Adolescent sexually diverse girls with dual sexual attraction face greater sexual and reproductive health risks for sexually transmitted infections and adolescent pregnancy than heterosexual girls. However, little is known about whether sexual risks among sexually diverse girls extend to differences in approach and avoidance sexting motivations and their associations to sexual consequences. A sample of 200 cisgender girls (N = 90 sexually diverse, 110 heterosexual) participated in an online survey of sexting experiences with boys and men. Sexually diverse participants were more motivated to sext for sexual expression, popularity/peer pressure, body image, and coercion than heterosexual participants and reported more negative sexting consequences. There were no differences in sexual subjectivity and both groups reported comparable levels of positive sexting consequences. Stratified regression analyses indicated no group differences in the associations between sexting motivations and consequences. Findings highlight sexting motivations with boys/men as a potential risk factor for cisgender girls, with negative consequences more prominent among sexually diverse girls. Sex education programs should consider incorporating "safer sexting" practices and digital sexual communication skills to mitigate negative sexting experiences and consequences with special attention to the experiences of sexually diverse girls.
This study aimed to describe HRQoL of both children and parents in a Chinese DSD cohort, evaluate caregiver burden, and employ the latent profile analysis (LPA) to identify distinct parental HRQoL profiles and their associated determinants. This study included 147 parents of children with DSD and 519 parents of healthy controls. Group differences in HRQoL were analyzed using t-tests or one-way analysis of variance (ANOVA). Multivariate regression identified predictors of parental HRQoL, and LPA classified parental HRQoL profiles with multinomial logistic regression used to assess their associated factors. Children with DSD had similar HRQoL scores to healthy controls (p > 0.05), but their caregivers showed significant impairments across all domains (p < 0.05). In multivariate analysis, caregiver burden and child HRQoL were significantly associated with parental HRQoL (p < 0.05), with caregiver burden mediating 60.8% of the effect of child HRQoL on parental HRQoL. Latent profile analysis identified three parental HRQoL profiles: "Poor" (24.5%), "Moderate" (35.4%), and "Good" (40.1%). Higher caregiver burden increased the odds of "Poor" and "Moderate" profiles (OR = 1.52 and 1.26, both p < 0.001), while better child HRQoL protected against "Poor" profile membership (OR = 0.91, p = 0.002).  This study reveals that HRQoL of children with DSD is comparable to the healthy controls, while their parents experience significant impairments in HRQoL, primarily determined by caregiver burden and the child's HRQoL. As caregiver burden mediates the impact of child HRQoL on parental HRQoL, clinical care must adopt a family-centered approach focusing on burden alleviation. • Children with DSD face complex medical and psychosocial challenges that may affect HRQoL in both patients and their families. • Their caregivers often experience significant psychological burden, which can negatively impact their own well-being. • In a Chinese DSD cohort, children's HRQoL was comparable to healthy controls, whereas their parents exhibited significant and heterogeneous HRQoL impairments across all domains, with three distinct parental HRQoL profiles identified via latent profile analysis. • Caregiver burden mediated 60.8% of the effect of child HRQoL on parental HRQoL, highlighting burden alleviation as a priority target in family-centered clinical care for DSD.
According to UNESCO (2018), there is an increased need for research on teacher effectiveness regarding sexuality education. This study aims to respond to this need through capturing the views, experiences, and preparedness of teachers to support the teaching of Relationships and Sexuality Education (RSE) to learners with Severe/Profound Intellectual Disabilities in Special Schools in the Republic of Ireland (ROI). Responding teachers (n = 34) to the predominantly quantitative online survey describe a lack of pre-requisite knowledge and skills required to teach RSE to learners with Severe/Profound Intellectual Disabilities, with a lack of access to professional learning opportunities or appropriate resources. Many teachers are not teaching RSE and therefore students who can be described as most vulnerable, are not accessing their human-right to sexuality education. Teachers identified the supports required as Continuing Professional Development (CPD), training & support; accessible & appropriate resources; and a dedicated programme and toolkit. Relationships and sexuality education for students with intellectual disabilities is an area of huge importance, both to safeguard them from harm and enable them to live fulfilling lives. People with disabilities have a human right to sexuality education. In the Republic of Ireland, the teaching of RSE for children with severe/profound intellectual disability is found to be unequally resourced within the education system. This study reports on teachers' views and experiences of teaching RSE in special schools in Ireland, amidst a vacuum of information, appropriate curricula or resources.
