To compare orthodontic bracket failure rates with and without primer in patients undergoing fixed appliances treatment. This split-mouth randomized controlled trial was conducted on 42 participants. Diagonal quadrants were randomly assigned to either the primer (control) or non-primer (experimental) group. Allocation was concealed in opaque envelopes and revealed at the time of intervention. Both genders, aged 12-30 years, and visiting for the management of malocclusion were included. Patients with dental anomalies, caries, or restorations were excluded. The direct bonding technique was used for the placement of conventional metallic brackets. Participants were followed up for six months, with monthly visits, and bracket failure within each group was recorded. Generalized estimating equation logistic regression was used to account for clustering of multiple attachments within participants and to estimate odds ratios. A total of 42 participants contributing 840 orthodontic attachments were analyzed over six months. Mean age was 17.81 ± 4.09 years, and 52.4% were female. Monthly attachment failure rates were low in both groups, ranging from 3.8% to 4.3% in the primer group and 3.6% to 6.0% in the non-primer group, with no significant unadjusted differences at any month. In multivariable generalized estimating equation analysis, bonding method was not significantly associated with attachment failure (non-primer vs primer: OR = 1.24, 95% CI = 0.72-2.13; p = 0.435). Male participants (OR = 2.31, 95% CI = 1.28-4.18; p = 0.005) and those aged ≤ 17 years (OR = 2.18, 95% CI = 1.22-3.91; p = 0.008) had significantly higher odds of failure. Failure risk declined modestly over time (OR = 0.95, 95% CI = 0.92-0.99; p = 0.028). No significant interaction effects were observed. Over a six-month follow-up period, omission of primer did not significantly increase orthodontic bracket failure rates. Male participants and younger patients showed a higher risk of bracket failure, irrespective of bonding method.
The impact of the duration and cumulative high disease activity on damage accrual in childhood-onset SLE (cSLE) is less well established. This study aimed to assess the cumulative burden of high disease activity and its association with damage accrual and clinical outcomes in patients with cSLE. This retrospective cohort study included cSLE patients with at least one year of follow-up. High disease activity status (HDAS) was defined as a SLEDAI-2 K score ≥10. Patients were classified into two groups: HDAS (ever experienced HDAS) and non-HDAS. Time-adjusted cumulative HDAS (cHDAS) was defined as the proportion of time spent in HDAS during the observation period. Clinical features, laboratory parameters, treatment, organ damage assessed by the SLICC/ACR Damage Index, and remission status were recorded at baseline and each follow-up visit. Logistic regression, Cox proportional hazards models, and Kaplan-Meier analyses were performed. Among 196 cSLE (mean age at diagnosis 11.3 ± 2.9 years; 82.1% female), 126 (64.3%) experienced high disease activity status (HDAS). Patients with HDAS had a significantly higher rate of damage accrual than those without (SDI ≥ 1: 33.3% vs. 11.4%, p < 0.001), with an odds ratio of 3.0 (95% CI 1.2-7.3; p = 0.017). Time-adjusted cHDAS was significantly higher in patients with damage than in those without (11.8 [2.4-33.0] vs. 1.5 [0-5.4], p < 0.001). Increasing thresholds of time-adjusted cHDAS were associated with a progressively higher risk of damage accrual, with hazard ratios rising from 6.2 at ≥5% to 16.1 at ≥15% (all p < 0.001). The mean time to damage was significantly shorter in patients with time-adjusted cHDAS ≥5% compared with <5% (5.0 [3.7-6.2] vs. 12.5 [11.3-13.7] years, p < 0.001). In multivariable analysis, neuropsychiatric involvement and time-adjusted cHDAS ≥5% remained independent predictors of damage accrual, with hazard ratios of 2.4 (95% CI 1.3-4.4, p = 0.008) and 4.2 (95% CI 2.1-8.3, p < 0.001), respectively. Higher time-adjusted cHDAS was associated with an increased risk of damage accrual, indicating that greater cumulative exposure to high disease activity is associated with damage. Neuropsychiatric involvement and time-adjusted cHDAS ≥5% were significantly associated with damage accrual.
