In 2024, the National Academies of Sciences, Engineering, and Medicine (NASEM) published a report entitled Advancing Research on Chronic Conditions in Women. A major purpose of this report was to summarize the current state of research into a series of 21 chronic conditions that affect women differently or that are more common in women. The American Society for Bone and Mineral Research (ASBMR) established a working group to evaluate the NASEM report's implications for women's MSK health. This perspective summarizes key research gaps identified in the NASEM report, including the lack of sex-specific data, underrepresentation of women in clinical studies, and minimal integration of MSK health with other chronic conditions. The NASEM report underscores the need for more comprehensive study designs that consider hormonal, genetic, and social determinants of health across the lifespan. In addition to osteoporosis, in this perspective, the ASBMR working group highlights emerging but poorly understood evidence of detrimental effects on musculoskeletal biology in non-MSK, chronic diseases that were identified in the NASEM report to disproportionately affect women. To advance the field, we advocate for better diagnostics, increased investment, and stronger representation of women in research studies. Addressing these gaps is critical for improving prevention, care, and outcomes for chronic conditions that uniquely or disproportionately affect women. Chronic health conditions affect women more than men, but past research has often overlooked this fact. In 2024, a national report highlighted how chronic conditions like osteoporosis, back pain and arthritis in women are underfunded and poorly understood. In response, a group from the American Society for Bone and Mineral Research reviewed the report to focus specifically on women’s musculoskeletal health. The report found that women are often not included in clinical studies, and that links between musculoskeletal health and many chronic conditions that impact women’s daily lives, including endometriosis and depression, have not been adequately investigated. In addition, reproductive transitions, such as menopause, are often associated with musculoskeletal symptoms and conditions in addition to osteoporosis, that are poorly understood. Musculoskeletal conditions often start early and last a lifetime, affecting mobility, pain levels, and quality of life. Yet, tools to diagnose, treat, and prevent these chronic conditions are limited. We believe research must do a better job reflecting women’s unique biology and life experiences. This includes ensuring that study participants are representative of the population, identifying better ways to track health over time, and improving access to care. As mobility is central to overall health and disease prevention, we believe that investing in women’s health research—especially in musculoskeletal health—can lead to earlier diagnosis, more effective treatments, cost savings and better lives for millions of women.
Multiple international reports, peer-reviewed studies, and medical organizations have documented that climate change-defined as the rapid, long-term shifts in global temperatures and weather patterns driven primarily by human activities, such as the burning of fossil fuels-is already affecting human health and well-being. Recently, many health professional organizations have called upon current and future health professionals to acquire the knowledge, skills, and agency to address this public health threat. The Climate Resources for Health Education (CRHE) project was created by students, trainees, and faculty through the Global Consortium on Climate and Health Education to address this gap. The CRHE program provides organized, comprehensive, evidenced-based, peer-reviewed, and freely accessible climate health learning resources that can be delivered in standalone sessions or integrated into existing curricula. This manuscript details the innovative, grassroots, and trainee-led approach to developing this educational resource, designed to support educators and learners to incorporate climate change and planetary health information into health curricula. To date, there have been over 400 unique individuals consisting of trainees and faculty that have contributed to the CRHE project. A survey of a small subset of CRHE volunteers (34 respondents of 95 invited volunteers) demonstrated that CRHE participation had positive impact on reciprocal mentorship, knowledge gained in climate and health, and experience in curriculum development. In summary, the CRHE program is a comprehensive, free online resource that aims to help close the gap between the documented health impacts of climate change and the extent of its integration into medical education.