ObjectivesThis qualitative study used the Consolidated Framework for Implementation Research (CFIR) to examine how stigma emerges in HIV prevention services for young Hispanic/Latino sexual minority men in North Carolina.MethodsIn-depth interviews were conducted with n = 14 community- and clinic-based providers between November 2023 and July 2024. Interviews were analyzed using a hybrid deductive-inductive approach.ResultsFindings identified multi-level factors shaping stigma experiences and practices. In the Outer Setting, sociocultural beliefs, discriminatory policies, and preventive care norms facilitated stigma, undermining trust and engagement in HIV prevention. Within the Inner Setting, organizational culture, physical space, accessibility, and workforce representation influenced whether services felt safe and trustworthy. Individual biases, limited awareness, stigmatizing communication, narrow biomedical framings of HIV risk, and inflexible service designs further reinforced stigma. Implementation processes that emphasized inclusive messaging, routine sexual health discussions, intentional workforce planning, and ongoing stigma-reduction training were described as opportunities to disrupt stigma across all CFIR domains.ConclusionStigma in HIV prevention for young Hispanic/Latino sexual minority men emerges across policy, organizational, and interpersonal levels. Implementation strategies that promote inclusive messaging, routine sexual health conversations, representative staffing, and ongoing training may help reduce stigma. Stigma in HIV Prevention Services for Young Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex With Men: What Providers See and How They and Their Organizations Can Build Trust and Welcoming CareYoung Hispanic/Latino gay, bisexual, and other men who have sex men face high HIV risk and often feel unwelcome or judged when trying to get or receive HIV-prevention services. This study explains how stigma manifests in those services and what providers and organizations can do to make services safer and more affirming.This qualitative study conducted one-on-one interviews with 14 providers who work in community organizations and clinics that serve young Hispanic/Latino gay, bisexual, and other men who have sex men in North Carolina. We used 2 well-known implementation and stigma frameworks to organize what providers said, enabling us to map where and how stigma appears in HIV-prevention services and how it might be reduced.Stigma was described at every level of the HIV-prevention system: in wider social values, in how organizations are run, in individual provider and staff attitudes, and in the way HIV-prevention programs are designed and put into practice. Providers reported that factors such as discriminatory laws, cultural norms that discourage preventive care, unwelcoming clinic environments, lack of representative staff, and personal biases all combined to make services feel less safe, less inclusive, and less trustworthy for young Hispanic/Latino gay, bisexual, and other men who have sex men.Because stigma is embedded across multiple levels, efforts to reduce it must also occur at those levels. Examples include redesigning services to be more flexible and person-centered and improving provider and staff training on stigma reduction and inclusive communication. The study provides suggestions for where organizations and decision-makers can act, such as using inclusive messaging, routinely discussing sexual health without judgment, planning for a more diverse workforce, and offering ongoing training, to improve the reach and impact of HIV-prevention services.
Biological sex has been shown to influence immune function and inflammatory responses. However, most preclinical studies in spinal cord injury (SCI) have predominantly used female animals, potentially introducing a sex bias in our understanding of post-injury inflammation. Given the central role of inflammation in secondary pathology and repair after SCI, males and females are likely to respond differently to this condition, with sex-dependent immune differences potentially shaping injury outcomes. In this study, we explored how biological sex shapes the course of inflammation after SCI and its potential impact on functional recovery. Locomotor recovery in the SCI mouse model was assessed using the Basso Mouse Scale (BMS). Autonomic recovery was analyzed through the spontaneous void spot assay. Peripheral and local immune responses were characterized by flow cytometry of blood and spinal cord samples, respectively, to track the temporal dynamics of distinct immune cell populations across acute and chronic stages of injury. We found that, acutely after SCI, males exhibit higher frequencies of circulating myeloid cells, whereas females show higher numbers of these cells in the spinal cord, suggesting delayed myeloid infiltration in males. At this timepoint, females initiate an early attempt to direct some cells toward a phenotype more favorable for tissue repair, with their infiltrative monocytes expressing both pro-inflammatory and alternative activation markers. Sex differences in blood CD54 expression at 4 weeks post-injury suggest that sex-specific immune responses may continue to develop at later stages after SCI. Post-injury welfare outcomes differ between sexes, with males exhibiting delayed post-operative recovery. However, spontaneous long-term functional recovery is largely comparable between sexes after SCI. Overall, our data identify biological sex as a key determinant of immune and neuroinflammatory responses after SCI while suggesting a limited impact on long-term recovery. These findings highlight the lack of rationale for the underrepresentation of males in preclinical studies and emphasize the importance of sex-inclusive research to better inform personalized therapeutic strategies.
