搜索结果：Health services & outcomes research methodology

Health literacy is a multidimensional determinant of health that influences diabetes outcomes and social inequities in health (SIH). Studies often measure it unidimensionally, failing to capture people's diverse health literacy skills. We identified multidimensional health literacy profiles among adults living with type 2 diabetes (T2D) in France and described their clinical, behavioral and social characteristics with a view to informing future tailored interventions. This study used a cross-sectional design based on a subsample of the Entred 3 national survey, combining self-reported questionnaire data with linked administrative health data covering the previous 10 years. Health literacy was assessed using the Health Literacy Questionnaire (HLQ) among 510 individuals with T2D who completed the cross-sectional survey online. Hierarchical clustering based on standardized HLQ scores identified distinct health literacy clusters. We identified 13 health literacy clusters among the online survey participants, labelled from A to M, five requiring tailored public health and clinical responses. Substantial heterogeneity concerning health literacy skills and associations with SIH and health outcomes was observed. For example, cluster A demonstrated strong self-management skills counteracted by severe barriers to care navigation and information comprehension in a highly vulnerable setting. Furthermore, cluster D reflected globally low health literacy scores, poor health outcomes and high exposure to risk factors despite recent diabetes diagnosis. A third example is cluster K, which highlighted strong relational and cognitive skills but limited engagement in self-care and significant exposure to risk factors despite favorable socioeconomic conditions. Health literacy profiles reflect complex combinations of skills, risks and social determinants, which can potentially inform how to tailor public health interventions, so that no group is left behind.

Background/Objectives: Health systems globally are transforming toward population-based, person-centred care, yet measurement systems frequently remain anchored in provider-centric or disease-specific frameworks. This paper presents the Systemic Health System Measurement Framework (SHSMF), a population health systems measurement architecture that completes a conceptual systemic health systems design and transformation trilogy with the Unified Care Model (UCM) and Systemic Health System Population Segmentation Model, addressing how health systems can measure whether systems integration is succeeding. Methods: This study employs a conceptual framework development and implementation case study design approach, with the Systemic Health System Measurement Framework (SHSMF) developed using the Health System Transformation Playbook (HSTP) methodology. The framework organises measurement around needs-based population segments, integrates Lifelong Care and Episodic Care measurement within a unified architecture, and cascades indicators across macrosystem, mesosystem and microsystem levels. Implementation was demonstrated through the development of performance and governance dashboards development at Yishun Health, a regional population health system serving approximately 320,000 residents in Singapore (2022-2024). Results: Descriptive analytics from the Lifelong Care Dashboard (207,980 residents across seven segments) and the Episodic Care Dashboard (230,365 inpatient cases across six segments) revealed systemic patterns not readily apparent through conventional approaches. Psychosocial complexity was consistently associated with disproportionate cost trends across both dashboards despite lower medical acuity. Quality indicator performance across psychosocially complex segments was not proportionally worse, yet these segments bore disproportionate costs, a pattern consistent with the view that segment-specific care redesign addressing psychosocial needs may be associated with both an improvement in outcomes and cost efficiencies. Conclusions: The Systemic Health System Measurement Framework (SHSMF) demonstrates that a measurement architecture explicitly designed around systemic needs-based population segments improves systemic health systems accountability and provides governance opportunities that conventional approaches may not achieve. The framework and its dashboard implementation offer a transferable methodology for health systems globally seeking to implement a whole-systems measurement architecture for value-based population health management.