Clinical phenotypes of atopic dermatitis (AD) can vary, with some individuals displaying difficult-to-treat prurigo nodularis-like lesions. We aimed to assess the real-world disease burden and treatment course of Japanese adults with AD-associated prurigo nodules (AD-Pn) receiving conventional AD treatments. Of the 300 participants with moderate-to-severe AD registered in the observational ADDRESS-J study between July 29, 2016 and July 4, 2017 (before the first biologic for AD was introduced), 285 had baseline and post-baseline prurigo assessments and were included in this exploratory analysis (108 with AD-Pn and 177 without Pn). Participants with AD-Pn versus those without Pn included more males (73.1% vs. 53.1%), and had more mean ± standard deviation (SD) visits for AD treatment in the previous year (11.5 ± 16.1 vs. 8.7 ± 6.6 visits), a higher proportion with an Investigator's Global Assessment (IGA) 4 score (39.9% vs. 18.6%), a higher mean ± SD Eczema Area and Severity Index (EASI) score (28.4 ± 15.1 vs. 23.5 ± 15.5), and a higher mean ± SD Patient-Oriented Eczema Measure (POEM) score (18.8 ± 6.2 vs. 15.6 ± 6.8). At baseline, 14.8% and 7.4% of participants with AD-Pn had been treated with oral immunosuppressants and oral corticosteroids, respectively, compared with 8.5% and 2.3%, respectively, of those without Pn. Individuals with AD-Pn previously received more intensive topical treatments. At 2 years, participants with AD-Pn had more severe AD than those without Pn, as assessed by IGA 4 scores (9.1% vs. 0.9%), and higher mean ± SD EASI total scores (12.5 ± 10.7 vs. 7.0 ± 8.1). In summary, individuals with AD-Pn were mostly males, whose AD was more severe and had improved less than those without Pn while receiving mostly conventional AD treatments over 2 years. AD-Pn might be an indicator for targeted treatment to improve long-term AD outcomes. Clinical Trial Registration: ADDRESS-J (UMIN Clinical Trial Registration: UMIN000022623).
Behçet's disease (BD) is a systemic vasculitis characterized by recurrent oral and genital ulcers, skin lesions, and ocular involvement. Uveitis is a major cause of disability and visual loss in BD. This study aimed to evaluate the safety and efficacy of adalimumab in refractory Behçet's uveitis. This prospective longitudinal cohort study included 25 patients with Behçet's disease and uveitis refractory to conventional immunosuppressive therapy. All patients received adalimumab 40 mg subcutaneously every other week and were followed for 1 year. Outcome measures included changes in best corrected visual acuity (BCVA), anterior chamber reaction, vitreous haze, retinal vasculitis, papillitis, retinitis, cystoid macular edema, corticosteroid use, and adverse events. Mean BCVA improved from 0.14 ± 0.20 at baseline to 0.21 ± 0.23 at the final visit (p = 0.021). The proportion of eyes with absent anterior chamber reaction increased from 24% to 96% (p < 0.001), while vitreous haze improved in 92% of patients. Vasculitis, retinitis, and papillitis decreased from 92% at baseline to 20% at final follow-up (p < 0.001). Mean systemic corticosteroid dose decreased from 27.20 ± 11 mg/day to 15.20 ± 6 mg/day (p < 0.001). Oral and genital ulcers were controlled in 84% of patients. Two patients discontinued adalimumab because of systemic infection, and one patient was switched to infliximab due to inadequate response. Adalimumab demonstrated significant efficacy in controlling ocular and systemic inflammation in refractory Behçet's uveitis with a meaningful steroid-sparing effect and acceptable safety profile over 1 year of follow-up.
