搜索结果：1993

In recent years, the number of refugees and internally displaced persons (IDPs) has dramatically grown worldwide. We aimed to examine psychological distress and its association with sleep and stress in two groups of IDPs with different lengths of displacement in comparison with the general population. Forty-five individuals displaced in 2008, 2.5 months before this study (2008 IDPs), 67 respondents displaced in 1993 (1993 IDPs), and 53 individuals from Tbilisi general population were assessed. All study participants completed the Insomnia Severity Index (ISI), Perceived Stress Scale (PSS) and Brief Symptom Inventory (BSI). Sociodemographic information such as age, sex, education level and marital status, was collected. The groups differed significantly on age, education, marital status, ISI, PSS, and Global Severity Index (GSI). The highest mean ISI and PSS scores were found for the 2008 IDPs, while the highest GSI score was observed in 1993 IDPs, although the GSI and PSS scores did not differ between the two groups of IDPs. The proportion of people with a GSI T score ≥ 63 was 47.2% in the general population, 71.6% in the 1993 IDPs, and 64.4% in the 2008 IDPs. The ISI and PSS were significant predictors of the GSI in all groups. The PSS exhibited the highest predictive power for 2008 IDPs (β = 0.429), while the ISI - in 1993 IDPs (β = 0.417). Psychological distress persists over time in IDPs. Although both stress and insomnia are strongly associated with psychological distress, perceived stress appears to have a stronger impact in the early resettlement period, whereas insomnia emerges as a more prominent predictor later, years after displacement. Therefore, sleep health in displaced population, and on a broader scale in individuals subjected to traumatic events, warrant attention in long-term perspective for implementing targeted interventions and effectively addressing well-being of affected individuals.

Sublingual immunotherapy (SLIT) is a well-established, safe, and patient-friendly treatment for allergic rhinitis. This study aims to provide a comprehensive bibliometric analysis of global research trends and emerging hotspots in SLIT for allergic rhinitis. Relevant publications were sourced from the Web of Science Core Collection (1993-2024). VOSviewer, CiteSpace, and the R "bibliometrix" package were used to visualize research collaborations, leading contributors, and thematic developments. This analysis of 696 publications on SLIT for allergic rhinitis reveals a dynamic, collaborative field. The USA, China, and Italy led production, with the University of Genoa as the top institution. Research is organized into six clusters: immunological mechanisms, clinical efficacy, epidemiology/guidelines, pediatric research, disease classification, and real-world evidence.The focus has evolved over two decades from initial clinical efficacy studies toward understanding underlying immune mechanisms (highlighted by recent keyword bursts like "dendritic cells"), biomarker discovery, and specialized pediatric applications. There is also a strengthened emphasis on long-term management and real-world effectiveness. SLIT research is diversifying, marked by a growing emphasis on immunology, personalized and pediatric approaches, and practical outcomes, providing a robust foundation for optimizing future therapy. Allergic rhinitis, often called hay fever, causes sneezing, a runny or blocked nose, and itchy symptoms. Medicines can help control symptoms, but they do not change the underlying allergy. Sublingual immunotherapy is a longer-term treatment that places small amounts of an allergen under the tongue to help the immune system become less sensitive over time. Because many studies on this treatment have been published, it can be difficult to understand how the research field has developed and what topics are now receiving the most attention.In this study, we reviewed and analyzed published research on sublingual immunotherapy for allergic rhinitis using a method called bibliometric analysis. Instead of re-testing the treatment in patients, bibliometric analysis looks at patterns across the scientific literature, such as how many papers are published each year, which countries and institutions publish the most, which journals publish the research, and which topics are becoming more important.We analyzed 696 publications indexed in the Web of Science Core Collection from 1993 to 2024. We found that research output increased over time, with strong contributions from the United States, China, and Italy, and major involvement from both universities and companies. Research topics clustered into areas including treatment effectiveness and safety, immune mechanisms, guidelines and health policy, pediatric studies, and real-world outcomes such as adherence. Overall, the field is expanding and increasingly focused on long-term management, immune pathways, and practical use in everyday care.