Climate change represents a major global health challenge with potential implications for mental health. Exposure to climate-related stressors is associated with an elevated risk of psychiatric disorders, including trauma- and stressor-related disorders (e.g., PTSD), depressive disorders, and anxiety disorders. Vulnerable populations-including children, women, older adults, individuals with pre-existing mental health conditions, and communities in low-income or disaster-prone regions-may be disproportionately affected. This umbrella review synthesizes current evidence on the mental health impacts of climate change, focusing on clinically relevant outcomes and underlying mechanisms. A systematic literature search was conducted across Web of Science, PubMed, Scopus, and Google Scholar for systematic reviews published between January 2014 and October 2024. Data extraction and methodological quality assessment were performed using the Joanna Briggs Institute Critical Appraisal Checklist, which evaluates methodological rigor, clarity of research questions, and appropriateness of data synthesis. Only English-language systematic reviews scoring ≥ 5/11 on the JBI checklist-reflecting moderate to high methodological quality-were included. Non-systematic reviews and studies without accessible full texts were excluded. The review protocol was registered in PROSPERO (CRD420251133963). Climate change may affect mental health through both direct and indirect pathways. Direct impacts include elevated risk or worsening of PTSD, depressive disorders, anxiety disorders, and suicidal behaviors, which may be precipitated or exacerbated by climate-related stressors. Indirect effects operate via socioeconomic disruptions, such as food insecurity, forced migration, poverty, and weakened social networks. Psychological responses described as eco-anxiety and solastalgia further illustrate the range of mental health outcomes associated with environmental changes. Climate change is associated with clinically relevant psychiatric outcomes across established diagnostic categories. The mechanisms underlying these associations involve complex neurobiological, socioeconomic, environmental, and cultural pathways. These findings underscore the importance of targeted psychiatric interventions, including cognitive behavioral therapy, trauma focused therapies, resilience-building, strengthening social support, promoting adaptive coping strategies, and enhancing preparedness of mental health services. Prioritizing vulnerable populations for psychiatric assessment, prevention, and intervention is essential. Integrating these strategies into clinical practice and public health planning is critical to support evidence-based mental health care.

This rapid review mapped how information and communication technologies (ICTs), particularly digital health applications, are being used within healthcare services for adults aged 55 years and older. Following the Joanna Briggs Institute methodology and guided by the Population-Concept-Context framework, studies published between 2016 and 2024 were identified and reported in accordance with the PRISMA extension for scoping reviews, based on a previously published protocol registered on the Open Science Framework. Nineteen studies were included after critical appraisal. The findings indicate that ICT use is most frequently associated with improved accessibility and coordination of healthcare services, support for health professionals' training and care management practices, and positive health-related outcomes for older adults, particularly in the domains of mental health, social participation, and self-care. However, the evidence remains heterogeneous and often limited in its reporting of design and implementation processes, highlighting the need for further context-sensitive research that addresses ethical, equity, and implementation considerations in the use of digital health technologies for older populations.

Background: Families caring for children with medical complexity (CMC) face sustained psychosocial demands that may impair health-related quality of life (HRQoL) and mental health. A clear map of how these outcomes are assessed and which factors shape them is needed to guide family-centered care. Methods: We conducted a scoping review following the Joanna Briggs Institute guidelines, and reports were prepared according to the PRISMA guidelines. Searches were conducted in PubMed, CINAHL, and EMBASE (January 2011 to December 2023) to find studies reporting on health-related quality of life (HRQoL) and/or mental health outcomes (anxiety, depression, burden) of family members and/or caregivers of CMC, including operationalization based on complex chronic condition (CCC) classifications, technology dependency, or the Pediatric Medical Complexity Algorithm (PMCA). Two reviewers independently screened records and recorded data, and the findings were synthesized narratively and thematically. Results: Sixty-seven studies met the inclusion criteria and spanned cross-sectional, cohort, case-control, pre-post and qualitative designs across conditions such as epilepsy, congenital heart disease, cerebral palsy, technology dependence and cancer. Common measures were PedsQL™ Family Impact Module, SF-36/12, HADS, Beck inventories and Zarit burden scales. Across the included studies, caregivers, predominantly mothers, frequently reported poorer HRQoL and higher levels of anxiety, depressive symptoms, or burden than comparison groups when these were available. Six recurrent themes emerged: (1) gendered caregiving with disproportionate maternal burden; (2) socio-economic gradients and financing models shaping outcomes; (3) culture, religion and spirituality as coping resources; (4) family and social support buffering distress; (5) school participation and coordinated services potentially reducing burden; and (6) interdependence between caregiver and child outcomes. Conclusions: Heterogeneous CMC definitions, outcome measures, and study designs limited comparability across studies. The mapped evidence suggests that family HRQoL and mental health outcomes are shaped by interacting clinical, social, and contextual factors. These findings may inform more family-centered and equity-oriented approaches to care. Future research should harmonize CMC definitions, standardize outcome measures, and prospectively evaluate multicomponent interventions.

