healthy ageing principles, resilience varies meaningfully across regions and working conditions. Organizational and contextual factors appear to matter more than individual lifestyle characteristics, highlighting the need to address physician well-being as part of sustainable geriatric care systems.
Contemporary data characterizing older adults admitted to cardiac intensive care units (CICUs) across diverse indications are limited. The objective of the study was to describe the clinical characteristics, critical care therapies, and in-hospital outcomes of older patients admitted to the CICU compared with younger adults. The Critical Care Cardiology Trials Network is a multicenter, international registry of CICUs. Between 2017 and 2024, participating centers contributed annual ≥2-month snapshots of consecutive medical CICU admissions. Admissions were categorized into 4 age groups: <65, 65-<75, 75-<85, and ≥85 years. Outcomes included CICU and in-hospital mortality and length of stay. Multivariable models adjusted for sex, illness severity (SOFA score), lactate, and kidney function. Among 35,265 admissions from 50 sites, 44%, 27%, 21%, and 9% were aged <65, 65-<75, 75-<85, and ≥85 years, respectively. Acute coronary syndrome was the most common admission diagnosis among all age groups. Patients aged ≥85 years had the lowest use of mechanical circulatory support (5.5%), which consisted exclusively of intra-aortic balloon pumps. Relative to patients <65 years, adjusted ORs of in-hospital mortality were 1.53 (1.40-1.67) for 65-<75 years, 1.83 (1.67-2.01) for 75-<85 years, and 1.95 (1.72-2.22) for ≥85 years. Among cardiac arrest patients the increase in mortality with age was steeper, reaching 3.09 (2.24-4.26) for patients ≥85 years. Patients ≥85 years in contemporary CICUs experience survival comparable to those aged 75-<85 years, except in the setting of cardiac arrest. These findings support consideration of factors beyond chronological age in CICU triage and treatment decisions.
Long-term real-world outcomes of edoxaban in chronic thromboembolic pulmonary hypertension (CTEPH) remain incompletely characterised despite emerging evidence, including the KABUKI randomised trial. To evaluate long-term effectiveness and safety of edoxaban in patients with CTEPH using a nationwide registry. We analysed the CTEPH AC Registry, a multicentre prospective observational cohort. Patients with CTEPH receiving edoxaban at registration were included. The primary effectiveness endpoint was morbidity and mortality events, a composite of all-cause death, lung transplantation, rescue pulmonary endarterectomy or balloon pulmonary angioplasty, ≥15% decline in 6-minute walk distance with worsening World Health Organization (WHO) functional class, or symptomatic venous thromboembolism. The primary safety endpoint was clinically relevant bleeding according to International Society on Thrombosis and Haemostasis criteria. Among 408 patients, median follow-up was 552 days. The cumulative incidence of morbidity and mortality events was 4.7%, 10.0%, and 14.1% at 1, 3, and 5 years, respectively. The cumulative incidence of clinically relevant bleeding was 3.2%, 4.8%, and 5.6%, respectively, and major bleeding occurred in 2.4% at 5 years. Symptomatic venous thromboembolism occurred in 1.5% at 5 years. Outcomes were broadly consistent across reperfusion history, WHO functional class, edoxaban dose, and renal function strata. In this Japanese nationwide registry, long-term edoxaban therapy was associated with sustained clinical stability in patients with CTEPH. No clear late-emerging safety signal was observed, but extrapolation beyond Japan requires caution, particularly in patients with different body size, renal function, or concomitant medication profiles.
Malnutrition is prevalent among older people in nursing homes, and assessing associated factors of malnutrition is critical for successful malnutrition prevention interventions. This study aimed to systematically evaluate the incidence and associated factors of malnutrition in older people living in nursing homes. PubMed, Embase, Web of Science, CINAHL, China Biological Medicine (CBM), Wan Fang, and China National Knowledge Infrastructure (CNKI) were comprehensively searched for observational studies investigating the incidence and associated factors of malnutrition among older people in nursing homes from inception to September 20, 2024. Two investigators independently selected the literature, evaluated their quality, and extracted relevant data. A total of 25 studies comprising 51,915 cases were included. The prevalence of malnutrition in nursing homes was 22% (95% CI: 0.19-0.25). Sociodemographic-associated factors of malnutrition among older people in nursing homes included age (OR = 2.39, 95%CI: 1.87-3.07), female (OR = 1.63, 95%CI: 1.34-1.99), marital status (OR = 1.37, 95%CI: 1.11-1.69), high cultural literacy (OR = 0.1, 95%CI: 0.02-0.49), denture (OR = 2.3, 95%CI: 1.17-4.51), and lack of exercise (OR = 1.25, 95%CI: 1.09-1.43). Physical and physiological function factors included care dependence (OR = 2.44, 95%CI: 1.99-3.00), disability for activities of daily living (OR = 3.37, 95%CI: 1.90-5.96), health self-assessment (OR = 2.05, 95%CI: 1.51-2.77), chewing function (OR = 1.77, 95%CI: 1.05-2.99), swallowing function (OR = 3.12, 95%CI: 2.21-4.41), intake (OR = 3.68, 95%CI: 1.72-7.86), appetite (OR = 7.59, 95%CI: 4.19-13.76), high BMI (OR = 0.29, 95%CI: 0.11-0.77), and pressure ulcer (OR = 1.74, 95%CI: 1.52-2.00). Disease-related associated factors included dementia (OR = 1.63, 95%CI: 1.54-1.74), depression (OR = 2.31, 95%CI: 1.24-4.29), frailty (OR = 3.37, 95%CI: 1.22-9.29), 1 < illness < 3 (OR = 3.86, 95%CI: 2.14-6.97), illness ≥ 3 (OR = 5.76, 95%CI: 2.81-11.79), diseases of the digestive system (OR = 1.31, 95%CI: 1.20-1.44), and cancer (OR = 1.26, 95%CI: 1.11-1.41). However, it remained unknown whether the use of medication (OR = 3.14, 95%CI: 0.38-25.77), diabetes (OR = 0.67, 95%CI: 0.49-0.93), and diseases of the respiratory system (OR = 1.55, 95%CI: 0.77-3,15) were associated with malnutrition. Malnutrition is a widespread problem among older people residing in nursing homes due to various physiological, psychological, social, and lifestyle factors. Future research should focus on developing risk prediction models based on these influencing factors, creating intervention programs, and conducting large-scale randomized controlled trials across multiple centers. The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42023477611.