Fasciola hepatica is a trematode that is easily visible to the naked eye. It infects sheep and cattle, but can sometimes be an accidental host in humans. This review was carried out to review the published studies on human Fasciola hepatica in Türkiye and to systematically examine the data obtained from the studies. Literature search was conducted using keywords such as "Fasciola hepatica, Fascioliasis, Türkiye (Turkey)" from "Pubmed, Google Scholar, Google" databases. In addition, poster presentations presented at congresses of national infectious disease societies on the subject were also included in the study. Eighty-four studies published in Türkiye between 1993-2022 and 183 cases examined in these studies were included in the evaluation. In this review, it was found that Fasciola hepatica infection is not rare in Türkiye, but clinicians were not aware of this and did not consider this infection in the differential diagnosis. It is seen that diagnostic methods such as serological and stool microscopy are not used adequately due to the fact that Fasciola hepatica infection is not considered in the differential diagnosis and the diagnosis methods is not available in every center. As Fasciola hepatica infection is not considered in the preliminary diagnosis and these diagnostic methods are not used sufficiently, we see that cases are often confused with primary or metastatic liver tumors in abdominal imaging, and therefore unnecessary invasive procedures are performed. In regions where Fasciola hepatica infection is endemic, Fasciola hepatica infection should be considered before performing a major surgical procedure in patients with typical clinical findings, elevated liver and cholestasis enzymes, and eosinophilia, and characteristic computed tomography or ultrasonography findings, and noninvasive diagnostic methods should be used first. Fasciola hepatica çıplak gözle kolayca görülebilen bir trematodtur. Koyun ve sığırları infekte etmekle birlikte, bazen insanlarda tesadüfi konakçı olabilmektedir. Bu derleme, Türkiye’de insan Fasciola hepatica ile ilgili yayımlanmış çalışmaları incelemek ve çalışmalardan elde edilen verileri sistematik olarak incelemek amacıyla yapılmıştır. Literatür taraması, “Pubmed, Google Scholar, Google” veri tabanlarından “Fasciola hepatica, Fascioliasis, Türkiye (Turkey)’’ gibi anahtar kelimeler kullanılarak konu ile ilgili tarama yapıldı. Ayrıca konuyla ilgili ulusal enfeksiyon hastalıkları derneklerinin kongrelerinde sunulan poster sunumları da çalışmaya dahil edilmiştir. Türkiye’de 1993-2022 yılları arasında yayımlanan 84 çalışma ve bu çalışmalarda incelenen 183 olgu değerlendirmeye alındı. Bu derlemede Fasciola hepatica enfeksiyonun Türkiye’de nadir olmadığı ancak klinisyenlerin bunun farkında olmadıkları ve ayırıcı tanıda bu enfeksiyonu düşünmedikleri bulunmuştur. Ayırıcı tanıda Fasciola hepatica enfeksiyonun düşünülmemesi ve her merkezde tanı imkanının olmaması gibi nedenlerle, serolojik ve gayta mikroskopisi gibi tanı yöntemlerin yeterince kullanılmadığı görülmektedir. Fasciola hepatica enfeksiyonunun ön tanıda düşünülmemesi ve bu tanı yöntemlerinin yeterince kullanılmaması nedeniyle, abdominal görüntülemede olguların sıklıkla primer veya metastatik karaciğer tümörleri ile karıştırıldığını ve bu nedenle gereksiz invaziv işlemlerin yapıldığını görmekteyiz. Fasciola hepatica enfeksiyonun endemik olduğu bölgelerde tipik klinik bulgusu olan, karaciğer ve kolestaz enzim yüksekliği ile birlikte eozinofilisi olan ve karekteristik bilgisayarlı tomografi ya da ultrasonografi bulguları olan hastalarda majör bir cerrahi girişim yapmadan önce Fasciola hepatica enfeksiyonu düşünülmeli ve öncelikle invaziv olmayan tanı yöntemleri kullanılmalıdır.

