搜索结果：2019

Embryo cryopreservation plays an essential role in assisted reproductive technology (ART). Vitrification has gradually replaced slow-freezing of embryos. In this study we investigated the effects of embryo vitrification on neonatal and maternal health. The retrospective study involved 19,752 in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles performed at the Reproductive Medicine Center in Women's Hospital, School of Medicine, Zhejiang University between October 2014 and September 2019. 7707 singletons got live birth, among which 427 were born after transfer of vitrified embryos, 3737 slow-frozen and 3543 fresh. Neonatal and maternal outcomes of singleton liveborns following transfer of vitrified were compared with slow-frozen and fresh embryos. Logistic regression analysis was conducted to adjust for possible confounders. Transfer of vitrified embryos was comparable with slow-frozen embryos in low birth weight, macrosomia, small/large for gestational age (SGA/LGA) and birth defects. When compared with transfer of fresh embryos, transfer of vitrified embryos was associated with a higher risk of hypertensive disorders in pregnancy (HDP) aOR 7.12 (3.82-13.06), postpartum hemorrhage (PPH) aOR 6.81 (3.15-14.48) and cesarean section aOR 1.67 (1.34-2.10). No statistical differences were found for birth defects. There was a rising trend in birth weight, fetal macrosomia and LGA, as well as a declining trend in LGA after transfer of vitrified embryos compared to fresh embryos, though no statistical differences were found for risks. Transfer of vitrified embryos was comparable in birth weight and birth defects with slow-frozen embryos. When compared with fresh embryo transfer, transfer of vitrified embryos showed higher risks of HDP, PPH and cesarean section, and a rising trend in birth weight, which needs further follow-up. IRB-20190052, 6th June 2019 retrospectively registered.

Physical activity (PA) is a key modifiable factor for elevated blood pressure (EBP). We aimed to clarify the evolving relationships between PA and EBP in childhood or adolescence by examining multilevel factors within an ecological model. National data were extracted from 2010, 2014, and 2019 cycles of the Chinese National Survey on Students' Constitution and Health, using a multistage stratified cluster sampling design. We defined EBP by the updated Chinese reference standards and obesity by sex- and age-specific body mass index (BMI) cutoffs. Inadequate PA was defined as <1 h/day; ecological factors at society-, school-, and individual-level were collected through a questionnaire. Multilevel logistic regression, interaction analyses, and population-attributable fractions were used to evaluate associations between multilevel ecological factors related to PA and EBP. We included 642,386 participants (7-18 years). The EBP prevalence increased from 13.6% to 17.9% alongside increasing obesity, while inadequate PA decreased in prevalence. Inadequate PA was associated with EBP in 2010, with the odds ratio (OR) of 1.17 (95% confidence interval [CI]: 1.04, 1.21) but attenuated during 2010-2019. The multilevel factors related to PA displayed interactions to reduce EBP risk (P for interaction <0.05). At the societal-level, urban residence was protective against EBP, whereas a lack of exercise facilities increases the odds. At the school-level, inadequate physical education and sports competitions, coupled with unhealthy dietary lifestyles at the individual-level, contributed to EBP (P <0.05). The contributions of individual-level ecological factors related to PA decreased but of societal- and school-level increased on EBP, independent of obesity. A rise in EBP burdens during 2010-2019 contrasted with an increase in PA. PA-related ecological factors across society-, school-, and individual-level exhibited complex interactions on EBP. Although the impact of individual-level lifestyles on EBP was waning and obesity remained a primary concern, there was increased recognition of societal- and school-level's ecological factors related to PA during 2010-2019. Promoting PA requires a comprehensive approach that addresses both facilitating and inhibiting factors, which is crucial for healthy blood pressure (BP).

