Skin aging in midlife women is influenced by intrinsic aging processes, hormonal transitions, and systemic factors that affect skin structure, hydration, and elasticity. Increasing interest has emerged in oral interventions targeting the gut-skin axis as a complementary strategy to topical skincare. However, clinical evidence linking postbiotic supplementation to objective changes in skin appearance remains limited. In this randomized, double-blind, placebo-controlled trial, 34 healthy women aged 40-55 years were assigned to receive either an oral postbiotic supplement (VMK223, 500 mg/day) or placebo for 12 weeks. Objective skin appearance parameters, including pore appearance, melanin levels, acne severity, wrinkle depth, hydration, and elasticity, were assessed at baseline and at weeks 4, 8, and 12 using a standardized, noninvasive skin analysis device. A composite skin quality score integrating pores, melanin, acne, and wrinkles was developed as an exploratory outcome. Overall, 29 participants completed the study (VMK223: n = 16; placebo: n = 13). Compared with placebo, VMK223 supplementation was associated with significantly greater improvements across multiple skin parameters over time. At week 12, the VMK223 group showed greater reductions in wrinkle depth (28.0% versus 4.4%, p < 0.001), pore appearance (22.0% versus 8.2%, p < 0.001), acne severity (15.9% versus 7.0%, p < 0.01), and melanin levels (11.5% versus 0.9%, p < 0.05), alongside greater increases in skin hydration (28.3% versus 11.0%, p < 0.001), and elasticity (26.8% versus 5.8%, p < 0.001). The composite skin quality score improved by 20.9% in the VMK223 group compared with 5.6% in the placebo group (p < 0.001). Improvements were progressive and most pronounced after 8-12 weeks. Oral postbiotic supplementation for 12 weeks was associated with significant improvements in multiple objective skin appearance parameters in healthy women aged 40-55 years. These findings support the potential role of postbiotics as a systemic, adjunctive approach for improving visible skin quality. Further studies incorporating biological markers are warranted to elucidate underlying mechanisms. Infographic available for this article. NCT04267731.
Prostate, breast, stomach, colon-rectum, lung, and hematologic cancers represent a regional public health burden among older adults in the Caribbean. We described 15-year trends in cancer incidence and mortality among older adults in Martinique. We conducted a population-based cohort study (2008-2022) from the population-based cancer registry of Martinique. Age-Standardized Incidence and Mortality Rates (ASIR and ASMR) were estimated using the Segi/Doll world standard population and Annual Average Percent Change (AAPC) with 95% confidence interval in patients ≥ 65 years, by tumor site and sex. We recorded 15,400 cancer cases over the entire study period (2008-2022), with 64.4% diagnosed in males. Overall ASIR remained broadly stable: in men, 2,257.8 per 100,000 (95% CI: 2,172.6-2,342.9) in 2008-2012 and 2,053.1 (95% CI: 1,982.8-2,230.4) in 2018-2022; in women, 847.8 (95% CI: 801.8-893.8) in 2008-2012 and 862.1 (95% CI: 821.2-902.9) in 2018-2022. Prostate cancer ASIR decreased from 1,355.5 per 100,000 (95% CI: 1,288.6-1,422.4) in 2008-2012 to 1,303.7 (95% CI: 1,242.0-1,365.5) in 2013-2017, and then significantly to 1,102.2 (95% CI: 1,049.6-1,154.9) in 2018-2022.Prostate cancer ASMR also declined from 293.50 per 100,000 (95% CI: 263.30-323.70) in 2008-2012 to 225.80 (95% CI: 205.00-246.50) in 2018-2022. Women breast cancer ASIR increased significantly from 177.3 per 100,000 (95% CI: 155.4-199.2) in 2008-2012 to 198.0 (95% CI: 176.5-219.6) in 2013-2017 and to 230.7 (95% CI: 208.9-252.5) in 2018-2022. Male lung and bronchial cancer incidence showed a significant AAPC decrease of -12.5% (95% CI: -23.3 to -0.13) in 2018-2022. Colorectal cancer ASMR in women remained stable: 68.2 per 100,000 (95% CI: 55.1-81.3) in 2008-2012, 63.8 (95% CI: 53.0-74.6) in 2013-2017, and 71.4 (95% CI: 60.3-82.5) in 2018-2022, and male stomach cancer AAPC decreased significantly during 2018-2022: -11.5% (95% CI: -20.1 to -1.94). Between 2008 and 2022, cancer incidence among older adults in Martinique showed decreasing prostate and lung cancer but increasing breast cancer, consistent with Caribbean and global trends. These patterns reflect screening practices, treatment advances, and COVID-19 disruptions. Future research should prioritize age-tailored cancer management and uninterrupted treatment access.