Climate change represents a significant global challenge, affecting rainfall and temperature patterns worldwide. The study analyzed climatic trends in two contrasting districts in Indian Himalayan Region viz., Solan district of Himachal Pradesh covering the foothill to mid-hills of Himalayas, and Tehri Garhwal district of Uttarakhand encompassing foothills to the Greater Himalayas. Temperature, precipitation, and soil moisture trends were analyzed using long-term (1964 to 1993 and 1994 to 2023) TerraClimate seasonal raster datasets and nonparametric statistical methods, i.e., the Mann-Kendall test and Sen's slope estimator. During the pre-urbanization period (1964-1993), Tehri Garhwal had increasing winter precipitation (1.71 to 4.93 mm year⁻1) and soil moisture (0.45 to 1.45 mm year⁻1), although a strong decline in monsoon precipitation (- 13.79 to - 2.00 mm year⁻1) with decreasing soil moisture (- 0.15 to 0.07 mm year⁻1) and weak temperature trends. In contrast, Solan experienced increasing winter (1.57 to 2.61 mm year⁻1) and summer precipitation (0.50 to 1.13 mm year⁻1) and soil moisture (0.51 to 1.42 mm year⁻1 in winter; 0.65 to 1.09 in summer), while monsoon (- 0.29 to - 0.47 mm year⁻1) and post-monsoon precipitation declined (- 0.55 to - 0.07 mm year⁻1). During the post-urbanization period (1994-2023), Tehri Garhwal had high spatial variability in monsoon precipitation (- 5.19 to 6.79 mm year⁻1), although Solan experienced a consistent monsoon decline (- 1.78 to - 2.76 mm year⁻1). Winter maximum temperature increased by 0.017-0.034 °C year⁻1 in Tehri Garhwal and 0.024-0.035 °C year⁻1 in Solan. Minimum temperature trends were higher in Solan, particularly during the post-monsoon season (0.044-0.062 °C year⁻1). Tehri Garhwal had declining soil moisture during winter and summer (- 0.82 mm year⁻1) and Solan had near-stable to slightly positive post-monsoon soil moisture trends (- 0.004 to 0.082). The study underscores the urgent need for localized climate adaptation measures to ensure the sustainability of water and land resources under climate change.

A population-based study has reported a higher prevalence of self-reported asthma among the Sámi compared with the general Swedish population. However, it remains unclear whether this reflects a true difference or reporting bias. This study aimed to estimate asthma incidence among the Sámi and compare it with that of the non-Sámi population using register-based data from 1993 to 2018. We conducted a retrospective cohort study using the Sámi electoral roll and the reindeer ownership register to identify Sámi individuals. Each Sámi participant was matched with four non-Sámi controls by age, sex and municipality. Asthma cases were identified through the National Patient Register, covering inpatient and specialist outpatient care. Incidence rate ratios (IRRs) were estimated using sex-stratified Poisson regression models. The study included 13,311 Sámi individuals and 53,219 controls. Sámi men (IRR = 1.19, 95% CI = 1.00-1.41) and women (IRR = 1.23, 95% CI = 1.04-1.45) had higher rates of specialist asthma diagnoses than controls. Sámi men, but not women, also had a higher risk of asthma-related hospitalisation (IRR = 1.43, 95% CI = 1.07-1.90). These findings suggest a higher asthma burden among the Sámi. Further research is needed to clarify underlying risk factors and inform targeted public health interventions.

Building on prior evidence linking self-reflective rumination to creativity, and given the well-established association between creativity and well-being, the present cross-sectional study examined associations between self-reflective rumination and self-beliefs in creativity and well-being (SBCW), with specific attention to the potential indirect role of creative self-efficacy. A large sample of Chinese college students (N = 1993) completed validated questionnaires assessing self-reflective rumination, SBCW (encompassing short-term and long-term dimensions), and creative self-efficacy. Structural equation modeling indicated that self-reflective rumination was significantly and positively associated with short-term SBCW. Furthermore, creative self-efficacy demonstrated a significant indirect association between self-reflective rumination and SBCW across both temporal dimensions, suggesting that constructive self-reflection correlates with stronger beliefs in the positive association between creativity and well-being. These findings highlight robust correlational patterns involving self-reflective rumination, creativity-related beliefs, and psychological well-being. The results also suggest that creative self-efficacy may be concurrently linked to reflective cognitive processes alongside creative behavior. The present study further supports the Creative-Being Model, which conceptualizes self-reflection, creativity, and well-being as interconnected components of human flourishing.