Mentalizing ability - the capacity to understand behavior as motivated by intentional mental states - develops within attachment relationships and has recently been suggested to influence sexual health. This study examined whether mentalizing ability and attachment insecurity (anxiety, avoidance) are associated with dysregulated sexuality (hypersexual behavior, low sexual desire), and whether mentalizing ability mediates these associations. Participants recruited online were classified according to self-reported high (n = 221 women, n = 732 men) or low sex drive (n = 680 women, n = 262 men), completed questionnaires on attachment, mentalizing ability, sexual desire, and hypersexual behavior. Among men and women with high sex drive, both attachment anxiety and avoidance were positively associated with hypersexual behavior, while mentalizing ability was negatively associated with hypersexual behavior. Moreover, mentalizing ability partially mediated the association between attachment insecurity and hypersexual behavior. Among participants with low sex drive, mentalizing ability partially mediated the negative association between attachment avoidance and sexual desire only in men. Similarly, only among men, both attachment anxiety and mentalizing ability were positively associated with sexual desire, yet no mediation was found. Overall, mentalizing ability appears to be a mechanism linking insecure attachment to hypersexual behavior, while being less central to low sexual desire.
Hypertrophic cardiomyopathy (HCM) is a heritable cardiac disorder characterized by increased left ventricular (LV) wall thickness, often leading to heart failure (HF). The role of cardiovascular magnetic resonance (CMR) imaging in predicting new onset of HF symptoms in patients with HCM remains unknown. This study aimed to identify CMR predictors of new-onset HF symptoms in individuals with HCM. This study was a single-centre retrospective cohort study of HCM patients treated at a tertiary referral centre in the USA who underwent CMR examination between 1998 and 2018, had no HF symptoms at baseline CMR, and at least 1 year of follow-up. Clinical data were collected by review of electronic medical records, and CMR images were analyzed by a blinded expert cardiac radiologis. The primary outcome was new onset of HF symptoms, defined as New York Heart Association (NYHA) class ≥ II at follow-up. Kaplan-Meier analyses and Cox proportional hazard analyses were performed. Of 1462 patients diagnosed with HCM who had at least 1 CMR, 276 HCM patients without HF symptoms (average age 52.7 years, 33.3% female),median maximum left ventricular (LV) wall thickness was 19 mm ([IQR] 17-22) with a and median LV ejection fraction of 71% (IQR 66-77). Late gadolinium enhancement was detected in 56.2%) patients (60.7% had mild; 30.7% moderate; 8.6% severe). During a median follow-up period of 6.3 years, 93 patients developed HF symptoms (NYHA class II in 56 (60.2%); class III in 31 (33.3%); and class IV in 6 (6.5%). Multivariable analysis adjusted for age showed that LA enlargement (HR 1.626; 95% CI 1.01-2.62; P = .045) and LV mass index (HR 1.014; 95% CI 1.007-1.022; P≤ .001) and sex (HR 1.7; 95% CI 1.074-2.691; P = .023) were independent predictors of new onset of HF symptoms in patients with HCM. Nearly half of the patients with HCM developed HF symptoms within 6.3 years. Left atrial enlargement, LV mass index, and sex were independent predictors of new onset of HF symptoms in HCM patients. These findings emphasize the value of CMR in HF risk stratification.
Paraphilic interests concerning individuals who are unwilling or unable to consent are risk factors for sexual offending. Treatment may help mitigate this risk and alleviate distress. The current study collected data on six such interests (pedophilia, hebephilia, exhibitionism, frotteurism, coercive sexual sadism, and biastophilia), as well as distress, sexual offending, help-seeking, satisfaction with sex life, and social acceptance in a population-based quota sample of 6491 Czechs. About 9% of the population reported at least one of the studied paraphilic interests, with estimates ranging from 0.9% to 4.5%. There were strong positive links between the paraphilic interests and detected sexual offending, with a median odds ratio of 7.56 (range: 5.09-19.54). Findings were mixed with regard to differences in sexual satisfaction or social acceptance when comparing participants with and without paraphilic interests. Fewer than half of individuals with a paraphilic interest associated with nonconsent reported distress, and among those, only a few reported help-seeking during the last five years. The most frequently reported reason for not seeking help was a lack of interest in such services, rather than a lack of services, shame, or stigma. Results indicate that treatment motivation and distress may be less prevalent, and issues related to sexual life satisfaction and acceptance less severe, among people with paraphilic interests associated with nonconsent in the general population than previously assumed.