Transfusion transmissible infections (TTIs) such as Human Immunodeficiency Virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis, remain a major public health concern in low-income countries due to inadequate blood donation systems. This highlights the urgent need for continuous surveillance and a deeper understanding of the factors associated with TTIs in Rwanda. A retrospective cross-sectional study analyzed voluntary blood donor records from the National Center for Blood Transfusion (NCBT) in Kigali, Rwanda, spanning January 2019 to December 2023. A census of all available records was used to select 38,345 eligible donors aged 18-60 years. Data were extracted from electronic databases and analyzed using SPSS version 25, with chi-square tests and multivariate logistic regression to identify predictors of transfusion-transmissible infections. The overall prevalence of transfusion-transmissible infections declined from 2019 to 2023, with HBV decreasing from 0.76% to 0.41%, HCV from 0.30% to 0.18%, HIV remaining stable at 0.04%-0.08%, and syphilis slightly increasing to 0.26%. Multivariate analysis showed that male gender was independently associated with HBV (aOR&#x2009;=&#x2009;2.60, 95% CI: 1.54-4.38, p&#x2009;<&#x2009;0.001) and HIV (aOR&#x2009;=&#x2009;3.84, 95% CI: 1.63-9.05, p&#x2009;=&#x2009;0.002). First-time donor status was independently associated with higher odds of HBV (aOR&#x2009;=&#x2009;4.09, 95% CI: 2.26-7.39, p&#x2009;<&#x2009;0.001) and HIV (aOR&#x2009;=&#x2009;2.95, 95% CI: 0.77-11.34, p&#x2009;<&#x2009;0.001). Gasabo district was independently associated with lower odds of HBV (aOR&#x2009;=&#x2009;0.56, 95% CI: 0.34-0.90, p&#x2009;=&#x2009;0.017) and higher odds of HCV (aOR&#x2009;=&#x2009;2.34, 95% CI: 1.25-4.40, p&#x2009;=&#x2009;0.008), relative to Nyarugenge. TTI prevalence among Kigali blood donors remained low with declining HBV and HCV trends from 2019 to 2023, while HIV rates stayed consistently low. Male gender, older age, first-time donor status, and specific occupations were independently associated with TTI positivity. Rwanda's blood screening protocols appear effective, though targeted interventions for high-risk groups and continued surveillance are recommended. Not applicable.

In 2022, the Swedish Women's Elite Ice Hockey League (SDHL) became the first women's league to introduce bodychecking. Using insurance data, this study examined injury incidence before and after the implementation of this rule. Since 2019, the SDHL has comprised 10 teams with 20-25 players on each. All players in SDHL have license insurance to take care of ice hockey injuries. All injuries that lead to contact with the insurance company are registered in a database. The insurance covers accidental injuries occurring during matches, organized team practices, hockey school sessions, and direct travel to and from these activities. Injury data from all seasons between 2019-2020 and 2024-2025 were analyzed. Injury rates (IR) per 1,000 player-game hours were calculated and compared across seasons and between pre-implementation (2019-2022) and post-implementation (2022-2025) periods. A total of 120 injuries were recorded among 92 players. IR per 1,000 player-game hours increased from 6.6 (95% CI 3.8-10.7) in season 2021-2022 to 16.7 (11.6-23.2) in 2022-2023, with moderately elevated rates remaining in subsequent seasons. When grouped by period before and after body checking implementation, IR increased from 6.0 (4.4-8.1) pre-implementation to 11.0 (8.6-13.7) post-implementation (p&#x2009;<&#x2009;0.05). The injury incidence was highest during the first season with body checking and declined in subsequent seasons compared with this initial post-implementation peak. The introduction of body checking in the SDHL was associated with a significant increase in injuries recorded through the insurance system, indicating that this rule change may lead to a higher injury burden. More research on this topic is needed if body checking is to be widely incorporated into women's ice hockey.

Biobanks have evolved from simple repositories into complex research infrastructures that require robust governance frameworks to ensure traceability, data integrity, and operational reliability. ISO 20387 provides internationally harmonized accreditation standards for biobanking; however, empirical evidence evaluating its organizational impact remains limited. We conducted a longitudinal observational study of a hospital-based biobank between 2019 and 2025. ISO 20387 accreditation obtained in 2022 was considered the structural intervention point in the analysis. Governance and quality indicators were evaluated across the sample lifecycle, including labeling error rate, metadata completeness, traceability completeness, nonconformity rate per 100 aliquots, on-time processing, and Corrective Action and Preventive Action (CAPA) closure time. Operational activity expanded substantially during the study period, with annual aliquot production increasing from 2142 aliquots in 2019 to a peak of 7668 in 2022. Governance indicators improved progressively during the pre-accreditation phase and stabilized following accreditation. Metadata completeness increased from 74% to 86% before accreditation to 99%-100% afterward, while traceability completeness rose from 71%-73% to 98%-99%. Nonconformity rates declined from 2.03-2.43 per 100 aliquots before accreditation to 0.75-0.90 afterward. On-time processing improved from 87%-93% to 98.5%-99%, and median CAPA closure time decreased from 53-63 to 39-42 days. ISO 20387 accreditation was associated with structural stabilization of governance processes in a hospital-based biobank undergoing substantial operational expansion. These findings suggest that accreditation can act as a catalyst for governance maturation, helping biobanking infrastructures maintain operational control and quality performance while scaling activity.