There is growing concern about rising cancer incidence among adults younger than 50 years. This collaborative study within the Spanish Network of Cancer Registries (REDECAN) aimed to examine cancer incidence trends in young adults in Spain. This population-based observational study used data from 15 cancer registries. All newly diagnosed cancer cases in individuals aged 20-49 years between 1993 and 2018 were included. For each sex and cancer site, truncated age-standardized incidence rates per 100,000 person-years were calculated using the European standard population (TASR-E). Temporal trends were assessed using Joinpoint regression analysis to estimate the annual percent change (APC). A total of 153,599 new cancer cases (58% in women) were diagnosed during the study period. Trends were heterogeneous, with more increases observed in women. Incidence rose for kidney (APC=2.5%), thyroid (4.0%), and Hodgkin lymphoma (1.1%) in men and for pancreas (2.0%), Hodgkin (2.1%) and non-Hodgkin (1.7%) lymphoma in women. Several digestive system (stomach, colon, rectum), breast and cervical cancers increased significantly among the youngest adults (<40 years old). In contrast, incidence declined for larynx, lung, urinary bladder, and liver cancers in both sexes (APCs ranging between -3.1% to -8.7%), and for lip, oral cavity, and pharynx cancers in men. In young adults, incidence of smoking-associated cancers has decreased substantially, whereas some obesity-associated cancers have increased among adults 20-39 years old. These findings underscore the need for stronger cancer prevention measures and a better understanding of the rising incidence of some cancers in young adults.

Extended-spectrum &#x3b2;-lactamase-producing Escherichia coli (ESBL-Ec) causing urinary tract infections (UTI) are presumed to originate from poultry, but evidence from resource-limited settings is scarce. We conducted a prospective surveillance of UTI patients alongside food sampling within the same temporospatial context in Dhaka, Bangladesh (2016-2018). A total of 2297 food samples, including 970 poultry meat, 504 fresh produce, 334 fish, 327 eggs, and 162 beef were collected from 24 wet markets and tested for E. coli and ESBL-Ec. During the same period, 110 ESBL-Ec isolates were obtained from 394 UTI patients residing near these markets. Phylogroups of ESBL-Ec from both sources were determined, and representative isolates were subjected to whole-genome sequencing. Additionally, seven-day dietary recall interviews were conducted with 100 ESBL-Ec UTI patients and 200 age- and sex-matched controls. Here we show that 87% (n&#x2009;=&#x2009;1993) of food samples are positive for E. coli while 30% (n&#x2009;=&#x2009;601) contain ESBL-Ec, predominantly in poultry meat (43%), followed by beef (36%), fish (24%), eggs (12%), and fresh produce (6%). Urinary ESBL-Ec isolates are dominated by phylogroup B2 (63%) and ST131 (56%), both absent in food. Poultry isolates show higher diversity compared to urinary isolates. ESBL-Ec ST648, ST38, ST10, ST457 occur in both sources, but core genome SNP analysis shows no clonal relatedness (&#x2009;>&#x2009;22 SNPs). Poultry consumption is not associated with ESBL-Ec UTI, although a seven-day recall may not capture prior colonization events. Overall, UTI-causing ESBL-Ec are genetically distinct from poultry isolates, suggesting that poultry is unlikely to be a major source of UTI in this setting. Urinary tract infections (UTI) are frequently caused by a strain of the bacterium Escherichia coli which produce an antibiotic resistance molecule, making many antibiotics ineffective. Although food animals are suspected sources of these resistant bacteria, evidence from low-income settings is limited. We investigated whether food contributes to UTI-causing antibiotic-resistant E. coli in urban Bangladesh. We compared these E. coli isolated from UTI patients to E. coli from commonly consumed foods collected within the same place and time. Genomic analysis revealed no genetic relatedness between food and clinical isolates. Moreover, dietary consumption of specific foods was not associated with infection risk. Together, these findings indicate that foodborne transmission is unlikely to be a major contributor to UTI-causing antibiotic-resistant E. coli in this region, highlighting the need to explore alternative transmission pathways.