To investigate risk factors for early childhood caries (ECC) among 1-2-year-old children in Beijing and to assess the effect modification of baseline caries experience on the associations between other risk factors and subsequent caries outcomes. A 12-24-month prospective study was conducted from 2021 to 2023, a total of 919 participants with valid data were included in this study, with a follow-up rate of 76.9%. Oral health information and related factors were collected through parent-completed questionnaires and clinical dental examinations. Univariate analyses and a zero-inflated negative binomial (ZINB) regression model were used to identify risk factors. Caries incidence during follow-up was 29.8%, and the mean increase in decayed, missing, and filled primary teeth (Δdmft) was 0.94 ± 1.94. In the full-sample ZINB model, significant predictors of caries risk were frequency of snack intake, frequency of candy consumption, frequency of bedtime tooth brushing, frequency of bottle use at bedtime, and baseline caries status. In the baseline caries-free group, additional significant predictors of incident caries risk were parents' caries status, frequency of saliva-sharing behavior, frequency of post-meal mouth rinsing, and the presence of additives in daily drinking water. Interaction analyses showed that the effects of parents' caries status, saliva-sharing frequency, post-meal mouth rinsing frequency, presence of additives in daily drinking water, bedtime brushing frequency, and history of dental attendance on caries risk differed significantly between children with and without baseline caries. The risk of early childhood caries (ECC) among 1-2-year-old children in Beijing was associated with multiple oral health-related factors. Baseline caries experience was a strong predictor of subsequent caries risk and significantly modified the effects of other risk factors.
Acetabular fractures are uncommon, but serious injuries. Demographic changes may have a significant impact on planning healthcare structures to improve treatment outcomes. Aim of this nationwide, registry-based retrospective controlled study was to identify incidence trends, demographic characteristics, and care structures of patients with acetabular fractures in Germany. We analyzed inpatient data from the Institute for the Hospital Remuneration System (InEK). Based on 52 095 patients with primary diagnosis of an acetabular fracture between 2019 and 2024, we calculated incidence rates for different age-groups and put a spotlight on geriatric acetabular fractures (> 65 years of age). Incidence rates in patients under 65 years remained stable, whereas patients over 65 years showed a significant age-dependent increase with an exponential rise in men aged 80 + with the highest incidence being 122.4/100 000 inhabitants annually. We recorded high levels of co-morbidity and nursing care dependency for elderly patients after acetabular fracture. Although 43% of patients were treated in hospitals > 500 beds, acetabular fractures were managed across all hospital sizes. There is a rapidly increasing incidence of geriatric acetabular fractures, predominantly driven by elderly male patients over 80 years. Patients over 65 years are associated with high rates of co-morbidities and nursing care levels.
A history of prior cardiac surgery (PCS) determines treatment decision and long-term outcomes in patients requiring aortic valve replacement. This study examined patient profiles, treatment-decisions and long-term outcomes of patients under 75 years with PCS undergoing transcatheter and surgical aortic valve implantation/replacement (TAVI, SAVR) in the Netherlands. Data from 1,284 patients (ages 50-75 years) with PCS undergoing TAVI or SAVR between 2015 and 2020 were analyzed using data from the Netherlands Heart Registration. Logistic and cox regression identified determinants of treatment selection and long-term mortality. Determinants were considered impactful if they had an odds ratio (OR) or hazard ratio (HR) of ≥ 1.5 or ≤ 0.7 and a prevalence of ≥ 5%. Of 1,284 patients, 690 underwent TAVI (54%) and 594 SAVR (46%). Prior index surgery most frequently involved coronary artery bypass grafting (CABG) (57% in the TAVI group vs 40% in the SAVR group; p < 0.001) and previous aortic valve surgery (25% vs 51%; p < 0.001). TAVI patients were significantly older (median 71 vs. 67 years, p < 0.001) and had a higher EuroSCORE II (median 5.7 vs. 4.4, p = 0.003) than SAVR patients. SAVR was the preferred strategy for intermediate-risk patients (62%), while TAVI was favored in high- and prohibitive-risk patients (62% and 94%, respectively). In descending order of odds ratio, the strongest independent determinants of TAVI selection were left ventricular ejection fraction ≤ 30% ((OR: 4.8; 95% CI: 2.6-8.8), poor mobility ((OR: 3.4; 95% CI: 1.6-7.0) and obesity/cachexia (OR 2.7; 95% CI: 1.6-4.4); the key determinants of SAVR selection were pure native aortic regurgitation (OR: 0.1; 95% CI: 0.1-0.3) and failing surgical bioprosthesis (OR: 0.7; 95% CI: 0.5-1.0. Thirty-day, 1- and 5 year survival after TAVI and SAVR was 97% and 96%, 83% and 91%, and 56% and 83%, respectively (p-value < 0.001). Left ventricular ejection fraction ≤ 30% and chronic lung disease were important mortality determinants for both procedures, with higher odds ratios for mortality in SAVR as compared to in TAVI patients. In the Netherlands, TAVI and SAVR rates were comparable among patients < 75 years with PCS. Higher-risk patients were directed toward TAVI except for those presenting with pure native aortic regurgitation and bioprosthesis failure who mainly received SAVR. Severe left ventricular dysfunction and chronic lung disease were key mortality predictors for both procedures.