and Purpose: Postoperative gastrointestinal dysfunction (POGD) is a significant complication following abdominal surgery and is characterized by delayed flatus and stool passage, postponed oral feeding, and dyspeptic symptoms. The study aimed to evaluate whether transcutaneous electrical acupoint stimulation (TEAS) accelerates gastrointestinal function recovery and reduces POGD-related complications after elective laparoscopic non-gastrointestinal surgery. Patients scheduled for selective non-gastrointestinal laparoscopic surgery were randomized into the TEAS or sham-TEAS group. TEAS group patients were administered electrical stimulation at acupoints Zusanli (ST36), Neiguan (PC6), and Hegu (LI4) starting 30&#x202f;min prior to anesthesia induction and continuing until surgery completion. Patients in the sham-TEAS group received a sham stimulus at the same acupoints, and no output current was delivered by disconnecting the device's output line. Our primary endpoint included the time to first flatus, whereas the secondary endpoints were the time to first defecation, postoperative nausea and vomiting (PONV) rate, length of hospital stay, hospital expenses, numeric rating scale (NRS) pain score, and incidence of postoperative complications. A total of 587 patients were enrolled and assigned to the TEAS (n&#x202f;=&#x202f;294) or sham-TEAS (n&#x202f;=&#x202f;293) group between May 15, 2019, and October 18, 2021. Compared with the sham-TEAS group, the TEAS group had a significantly shorter time to first flatus (median [interquartile range (IQR)], 21.50&#x202f;h [19.0-23.5&#x202f;h] vs. 23.5&#x202f;h [21.0-26.0&#x202f;h]; p&#x202f;<&#x202f;0.001) and time to first defecation (41.2&#x202f;h [38.5-45.0&#x202f;h] vs. 46.0&#x202f;h [42.0-52.0&#x202f;h]; p&#x202f;<&#x202f;0.001). Additionally, the TEAS group showed lower rates of PONV (15% vs. 22.9%; p&#x202f;=&#x202f;0.015) and abdominal distention (21.1% vs. 29.7%; p&#x202f;=&#x202f;0.017), as well as lower NRS pain scores (median [IQR], 3 [2-3] vs. 3 [2-3.5]; p&#x202f;=&#x202f;0.026). There were no significant differences in hospital stay length and hospitalization expenses. TEAS accelerates gastrointestinal function recovery in patients undergoing laparoscopic non-gastrointestinal surgery, reducing PONV, abdominal distention and postoperative pain without increasing hospital stay or costs.

End-stage kidney disease continues to disproportionally impact the lives of First Nations(FN) peoples. This paper examines the trajectory of chronic kidney disease (CKD) care in FN individuals who started dialysis. We used health administrative data held at the Manitoba Centre for Health Policy (MCHP) for the period of 2000-2019, which was linked to the Manitoba First Nations Research File to identify Registered FN. Data we used included: Diagnostic Services Manitoba Laboratory Data, Medical Claims, Hospital Discharge Abstracts, Drug Program Information Network Data, Public Canadian Census Files, Manitoba Health Insurance Registry, and Physician Resource File. All records are de-identified. Our primary outcome was to assess the frequency of uninformed dialysis starts among FN. We identified 1,686 FN people who started dialysis during the study period. Of those, 396 (23.5%) started dialysis within three months of their first nephrology visit. We compared those initiating dialysis within 3 month to other FN with longer nephrology follow-up: as a group, FN initiating dialysis within 3 month of their first nephrology visit were more unwell as evidenced by a significantly higher Elixhauser co-morbidity index (5 vs. 3 P&#x2009;<&#x2009;0.001), hypertension (70.7% vs. 57.1% p&#x2009;<&#x2009;0.001) and congestive heart failure (31.1 vs17.4% P&#x2009;<&#x2009;0.001). Primary care visits in all FN groups with CKD occurred in over 95% and CKD screening was similar in all groups at over 40% a year prior to the first nephrology visit. Less than 70% of FN with CKD were on appropriate preventative medications (69 vs. 68% p&#x2009;=&#x2009;NS)) IMPLICATIONS: Improvements in primary prevention at the primary care level are needed to avoid late nephrology referrals and improve overall care of FN with CKD.