To evaluate the safety and efficacy of Compound Ciwujia Granules in the treatment of insomnia(heart-spleen deficiency syndrome), a multicenter, randomized, double-blind, double-dummy, positive drug-controlled, parallel-group clinical trial was conducted. A total of 423 eligible patients were enrolled and randomly assigned in 1∶1 ratio to experimental group or control group using block randomization. The experimental group(n=212) received Compound Ciwujia Granules + placebo for Guipi Granules, while the control group(n=211) received Guipi Granules + placebo for Compound Ciwujia Granules. The treatment lasted for 4 weeks, with visits conducted at baseline and at weeks 2 and 4 of treatment. The primary efficacy outcomes were the change in PSQI scale scores after 4 weeks of treatment(reduction from baseline) and improvement rate of PSQI scale scores. The secondary efficacy outcomes were PSQI single factor scores, changes in sleep diary records, ISI scale scores, use of sedatives and hypnotics, and TCM syndrome scores. Regarding primary efficacy outcomes, after 4 weeks of treatment, the reduction in PSQI scale scores in the experimental group was greater than that in the control group(P<0.000 1), and the PSQI improvement rate was also superior to that of the control group(P<0.000 1). The least-squares mean difference in PSQI scale scores changes between the two groups(experimental group minus control group) and the corresponding 95%CI were-1.13[-1.63,-0.64] in FAS and-1.16[-1.65,-0.67] in PPS. As the upper limits of the confidence intervals were below 0, the efficacy of the experimental group was considered superior to that of the control group, and the superiority test was confirmed. Regarding secondary efficacy outcomes, after 4 weeks of treatment, PSQI single factor scores in the experimental group were significantly improved, and both the ISI scale scores and TCM syndrome scores were significantly reduced compared with those in the control group(P<0.05). No statistically significant differences were observed between the two groups in changes in sleep diary records the use of sedative-hypnotic drugs. In terms of safety, 61 patients(83 events, 28.77%) in the experimental group and 44 patients(82 events, 21.05%) in the control group experienced adverse events. Adverse drug reactions occurred in 7 patients(8 events) in the experimental group and in 8 patients(12 events) in the control group. No serious adverse reactions were reported, and laboratory examinations revealed no abnormalities requiring special attention. These results indicate that Compound Ciwujia Granules administered for 4 weeks are effective and safe for the treatment of insomnia(heart-spleen deficiency syndrome).
Objective: To develop a point cloud non-rigid deformation algorithm, Local Projection Deformation Match (LPD-Match), for optimizing the edge transition of the nasal prosthesis and complementing the previously developed Facial Mesh Generation Network (FMGen-Net) model to automate the construction of target reference data for the nasal prosthesis. Methods: The LPD-Match algorithm was developed based on the local projection deformation strategy. Three-dimensional facial scans from 20 subjects without significant facial deformities who first visited the Department of Prosthodontics, Peking University School and Hospital of Stomatology, between February 2023 and November 2023 were collected, and full nasal defect data were simulated on these scans. To evaluate the effectiveness of LPD-Match alogrithm in edge transition optimization, a paired experiment was designed. For each model, two methods for constructing target reference data were compared. The control group untilized FMGen-Net alone, while the experimental group integrated FMGen-Net with the LPD-Match algorithm. The "edge fitness" metric was defined to evaluate the edge transition of the prosthesis by calculating the three-dimensional (3D) curve deviation and maximum curve deviation between the defect boundary curve and the prosthesis boundary curve. Additionally, the "morphological similarity" metric was introduced to assess the morphology restoration of the nasal defect reference data.Using the nasal region data from the original three-dimensional facial scans as the gold standard, the root mean square error of the three-dimensional morphological deviation and the maximum morphological deviation between the prosthesis design data and the gold standard were calculated for both groups. Results: Analysis of the "edge fitness" metric showed that the root mean square error of the 3D curve deviation in the control group averaged (0.62±0.23) mm, whereas in the experimental group, it was (0.16±0.07) mm. The maximum curve deviation in the control group averaged (1.57±0.64) mm, while the experimental group showed a reduced value of (0.52±0.30) mm. Statistical analysis showed significant differences between the two groups (t=11.33, P<0.001; t=10.17, P<0.001), with the experimental group showing superior edge