Over the past three decades, music has been increasingly incorporated into stroke motor rehabilitation; however, the term music-based intervention has been applied inconsistently. Interventions range from simple rhythmic cues to complex interactive activities, yet these distinctions are often insufficiently described to allow meaningful comparison across studies. This scoping review examined how music and sound have been conceptualized and applied in stroke motor rehabilitation research published between 1993 and 2023. Ninety-seven studies were identified through major databases. Data were extracted on definitions of music and sound, auditory stimulus characteristics, delivery methods, and provider expertise, followed by numerical and thematic analyses. Substantial heterogeneity was found in how musical elements and auditory designs were reported, with many studies lacking essential information on stimulus structure. Comparative analysis identified three overarching approaches: (1) stimulus-based methods targeting movement timing, (2) task-based methods involving rhythmic or instrumental performance, and (3) process-based methods emphasizing relational and interactive engagement. These approaches were positioned along a continuum ranging from mechanically oriented to relationship-centered interventions. The findings highlight persistent conceptual ambiguity between music and sound and underscore the need for clearer and more systematic reporting of musical parameters. Conceptualizing music as a multidimensional therapeutic component may support stronger integration of neuroscientific and clinical perspectives when explaining mechanisms of stroke motor recovery.

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.

Activating transcription factor 3 (ATF3) functions as a central regulator of metabolic homeostasis across multiple physiological systems. A bibliometric analysis of ATF3 research (1993-2025) demonstrates an exponential growth trend, particularly in metabolic disease research demonstrating a robust 14.15% annual growth rate, underscoring ATF3's emerging importance in metabolic regulation. This review synthesizes current knowledge of ATF3's multisystem regulatory functions, spanning endocrine, cardiovascular, nervous, immune, respiratory, digestive, and urogenital systems, and explores the molecular mechanisms by which ATF3 coordinates cellular stress responses, metabolic adaptation, and tissue-specific homeostasis. Particular emphasis is placed on ATF3's regulation of perivascular adipose tissue (PVAT) and its contribution to obesity-related vascular dysfunction. Atf3 deficiency profoundly alters PVAT structure, adipocyte browning capacity, inflammatory signaling, and insulin sensitivity, establishing ATF3 as a critical determinant of adipose-vascular crosstalk. We further evaluate emerging therapeutic strategies targeting ATF3, including natural compounds (Salvia miltiorrhiza derivatives, sulfuretin) and synthetic modulators (SW20.1, ST32 series), that show promise in experimental metabolic disorders. Current challenges in therapeutic translation include achieving tissue-specific targeting and optimizing drug delivery systems. This comprehensive analysis positions ATF3 as a master regulator linking stress responses with metabolic homeostasis, highlighting its potential as a therapeutic target for obesity-related metabolic and vascular disorders.

Holmium laser enucleation of the prostate (HoLEP) has emerged as an alternative for benign prostatic obstruction (BPO), with fewer perioperative and functional complications. However, its comparative performance relative to robot-assisted simple prostatectomy (RASP) remains debated, requiring updated evaluation. A systematic review and meta-analysis of studies comparing HoLEP and RASP was performed using PubMed, Scopus, and Cochrane databases through August 2025. Outcomes were pooled using mean differences (MDs) and odds ratios (ORs) with random-effects models. Risk of bias assessment and trial sequential analysis were conducted to evaluate the robustness of evidence. Thirteen studies, including 1993 patients, were analyzed. HoLEP was associated with shorter operative time (MD = -32.05 minutes), lower transfusion rates (OR = 0.34), fewer Clavien-Dindo grades III and IV complications (OR = 0.39), and earlier catheter removal (MD = -3.84 days). Postoperative International Prostate Symptom Score modestly favored RASP (MD = 0.96). No significant differences were observed in quality of life, maximum urinary flow rate, International Index of Erectile Function, prostate-specific antigen reduction, postvoid residual volume, estimated blood loss, specimen weight, hospital stay, minor complications, trifecta achievement, or postoperative urge and stress incontinence. HoLEP provides improved perioperative safety with largely comparable functional outcomes compared with RASP. Further high-quality comparative studies are needed to confirm long-term effectiveness.