Central Serous Chorioretinopathy(CSC) is a chorioretinal disorder, predominantly affects young to middle-aged adults, resulting serious vision disorder. This study aimed to develop a Bayesian network model to predict the key factors influencing the early therapeutic efficacy of 577&#xa0;nm-SML in patients with CSC. A total of 159 patients (159 eyes) diagnosed with CSC and treated with 577&#xa0;nm-SML at the First Affiliated Hospital of Guangxi Medical University from January 2019 to November 2023 were retrospectively analyzed. Baseline data including age, sex, eye side, disease course, and past medical history were collected. Ophthalmic imaging detects central macular thickness (CMT), macular foveal volume (MFV within 1mm, 3mm, 6mm diameter), height and area of subretinal fluid (SRF), structural changes in the outer retinal layers (ORL), type and area of leakage lesions, etc. Influential variables significantly associated with 577nm-SML efficacy were screened using LASSO regression, then construct a Bayesian network model to predict factors that significantly affect the therapeutic effect. LASSO regression identified 19 significant variables related to treatment outcomes from the 40 possible risk factors included, including disease duration, sex, eye Side, smoking, hormone, macular foveal volumes (3 mm and 6 mm diameters), and the height and area of SRF, ORL integrity, typical PED, location of PED, location of RPE bulging, heterogeneity of NPL, HF of ORL, HF of choroid, leakage type, leakage location, leakage correlate with OCT. The Bayesian network presents complex interactions among these factors, shows that patients with smaller macular foveal volumes (within 3 mm diameter), shorter disease duration, and focal leakage exhibited superior responses to 577nm-SML treatment. The therapeutic response to 577nm-SML in CSC is influenced by multifactorial dynamics. Bayesian network can well present the complex network relationship between the therapeutic effect of 577nm-SML and related influencing factors, and identify potential risk factors that affect early efficacy.

This retrospective naturalistic study compared response patterns and tolerability of high-frequency left-DLPFC repetitive transcranial magnetic stimulation (rTMS) in patients with major depressive disorder (MDD) and bipolar depressive disorder (BD) under real-world clinical conditions. A total of 161 patients (95 MDD, 66 BD) who completed 20 sessions of 10&#x2009;Hz rTMS between 2019 and 2023 were evaluated. Diagnoses were established using the SCID-5. Symptom severity was assessed with the Hamilton Depression Rating Scale (HAM-D). Response was defined as &#x2265;50% HAM-D reduction, remission as post-treatment HAM-D&#x2009;&#x2264;&#x2009;7. Multivariate logistic regression identified independent predictors of response. The MDD group demonstrated a significantly higher response rate than the BD group (48.4% vs. 28.8%; p&#x2009;=&#x2009;0.013), while remission rates were comparable (21.1% vs. 21.2%; p&#x2009;=&#x2009;1.000). Female patients exhibited higher response rates in both groups, reaching significance in MDD (58.8% vs. 36.4%, p&#x2009;=&#x2009;0.029). Multivariate analysis confirmed diagnosis (OR = 2.25, p&#x2009;=&#x2009;0.025), female sex (OR = 2.35, p&#x2009;=&#x2009;0.014), and lower baseline HAM-D scores (OR = 0.85, p&#x2009;=&#x2009;0.018) as independent predictors of response. rTMS was well tolerated, with mild transient side effects in 36.6% of participants and only one hypomanic activation. In this naturalistic sample, MDD showed a higher response than BD, while remission rates were comparable. Given the retrospective, completer-based design and asymmetric sampling, these findings are exploratory and should inform future controlled studies rather than current clinical practice. Under real-world conditions, rTMS produced significantly higher response rates in unipolar depression (48.4%) than in bipolar depression (28.8%), while remission rates were comparable (21.1% vs. 21.2%).MDD diagnosis, female sex, and lower baseline HAM-D scores independently predicted treatment response.rTMS was well tolerated in both diagnostic groups, with a low rate of affective switching in patients with bipolar depression.These exploratory findings suggest that diagnostic subtype may be associated with rTMS response and that alternative stimulation strategies for bipolar depression merit further study; they do not, by themselves, have direct clinical-implementation implications.Further controlled studies with larger samples and longer follow-up are needed to validate these results.