Rheumatoid arthritis (RA) frequently affects the forefoot, causing pain and deformity even in remission. Subclinical inflammation may persist and vary with disease duration. This study aimed to compare clinical, ultrasound, and radiographic features of the forefoot in RA remission with metatarsalgia according to disease duration (< 10 vs. ≥ 10 years). Cross-sectional study including 84 RA patients in remission (DAS28 < 2.6) with metatarsalgia: 33 with < 10 and 51 with ≥ 10 years of disease duration. Clinical, biomechanical, ultrasound (B-mode and Power Doppler (PD), and radiographic variables were assessed by blinded evaluators. The ≥ 10-year group showed greater structural burden. Total synovitis was similar between groups, more frequent at central metatarsophalangeal joints (MTPs) (particularly MTP2 in < 10 years), and PD was rare (6%). The overall pattern was consistent with early MTP1/5 involvement and progressive structural accumulation at MTP2-4, with higher odds of erosions (OR 3.5-5.0), joint space narrowing (JSN; OR 2.8-4.4), and subluxations (MTP2 OR 5.31; MTP3 OR 2.50) in the ≥ 10-year group. In RA remission with metatarsalgia, our findings are consistent with early structural involvement at MTP1/MTP5 and more frequent B-mode synovitis at central joints, with progressive structural burden at MTP2-4 as disease duration increases. PD positivity was uncommon (6%), whereas ultrasound remained essential to detect synovitis. Our findings support systematic assessment of all MTP joints (MTP1-5), with particular attention to MTP1/MTP5 in earlier disease and careful structural evaluation of central rays in longer disease duration. As a cross-sectional study, temporal or causal sequences cannot be inferred.
To translate and culturally adapt the Wheelchair Skills Test-Questionnaire (WST-Q) into Italian, and to assess its reliability, measurement error and validity in manual wheelchair users. The WST-Q was translated and culturally adapted using forward-backward translation, expert review, and cognitive debriefing with wheelchair users and rehabilitation professionals. Internal consistency (Cronbach's α), test-retest reliability (Intraclass Correlation Coefficient, [ICC]), measurement error (Standard Error of Measurement [SEM] and the Smallest Real Difference [SRD]) were calculated. Validity was examined through WST-Q scores correlations (concurrent validity) and known-groups comparisons (years of use, training) (construct validity). A General Linear Model (GLM) was used to explore the effects of clinical and demographic factors, accounting for interaction terms. Seventy-four manual wheelchair users, with a mean age of 44.0 years (SD: 15.7), participated in the study. Cronbach's α was 0.96-0.97 across WST-Q scores. ICCs indicated excellent test-retest reliability (0.88-0.92). SEM ranged from 4.9 to 6.9, and SRD from 13.6 to 19.3. Strong correlation among WST-Q scores was observed (p = 0.81-0.90, p < 0.001). Known-groups validity showed higher scores in participants with >2 years of wheelchair use and in those with training. GLM analysis identified significant effects of baseline pathology, wheelchair type, gender, and training, with several interaction effects, explaining 77-89% of score variance. The Italian WST-Q demonstrated excellent reliability, acceptable measurement error, and good validity. It is suitable for assessing self-reported manual wheelchair skills in Italian rehabilitation settings, supporting standardised and evidence-based practice. The Italian Wheelchair Skills Test-Questionnaire (WST-Q) demonstrated excellent internal consistency, test-retest reliability, and construct validity, supporting its use as a standardised self-report measure for manual wheelchair skills assessment in Italy.The established measurement error indices (Standard Error of Measurement and Smallest Real Difference) enable clinicians and researchers to distinguish true changes in wheelchair skills from random variation, improving the accuracy of outcome evaluation.The WST-Q can help identify differences in skill performance linked to training, wheelchair type, and health condition, informing individualised rehabilitation planning and targeted skill development interventions.