Ultra-processed food (UPF) consumption has been linked to adverse health effects, yet findings from prospective cohort studies on mortality remain inconsistent. This study included 82,221 participants from the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. At baseline (1993-2001), dietary intake was assessed using the Baseline Questionnaire (BQ) and validated Dietary History Questionnaire (DHQ). UPF intake was defined according to the NOVA classification system. Daily food intake (g/day) was estimated from reported frequency and portion size, and energy and nutrient intakes were computed using the DietCalc analysis program. Mortality outcomes, including all-cause, cancer, circulatory system diseases, nervous system diseases, and other causes, were ascertained. Multivariable Cox models were used to estimate the associations between UPF intake and all-cause and cause-specific mortality. During a median 17-year follow-up, 24,237 deaths occurred. No association was found between UPF intake and cancer mortality. Despite this, the highest UPF intake quarter, relative to the lowest, was associated with a 10% higher risk of all-cause mortality (HR: 1.10, 95% CI: 1.06-1.14), a 9% higher risk of circulatory system diseases mortality (HR: 1.09, 95% CI: 1.02-1.17), a 20% higher risk of nervous system diseases mortality (HR: 1.20, 95% CI: 1.06-1.37), and a 28% higher risk of mortality from other causes (HR: 1.28, 95% CI: 1.18-1.39). In the joint analysis of UPF intake and diet quality assessed by the Healthy Eating Index-2015 (HEI-2015), no consistent association was observed between UPF intake and mortality within most HEI-2015 quarters. However, among individuals in the highest quarter of UPF intake, those with the highest HEI-2015 scores had a significantly lower mortality risk than those with the lowest HEI-2015 scores, suggesting that higher diet quality may attenuate the adverse effect of high UPF consumption. Our study showed that a higher consumption of UPF was linked to increased mortality in all-cause, as well as in circulatory system diseases, nervous system diseases and other causes diseases.

Most patients with opioid use disorder have experienced traumatic events; however, sex differences in trauma exposure, its timing, and its association with treatment outcomes remain unclear. Of the 1194 patients admitted to a methadone maintenance treatment (1993-2025), 923 completed an intake questionnaire assessing traumatic events and their timing relative to substance use (before, during, "always", or "never"). Predictors of long-term retention were examined using Kaplan-Meier analyses and a Cox multivariate model. Of 923 participants, 23.5% were female, and 74.4% reported trauma. Males (35.7%) more often reported trauma during substance use than females (27.6%), whereas females more frequently reported trauma occurring "always" (31.3%) than males (22.2%; p=0.024). Interpersonal trauma category was more prevalent in females (59% vs. 40.2%, p<0.001) with no differences in physical trauma (50.8%) and self-directed harm (38.8%). The age of opioid initiation was comparable between sexes but females were admitted to MMT younger. Substance use at admission was comparable between sexes, as were one-year and long-term retention (mean=9.8 years, 95% CI 9.1-10.6). Long-term retention between trauma timing groups and trauma categories were comparable, also when stratified by sex. Sex-specific differences emerged only when trauma type and timing were considered. Specifically rape history was associated with shorter retention among males but not females. Traumatic experiences differed between sexes but were not associated with long-term retention and did not change the comparable outcomes between sexes. A bigger sample is needed to confirm the findings of shorter retention in male who experienced rape.