Children and adolescents in the Middle East and North Africa (MENA) experience a high burden of mental health problems, yet school-based services remain fragmented. Schools offer a strategic platform for prevention and early intervention, but implementation evidence in MENA is limited. We conducted a systematic review and evidence map of PreK-12 school-based mental health and related health-promoting interventions in MENA countries. Searches were conducted from database inception to August 2025. Implementation strategies were coded using the ERIC framework, and implementation outcomes were classified using Proctor's taxonomy. Twenty-four studies met inclusion criteria. Interventions included targeted mental health programs, universal promotion initiatives, health-promoting curricula with psychosocial components, and digital safety interventions. Common strategies were training school staff, cultural adaptation, and integration into existing routines. Adoption and feasibility were frequently reported; fidelity, sustainment, cost, and equity outcomes were rarely assessed. Strengthening school mental health in MENA requires policy integration, structured workforce support, equity-focused implementation metrics, and sustainable financing mechanisms. School-based mental health interventions are increasing across MENA, but systematic implementation planning is essential for long-term scale and impact.

Integrated care for TB and mental health is critical, as mental disorders worsen TB outcomes. WHO guidelines recommend routine screening for mental health conditions and integrated care for TB patients, yet implementation remains uncertain. We conducted a survey with the participation of 34 experts from 26 countries from the WHO European Region within TBnet and the ADVANCE-TB COST Action, followed by a Delphi process to assess the uptake of WHO recommendations and build consensus on strategies for integrated TB-mental health care. The survey showed substantial gaps: only 21% of experts, representing six countries, reported local or national guidelines integrating mental health into TB care, and systematic screening was rare, including for drug-resistant TB. Building on these findings, the Delphi process reached consensus on the need for validated screening tools at key treatment stages, structured referral pathways, and tighter alignment between TB and mental health services. Eighteen consensus recommendations were developed, addressing training, routine data collection, technology-supported care, and sustainable financing. Mental health remains insufficiently integrated into TB care across the WHO European Region. Routine screening coordinated referral systems and implementation of the proposed recommendations are essential to deliver people-centred, equitable, and effective TB care.

Temporomandibular joint (TMJ) ankylosis is a debilitating disorder caused by fibrous or osseous fusion of the joint components, significantly restricting mandibular mobility. As TMJ ankylosis disrupts normal facial growth, resulting in persistent functional and aesthetic challenges. The Medio-Lateral Depth (MLD) of the bony ankylotic mass is a vital yet underexplored factor influencing the complexity of surgery. Increased MLD and density of the ankylotic mass significantly elevate surgical complexity and the risk of postoperative complications. This study aims to assess the role of the Medio-Lateral Depth (MLD) of the bony ankylotic mass in influencing surgical outcomes (operative time, intraoperative blood loss, complication rates, hospital stay, etc.) and specific indicators of morbidity. and Methodology. This study was designed as a prospective single centre, cohort study. The medio-lateral depth (MLD) was measured pre-operatively by CT scan and intra operatively by depth gauge scale.Other post operative surgical outcomes were correlated to the MLD. 34 patients were included in the study. In the Outcomes-based severity index fit assessment the predictors especially CT Depth and Intra-op Depth explain the intercept severity classification perfectly and Chi-square&#x2009;=&#x2009;51.66, p&#x2009;<&#x2009;0.001&#x2009;&#x2192;&#x2009;chi square value shows very significant outcomes variable. Significant correlations were also found between MLD intra-op and drain collection on POD-1 (R&#x2009;=&#x2009;0.5793, p&#x2009;=&#x2009;0.0003). The cases in this series were classified into mild, moderate and severe cases depending on the variability of MLD measured preoperatively by CT scan and Intra operative MLD therefore nomenclated as Venkatesh MLD severity index (VSI) for ankylotic mass. Mild&#x2009;<&#x2009;2.5&#xa0;cm, Moderate 2.5&#xa0;cm to 4.0&#xa0;cm and Severe&#x2009;>&#x2009;4.0&#xa0;cm. Increasing MLD in ankylotic masses is strongly associated with surgical complexity, intraoperative challenges, and postoperative recovery. MLD remains a pivotal prognostic anatomical parameter, influencing operative time, blood loss, and recovery trajectories. To optimize surgical outcomes, the protocol must integrate advanced preoperative imaging and meticulous planning, with a specific focus on MLD-informed surgical training.