The hospital discharge process entails substantial challenges, particularly among older multimorbid patients with a high risk of subsequent readmission and/or death. Discharging hospitals often face a decision regarding whether such patients should be discharged to a short- or long-term stay at a nursing home, or sent home with community-based support services. Therefore, the aim of this study was to investigate the impact of these forms of post-hospital care on readmissions and mortality. We used data from national Swedish health-, and social care registries from 2015 to 2019 to perform a retrospective analysis using a target trial emulation design. The study included patients above 65 years of age with multimorbidity who were community dwelling prior to hospitalization and subsequently discharged to either a nursing home or back to their own residence with formal home care interventions. To estimate the average treatment effect on the treated of nursing home vs. in-home care, each hospital discharge to a nursing home was matched to a discharge to home care using a propensity score generated by a gradient boosting model based on the patient's previous medical and social care history. Outcomes were assessed using a double robust approach consisting of survival analysis with statistical adjustment for residual confounding. Hospital discharges to nursing homes had a lower risk of hospital readmission across 7-, 30- and 90-day endpoints, with hazard ratios of 0.64, 0.77, and 0.85 respectively. Short term (7&#xa0;day) mortality was similar between hospital discharges to home care and nursing homes (HR 0.92), but higher at 30 and 90 days among nursing home discharges (HR 1.32 and 1.54, respectively). Our findings suggest benefits of nursing home care in terms of reduced readmission, especially in the short-term. While short term mortality was similar between groups, longer term mortality was higher for nursing home discharges, which may be the result of differences in care practices or unmeasured confounding. Taken together, the study suggests that the strongest impact of NH care is in the short term, while further research is needed to validate the results, particularly regarding longer-term mortality.

Low birth weight (LBW) is a serious global health issue that is indicative of an increased risk of newborn illness and mortality. LBW refers to a newborn weighing under 2,500&#xa0;g (5.5 pounds) at birth, primarily due to either poor fetal growth, premature labor, or both. It is more prevalent in low and middle-income countries than in high-income countries. The entire study has been completed with the help of secondary data collected from the NFHS-5 of India, a cross-sectional national representative survey conducted from 2019 to 2021. In this study, the low birth weight of children is considered as an outcome variable. Based on previous research, various socio-economic and demographic variables were selected in this study. This study used Pearson's chi-square statistics and multivariable binary logistic regression to identify the association between low birth weight of children and maternal anemia and BMI (Body Mass Index). And descriptive statistics is also performed to analyze the data. The result shows that there is significant association between the maternal anemia and BMI with the occurrence of low birth weight. It is found that the occurrence of low birth weight is higher among severely anemic women and underweight women. Additionally, the prevalence of LBW is high among those women who use cigarettes and tobacco, and those children of multiparity, are female children, and are from central, western, and northern regions. So, it can be said that maternal anaemia and BMI is correlated with the prevalence of low birth weight among children. Hence, implementing appropriate interventions for pregnancy care and ensuring well-planned nutrition can significantly alleviate the challenges associated with LBW in India.

The COVID-19 pandemic has raised concerns about adverse effects on youth mental health, including suicidal behavior. While suicide mortality remained stable in many countries, less is known about temporal changes in suicide attempts presenting to clinical services. This study examined trends in psychiatric emergency presentations following suicide attempts among children and adolescents across COVID-19 pandemic phases and their association with the intensity of governmental containment measures. A retrospective analysis was conducted at a tertiary care center in Vienna, Austria, between January 2019 and December 2023, distinguishing pre-pandemic, pandemic, and post-pandemic periods. COVID-19 containment stringency was quantified using the Oxford COVID-19 Government Response Tracker Stringency Index. Temporal changes in monthly suicide attempt presentations were analyzed using Poisson regression models, adjusting for linear time trends. A total of 6,319 psychiatric emergency presentations were recorded, including 722 presentations following suicide attempts (11.4%). Compared with the pre-pandemic period, suicide attempt-related presentations increased significantly during the pandemic (RR&#x2009;=&#x2009;1.80, p < .001), while the post-pandemic period did not differ significantly from pre-pandemic levels. Higher monthly suicide attempt presentation rates were associated with greater containment stringency (RR per point&#x2009;=&#x2009;1.007, p < .001). An independent upward temporal trend in suicide attempt presentations was observed across the study period. Associations with policy stringency and persistent temporal trends suggest that suicide attempts may serve as an indicator of psychosocial burden not captured by mortality data alone. Continuous monitoring of emergency presentations and access to low-threshold mental health support are necessary beyond periods of acute crisis.