Patient-reported outcomes (PROs) after total knee arthroplasty (TKA) are well-documented in Western populations, but long-term recovery and its determinants in multiethnic Asian populations remain poorly understood. We aimed to characterise 5-year WOMAC recovery after TKA and to identify patient, clinical, and surgical factors associated with the odds of improvement at each consecutive postoperative interval in a multiethnic Asian cohort. This registry-based cohort study used prospectively collected data from a tertiary hospital in Singapore. We included 4964 consecutive cases with osteoarthritis undergoing primary TKA between December 1, 2008, and December 31, 2023. The primary outcomes were changes in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total and subscale scores, measured at baseline and at 6 months, 1, 2, and 5 years postoperatively. The mean (SD) total WOMAC score improved from 38.6 (15.1) at baseline to 7.5 (9.2) at 5 years. The greatest improvement occurred within the first 6 months (mean change, 27.6 points; P value < .001). In multivariable interval-specific analyses, older age (≥ 75 years; OR 0.55, 95% CI 0.39-0.79) and the presence of one or more comorbidities (OR 0.83, 95% CI 0.71-0.96) were independently associated with lower odds of long-term improvement. Interval-specific associations with ethnicity were also observed for pain and stiffness. In this large, multi-ethnic Asian cohort, TKA was associated with substantial and durable WOMAC improvements, primarily within the first 6 months. Interval-specific predictors of improvement were dominated by patient-level factors, notably age, comorbidity, and ethnicity, while surgical variables showed limited association. These findings support the potential value of patient-centred risk stratification and culturally responsive perioperative care in optimising long-term outcomes.
The socio-economic situation in Lebanon has been dramatically deteriorating over the years affecting food insecurity (FI), psychological distress, and health-related quality of life (HRQoL). Therefore, the objectives of the study are to estimate the prevalence and severity of FI among Lebanese residents; evaluate the association between FI and psychological distress; and examine the association between FI and HRQoL. A cross-sectional study was conducted among residents of Lebanon aged 18 years or older in 2024. The final sample included 519 participants. The Food Insecurity Experience Scale, Beirut Distress Scale (BDS), and EQ-5D-5 L were used to assess FI, distress, and HRQoL levels, respectively. The questionnaire also included sociodemographic and general health-related questions. Regression analysis was applied to explore the association of FI with psychological distress and HRQoL after adjustment for relevant covariates. 14.3% of the participants exhibited moderate to severe FI. A moderate level of HRQoL was shown with a mean of 74.18 (SD = 19.0) for the EQ-VAS. Moreover, FI was significantly associated with HRQoL and psychological distress. FI (B = 5.183), age (B = 0.092), gender (B = 3.998), employment status (B = 0.558), and job loss (B = 6.021), were significant predictors of the BDS (p < 0.05). Whereas FI (B = - 8.490), age (B = - 0.461), job loss (B = - 4.659), and household income (B = 1.466) were significant predictors of EQ-VAS (p < 0.05). FI was associated with poorer mental health and lower HRQoL among Lebanese residents. This highlights the impact of the socio-economic crisis and provides data that could guide efforts to improve population health, especially for NGOs that are providing support to local communities. Lebanon has been facing severe socio-economic crises over the past years that have negatively affected food security, people’s mental health, and overall wellbeing, yet no population-based studies have been conducted to date to explore these issues. This study investigates the association of food insecurity with mental health, specifically psychological distress, and health-related quality of life. It aims to identify vulnerable groups that are most affected by the crises in order to develop targeted interventions. The study measures the prevalence of food insecurity among Lebanese residents and examines whether it is associated with higher psychological distress and lower health-related quality of life. Results revealed that about 14% of the participants were food insecure (moderate to severe FI) and it was linked to higher distress levels, and poorer health-related quality of life. Female, older individuals, unemployed, those who lost their jobs because of the crisis, those with lower educational attainment, and lower monthly income, showed worsened outcomes. The study revealed key dimensions of health that have been affected and provided data that could guide efforts to improve health of the population, especially for various NGOs that are providing support to local communities.