Background: Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, had profound primary effects on global health and secondary effects through widespread disruption of healthcare systems, limiting access to elective medical services essential for the management of chronic diseases such as liver cirrhosis. Elective hospitalizations play a key role in disease monitoring, prevention of complications, and therapeutic optimization. This study aimed to evaluate the impact of the pandemic on the clinical profile, disease severity, and outcomes of patients electively admitted with liver cirrhosis across three periods: pre-pandemic, pandemic, and post-pandemic. Methods: This retrospective, single-center cohort study included 248 adult patients electively admitted with a primary diagnosis of liver cirrhosis between February 2018 and February 2024. Patients were stratified according to admission period. Data on demographics, clinical presentation, etiology, decompensation markers, severity scores (Child-Pugh, Baveno), procedures, and hospitalization outcomes were analyzed. Results: A total of 248 patients were included, with a significant reduction in elective admissions during the pandemic (23.0% vs. 46.4% pre-pandemic), followed by partial recovery post-pandemic (30.6%) (p = 0.031). A higher proportion of urban patients was observed during the pandemic (70.2%, p = 0.004). Disease severity increased during the pandemic, with a higher prevalence of Child-Pugh C (17.5%) and Baveno stage 6 (10.5%), whereas post-pandemic data showed improvement (Child-Pugh C: 6.57%; no Baveno stage 6; p = 0.004). Ascites (47.4%) and paracentesis (21.1%) peaked post-pandemic (p = 0.012; p = 0.003). Endoscopic activity decreased during the pandemic (22.8%, p = 0.017), while interventional procedures were more frequent (8.8%, p = 0.045). Transfusion requirements (17.5%, p = 0.001) and hospitalization costs (&#x20ac;467.08, p = 0.01) were highest during the pandemic, while no deaths were recorded post-pandemic. In-hospital mortality was observed in 1.7% of patients during the pre-pandemic period and increased to 3.5% during the pandemic period, while no deaths were recorded post-pandemic. Conclusions: The COVID-19 pandemic significantly altered elective cirrhosis care, leading to reduced admissions, increased disease severity, and higher resource utilization. Although partial recovery was observed post-pandemic, persistent evidence of delayed decompensation underscores the importance of maintaining continuity in elective hepatology services.

Chronic Obstructive Pulmonary Disease (COPD) poses a substantial public health challenge in China owing to its increasing prevalence and substantial economic burden. In response, the diagnosis-intervention packet (DIP) payment reform was implemented to control healthcare costs and enhance service efficiency. To evaluate the effect of the DIP reform on medical costs, hospitalization days, and individual out-of-pocket payments for COPD inpatients in M City, a pilot city in central China, we conducted an interrupted time series (ITS) analysis using monthly reimbursement records from January 2020 to December 2023. The study included 84,410 hospitalized patients from a city-wide database of 3,241,233 inpatient records with COPD who met the inclusion criteria. The analysis focused on the total healthcare costs, length of stay, and individual out-of-pocket costs. The DIP reform resulted in a 3.7% reduction (95% CI: 0.9% to 6.5%) in the total hospitalization costs in the first month post-reform, with a sustained monthly decline of 0.8% (95% CI: 0.5% to 1.1%). The length of stay decreased from 9.53 (95% CI: 9.31 to 9.75) to 8.74 days (95% CI: 8.62 to 8.86). Conversely, the proportion of out-of-pocket payments relative to total costs increased. While the DIP reform effectively reduced hospitalization costs and days, it led to an increase in individual out-of-pocket payments. Future research should focus on optimizing payment rules, enhancing the supervision of medical services, and refining health insurance policies to achieve the reform's objectives better and alleviate the financial burden on patients.