Males, who disproportionately account for 83% of oropharyngeal cancer cases, are underrepresented in health promotion research, including human papillomavirus (HPV) vaccination studies. The initial exclusion of males in HPV vaccine research, policies, and interventions has negatively affected male vaccine uptake. Furthermore, stigma, a well-documented barrier to healthcare engagement, has been overlooked in HPV vaccination behaviors. This study aimed to provide a more contextualized understanding of HPV vaccine disparities among adult males by applying the Health Stigma and Discrimination Framework (HSDF) to examine how stigma is produced, enacted, and sustained across social systems, which may impact male vaccine uptake. This qualitative study analyzed previously collected data from virtual group interviews conducted in 2021 with a convenience sample of 13 vaccine-eligible males aged 18-35 residing in El Paso, Texas, United States. Participants completed a demographic survey and participated in semi-structured discussions about their knowledge, attitudes, and experiences with HPV and vaccination. Data were analyzed by employing the Critical Discourse Analysis (CDA) method and the Health Stigma and Discrimination Framework (HSDF) to guide the methodological and analytical processes, helping to map stigma processes and mechanisms across individual, interpersonal, and structural levels to identify multi-level influences on male HPV vaccine behavior. Analysis identified four overarching themes reflecting the discursive construction of stigma processes and mechanisms, spanning proximal to distal levels of influence. At the individual level, (1) male sexual health and manhood reflects how internalized sex-specific beliefs and masculine norms fostered shame and discomfort around male sexual health, often framing males as unaffected by HPV rather than vulnerable or in need of vaccination. At the interpersonal level, (2) cultural and familial forces captures how discourses of intergenerational silence, religious morality, and sexual health taboos perpetuated stigma processes and mechanisms, constraining open discussion about HPV and vaccination. At the systemic level, (3) structural barriers to vaccination reflects how policy environments, institutional practices, and health system norms perpetuate systemic-level obstacles restricting vaccine access. Finally, at the multi-level, (4) stigma resistance reflects counter-narratives that highlight affirming, peer-informed, perspectives and reframed male vaccination as legitimate and necessary. Findings provide an in-depth examination of how stigma processes and mechanisms-rooted in masculine norms, sexual health taboos, intergenerational silence, misinformation, and institutional exclusion-shape HPV vaccination access, beliefs, and behaviors among vaccine-eligible adult males. In contrast, participants expressed resistance to these stigmatizing narratives by reframing male vaccination as a necessary and achievable health behavior when supported by peer-informed, culturally resonant messaging. These findings highlight the need for multi-level interventions that replace stigmatizing discourses and practices with affirming male narratives in HPV and broader sexual and reproductive health prevention efforts.
To quantify continuity of care in general practice in the Australian population, including variation according to patient characteristics and over time, to support ongoing policy reforms directed towards improving general practice care. Repeated cross-sectional analyses of linked whole-of-population data from the Medicare Benefits Schedule, the Medicare Consumer Directory and the Census of Population and Housing (2021). Continuity was assessed in people with at least four general practitioner visits in a 2-year period (about 80% of the population). Relational continuity of care in general practice, measured with the Usual Provider Index, for eight overlapping 2-year periods (2016-2017 to 2022-2023). High continuity was defined as having ≥ 70% of visits with one provider. About one-third of the population had high continuity of care (range: 31.3% in 2018-2019 to 37.2% in 2020-2021). After adjustment for age, sex and remoteness, high continuity was more common among those with greater care needs, including those who were older (≥ 70 years vs. 0-14 years: adjusted prevalence ratio [aPR], 1.88) or with health conditions (e.g., ≥ 3 vs. none: aPR, 1.14) and those who were living in more disadvantaged areas (e.g., most vs. least disadvantaged: aPR, 1.22), born overseas (e.g., born in Southern or Eastern Europe vs. born in Australia or New Zealand: aPR, 1.20) or not proficient in English (aPR, 1.29). However, it was less common for females compared with males (aPR, 0.90) and those living remotely (e.g., very remote vs. major cities: aPR, 0.43). While most people in Australia do not receive continuous care in general practice with a specific provider, those with greater healthcare needs are more likely to. With ongoing policy reforms, monitoring continuity of care may provide insights into the consequences for quality of care. Continuity of care is central to quality primary care, but data for the general Australian population are lacking. Among the approximately 80% of Australians with at least four general practitioner visits in a 2‐year period, around one‐third had high continuity (≥ 70% of visits with their usual general practitioner), with small increases since 2020. Proportions were higher among those with greater healthcare needs (e.g., older age, more socioeconomically disadvantaged, with health conditions), but lower in remote areas. Monitoring continuity may provide insights into consequences of health policy reforms, both intended and unintended, to optimise primary care in Australia.