Pyogenic liver abscess (PLA) is a life-threatening infection rising in East Asia, especially among patients with type 2 diabetes. Although SGLT2 inhibitors improve glycemic control and offer extraglycemic benefits, their effect on PLA risk is unknown. Using Taiwan's National Health Insurance Research Database, we conducted a nationwide retrospective cohort study of adults with T2DM. After 1:1 propensity score matching, 258,800 SGLT2i users and 258,800 non-users were included. The primary outcome was incident PLA. Incidence rates were calculated per 1,000 person-years, and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards models. Additional analyses included subgroup analyses with interaction testing, a time-dependent Cox model, a competing-risks model, and a negative-control outcome analysis using fracture. During follow-up, 1,275 PLA events were identified. The incidence rate of PLA was 0.75 per 1,000 person-years in SGLT2i users and 0.83 per 1,000 person-years in non-users. In the primary multivariable Cox model, SGLT2i use was associated with a lower risk of PLA compared with nonuse (aHR, 0.88; 95% CI, 0.79-0.99). This inverse association was generally consistent across most subgroups. In the time-dependent analysis, SGLT2i use remained associated with a lower PLA risk (aHR, 0.72; 95% CI, 0.64-0.81). SGLT2i therapy was independently associated with reduced PLA risk in T2DM patients, particularly with prolonged exposure. These findings suggest an inverse association between SGLT2i use and the risk of pyogenic liver abscess in patients with T2DM.
Strong communication skills support Australian Aboriginal and Torres Strait Islander children's connections to community, culture, and education. Ongoing impacts of colonisation and social determinants of health may increase the likelihood of speech, language, and communication needs for Aboriginal and Torres Strait Islander children, however national data is limited. Speech-language pathology can address speech, language, and communication needs, but factors impacting access for this population are not well understood. This study aimed to establish caregiver reported prevalence of speech, language, and communication needs in Aboriginal and Torres Strait Islander children aged 0-6 years and identify facilitators and barriers to accessing support. Mixed modelling and qualitative content analyses were used to examine data for 474 children in a national longitudinal study of Aboriginal and Torres Strait Islander children. In total, 47.0% of children had speech, language, and communication needs between 0-6 years, with only 48.0% with speech, language, and communication needs, accessing support. Higher access was linked to caregiver-rated health, concern duration, and concerns across multiple communication domains. Key access barriers included service availability and awareness. The high prevalence of speech, language, and communication needs and limited access to support highlights the need to reduce access barriers and consider public health models of intervention that incorporate Aboriginal and Torres Strait Islander views of health.
Anxiety among adolescents has increased globally during the COVID-19 pandemic. Adolescents in juvenile detention centers (JDCs) may be particularly vulnerable due to restricted liberty and social isolation. Movement-based interventions such as Dance/Movement Therapy (DMT) have been studied as approaches to support emotional regulation. This exploratory study investigated the psychophysiological effects of a structured DMT intervention on anxiety reduction among adolescents in JDCs, focusing on anxiety-related changes in dopamine (DA) levels and body temperature. This quasi-experimental study included 55 female adolescents from a single juvenile detention center. Participants were allocated to either a non-DMT control group (n = 30, 16.17 ± 1.73 years), which maintained their usual institutional routine throughout the 8-week study period, or a DMT group (n = 25, 16.23 ± 1.68 years) that completed 24 DMT sessions over the same period. Anxiety and physiological measures were assessed before and after the intervention. Anxiety was measured using the Beck Anxiety Inventory (BAI). Physiological measures included mean body temperature (mTb), calculated from tympanic (core) and skin temperature measurements, and plasma DA levels measured using high-performance liquid chromatography (HPLC). Following the intervention, the DMT group showed a significant reduction in BAI scores (-16%, p < 0.001), along with significant increases in mTb (0.11 ± 0.07 °C, p < 0.001) and DA levels (+ 30%, p < 0.001). BAI scores were negatively correlated with mTb and DA levels, whereas mTb was positively correlated with DA levels. This study provides preliminary evidence that DMT may help alleviate anxiety and support psychophysiological regulation among adolescents in JDCs. However, the exploratory design, single-center setting, and all-female sample may limit generalizability. Future multi-center studies with more diverse samples are needed to confirm these findings and clarify the underlying mechanisms.