BackgroundSepsis affects an estimated 166 million people annually. Short-term survival has been the primary focus of research to date, yet individuals who survive acute sepsis face substantial long-term challenges, including chronic illness, physical disability, cognitive impairment, chronic organ dysfunction, cardiovascular events, and psychological disorders. These complications contribute to personal economic hardship, high healthcare utilization, frequent rehospitalization, and significant mortality rates.ObjectivesWe aimed to identify and summarize key interventions for sepsis survivors' post-hospital discharge - including physical rehabilitation, psychological care, provider assessments, monitoring, medication, and education - and to identify gaps in current evidence to elucidate future research priorities.MethodsA systematic scoping review was completed across five databases, supplemented with hand searching. Two reviewers independently screened and extracted data. Eligible studies focused on adult survivors of sepsis, where interventions were implemented after discharge from acute care, and included any research design.ResultsThirteen studies with four follow-up papers were included. Five reported on the impact of simultaneous intervention protocols, four on physical rehabilitation alone, and two on provider assessment and follow-up. The final two focused on psychological care, and pharmacotherapy. Mortality and readmission rates were the most common outcomes measured; satisfaction with care services, mental health outcomes, and cardiovascular event incidence were also evaluated. Qualitative study data was limited. Four studies mentioned intervention costs, but none completed a cost-benefit analysis. Based on a limited pool of evidence, protocolized multi-intervention approaches, provider assessment and follow-up, and physical rehabilitation show some promise in reducing hospital readmissions and improving long-term survival from sepsis. No interventions positively impacted sepsis survivors' mental health. Further, no studies evaluating educational interventions alone were identified.ConclusionsThis review highlights the need for more comprehensive, multidisciplinary post-sepsis care interventions. Future research should focus on patient education, mental health support, and cost-effectiveness analyses to inform evidence-based post-sepsis care strategies.

Advances in cancer treatment have improved survival rates; however, patients continue to experience significant treatment-related side effects, leading to reduced quality of life. Prehabilitation is an intervention that occurs before treatment and can improve patients' functional capacity, recovery, and well-being through exercise, nutrition, and psychological support. Typical hospital-based prehabilitation is not accessible to all patients due to geographical, socioeconomic, and time-related barriers. Technology-based approaches, including eHealth and mobile health (mHealth) interventions, may overcome these barriers by enabling remote, patient-centered delivery. However, the current evidence base is heterogeneous and lacks synthesis regarding feasibility, acceptability, and outcomes. This protocol for a scoping review aims to outline how we will systematically map and synthesize the evidence on technology-based prehabilitation interventions for people with cancer to identify intervention designs, assess feasibility and accessibility, and highlight knowledge gaps to guide future research and practice. The review will follow the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. A 3-step search strategy will be applied across multiple databases and gray literature sources. Eligible studies will include adults (aged &#x2265;18 years) with a cancer diagnosis who are scheduled for elective treatment (surgery, radiotherapy, chemotherapy, immunotherapy, or hormone therapy). Interventions must involve eHealth or mHealth approaches supporting unimodal or multimodal prehabilitation activities such as exercise, nutrition, psychological support, or lifestyle modification. Outcomes of interest include functional fitness, quality of life, psychological well-being, treatment preparedness, recovery, adherence, and feasibility. Two independent reviewers will conduct title, abstract, and full-text screening, with disagreements resolved through discussion or consultation with a third reviewer. Data will be charted and presented in tables and figures and as a narrative synthesis. Critical appraisal using JBI tools will contextualize methodological quality but not exclude studies. Risk of bias will be assessed using the Cochrane Risk of Bias Tool for Randomized Trials version 2 (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions version 2 (ROBINS-I V2) tool. This will not be used to exclude studies, but to determine the quality of articles included. The search strategy has been pilot tested and finalized. Database searches are scheduled to commence in March 2026, with study selection and screening anticipated to be completed by April 2026. Data analysis and synthesis are expected to begin in May 2026, and final results will be available by October 2026. This protocol outlines a rigorous and transparent approach to mapping the current evidence on technology-based prehabilitation in cancer care. By systematically characterizing intervention features, outcome domains, and evidence gaps, the review will provide an up-to-date evidence map to guide future research priorities, inform clinical implementation, and support the development of more standardized and inclusive prehabilitation pathways.