In Sweden, approximately half of all individuals who die receive municipal care prior to death. Access to high-quality palliative care remains unequal, with known disparities between both care settings and diagnostic groups. Individuals receiving municipal home care are at higher risk of acute hospital admissions and in hospital death than those in long-term care facilities. However, the impact of municipal care setting on the quality of end-of-life care is largely unknown. The aim of this study was to describe the impact of care setting on the quality of end-of-life care among patients receiving municipal healthcare services. This population-based cohort study included all individuals reported during 2023-2024 in the Swedish Register for Palliative Care as recipients municipal palliative care during the last week of life (n = 50,219). Associations between care setting (ordinary housing, and long- and short-term care facilities) and end-of-life quality indicators were analyzed using modified Poisson regression to estimate risk ratios (RR) with 95% confidence intervals. Analyses were adjusted for age, sex, and cause of death. Compared to individuals receiving care in ordinary housing, those in long- and short-term care were more likely to receive symptom assessments ([RR; 95% CI] 1.14; 1.09-1.19 vs. 1.08; 1.03-1.13). However, they were less likely to receive end-of-life information ([RR; 95% CI] 0.92; 0.91-0.94 vs. 0.98; 0.97-0.99), bereavement support for relatives ([RR; 95% CI] 0.98; 0.97-0.99 vs. 0.95; 0.94-0.96), and external pain consultations ([RR; 95% CI] 0.52; 0.49-0.57 vs. 0.81; 0.76-0.88). Care setting influences the quality of municipal end-of-life care. Strengths and weaknesses vary across settings, highlighting the need for targeted quality improvement efforts.
Classic congenital adrenal hyperplasia (CAH) requires lifelong glucocorticoid (GC) therapy and the knowledge of how and when to administer GC stress doses to prevent life-threatening adrenal crises. The aim of our study was to investigate patient perception of CAH self-management in relation to clinical and socioeconomic characteristics and health-related quality of life (HRQoL). Sixty-nine patients with classic CAH, aged 16 to 75 years, participating in the study to create the disease-specific patient-reported outcome tool, CAHQL, answered 7 questions about disease self-management. Patient perceptions regarding CAH self-management were analyzed in relation to clinical and socioeconomic characteristics, biochemical disease control and CAHQL domain scores (General Health, Adrenal Insufficiency, Glucocorticoid Excess, Physical Functioning, Mental Health and Cognition, Social Functioning, and Sexual Functioning). Eighty percent reported that they mostly or strongly agree that they feel comfortable managing CAH whereas over half worry about adrenal crises. All CAHQL domain scores were strongly correlated with at least one self-management question (p < 0.05); better HRQoL was associated with greater confidence in self-managing CAH. Increased worry about stress dosing and adrenal crises was associated with greater number of stress doses and hospitalizations in the past 6 months (p < 0.05). Greater number of household members, being married and male sex were associated with increased confidence in receiving help from others regarding adrenal crisis (p < 0.05). After adjusting for relationship status, sex remained significant. No associations were found between patient perceptions regarding CAH self-management and phenotype, age, biomarkers of disease control, insurance type, income bracket, education or work status. Confidence regarding self-management of CAH is associated with better HRQoL as measured by CAHQL and was not related to socioeconomic characteristics or level of disease control. Integrating systematic evaluation of self-management skills and the HRQoL burden of having CAH into standard of care is recommended.