To develop a semi-automated method to segment "black hole" lesions on post-gadolinium 2D T1-weighted images (GdT1) in multiple sclerosis (MS) that follows radiological intensity rules and perform multi-center validation. Multi-center spin-echo GdT1 images and accompanying proton-density (PD)/T2-weighted images and manual T2 lesion masks of the REFLEXION study (NCT00813709) of suspected/early MS were used. Briefly, the proposed method segments cortical gray matter (GM) to derive a T1-weighted intensity threshold, which is applied inside co-registered T2 lesion masks to segment black hole lesion voxels. It was optimized on a training set (N = 40, 57.5% female, mean age 31.4 ± 8.7 (standard deviation) years), and 274 patients formed the test set (61.3% female, age 31.8 ± 8.4 years). Performance was quantified by the Dice similarity coefficient (DSC) and the intraclass correlation coefficient (ICC) for absolute agreement with manual segmentations. Lesion-wise sensitivity and specificity were calculated. Optimization resulted in: (1) GM selection as minimally 0.8 total WM plus GM partial volume, masked by MNI cortex; (2) normalized mutual information-driven linear co-registration of T2 to GdT1 images, interpolating T2 lesion masks using trilinear interpolation and 0.6 threshold; (3) mean intensity inside GM mask used as upper intensity threshold. The optimized method had acceptable spatial accuracy (DSC: 0.39 ± 0.26) and good volumetric accuracy (ICC: 0.84, 95% CI [0.72, 0.90]. Lesion-wise sensitivity was 0.91 ± 0.19, and lesion-wise specificity was 0.62 ± 0.22. The proposed method to semi-automatically segment black holes from post-gadolinium T1-weighted images shows acceptable performance. As a potential aid to radiologists, the method is not recommended to be used entirely without human intervention. Question T1-hypointense "black hole" lesions reflect disease severity in multiple sclerosis but are not routinely quantified due to a lack of reliable analysis methods. Findings A rule-based semi-automated method for GdT1 "black hole" lesion segmentation was developed and optimized, and then validated in a large unseen multi-center test set. Clinical relevance This method adds quantitative information about GdT1 "black hole" lesions to the radiological assessment of multiple sclerosis disease severity, when false positives are manually removed. This can enhance the characterization of individual patients and advance the understanding of the disease.
Mental health conditions account for 18% of years lived with disability worldwide. 1-in-6 adults are affected in England, with most mental health conditions beginning in childhood and adolescence. Mental distress and ill health are unequally distributed in the UK, with strong associations with wider determinants of health, and higher prevalence among systemically disadvantaged groups. Currently, there is a lack of evidence to inform effective and timely policymaking for primary prevention in the UK. In recognition of these challenges, a national Population Mental Health (PMH) Consortium was established, as part of Population Health Improvement UK (PHIUK). PHIUK is a national research network which works to transform health and reduce inequalities through change at the population level. Our aim is to establish an interdisciplinary PMH Consortium, focussing on upstream determinants and the prevention of risks and onset of mental health conditions through interdisciplinary stakeholder engagement, to create new opportunities for population-based improvement of mental health in the UK.The PMH Consortium brings together leading interdisciplinary representation in population mental health, spanning from sciences to the arts, across the UK. Membership includes six academic institutions, third sector organisations, lived experience expertise, and strong links with national bodies to ensure integrated cross-national and regional policy impact. The PMH Consortium comprises four cross-cutting platforms (Partners in policy, implementation, and lived experience; Data, linkages, and causal inference; Narrowing inequalities; Training and capacity building) and three challenge areas (Children and young people's mental health; Prevention of suicide and self-harm; Multiple long-term conditions) which are highly integrated and interdependent. The work will be underpinned by a Theory of Change across an initial four-year life cycle. This paper describes the aim, objectives, and approach of the PMH Consortium, as well as anticipated challenges and strengths. The goal of the PMH Consortium is to develop a model for population mental health research and policy translation that is both scalable and sustainable. It is critical to ensure continued impact and viability beyond the initial four years, contributing to the prevention of mental health conditions in the UK, with personal, economic, social, and health benefits.