Semaglutide, a glucagon-like peptide-1 receptor agonist, is an established therapy for type 2 diabetes (T2D), offering robust glycemic control and weight reduction. Vitamin D has been implicated in metabolic regulation, yet its influence on semaglutide-induced outcomes remains unclear. We conducted a retrospective cohort study of 5,384 adults with T2D, enrolled in Leumit Health Services, who initiated semaglutide therapy between February 1, 2019, and December 31, 2022. All patients had documented serum 25-hydroxyvitamin D [25(OH)D] levels prior to treatment initiation. Metabolic outcomes- including glycemic control (HbA1c), body mass index (BMI), and lipid profile- were assessed at 12&#x202f;months. Associations between baseline 25(OH)D levels and metabolic changes were evaluated using multivariable regression models, adjusted for demographic and clinical covariates. The median baseline 25(OH)D level was 19.3&#x202f;ng/mL. Compared with patients with 25(OH)D levels <15&#x202f;ng/mL, those with levels of 15-25&#x202f;ng/mL and >25&#x202f;ng/mL exhibited greater reductions in HbA1c [&#x3b2;&#x202f;=&#x202f;-0.083, 95% CI (-0.154 to -0.013), p&#x202f;=&#x202f;0.020; and &#x3b2;&#x202f;=&#x202f;-0.096, 95% CI (-0.173 to -0.017), p&#x202f;=&#x202f;0.016, respectively] and BMI [&#x3b2;&#x202f;=&#x202f;-1.02, 95% CI (-1.46 to -0.58); and &#x3b2;&#x202f;=&#x202f;-1.29, 95% CI (-1.77 to -0.80); both p&#x202f;<&#x202f;0.0001]. No association was found with lipid profile. Higher baseline 25(OH)D levels are independently associated with improved glycemic and weight loss responses to semaglutide in individuals with T2D. Prospective trials are warranted to explore whether vitamin D supplementation may potentiate semaglutide's metabolic effects.

A growing body of original research has recently investigated virtual reality (VR)-based interventions for physical activity and self-management, yet yielded inconsistent results. This systematic review and meta-analysis aims to evaluate the effectiveness of VR-based physical activity and self-management interventions in improving glycemic control and modifying health-related behaviors among patients with type 2 diabetes mellitus (T2DM). A total of 10 studies involving 1,005 adults with T2DM were included, comprising 5 randomized controlled trials (RCTs), 1 non-randomized controlled trial (nRCT), and 4 self-controlled before-after studies. Of these, participants in the intervention groups received VR-based interventions, including immersive or interactive VR programs for diabetes self-management education or physical activity promotion, with most intervention durations ranging from 8 to 24 weeks. Control groups received traditional approaches, including routine care, in-person diabetes self-management programs, and content-equivalent 2D websites. The pre-post intervention analysis revealed that glycated hemoglobin (HbA1c) levels decreased significantly post-intervention (mean difference (MD) = -0.50, 95% CI: -0.92 to -0.08, p&#x2009;=&#x2009;0.02). While VR-based physical activity and self-management interventions did not demonstrate superior efficacy to traditional intervention methods in glycemic control or behavioral outcomes, their unique advantages - including enhanced adherence, greater accessibility, and reduced spatiotemporal constraints - position them as a viable alternative for diabetes management. Nevertheless, the field requires more rigorously designed RCTs to establish efficacy and a systematic exploration of VR implementation protocols to maximize therapeutic benefits.

The posterior fossa is a critical anatomical region housing the cerebellum and brainstem. Posterior fossa malformations are a heterogeneous group of conditions challenging to diagnose and prognosticate prenatally. Fetal magnetic resonance imaging (MRI) plays an important role in their assessment. This retrospective study examined the clinical and radiological data from 115 maternal-fetal dyads (116 fetuses) with posterior fossa malformations on fetal MRI, assessed concordance with postnatal imaging, and investigated MRI features associated with adverse outcomes. Fetal posterior fossa malformations were heterogenous: 66% (76/116) were structural and 34% (40/116) involved only CSF-containing lesions. Cerebellar hypoplasia was the most frequent posterior fossa malformation, observed in 33% (38/116). 78% (91/116) of posterior fossa malformations were "complex" (with additional central nervous system and/or extraneural anomalies). Concordance between fetal MRI and postnatal imaging was 51% (27/53), which improved to 69% (20/29) when CSF-containing lesions were excluded. Among terminated pregnancies who underwent autopsy, the fetal MRI diagnosis was confirmed in 75% (12/16). Chiari-II malformations, pontocerebellar hypoplasia and cerebellar asymmetry were consistently confirmed on postnatal imaging. Four fetuses with cerebellar hypoplasia had normal postnatal imaging. Structural and "complex" posterior fossa malformations were more likely to have poor pregnancy outcomes (i.e., termination, fetal demise, or neonatal death) than CSF-only and isolated anomalies. Genetic testing was positive in 24% (19/80) of tested cases, and 16% (19/116) of the overall cohort. Fetal MRI has an important role in the accurate diagnosis and management of posterior fossa malformations, particularly for structural anomalies which are associated with poor pregnancy outcomes.