transition. For the "morphological similarity" analysis, the root mean square error of the 3D morphology deviation was 1.30 (1.00, 1.83) mm in the control group and 1.23 (0.90, 1.63) mm in the experimental group. The maximum morphology deviation in the control group was 4.26 (2.96, 5.02) mm, while the experimental group demonstrated 3.85 (2.92, 4.56) mm. Statistical testing showed significant differences between the two groups (Z=-3.40, P<0.001; Z=-2.09, P=0.037), indicating the superior morphological restoration effect of the experimental group. Conclusion: This study proposes a method using point cloud non-rigid deformation algorithms to optimize the edge transition of the nasal prosthesis and the preliminary verification demonstrates its feasibility and effectiveness. Compared with FMGen-Net model alone, the combined method integrating LPD-Match alogrithm with FMGen-Net model improved the marginal adaptation of nasal prosthesis target reference data while maintaining favorable morphological reconstruction performance.The proposed method shows potential for personalized digital reconstruction of nasal defects in clinical prosthodontics. 目的： 建立一种基于局部投影变形策略的点云柔性变形匹配（LPD-Match）算法优化鼻赝复体的边缘移行，并将其作为课题团队前期研究中建立的面部网格生成网络（FMGen-Net）模型的有益补充，以实现鼻赝复体数据的自动构建。 方法： 基于局部投影变形策略建立LPD-Match算法。收集2023年2至11月于北京大学口腔医学院·口腔医院修复科初诊的20例面部无明显畸形的牙体缺损或牙列缺损患者的三维颜面扫描数据，模拟构建全鼻缺损数据。为评价LPD-Match算法的优化效果，设计配对实验：对每例全鼻缺损数据采用两种方法进行目标参照数据构建，以FMGen-Net模型构建的目标参照数据为对照组，以FMGen-Net模型结合LPD-Match算法构建的目标参照数据为实验组。使用边缘密合度评价目标参照数据中鼻赝复体数据的边缘移行效果，通过计算缺损边界曲线与赝复体边界曲线之间的三维曲线偏差及最大曲线偏差进行分析。使用形态相似性评价目标参照数据的鼻形态修复效果，以患者三维颜面扫描数据中的鼻部数据为金标准，分别计算两组鼻赝复体数据与金标准之间的三维形态偏差及最大形态偏差。 结果： 边缘密合度结果显示，对照组三维曲线偏差的均方根误差值为（0.62±0.23）mm，实验组为（0.16±0.07）mm；对照组最大曲线偏差为（1.57±0.64）mm，实验组为（0.52±0.30）mm，实验组鼻赝复体数据的边缘移行效果均显著优于对照组（t=11.33，P<0.001；t=10.17，P<0.001）。形态相似性结果显示，对照组三维形态偏差的均方根误差值为1.30（1.00，1.83）mm，实验组为1.23（0.90，1.63）mm；对照组最大形态偏差为4.26（2.96，5.02）mm，实验组为3.85（2.92，4.56）mm；实验组目标参照数据的鼻形态修复效果均显著优于对照组（Z=-3.40，P<0.001；Z=-2.09，P=0.037）。 结论： 本项研究提出使用LPD-Match算法优化赝复体边缘移行效果的技术路线，初步验证LPD-Match算法在赝复体边缘移行优化方面的可行性和有效性。LPD-Match算法结合FMGen-Net模型构建鼻赝复体数据的方法，可在达到理想的边缘移行效果的同时，进一步改善鼻赝复体形态。.
Publicly available, large language models (LLMs) can enhance citizen management of their health and chronic illnesses, yet there are few research methods that can be used to understand the technology's impact upon cognitive processes such as information seeking, decision-making, problem solving and mental model development. Even less research has examined how these cognitive interactions influence subsequent use of the citizens socio-technical system which includes health services (e.g. regional health authorities), community services that support health (e.g. physiotherapy services, pharmacies), visits to health professionals (e.g. physicians, nurse practitioners or physiotherapists) and interactions with informal caregivers (e.g., family, friends). In this paper we outline a methodology we have developed to assess the impacts of LLMs on the cognitive and sociotechnical activities of their users which represents an integration of Think Aloud Protocols with Prompted Reflections called Think-Reflect LLM (TR-LLM). The methodology is described as well as key considerations for data collection and analysis.
Patient satisfaction is a critical indicator of healthcare service quality, particularly in specialized outpatient departments where service processes are complex and resources are constrained. This study aims to develop an explainable artificial intelligence framework to predict patient satisfaction and to identify the key factors influencing satisfaction in a public ophthalmology outpatient department. Survey data were collected and patient satisfaction was transformed into both binary and three-class settings. Multiple machine learning models, including Random Forest, Gradient Boosting, Extreme Gradient Boosting, Categorical Boosting, and Light Gradient Boosting, were evaluated using a nested stratified cross-validation with 5 outer folds and 5 inner GridSearchCV folds. To address class imbalance, SMOTE-NC and G-SMOTENC were applied only within the training folds. Model performance was assessed to identify the best-performing predictive approach, which was subsequently analyzed using SHapley Additive exPlanations (SHAP). Among the evaluated models, Gradient Boosting with G-SMOTENC achieved the highest performance in the binary setting, while Random Forest performed best in the three-class setting. SHAP analysis showed that length of stay contributed most strongly to satisfaction predictions in both settings, followed by demographic and visit-related variables. The results suggest that combining predictive modeling with SHAP-based interpretation can support transparent, context-specific assessment of patient satisfaction in the studied outpatient setting. The proposed approach provides interpretable, context-specific insights that may support data-driven resource management and future service improvement in specialized outpatient settings.