Daihai Lake, a typical closed inland lake in the arid and semi-arid region of Inner Mongolia, has been subject to two consecutive years of ecological water replenishment to mitigate its severe ecological degradation. While the lake water level has risen and wetland ecosystems have been gradually restored, existing studies have predominantly focused on changes in lake water quality, leaving a critical research gap regarding the hydrochemical evolution, formation mechanisms, and drinking water safety risks of groundwater in the plain area of the Daihai Lake Basin under the dynamic conditions of ongoing water replenishment. To fill this gap, this study systematically analyzed the hydrochemical characteristics and formation mechanisms of groundwater in the study area, and conducted a comprehensive groundwater quality assessment. A suite of representative groundwater samples were collected from the study area after two years of ecological water replenishment, and analyzed using an integrated set of methods including Self-Organizing Map (SOM) clustering, hydrochemical graphical analysis, ion ratio analysis, multivariate statistical analysis, and the Entropy-weighted Water Quality Index (EWQI) method. The results show that: (1) Groundwater is divided into three clusters via SOM, with distinct ion sources from carbonate/silicate weathering and halite dissolution across clusters; some samples have excess SO₄2- and HCO₃-, requiring additional cations for charge balance. (2) Groundwater evolution is jointly controlled by water-rock interaction and evaporative concentration, with limited influence from atmospheric precipitation. (3) Three high-fluoride enrichment mechanisms are identified: mineral dissolution under weakly alkaline conditions, evaporative concentration-driven F⁻ enrichment, and accelerated dissolution of fluorine-bearing minerals induced by acidic mining wastewater. (4) 89% of Cluster-3 groundwater meets drinking standards (EWQI < 50), while 70% of groundwater samples from Cluster 1 and Cluster 2 are of poor quality, mainly distributed in the southwestern lakeshore. This study systematically elucidates the hydrochemical characteristics and formation mechanisms of groundwater in the Daihai Lake Basin under continuous ecological water replenishment, identifies key risk zones for groundwater quality, and provides a solid scientific basis for the protection and sustainable utilization of regional groundwater resources, as well as the optimization of ecological water replenishment strategies in similar arid and semi-arid inland lake basins.
Wilson disease (WD) is a rare autosomal recessive disorder of copper metabolism presenting with acute liver failure, cirrhosis, or neurologic involvement. Liver transplantation (LT) is the definitive treatment; however, data remain limited, particularly from regions reliant on living donor LT (LDLT). We retrospectively analyzed a prospectively collected transplant database, identifying all patients (≥ 14 years) who underwent LT for WD between January 2001 and December 2023. Data on demographics, LT indications, disease characteristics, pre-transplant therapy, complications, and outcomes were collected. Survival was assessed using Kaplan-Meier methods, and neurologic outcomes from clinical documentation. Forty-one patients underwent LT for WD (median age: 23 years; 51.2% female). Ascites was present in 68.4%, encephalopathy in 32.4%, and hepatocellular carcinoma in 5.1%. Acute liver failure was the initial presentation in 17.9%. LDLT comprised 53.7%. Acute cellular rejection occurred in 29.7% but was manageable; no patient required re-transplantation. Neurologic involvement was present in 17.1%, with 71% improving post-LT. One-, five-, and ten-year survival rates were 94%, 94%, and 82%. LT for WD yields excellent long-term survival. Neurologic improvement occurred in most Neuro-Wilson patients, supporting LT even in neurologically affected cases. LDLT plays a crucial role in regions with limited deceased donors.
Segmentation of spinal nerve rootlets is relevant for spinal level estimation, lesion classification, neuromodulation therapy, and group-level analyses. The aim of this study was to develop a deep learning method for the automatic segmentation of C2-T1 dorsal and ventral spinal nerve rootlets on various MRI scans. The study included MRI scans from two open-access and one private dataset, consisting of 3D isotropic 3T turbo spin echo T2-weighted (T2w) and 7T MP2RAGE (T1-weighted [T1w] INV1 and INV2, and UNIT1) MRI scans. A deep learning model, RootletSeg, was developed on 93 MRI scans from 50 healthy adults (mean age, 28.70 years ± 6.53 [SD]; 28 [56%] males, 22 [44%] females) and achieved a mean ± SD Dice score of 0.67 ± 0.09 for T1w-INV2, 0.65 ± 0.11 for UNIT1, 0.64 ± 0.08 for T2w, and 0.62 ± 0.10 for T1w-INV1 contrasts. RootletSeg accurately segmented C2-T1 spinal rootlets across MRI contrasts, enabling the determination of spinal levels directly from MRI scans. The method is open-source and can be used for a variety of downstream analyses.