Rotator cuff arthropathy is characterized by pain and pseudoparalysis, for which reverse shoulder arthroplasty (RSA) is an established treatment. Appropriate deltoid tensioning is critical to functional outcomes, yet objective radiographic surrogate measures of tensioning remain limited. This study aimed to evaluate the association between acromion to greater tuberosity distance (AGTD) as a surrogate for deltoid tension and postoperative motion, functional outcomes, and pain following RSA. We conducted an observational retrospective case series, examining 61 patients who underwent RSA. Patients were evaluated using Constant-Murley shoulder score, visual analog scale pain score, Oxford shoulder score, and the University of California, Los Angeles shoulder score. Postoperative assessments were performed at 6-month and 1-year intervals. The AGTD was measured by two independent observers based on postoperative plain radiographs. Mean patient age was 69.9&#xb1;8.3 years. At 1 year postoperative, significant improvements were observed in forward flexion, abduction, pain, and all functional outcome scores (all P<0.001). Spline modeling demonstrated a non-linear association between AGTD and outcomes, with superior function and lower pain observed within an intermediate AGTD range centered near 45 mm. Both shorter and longer distances were associated with less favorable results. In our study, an intermediate AGTD centered near 45 mm was associated with more favorable functional outcomes, whereas shorter or longer distances demonstrated poorer results. Our findings provide further confirmation that RSA is a dependable treatment option for rotator cuff arthropathy. IV.

The impact of age on perioperative morbidity and long-term oncologic outcomes in colorectal cancer remains controversial. Although aging is linked to greater comorbidity and functional decline, advances in perioperative care have challenged the idea that older patients have worse outcomes. This study evaluated surgical and oncologic results in patients aged &#x2265;&#x2009;75&#x2009;years compared with younger individuals. We conducted a retrospective cohort study including patients who underwent colorectal resection with primary anastomosis between 2015 and 2022. Patients were grouped by age (<&#x2009;75 vs. &#x2265;&#x2009;75&#x2009;years) and matched 1:1 using propensity scores based on preoperative clinical and tumor-related variables. Major complications (Clavien-Dindo grade &#x2265;&#x2009;III) were analyzed using logistic regression, and OS and RFS were assessed using Kaplan-Meier curves and Cox proportional hazards models. Of 651 eligible patients, 272 were included in the matched cohort. No statistically significant differences were found between age groups in hospital stay (4.5 vs. 4.0&#x2009;days; p&#x2009;=&#x2009;0.270), reintervention (13.2% vs. 8.8%; p&#x2009;=&#x2009;0.333), major complications (14.0% vs. 8.8%; p&#x2009;=&#x2009;0.252), or 30-day perioperative mortality (3.7% vs. 0.7%; p&#x2009;=&#x2009;0.216), although perioperative mortality was numerically higher among patients aged &#x2265;&#x2009;75&#x2009;years. Age&#x2009;&#x2265;&#x2009;75&#x2009;years was not significantly associated with major complications in multivariable analysis (OR 1.73; 95% CI 0.79-3.94). Five-year OS and RFS also did not differ significantly between groups. Older age was not associated with statistically significant differences in major complications or long-term oncologic outcomes in this matched cohort. However, clinically meaningful differences, particularly in short-term perioperative risk, cannot be excluded. Chronological age alone should not preclude curative-intent surgery.