A corneal ulcer prevention program trained Female Community Health Volunteers (FCHVs) to diagnose and treat corneal abrasions in Nepal. To understand community eyecare-seeking behavior, program awareness, and program perceptions. This mixed-methods study was conducted in program communities. Surveys assessed awareness in a random sample of 10-20 households per community at 6 and 18 months after program initiation. Focus group discussions (FGDs) with community members and FCHVs examined care-seeking behavior and perceptions at 9 months. Six communities were randomly selected for FGDs, and within each, a random sample of 10 males and 10 females were invited to participate. FCHVs from these communities participated separately. The intervention was modified based on the FGDs before the final survey. The pre-FGD survey found 3.1% (SD 7.2%) of participants were aware of the program. All 13 FGDs (92 participants) indicated eye trauma and delayed care-seeking were common. Participants from only four FGDs reported awareness of the FCHV program though participants from all FGDs indicated a willingness to seek eye care from the FCHVs. As FGDs identified word-of-mouth and door-to-door outreach as effective publicity approaches, two door-to-door campaigns were subsequently implemented. Household surveys 9 months after the FGDs found that program awareness increased to 32.9% (SD 26%, p-value <0.001). FGDs revealed that eye trauma and delayed care-seeking were common, underscoring the need to address barriers to timely care. Community engagement strategies identified during FGDs were successfully implemented. Program awareness was much higher post-FGDs, although causality cannot be established in this observational study. Main findings: Two key explanations for poor vision outcomes in Nepal were identified: eye trauma and delayed care-seeking.Added knowledge: Although initial awareness of the corneal ulcer prevention program was low, communities demonstrated strong receptivity to visiting FCHVs for eye health when adequately informed.Global health impact of policy and action: Focus group discussions revealed a willingness to use community health volunteers as a resource for eye health and informed changes to intervention publicity that may have been temporarily associated with increased awareness of the corneal ulcer prevention program.
Patients with advanced pancreatic ductal adenocarcinoma (aPDAC) often experience general health decline at diagnosis due to a high-symptom burden. The optimal management of symptoms and/or poor performance status (PS) in these patients remains an unmet medical need. In this multicenter study, patients with PS≥2 and pathologically confirmed or imaging-suspected aPDAC were included at first oncology visit in a personalized 14-day emergency integrative supportive care program (14-EISCP) to manage pain, nutrition, diagnostics, and stenting procedures. The primary endpoint was the 14-EISCP success in feasibility of planned procedures and clinical benefit defined as post-EISCP PS≤1, ≥5 points improvement in fatigue, pain, global health-related quality of life (HRQoL) scores (EORTC QLQ-C15-PAL), or chemotherapy initiation within 30 days. A total of 106 patients were included; 93 evaluable patients considered for primary endpoint analysis (median age: 76 years [68-80], PS3: 20.9%, metastases: 61.3%). The median overall survival was 4.1 months (IC95% 2.6-5.6). The 14-EISCP was successful in 59.1% (n=55) of patients, meeting the primary objective (clinically relevant). The 14-EISCP feasibility was achieved in 70.9% of cases. Post-EISCP clinical benefit was observed in 79.6% of patients, with PS improvement to 0/1 in 13.2%, HRQoL improvement in 23.9%, and chemotherapy initiation ≤30 days in 73.1%. Among evaluable patients, 17.2% received mFOLFIRINOX or gemcitabine-nab-paclitaxel, 35.4% received FOLFOX, 25.3% had gemcitabine or 5-fluorouracil alone, and 22.2% received best supportive care. In patients with PS2 at baseline, the administration of doublet/triplet chemotherapy was associated with improved overall survival compared to single-agent. These results offer a promising framework for improving outcomes in aPDAC patients, bridging the gap between symptom management and systemic therapy administration. In patients with PS≥2 and aPDAC, the personalized 14-EISCP was feasible and lead to meaningful clinical benefit, allowing doublet or triplet chemotherapy in half the patients.
The healing of chronic wounds remains a complex and challenging clinical issue. Antioxidant and antibacterial treatments play a crucial role in facilitating the wound healing process. Multifunctional hydrogels derived from natural products have shown promising potential in promoting skin tissue regeneration. In this study, a composite multifunctional hydrogel (CS/CSGA-DAHA) was developed by incorporating dopamine-modified hyaluronic acid (DAHA) and gallic acid-modified chitosan (CSGA), crosslinked through a combination of poly-electrolyte interactions and Schiff base reactions. The resulting hydrogel exhibited a porous microstructure, elastic solid-like mechanical behavior, and effective antibacterial activity against both Gram-negative and Gram-positive bacteria. Furthermore, the cytocompatibility of the hydrogel was confirmed through CCK-8 assay and fluorescent imaging analysis after co-cultivation with L929 fibroblast cells. This research introduces an innovative multifunctional hydrogel with promising potential as a wound dressing for various applications in chronic wound management.