Hyperbaric oxygen therapy (HBOT) is an established treatment for pelvic late radiation tissue injuries (LRTIs) in cancer survivors, yet its impact on sexual health outcomes has previously not been examined. To investigate longitudinal changes in sexual health following HBOT in pelvic cancer survivors with LRTIs and to examine whether baseline severity and changes in pelvic LRTI symptoms predict sexual health outcomes, including gender differences. This one-group longitudinal observational study included eight assessment points. A total of 137 cancer survivors with pelvic LRTIs underwent 27-30 HBOT in monoplace chambers, breathing 100% oxygen for 90 min at 2.4 atmospheres absolute. Data were analyzed using latent growth curve modeling. Sexual health was assessed using the EORTC Quality of Life Sexual Health Questionnaire, while pelvic LRTIs (urinary and bowel) were measured using the Expanded Prostate Cancer Index Composite. Sexual health scores did not change significantly over 58 weeks (total change = -0.49, P = .742), despite significant improvements in urinary (total change = 8.98 points; P < .001) and bowel symptoms (total change = 8.25 points; P < .001). Greater early improvement in urinary symptoms predicted higher sexual satisfaction (95% CI = 0.02-0.19; P = .015), with stronger associations observed among men (bmale*change = 3.30, P = .032, CI = 0.38, 6.32). Although HBOT improves pelvic LRTIs, persistent sexual health challenges highlight the need for comprehensive, multidisciplinary survivorship care. Strengths include a relatively large, gender-balanced sample, longitudinal design, validated measures, and a standardized treatment protocol. The absence of a control group limits causal inference. Despite improvement of urinary and bowel symptoms, HBOT does not seem to restore sexual health. Further research is needed to confirm these findings and address other sexual health interventions. ClincalTrials.gov registration number NCT03570229.
Despite advances in limb-salvage surgery in orthopaedic oncology, the effect of ethnicity and sex on patient function recovery remains unclear. Our study examined the influence of sex and ethnicity on functional outcomes for patients with bone tumors undergoing lower extremity endoprosthetic reconstruction. This study was a secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. Functional outcomes were assessed preoperatively and at 3, 6, and 12 months postoperatively using the Musculoskeletal Tumor Society 1993 (MSTS-93) and Toronto Extremity Salvage Score questionnaires. Delta scores (postoperative minus preoperative) and minimal clinically important difference thresholds were calculated by ethnicity and sex, and group differences were analyzed. Among the 604 patients included, the main ethnic groups were White (63.6%), Asian (18.7%), Black (7.1%), Hispanic (5.6%), and Other (5%). Asian patients had markedly higher preoperative and postoperative MSTS-93 and TESS scores than other groups, although delta scores were similar across all ethnicities. Although MCID achievement rates for MSTS-93 did not differ by ethnicity, Asian patients showed a higher MCID achievement rate for TESS at 3 and 6 months. Sex-based analyses revealed that men had higher baseline functional scores, but women demonstrated greater postoperative improvements, as reflected by higher delta scores. Although postoperative MSTS-93 MCID achievement rates were similar between sexes, women exhibited higher TESS MCID achievement across all postoperative timepoints. Asian patients had higher functional outcomes after endoprosthetic reconstruction, and ethnic minorities did not show worse outcomes than White patients. Additional research should explore these trends in different settings. I.
The aims of this study were to investigate whether children from different culturally and linguistically diverse (CALD) backgrounds in Australia have similar Health Related Quality of Life (HRQoL), in early childhood, middle childhood, and adolescence. We used data from 9099 children from the Longitudinal Study of Australian Children (LSAC), aged between 2 and 17 years, including HRQoL measured with the parent proxy Pediatric Quality of Life Inventory (PedsQL). The study pertained to cohort data from 2004 to 2018. CALD groups were defined according to child, mother's and father's country of birth and main language spoken at home. The association of child HRQoL with CALD group, was analysed using generalised estimating equations, adjusted for age, sex, socioeconomic position (SEP) and weight status. Children of Middle Eastern or North African, South-East Asian, South and Central Asian and Oceania backgrounds had significantly lower HRQoL (p < 0.05) than children from English speaking backgrounds. These disparities were greatest during middle childhood and adolescence and only partly explained by lower SEP and weight status. Disparities in physical HRQoL were greater than psychosocial HRQOL. Considerable inequity in HRQoL is present in Australian children from different CALD backgrounds. This study highlights the need for culturally tailored programs for school-aged children to improve their physical HRQoL. Health-related quality of life is an important measure of child overall health and includes physical and psychosocial health. There is evidence for lower quality of life in some culturally diverse populations, but no studies have examined this in children and adolescents. We used data from a very large Australian study that measured quality of life of children from age 2 to age 17 years and found lower quality of life among some cultural groups that developed primarily in middle childhood. Disparities in physical HRQoL were greater than psychosocial HRQOL. This highlights the need for culturally tailored programs for school-aged children to improve their physical HRQoL.