Despite modest improvement, the lifespan of a child on dialysis continues to be 40 years shorter compared to healthy children. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in these patients. Risk factors for CVD are present even in early stages of chronic kidney disease (CKD) and accelerate as the child's renal function deteriorates. As a result, the highest burden of CVD exists in patients on chronic dialysis. Although dialysis is life-sustaining, the dialysis procedure promotes cardiovascular damage. Both traditional and non-traditional CVD risk factors drive this acceleration. More concerning, the dialysis procedure itself is cardiotoxic. Because of coexisting poor cardiac reserve and altered sympathetic tone in this patient population, dialysis induces repetitive contractile, ischemic injury termed myocardial stunning. This ischemia-reperfusion injury is reversible at first. However, with repetitive episodes, this injury will trigger alterations in cardiac function that decrease contractile function in order to preserve viability. Ultimately, these adaptations lead to remodeling and fibrosis. There is no targeted therapy available to reverse cardiovascular damage in these patients. Intensive monitoring and management of modifiable risks such as hypertension and anemia in the early stages of CKD to optimize cardiovascular health is imperative. However, in late CKD, especially in those patients who are not candidates for preemptive renal transplantation, optimization of the dialysis procedure is critical to prevent acceleration of their CVD burden. Improved assessment of dry weight as well as data-driven fluid management programs may decrease some risk. More importantly, standard implementation of intensified dialysis prescriptions by increasing time or through the addition of convective clearance may mitigate progressive cardiovascular damage and enhance survival. In this review, the pathophysiology of dialysis-induced cardiovascular damage will be reviewed. The management strategies to limit the cardiovascular burden in our patients are also discussed.
Ongoing neurodevelopmental care is essential for children with congenital heart disease (CHD). Understanding delivery and uptake of neurodevelopmental care pathways can inform implementation and resource planning. This study applied simulation modelling to explore outcomes from a neurodevelopmental care pathway for children with CHD. The model was developed using data from a Queensland program to explore health service interactions for neurodevelopmental screening, formal assessment, and early intervention, up to five years. Modelling was intended to provide a baseline understanding of the pathway, rather than evaluating against a reference standard. Hypothetical scenarios explored how changes in screening and referrals influenced the identification of developmental concerns, and how developmental concern severity affected intervention referrals. Based on available data, 58% of the cohort remained under routine surveillance and 25% had accessed early intervention for one or more developmental delays. Scenarios defined by increased screening projected up to 55% of the cohort having a developmental concern identified during screening and 45% having a developmental delay identified following assessment. Simulation modelling was useful for understanding outcomes from a neurodevelopmental pathway and how differences in screening and assessment affected health service interactions. Findings may inform policy and resource planning for future neurodevelopmental pathways. This study shows that simulation modelling is a useful approach for evaluating a neurodevelopmental care pathway for children with CHD, to understand movement through neurodevelopmental screening, assessment, and interventions. Scenario-based modelling provides insights into factors influencing pathway engagement, contributing evidence to strengthen understanding of service gaps and areas where improvements can most effectively impact engagement and resourcing. This study identifies neurodevelopmental screening as the most influential stage impacting downstream outcomes, underscoring its importance as a strategic intervention point. This study's approach provides a general framework for evaluating similar pathways and a potential baseline for assessing future policy or service changes.
The association between preoperative peripheral nerve block (PNB), major adverse cardiovascular events (MACE), and postoperative length of hospital stay (LOS) in elderly patients who underwent major thoracic and abdominal surgery remains unclear. This study aims to explore the potential mediating effect of MACE on the association between preoperative PNB and postoperative LOS using a statistical mediation framework. In this retrospective cohort study, perioperative data were collected from elderly patients (aged over 65 years) who underwent major thoracic and abdominal surgery. Mediation analysis was employed to examine the relationships between PNB, MACE, and postoperative LOS. A total of 1915 patients were included in the analysis, with 68.7% (1316/1915) receiving preoperative PNB. Compared to patients who did not receive PNB, those who did had a significantly lower incidence of MACE (P < 0.001) and a shorter postoperative LOS (P < 0.001). The adjusted total and direct associations of PNB with postoperative LOS were - 0.809 days (95% confidence interval [CI], -1.236 to -0.390; P < 0.001) and - 0.661 days (95% CI, -1.077 to -0.250; P = 0.003), respectively. A statistically significant indirect association via MACE was observed (adjusted β=-0.149 days; 95% CI, -0.271 to -0.060; P < 0.001), indicating that 18.1% (95% CI, 6.7% to 41.0%) of the total association was statistically attributable to the indirect pathway through MACE under the model assumptions. A sensitivity analysis excluding postoperative covariates yielded consistent results (proportion mediated: 25.3%). Our findings suggest that the observed association between preoperative PNB and reduced postoperative LOS in elderly patients following major thoracic and abdominal surgery may be partly explained by a statistically significant indirect pathway through a reduction in MACE, potentially accounting for approximately 18% of the total effect. These findings are hypothesis-generating and represent statistical associations rather than demonstrated causal mechanisms. ChiCTR2400087610; https://www.chictr.org.cn.