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder and a leading cause of kidney failure. Although typically considered an adult-onset condition, a subset of patients present in utero or within the first 18 months of life (very early-onset ADPKD; VEO-ADPKD). This subgroup may experience a more severe disease course. A systematic search of MEDLINE was conducted to identify studies reporting clinical, genetic, radiologic and kidney outcome data in children (<&#x2009;18 years) with VEO-ADPKD. Case series including fewer than three VEO-ADPKD patients were excluded. ADPKD diagnosis was based on 2019 international consensus radiologic criteria, including age-appropriate cystic and/or enlarged kidneys, with supportive family history and/or genetic confirmation. Children with non-VEO-ADPKD reported within the same studies were included for comparison. Outcomes of interest included inheritance patterns, genetic profile, hypertension, proteinuria, chronic kidney disease (CKD), kidney failure, and perinatal death. Descriptive analyses and Bayesian model-averaged random-effects meta-analyses were performed using JASP (version 0.9.13) with a conditional model specification. A non-informative Beta (1,1) prior was used. Nineteen studies comprising 736 ADPKD children (VEO: 335, non-VEO: 401) met inclusion criteria. Bayesian model-averaged meta-analysis (8 studies) showed higher odds in VEO-ADPKD for hypertension (OR 2.08, 95% CrI 1.00-2.70; BF&#x2081;&#x2080; 18.2), proteinuria (OR 1.58, 1.00-2.60; BF&#x2081;&#x2080; 4.0), CKD (OR 1.77, 1.00-2.66; BF&#x2081;&#x2080; 7.4) and kidney failure (OR 1.99, 1.00-2.69; BF&#x2081;&#x2080; 10.6). Evidence for maternal inheritance in VEO-ADPKD was weak (OR 1.31, 1.00-2.44; BF&#x2081;&#x2080; 1.6). Biallelic PKD1 mutations (38/158 vs. 0/147) and perinatal death (34/320 vs. 0/401) occurred exclusively in the VEO group and are reported descriptively, as complete separation precluded pooled estimation. VEO-ADPKD represents a distinct, high-risk pediatric phenotype characterized by earlier and more severe kidney involvement. These findings emphasize the importance of early diagnosis, comprehensive genetic evaluation, and close monitoring. Genetic testing is essential to identify children with biallelic mutations, representing a clinical entity more akin to mild autosomal recessive polycystic kidney disease. Standardized phenotyping and prospective pediatric studies are needed to guide early therapeutic interventions and improve long-term outcomes in this rare population. NA.

In-work poverty (IWP) affects individuals who are employed but have an equivalised disposable household income below 60% of the national median. While IWP is associated with poorer mental health, it remains unclear whether escaping IWP reduces mental health risk or whether adverse effects persist after upward mobility. This study examines whether escaping IWP reduces mental health risk in Sweden, and whether moving moderately versus substantially above the poverty line differentially affects outcomes. This cohort study included 93,962 Swedish workers aged 24-60 who were in IWP in 2012. Escaping IWP was defined as moving from IWP in 2012 to either "moderately above" (60-100% of the median) or "substantially above" (>100% of the median) the poverty line in 2013, with those remaining in IWP as the reference group. Outcomes were first-diagnosed mental health disorders and first SSRI prescriptions during 2014-2019. Sex-stratified Cox regression models estimated crude and adjusted hazard ratios (AHRs) with 95% confidence intervals. Moving moderately above the poverty line was not associated with a significantly lower risk of either outcome. Men who moved substantially above the poverty line had a significantly lower risk of diagnosed mental health disorders (AHR 0.65, 95% CI 0.50-0.84) and SSRI prescriptions (AHR 0.85, 95% CI 0.74-0.97). No significant associations were observed among women. Escaping IWP yields greater mental health benefits for men than women, and only substantial income gains were associated with improved outcomes. Policies should address not only IWP reduction but also the adequacy and stability of upward mobility pathways.