The mechanism underlying pathways between H. pylori infection, gastric atrophy, and esophageal adenocarcinoma (EAC) is yet to be quantitatively investigated. 435 patients with EAC and 1298 cancer free subjects were included from the International Barrett's and Esophageal Adenocarcinoma Consortium (BEACON). Samples collected from 1993 to 2004. Gastric atrophy was determined by serum pepsinogens. H. pylori infection was assessed by antibodies against 15 antigens. Logistic regression models were fitted to estimate odds ratio, to quantify the association between antibodies and gastric atrophy. The 4-way decomposition of the overall effect in natural direct and indirect effects was used to measure the intermediate effects of mediators between H. pylori and EAC, while also considering their role as effect modifiers. Seropositivity for 15 H. pylori antigens was associated with a lower risk of EAC; the ORs ranged from 0.44 (95% CI; 0.40-0.49) to 0.91 (95% CI; 0.84-0.98). Seropositivity for multiple antigens was also associated with a reduced risk of EAC. The effect of H. pylori infection was not mediated through gastric atrophy, body mass index (BMI), and gastroesophageal reflux disease (GERD), whether these factors were examined individually or jointly, as the estimates of natural indirect effects were close to 0. This study confirmed the inverse association between H. pylori and EAC, which was not mediated by gastric atrophy nor the combination with BMI and GERD. It suggests refining EAC risk prediction models and exploring other potential mediators and pathways between H. pylori and EAC.

As health systems globally are facing unprecedented demands, allied health clinicians undertaking advanced practice (AP) roles are increasingly supporting medical professionals, improving health system efficiencies and outcomes. The aim of this mixed methods systematic review was to identify what AP roles dietitians are undertaking and examine how these roles align with the British Dietetic Association (BDA) definition of AP. A systematic review of the literature was conducted on the 22nd August 2025 via MEDLINE, CINAHL and Web of Science with the following inclusion criteria; English language, peer-reviewed journals articles of any date describing dietitians undertaking AP roles as critiqued by the reviewers against the BDA AP capabilities pillars of advanced practice. Papers not published in the English language, conference abstracts, grey literature and studies describing entry level dietitian roles/routine nutrition care were excluded. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tools, synthesis followed the JBI convergent integrated approach to mixed methods systematic reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement 2020 (PRISMA 2020) was used to guide reporting. Of the 2209 studies identified by the search strategy, six studies were included in the systematic review. Dates of publication ranged from 1993 to 2014, with papers from the United States of America (n&#x2009;=&#x2009;5) and the United Kingdom (n&#x2009;=&#x2009;1). Studies included four original research studies, one Delphi survey and one narrative review. Five specialist area AP roles were identified; inherited metabolic diseases (IMD) dietitian, advanced level specialist practitioner (in paediatric, metabolic, renal specialties) and advanced level practitioners in diabetes and two generalist roles. Key themes were synthesized for each of the BDA AP pillars within the included studies. Despite interest in AP internationally, this systematic review identified only a small number of dietetic roles meeting all BDA AP pillars. Geographical, jurisdictional and dietetic association differences in definitions of AP, along with apparent underreporting in the literature, suggest this review likely understates the depth and breadth of contemporary dietetic AP. High-quality research published by dietitians practicing at an advanced level, clearly stating alignment with AP definitions/frameworks is required to solidify the value of dietetic AP within the global health system. No funding was sought for this review. PROSPERO: Registration Number CRD420251127046 (https://www.crd.york.ac.uk/PROSPERO/view/CRD420251127046).

Understanding genetic variability of Plasmodium falciparum (Pf) is essential for addressing malaria transmission patterns and formulating effective treatment strategies. This study aims to examine the genetic structure of Indian Pf population over the past three decades by analysing the evolving patterns of Pfmsp1 and Pfmsp2 genes and the prevalence of Pfcrt-resistant genotypes, while exploring their correlation with infection clonality. A total of 304 malaria-positive samples from 14 Indian states between 1993 and 2023 were analysed. Allelic polymorphism of Pfmsp1 and Pfmsp2 was assessed using PCR, while Pfcrt genetic polymorphism was analysed via amplicon sequencing. Period-wise, multiplicity of infection (MOI) for both Pfmsp1 and Pfmsp2 peaked in 1990s, declining over time, with the lowest MOI observed during 2020-2023. K1 allele of Pfmsp1 and FC27 allele of Pfmsp2 were the most prevalent. Clonality varied significantly across six Indian regions and four time periods. The K76T mutation in Pfcrt, a marker for chloroquine resistance, was predominant in 83.54% of samples. The K1 allele was significantly associated with CVMNK (P&#x2009;=&#x2009;0.026), FC27 with SVMNT (P&#x2009;=&#x2009;0.005), and IC/3D7 with both CVMNK and CVIET haplotypes (P&#x2009;<&#x2009;0.001). The study also included analysis of Indian and global distribution of Pfcrt genotypes. The decline in MOI and polyclonality of Pf populations highlights the success of ongoing malaria control strategies. However, chloroquine-sensitive Pf parasites have yet to re-emerge, as resistant strains continue to persist. To monitor the sensitivity towards chloroquine, molecular surveillance needs to be carried out regularly along with in-vivo studies. The online version contains supplementary material available at 10.1007/s12088-025-01519-3.