Glaucoma progression forecasting from sparse longitudinal data remains unsolved, as existing models require dense multi-year inputs and lack the biological constraints. We introduce a sparse-observation framework that predicts multi-horizon outcomes from only two visits, incorporating a novel TCMH (Temporally Consistent Multi-Horizon) loss that enforces monotonic risk ordering to reflect irreversible disease biology. Applied to glaucoma progression, we integrate circumpapillary retinal nerve fiber layer (cpRNFL) images, visual field total deviation (VFTD) maps, and clinical covariates through ConvNeXt architecture trained with TCMH loss. In 3,593 patients (13,087 sequences), our model achieved AUROC 0.968 and accuracy 0.947 for two-, three-, and four-year progression forecasting, with 10.2% better calibration than baseline and 0.0163 maximum demographic disparity. At 90% coverage, classification error remained 2.5%, enabling automated risk stratification with expert review for only uncertain cases. The model exceeded three independent specialist graders on specificity (0.98 vs. 0.57-0.73) on 108 held-out eyes. These results establish sparse-observation temporally consistent forecasting as a generalizable paradigm for calibrated long-horizon risk prediction in irreversible progressive diseases.
This study examines how national policies have framed substance use issues among older adults in Norway. An analysis of 18 Norwegian white papers published between 2003 and 2024 by the Ministry of Health and Care Services, the Ministry of Social Affairs, and related ministries was conducted through "What Is the Problem Represented to Be?" poststructural analysis. White papers acknowledge increasing alcohol and substance use among older adults and depict these developments as significant challenges for health and social services both at present and in the future. In response, the following three strategies are proposed: promoting active aging to address inactivity, which can contribute to substance use; combating loneliness and isolation, which represent both the causes and consequences of substance use among elderly individuals; and implementing preventive home visits to help older individuals manage daily challenges and recognize early signs of harmful substance use. Relevant policies primarily address alcohol and prescription drugs but largely ignore the so-called illicit substances. The strategies employed constitute a funnel, leading from broad and preventive strategies to narrow and curative strategies. Although this variation holds some promise, we argue that these policies inadvertently portray substance use in older adults as if all individuals with substance use problems share the same characteristics, experiences, and needs. This generalization risks exacerbating health inequalities among older adults who use substances.
To examine the impact of different disease activity states (DAS) on outcomes in a longitudinal inception childhood-onset SLE cohort. Three DAS were included-remission: clinical SLE DAS (SLE Disease Activity Index (SLEDAI)=0, prednisone (≤5 mg/day) and/or immunosuppressants (IS) (maintenance dose)); lupus low DAS (LLDAS): SLEDAI ≤4 with 0 scores for major organ involvement, no increase in any SLEDAI component since the previous visit, on prednisone (≤7.5 mg/day) and/or IS (maintenance dose); and active disease otherwise. The association of these DAS with new damage (increase of at least 1 point in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI)), severe new damage (an increase of ≥3 points in the SDI) and mortality (any cause) at any time during the follow-up was examined using Cox proportional hazards regression models. The majority of the 212 patients included had active disease at baseline (84%). There was no association between LLDAS and lower risk of new damage or severe new damage (HR 0.98, 95% CI 0.43 to 2.22, p=0.955 and HR 0.40, 95% CI 0.04 to 3.62, p=0.415, respectively). Remission was associated with lower risk of new damage (HR 0.36, 95% CI 0.15 to 0.91, p=0.030), but it had no impact on mortality (HR 0.45, 95% CI 0.06 to 3.66, p=0.454). Attaining LLDAS and remission was lower in our cohort than in other contemporary paediatric lupus cohorts. Remission but not LLDAS was associated with lower risk of new damage over 4.3 years of follow-up. None of these DAS were associated with mortality.