Anxiety is a common but underdetected or underdiagnosed symptom in dementia, affecting quality of life and care outcomes. Clinical trials are essential for informing effective management, yet the use of patient-reported outcome measures (PROMs) in dementia trials remains unclear. This review examined how validated PROMs are used to assess anxiety in dementia trials, including measurement tools, methods, demographic representation and evidence gaps. A systematic review was conducted following PRISMA and Cochrane Handbook guidance, with protocol registration on PROSPERO (CRD42025649920). Randomised controlled trials published between January 2015 and February 2025 were included if they assessed anxiety in mild to moderate dementia using validated PROMs within pharmacological or non-pharmacological interventions. Searches were conducted across MEDLINE, Embase, PsycINFO, Cochrane Library and ClinicalTrials.gov, supplemented by citation tracking. Two reviewers independently undertook study selection, data extraction and risk of bias assessment. Due to heterogeneity, findings were narratively synthesised. Of 2328 records screened, 29 trials (n = 5697) met inclusion criteria. While 93.1% used validated anxiety measurement tools, only 44.4% employed PROMs, most frequently the Hospital Anxiety and Depression Scale, mainly in non-pharmacological trials. Women and individuals of White ethnicity were overrepresented, and no studies examined PROM effectiveness by sex and ethnicity. Most trials showed moderate to high risk of bias, and evidence was confined to high-income countries. Anxiety outcomes in dementia trials remain largely proxy-reported. Existing anxiety PROMs are generic and unvalidated for dementia populations. There is a critical need for dementia-specific, culturally sensitive anxiety PROMs, improved demographic reporting and integration of anxiety assessment within dementia core outcome sets. Feedback from research participants in dementia studies, who reported experiencing anxiety, motivated this systematic review. Patient and public involvement was examined across all included studies. The lack of validated dementia-specific anxiety PROMs identified in this review highlights a broader gap in co-produced outcome development within dementia research. These findings emphasise the need for meaningful involvement of people living with dementia and care partners in the development, validation and cultural adaptation of anxiety PROMs to ensure that trial outcomes are relevant, acceptable and representative.
Guillain-Barré syndrome (GBS) is an immune-mediated neuropathy that may be influenced by infectious, demographic, and healthcare-related factors. Although increasing attention has been paid to neurological complications during the COVID-19 pandemic, the global burden, inequalities, and future trends of GBS remain insufficiently characterized. This population-based observational epidemiological study used data from the Global Burden of Disease Study 2021 to assess the burden of GBS across 204 countries and territories from 1990 to 2021. The main outcomes included prevalence, years lived with disability (YLDs), age-standardized prevalence rate (ASPR), age-standardized YLD rate (ASYR), and estimated annual percentage change (EAPC). Analyses were stratified by sex, age group, country, region, and socio-demographic index (SDI). Inequality analysis, decomposition analysis, Joinpoint regression, and Bayesian age-period-cohort modeling were further used to assess socioeconomic disparities, driving factors, temporal changes, and future trends. From 1990 to 2021, the global burden of GBS increased substantially. In 2021, the global number of prevalent cases reached 471,850, and the ASPR was 5.91 per 100,000 population. The corresponding number of YLDs was 139,639, with an ASYR of 1.75 per 100,000 population. The burden was lowest among children younger than 5 years and increased progressively with age. Males generally had a higher burden than females, particularly among older adults. Low-SDI regions experienced disproportionately higher ASPR and ASYR, indicating substantial global inequalities. The increases observed after 2019 temporally coincided with the COVID-19 pandemic; however, this association should be interpreted cautiously. Decomposition analysis suggested that epidemiological changes, population growth, and population aging collectively contributed to the increasing burden of GBS. The global burden of GBS increased markedly from 1990 to 2021, with substantial regional, sex-, age-, and SDI-related heterogeneity. The post-2019 increase temporally coincided with the COVID-19 pandemic, but causal inference should be avoided due to the observational nature of this study. Strengthening neurological surveillance, improving early diagnosis and treatment capacity, and reducing healthcare disparities in low-SDI regions may help mitigate the future burden of GBS.