Despite regulatory initiatives to improve female representation in clinical trials, sex-based disparities persist, particularly in oncology. This is of concern given the rising burden of lung cancer in women. We aimed to quantify female representation in lung cancer clinical trials over the past three decades and to examine whether trial-level differences in female enrolment were associated with differences in reported adverse events (AEs). We conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) evaluating drug therapies for lung cancer, identified through PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from Jan 1, 1993, to April 1, 2025. Two reviewers independently assessed study eligibility, extracted data, and evaluated risk of bias. Enrolment incidence disparity (EID) was calculated to assess female representation. Reported incidence of AEs was analysed in relation to female representation across treatment settings. This study is registered with PROSPERO (CRD42024537925). Among 44,915 records identified, 636 studies comprising 265,989 participants were included. Most studies were judged to be at low risk of bias (83%), whereas 3% were at high risk. The pooled EID was -3.17% (95% CI: 4.10, -2.24), indicating underrepresentation of women overall, particularly in trials conducted in very high Human Development Index (HDI) settings, including Europe, Oceania, and North America. Underrepresentation was also observed across several trial subgroups, including younger populations, predominantly Caucasian populations, and selected disease-stage strata. Trial-level differences in female representation were associated with differences in reported AE incidence across treatment settings. Women remain underrepresented in lung cancer RCTs, which may limit the generalisability of trial findings to female patients. Trial-level differences in female representation were associated with differences in reported AE incidence, supporting the need for more inclusive recruitment and more transparent sex-disaggregated safety reporting.

National Institutes of Health (NIH) investment in artificial intelligence (AI) within surgical specialties is rapidly expanding, yet whether funding aligns with disease burden or reflects structural disparities remains unclear. Cross-sectional analysis of NIH RePORTER (1993-2024) identified 1,657 AI grants across eight surgical specialties. Multivariable regression of 976 grants to 379 investigators (2021-2024) evaluated associations between funding and 2021 disability-adjusted life years (DALYs), adjusting for region, investigator sex, and degree. Primary endpoints were total funding and grant number relative to disease burden; secondary analyses assessed regional and investigator variation. NIH AI funding was not associated with disease burden after adjustment (funding: IRR 1.00, 95% CI 0.99-1.01, p>0.9; grant number: IRR 0.93, 95% CI 0.87-0.99, p=0.033). Funding per DALY varied widely across disease categories without proportional allocation to higher-burden conditions. Regional disparities were evident: compared with the Midwest, the South received more grants (IRR 1.46, 95% CI 1.10-1.94) but lower per-grant funding (IRR 0.79, 95% CI 0.65-0.94). Female investigators received fewer grants than male investigators (IRR 0.69, 95% CI 0.57-0.84), although per-award funding was similar. NIH funding for AI research in surgical specialties is not aligned with disease burden and instead reflects regional and investigator-level variation. These findings identify structural disparities in funding allocation and establish a benchmark for policy efforts to better align AI research investment with population health needs.Pr&#xe9;cis: Analysis of 1,657 NIH grants for AI research in surgical specialties found funding was not associated with US disease burden, and correlated with regional and investigator characteristics. We highlight the need for further research into factors driving allocation in this emerging field.