BackgroundPatient-led melanoma surveillance using mobile dermoscopy and teledermatology may support earlier detection and improve access to dermatology care for underserved populations.MethodsWe conducted semi-structured interviews with Melanoma Self Surveillance (MEL-SELF) Trial participants (control, intervention and run-in participants) to explore ways to support mobile teledermatology uptake among underserved populations. Participants had 1+ underserved population characteristics: age ≥70 years, residence outside major cities, low income, and Aboriginal and/or Torres Strait Islander (First Nations Australians) identity. We used thematic analysis to code data and report findings.ResultsOf the 22 participants (55% women; mean age 64.7 years), nine were ≥70 years, 13 lived outside major cities, four had low income and two identified as First Nations Australians (six had ≥2 characteristics). Participants valued the convenience of home-based skin checks, reassurance from expert feedback delivered via teledermatology and increased access to dermatology care. Family or partner support helped participants use the technology and examine hard-to-see areas, which increased confidence and adherence to the intervention. Barriers to skin self-examination included physical limitations, low confidence, and difficulties using the app or dermatoscope. Regional participants noted that teledermatology could potentially help reduce travel costs, provided additional clinic visits were not prompted by the teledermatology. Participants suggested that clear instructions and face-to-face training would facilitate uptake in practice, and that help from health professionals may also be beneficial.ConclusionTailored instructions, training, and technical assistance may help underserved groups use patient-led melanoma surveillance and improve their access to dermatological care.
Sustained behavior change remains one of the greatest challenges in personalized nutrition and lifestyle medicine, despite well-established links between diet, physical activity, sleep, stress regulation, and chronic disease risk. Consumer health technologies-including activity and sleep trackers, heart rate (HR) and heart rate variability (HRV) monitors, continuous glucose monitors (CGM), and bioelectrical impedance-based body composition scales-provide objective, at-home metrics that translate lifestyle behaviors into measurable physiologic and metabolic feedback. Wearable-derived data can enhance self-awareness, reinforce learning, and support adherence by revealing patterns between lifestyle behaviors and outcomes such as glycemic variability, autonomic balance, energy expenditure, and changes in fat and lean mass. Evidence across domains such as sleep, stress regulation, physical activity, and glycemic response suggests that these tools are most effective when used to identify trends over time between clinical encounters and guide personalized adjustments, rather than as isolated metrics. Integrated within a clinician-guided, patient-centered framework, these technologies can reinforce self-regulation, refine individualized recommendations, and extend care between visits. As digital platforms evolve, integration with AI and emerging biologic insights-including nutrigenomics and the gut microbiome-may further enhance precision. Furthermore, when clinical oversight is maintained, patients may develop greater awareness and agency over the relationships between daily behaviors and physiological responses.
Iron deficiency (ID) affects up to 40% of pregnant women in the third trimester, even in highly resourced and iron-supplemented populations, with adverse consequences for maternal health and long-term offspring development. Psychological stress may compromise iron status through hypothalamic-pituitary-adrenocortical (HPA) axis dysregulation and inflammation, but no study has directly examined cortisol in relation to iron status across human pregnancy. This longitudinal study examined associations between HPA function and maternal iron status across pregnancy and tested whether IL-6 and CRP mediated the relationship between cortisol and ferritin across gestation. One hundred sixty-eight pregnant Black women with Medicaid insurance completed up to four laboratory assessments across pregnancy. Salivary cortisol was measured before and in response to the Trier Social Stress Test, yielding basal and reactive cortisol indices. Serum ferritin, IL-6, and CRP were collected at each visit. Trimester-specific regression models examined cortisol reactivity in relation to ferritin; linear mixed-effects models with moderated mediation tested whether basal cortisol predicted ferritin via inflammation. Higher cortisol reactivity was associated with lower ferritin specifically in the third trimester (std. β = -0.197, p = .004). Higher basal cortisol predicted a steeper IL-6 rise across gestation ( p = .002), and IL-6 was positively associated with ferritin (b = 0.236, p = .006), consistent with inflammatory iron sequestration. The indirect effect of basal cortisol on ferritin via IL-6 was statistically significant, and higher basal cortisol was negatively associated with cortisol reactivity in the third trimester. No pathway was observed through CRP. Greater cortisol reactivity predicted lower third-trimester ferritin, a pattern that suggests cumulative iron depletion, atypically sustained HPA reactivity in late pregnancy, or both. To our knowledge, this is the first prospective study linking cortisol reactivity to iron status across human pregnancy, identifying maternal stress physiology as a novel target for understanding and addressing gestational iron deficiency.