Accurate assessment of shoulder range of motion is essential for clinical decision-making in physiotherapy. While visual estimation of joint angles is commonly used in practice, its agreement with objective reference measurements under clinically relevant conditions remains unclear. This study aimed to assess the agreement between video-based expert visual estimation of shoulder abduction and three-dimensional (3D) motion capture as a reference standard. A cross-sectional method comparison study was conducted. Shoulder abduction movements of four healthy participants were recorded using a 3D motion capture system. Twenty-four video recordings were presented to experienced physiotherapists (≥ 10 years of clinical experience), who visually estimated joint angles via an online questionnaire. Differences between estimated and reference values were analysed using descriptive statistics, Bland-Altman analysis, and cross-classified mixed-effects modelling to account for repeated measurements across raters and video stimuli. A total of 923 paired observations from 33 experts were analysed. Visual estimation showed a consistent tendency toward overestimation, with a mean difference of 14.7° (SD 11.6°) and limits of agreement ranging from - 8.0° to 37.5°. A cross-classified mixed-effects model estimated a mean bias of 14.5° (95% CI 11.8° to 17.3°), confirming systematic overestimation. Most estimates (89.9%) exceeded the reference value. Variability was substantial, with 27.3% of variance attributable to differences between video stimuli and 10.5% to differences between raters. Visual estimation of shoulder abduction angles by experienced physiotherapists showed limited agreement with a 3D motion capture reference and a consistent tendency toward overestimation. Given the observed variability, visual estimation alone may be insufficient for accurately detecting small changes in joint angle. The use of objective measurement tools may support more reliable assessment in clinical practice.
Circulating sex hormone-binding globulin (SHBG) concentrations are lower in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH), reflecting its potential role in metabolic liver dysfunction. Our prior studies demonstrated that SHBG can attenuate MASLD by limiting hepatic lipid deposition, partly through suppression of lipogenic pathways, in both cellular and animal models. In the present work, we have examined whether SHBG could protect against development of liver fibrosis. For this purpose, in vitro and in vivo studies were performed. In vitro, we used co-cultures of human hepatocellular carcinoma cell line (HepG2) and human hepatic stellate cell line (LX-2) cells transfected using an SHBG expression vector vs. vehicle and treated with transforming growth factor beta 1 (TGF-β1). For in vivo studies we used wild-type and human SHBG transgenic mice developing liver fibrosis induced by carbon tetrachloride (CCl4). Our results clearly showed that SHBG overexpression reduced the TGF-β1-induced expression in collagen in LX-2 cells. Moreover, SHBG overexpression reduced the CCl4 induced liver fibrosis in both male and female mice. Histological examination revealed that SHBG transgenic mice had reduced NAS score and decreased collagen accumulation, assessed by Sirious Red staining. In addition, human SHBG transgenic mice treated with CCl4 exhibited lower collagen 1A1 (Col1A1) protein levels when compared with wild-type CCl4 treated mice. Mechanistically, SHBG attenuated fibrosis primarily through modulation of the TGF-β1/matrix metalloproteinases (MMPs)/tissue inhibitor metalloproteinases 1 (TIMP1) axis, characterized by reduced TGF-β1 levels, increased metalloprotease activity, and decreased TIMP1 levels compared with wild-type CCl4 treated mice. Notably, female SHBG transgenic mice exhibited greater protection against fibrosis than males, indicating a sex-dependent effect likely mediated by differences in sex steroid signaling. Taken together, we demonstrate for the first time that SHBG protects against liver fibrosis by promoting collagen degradation via the TGF-β1/MMPs/TIMP1 pathway. Further research is needed to elucidate the role of sex steroids in the regulation of MMPs and the observed sexual dimorphism.
A previous study found that individuals with identical EQ-5D-5L profiles reported systematically higher EQ VAS scores with increasing educational attainment, which suggests a 'hidden' socioeconomic gradient not captured by the EQ-5D-5L. This study examines the robustness and generalisability of these findings using multi-country data. We analysed data from 32,327 respondents aged 25 to 79 years across eight high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK, and the US. The data came from the EQ-DAPHNIE study. Within ten selected EQ-5D-5L health profiles, we used linear regression models to estimate the associations between EQ VAS scores and educational attainment or subjective income status, adjusting for age, sex, and country. We observed a consistent educational gradient in EQ VAS scores across most EQ-5D-5L profiles. Tertiary education was associated with higher scores in all ten profiles, with effects statistically significant at p < 0.10 in seven, of which four at p < 0.01. Income status showed an even stronger gradient, with significant associations in nine of the ten profiles. These patterns were evident in all eight countries. These multi-country findings provide robust evidence of a socioeconomic gradient in EQ VAS scores among respondents who report identical EQ-5D-5L health profiles, over and above what is reflected in the five EQ-5D-5L dimensions. This pattern has implications for the use of EQ-5D-5L values in equity-informative health technology assessment and population health monitoring.