Previously, a conditional probability model was developed to determine which transport method, drip and ship (transport to the primary stroke center for thrombolysis and then transfer to an endovascular therapy center) or mothership (direct transport to an endovascular therapy center), predicts the best outcomes for patients with suspected acute ischemic stroke. We compare and validate the conditional probability model based on the RACECAT (Rapid Arterial Occlusion Evaluation in Catalan Trial [Transfer to the Local Stroke Center Versus Direct Transfer to Endovascular Center of Acute Stroke Patients With Suspected Large Vessel Occlusion in the Catalan Territory]). Regional and individual level comparisons were performed by applying the conditional probability model to predict the best transport method compared with actual transport and outcomes. The primary outcome was the modified Rankin Scale score at 90 days. Ordinal logistic regression was used to assess the influence of matching transport methods on 90-day modified Rankin Scale outcomes. Subanalysis was performed to evaluate outcomes of patients with hemorrhagic stroke. The conditional probability model was highly consistent with the RACECAT result overall: transport method outcomes were similar. 66.1% of Catalonia was predicted to have near equivalent outcomes for drip and ship compared with mothership. Drip and ship best predicted transport in larger areas in the daytime, and mothership for larger areas in the night. There was no significant difference in 90-day modified Rankin Scale outcomes between patients with matching versus mismatched transport methods (odds ratio, 1.13 [95% CI, 0.93-1.37]). Patients with hemorrhagic stroke had worse outcomes in those predicted and randomized to mothership versus those predicted to mothership and randomized to drip and ship (odds ratio, 3.53 [95% CI, 1.12-11.12]). The conditional probability model for stroke transport successfully predicted the RACECAT clinical trial results, showing no difference in outcomes between drip and ship and mothership transport methods. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02795962.

In Aotearoa New Zealand, human papillomavirus (HPV) self-testing was introduced simultaneously with HPV primary screening in September 2023 to improve access and reduce inequities for priority populations, including Indigenous M&#x101;ori, Pacific and under-screened people. To contribute policy-relevant information, we implemented non-standard engagement and screening strategies, including text message invitation, mailed test kits, at-home self-testing, telehealth support and follow-up by a central nurse-led co-ordination team. We partnered with an Auckland primary health organisation (PHO) with high enrolment of priority populations. We invited people eligible for cervical screening aged 30-69&#xa0;years by text message to receive mailed test kits (April-October 2023); people who did not respond were re-invited (October-November 2023). Offering a financial incentive to return a sample (intervention group) was compared with no offer (control group) in a sub-group of eligible M&#x101;ori and Pacific who received a repeat mailed test kit in a nested randomised controlled trial (April-May 2024). Self-tested participants were invited by text message to an online survey. We invited 25,315 people and 24.0% opted in. Lower initial consent rates were increased after additional re-invitation reminders for M&#x101;ori (20.0% to 30.4%) and Pacific (13.7% to 24.9%), with the final consent rate in M&#x101;ori equal to European/Other (29.2%; p&#x2009;=&#x2009;0.284). Almost half (48.2%) of consenting participants returned a sample, giving a self-test uptake of 11.6% (n&#x2009;=&#x2009;2,925). Uptake was significantly lower (all p&#x2009;<&#x2009;0.001) for M&#x101;ori (12.7%) and Pacific (8.4%) vs. European/Other (19.0%), and for those under-screened (10.5%) vs. those overdue by&#x2009;<&#x2009;6&#xa0;months (19.4%). In the RCT, sample return rate did not differ significantly (p&#x2009;=&#x2009;0.704) between the intervention (7.9%) and control (8.5%) groups. HPV was detected in 7.7% of 3,018 valid results. Follow-up test rates were high (96.8% for cytology, 90.5% for colposcopy). Almost all survey respondents preferred a mailed at-home self-test for their next screen (91.9%; n&#x2009;=&#x2009;193 of 210). Invitation by text message to mailed at-home HPV self-testing engaged priority populations in cervical screening. Central co-ordination support achieved high rates of sample return and follow-up testing where required. A mailed at-home testing option, strongly preferred by survey respondents, warrants consideration in a broader programme to improve access to cervical screening, with additional targeted strategies to improve sample return rates for priority populations. While the overall study did not reach the ICJME or WHO criteria for clinical trial registration, the nested RCT was retrospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12625000798460) and World Health Organization (WHO UTN U1111-1324-8454).