Unplanned hospital readmissions not only negatively impact patients' quality of life but also pose a substantial burden on both the hospital and the individuals. Hence, there is a growing need to identify and prevent avoidable readmissions, aiming to reduce mortality and enhance the quality of care. LACE index (Length of stay, Acuity of the admission, Comorbidity of the patient, and Emergency department visits) and HOSPITAL scores (Hemoglobin at discharge, discharge from an Oncology service, Sodium level at discharge, Procedure during index admission, Index Type of admission, number of Admissions during the last 12 months, and Length of stay) are widely used tools to assess the risk of readmission. This study was conducted to determine if the LACE index and HOSPITAL Score are fair predictors of 30-day readmission in adult patients admitted to the internal medicine service at a tertiary care center in a lower-middle-income country (LMIC) like Pakistan. This study employed a retrospective cohort study design. The study includes 35,496 patients, aged 18 and above, admitted to the internal medicine service (both from emergency room and elective admissions) at a tertiary care hospital in Karachi, Pakistan, for 5 years (2016-2020). Out of these patients, 8.0% (2,822) were readmitted within 30 days of their index-admission. The mean age of all patients was 55.3 years (S.D. = 18.9), with males constituting 53.4% (n = 18,958). Patients readmitted within 30 days demonstrated a higher mean LACE index compared to those not readmitted (8.9 vs. 7.4, p-value < 0.001). Additionally, the mean HOSPITAL score was higher in patients readmitted within 30 days compared to those not readmitted (3.4 vs. 2.6, p-value < 0.001). An ROC curve evaluation of the LACE index and HOSPITAL score for this population showed an AUC of 0.670 (95% CI = 0.65-0.69) and 0.655 (95% CI = 0.63-0.67), respectively. The LACE index and HOSPITAL scores demonstrated fair discrimination in predicting readmissions in an LMIC hospital. This suggests their potential for improving early detection and intervention strategies to mitigate readmissions. This study concludes that both scores had comparable performances in an LMIC setting, guiding their adequate integration in routine healthcare systems workflows.
There has yet to be a comprehensive multi-state study describing the children that use school-based health centers (SBHCs). This study seeks to determine sociodemographics, care utilization patterns, and prevalence of asthma and overweight among children seeking care at SBHCs. This retrospective cross-sectional analysis examined electronic health record data of children utilizing SBHCs within a large network of community-based clinics, consisting of 180 SBHCs in 14 U.S. states from 2012-2018. Demographics of exclusive SBHC users (SBHC-only group) were compared to utilizers of SBHCs plus non-SBHC community health centers (SBHC+ group). Of 179,970 children with ≥1 ambulatory visit at a SBHC, 75.6% received care exclusively at SBHCs. Many SBHC-users reported family income <138% of the federal poverty line (48.9%) and self-identified as Hispanic (45.7%). Among SBHC utilizers, the prevalence of asthma (8%) and overweight (30%) were comparable to national statistics. Overall, 33% of children received well-childcare and 24% received influenza vaccinations exclusively at SBHCs. When comparing the two groups within the study, the SBHC-only group were older, and more lacked insurance (13.4%) compared with SBHC+ children (2.6%). The SBHC-only group had fewer total yearly visits, fewer yearly well-child visits, and fewer influenza vaccinations. In age stratified groups, preschool-aged children received the most well-childcare and influenza vaccinations in SBHCs. SBHCs serve a pediatric population that is disproportionately low-income, uninsured, and Hispanic. Children, particularly preschoolers, receive preventive healthcare at SBHCs. Given the population served, SBHCs have strong potential to address pediatric health inequities if adequately resourced, utilized, and integrated with other facilities including community health centers.
Human activity has significantly altered the salt cycle, affecting an estimated 2.5 billion acres of soil worldwide. Elevated soil salinity is a well-known plant stressor, but it may also affect interactions between plants and insects, which are often sodium limited. Elevated sodium in nectar can increase pollinator visitation, but no previous study has examined the effects of elevated soil salinity on visitation by pollen-collecting bees. Our study tested whether increased soil salinity impacts pollen sodium and Bombus spp. visitation to Solanum carolinense, a buzz-pollinated perennial wildflower that rewards pollinators only with pollen. Soil salinity around the root zone of Solanum carolinense growing wild in an early successional field was artificially increased with a salt solution to observe changes in pollen sodium and other cations, pollen viability, and pollinator visitation. Salt addition to the soil increased soil salinity by over five-fold, but there was no effect on the sodium levels of S. carolinense pollen. The salt treatment had no effect on pollinator visitation or pollen viability. Although high soil salinity has been shown to increase nectar sodium levels and thus pollinator visitation, we infer from our results that S. carolinense is able to largely exclude sodium from its pollen, preventing high salinity soil from affecting pollinator attraction and pollen viability.