To identify trajectories of frailty as older men age and to assess the associations between sociodemographic, lifestyle, and health factors with those trajectories. Community-based cohort study. Data from 1319 men aged 71 years or older, residing in Western Australia and participating in the Health in Men Study. Frailty was assessed on at least 2 occasions between 2001 and 2019 using the five-point FRAIL scale that measures fatigue, resistance, ambulation, illnesses, and weight loss. Latent frailty trajectories over age were identified using a group-based trajectory model with an extension to allow for participant attrition because of death. Multinomial logistic regression was used to assess differences in sociodemographic, lifestyle, and health factors between the frailty trajectory groups. Sensitivity analyses were performed to assess the impact of including/excluding participants who dropped out. During follow-up, 999 (66.9%) participants died. Four distinct frailty trajectories were identified: prefrail to frail (11.7%), steady decline (39.2%), slower decline (37.2%), and sustained nonfrailty (11.9%). Smokers, those with less than 150 minutes of physical activity per week, or those having a diagnosis of cardiovascular disease or diabetes by age 70, were all more likely to be in the prefrail to frail trajectory than the sustained nonfrailty group. Sensitivity analyses showed similar results when those who were lost to follow-up were included in the analysis; however, when limiting the data set to only those who continued to participate throughout the study period, the most severe frailty trajectory was no longer detected. We identified heterogeneity in frailty progression as men age. Frailty interventions may need to focus on lifestyle modifications and addressing or preventing underlying medical conditions prior to the age of 70. Adjustment for nonrandom attrition of participants is required to determine the long-term impact of frailty.

Primary hyperoxalurias (PH) are rare recessive autosomal genetic diseases inducing increased hepatic oxalate production. Apart from genetic background, their prognosis depends mainly on diagnosis delay. We recently reported shorter diagnosis delay in children compared with adults (1.2 (0.1-3.0) versus 30 (17-36) years) in a French PH cohort of 52 patients diagnosed between 2015 and 2019. In 2020, the first RNA interfering therapy was approved, leading to increased awareness and communication from reference centres, scientific societies and pharmaceutical companies. Our aim was to evaluate whether diagnosis delay was improved in this global setting. We performed a retrospective study including all consecutive patients that received a positive genetic test for PH in our expert genetic laboratory in Lyon between January 2020 and December 2024. We compared outcomes with the historical cohort. Diagnosis delay was defined by the time between the first symptoms and the result of genetic test. In total, 62 patients (37 children) were included. Forty-two (78%) patients had PH type 1, 5 (8%) had PH2 and 11 (18%) had PH3. The diagnosis delay remained significantly shorter in children as compared to adults (0.75 (1.10) versus 15 (16.21) years, p&#x2009;<&#x2009;0.05), but decreased in both sub-groups when compared to the previous study. The delay in PH diagnosis in France has been halved over the past five years. This improvement may be associated with recent therapeutic developments and increased awareness of the disease. Earlier diagnosis may enable earlier management, which might ultimately contribute to improved overall prognosis.

Myelin oligodendrocyte glycoprotein antibody-associated optic neuritis (MOG-ON) is a subtype of demyelinating optic neuritis (ON) characterized by a considerable risk of relapse; however, the demographic and clinical factors associated with recurrence remain poorly defined, posing ongoing challenges for patient management. A retrospective analysis was conducted on adult-onset MOG-ON patients diagnosed in the Ophthalmology Department of the Chinese People's Liberation Army General Hospital (PLAGH) from January 2019 to January 2024. Patients were divided into two groups based on their experience of a relapse course: the relapsing group and the monophasic group. Multivariate analysis was performed to examine the effects of various clinical factors on the risk of recurrence. Among 126 screened participants, 56 were excluded. A total of 70 patients (median [IQR] age at onset, 35.50 [30.00, 48.75] years; 46 females [65.71%]) were included. During a median follow-up of 31.50 (IQR 21.25-52.75) months, disease relapse occurred in 54.29% (38/70) of patients. Multivariate analysis revealed that being female significantly elevated recurrence risk (hazard ratio [HR] 3.92, 95% CI 1.63-9.42, p&#x2009;=&#x2009;0.002), while administration of immunosuppressive maintenance therapy after the first episode was associated with a lower likelihood of recurrence (HR 0.30, 95% CI 0.10-0.87, p&#x2009;=&#x2009;0.026). At the final follow-up, the relapsing group had significantly worse visual outcomes compared with the monophasic group (median [IQR] VA, 0.40 [0.16-0.82] logMAR vs. 0.22 [0.10-0.40] logMAR; p&#x2009;=&#x2009;0.012). In adult-onset MOG-ON, female sex is associated with an increased risk of recurrence, whereas early maintenance immunosuppressive therapy is associated with a lower recurrence risk. Furthermore, patients with a relapsing disease course exhibit poorer visual outcomes at follow-up compared with those with a monophasic course.