This systematic review and multilevel meta-analysis evaluated the effects of whole-body vibration (WBV) interventions on dynamic balance among older patients after stroke and examined potential moderators and dose-response relationships. A comprehensive search was conducted across several databases, including PubMed, Web of Science, PsycINFO, the Cochrane Library, and the CNKI International Version, from inception to December 26, 2025. The inclusion criteria focused on randomized controlled trials involving patients who had experienced a stroke, with a mean age of at least 60 years at either the sample or arm level. Standardized mean differences (SMDs), adjusted using Hedges' g correction, were computed from between-group changes from baseline to the immediate post-intervention period. A three-level random-effects model was employed, with additional sensitivity analyses, robust variance estimation, subgroup analyses, meta-regression, and exploratory dose-response modeling. Twelve randomized controlled trials (RCTs) involving 486 participants and reporting 26 effect sizes were included in this analysis. WBV-based interventions were associated with improved dynamic balance in older patients after stroke, with an SMD of 0.69 (95% CI: 0.27 to 1.11, P = 0.002), despite substantial heterogeneity (I² = 72.6%). The pooled effect remained directionally consistent across sensitivity analyses and small-sample-corrected robust variance estimation, although the overall certainty of the evidence was rated as low. Subgroup analyses indicated positive effects for both WBV alone and WBV combined with other rehabilitation components, with no significant differences between the two intervention modes. Additionally, exploratory dose-response modeling suggested a possible intervention range of approximately six sessions per week, each lasting 20-22 min, over 5-6 weeks, yielding a cumulative exposure of approximately 7.6-10.6 h. Low-certainty evidence suggests that WBV interventions may improve dynamic balance in older stroke patients. However, these findings should be interpreted cautiously given significant heterogeneity, concerns about risk of bias, and the limited number of trials. Furthermore, subgroup analyses and dose-response findings should be considered exploratory and hypothesis-generating rather than definitive clinical recommendations.
Emerging arboviruses such as chikungunya virus (CHIKV), dengue virus (DENV), and Zika virus (ZIKV) pose growing public health challenges, demanding reliable diagnostic systems to support outbreak responses. During the July 2025 CHIKV outbreak in China, the absence of domestic nucleic acid reference materials (RMs) and external quality assessment (EQA) programs hindered diagnostic standardization. We developed pseudovirus-based RNA RMs for CHIKV, DENV, and ZIKV and certified their concentrations using digital PCR across 9 laboratories for each virus, ensuring stability and commutability with WHO international standards and clinical samples. Leveraging these RMs, China conducted its first nationwide arbovirus nucleic acid EQA program. All three RMs were officially approved by China's State Administration for Market Regulation, with codes GBW(E)091403, GBW(E)091405, and GBW(E)091409 for CHIKV, DENV, and ZIKV, respectively. The EQA program involved 937 laboratories across 31 provinces and employed 51 amplification kits. Over 97.5% of laboratories achieved perfect scores and >99% were qualified, reflecting strong overall testing capacity. Crucially, the EQA revealed systematic gaps: institutional differences in testing scope and performance were evident, pooled testing in blood stations missed low CHIKV levels, and reagent-dependent differences in Cycle threshold values and amplification efficiency (78.9% to 146.4%) affected low-concentration CHIKV and DENV-2 detection. These findings underscore the power of large-scale EQA to expose hidden inter-laboratory and reagent inconsistencies. By integrating standardized RMs with nationwide EQA, this work provides a robust framework for diagnostic harmonization, drives quality improvement, and strengthens preparedness for future arboviral threats.