The menopausal transition is a critical period in women's health, characterised by profound endocrine changes that may influence cardiometabolic risk, body composition, bone and muscle health, and overall functional trajectories. Beyond symptom burden, accumulating evidence suggests that this transition represents a window of vulnerability for the acceleration of long-term chronic disease risk, independently of chronological ageing. This critical narrative review synthesises current evidence on the role of nutrition during the menopausal transition, focusing on cardiometabolic health, bone and muscle function, and the clinical interpretation of menopausal symptoms, with the aim of proposing a pragmatic and clinically translatable prevention framework. A literature search was conducted in PubMed/MEDLINE, Embase and the Cochrane Library from inception to 2025. Priority was given to systematic reviews, meta-analyses, large longitudinal cohort studies and randomised controlled trials when available. Evidence was analysed qualitatively within a clinically oriented framework, with particular attention to heterogeneity of findings and limitations of nutritional interventions. The menopausal transition is associated, in some women, with unfavourable shifts in cardiometabolic trajectories, accelerated bone loss, and increased skeletal muscle vulnerability, although these changes remain heterogeneous and strongly influenced by lifestyle factors. The most consistent evidence suggests that overall dietary quality, particularly Mediterranean- and DASH-type dietary patterns, contributes to the modulation of cardiometabolic risk and supports bone and muscle health. In contrast, nutrition-specific effects on vasomotor symptoms appear modest and inconsistent. Nutritional strategies seem most relevant when implemented early, integrated with physical activity, and adapted to individual risk profiles. Nutrition should be considered a modifiable component of lifestyle contributing to reasoned prevention during the menopausal transition. Its primary role lies in supporting functional preservation and modulating cardiometabolic trajectories rather than providing uniform symptomatic relief. An integrated, individualised approach embedded within broader medical and lifestyle strategies appears most clinically relevant at this life stage.
Shoulder arthroplasty has evolved substantially in surgical technique, implant design, and indications. Careful coordination across the patient care pathway remains central to optimizing outcomes. Concurrently, rapid advances in digital health, wearable technologies, smart implants, and intraoperative innovations are being explored across orthopedics, with emerging applications in shoulder arthroplasty. This narrative review synthesizes current evidence on digital technologies relevant to shoulder arthroplasty, with particular attention to the strength and origin of the available data. A structured review of recent literature was performed, including primary studies in shoulder arthroplasty as well as relevant evidence extrapolated from hip and knee arthroplasty. Areas examined included CT-based 3D planning, navigation, patient-specific instrumentation, robotics, augmented/mixed reality, mobile health (mHealth) platforms, wearable devices, tele-rehabilitation, sensor-enabled implants, and artificial intelligence (AI). In shoulder arthroplasty, digital planning tools, navigation systems, and patient-specific instrumentation have demonstrated improvements in implant positioning accuracy in selected studies; however, evidence linking these technologies to superior long-term clinical outcomes remains limited. Robotic systems and augmented reality applications are in early investigational phases. Postoperative digital health tools, including tele-rehabilitation and wearable monitoring, have shown non-inferior functional outcomes compared with conventional care in hip and knee arthroplasty, with only preliminary and pilot data currently available in shoulder populations. Sensor-enabled implants and AI-based predictive models represent emerging areas of research, but external validation, workflow integration, and cost-effectiveness analyses remain insufficient. Digital and smart health technologies in shoulder arthroplasty are evolving and largely investigational. While early findings and extrapolated evidence from other arthroplasty domains suggest potential benefits in planning accuracy, patient engagement, and outcome monitoring, robust shoulder-specific clinical validation is limited. Further prospective studies are required before widespread clinical adoption can be recommended. This narrative review synthesizes emerging evidence in this field, which is currently dominated by feasibility studies, technical reports, and early-phase clinical investigations, with limited high-level outcome data specific to shoulder arthroplasty.
Vulvar cancer is a rare gynecologic malignancy in which regional lymph node status represents the most powerful prognostic factor and a key determinant of therapeutic strategy. For the past 60 years, bilateral inguinofemoral lymphadenectomy was the standard approach for staging and disease control. Although effective, this procedure was associated with substantial morbidity, including wound complications, chronic lower limb lymphedema, and long-term impairment of quality of life. In the past 20 years, sentinel lymph node (SLN) mapping has emerged as a less invasive alternative for selected patients with unifocal, clinically node-negative vulvar tumors less than 4 cm in diameter. Large prospective trials, such as GROINSS-V and GOG-173, demonstrated that sentinel node biopsy is feasible, safe, and significantly reduces postoperative morbidity while maintaining excellent oncologic outcomes in appropriately selected patients. Nevertheless, concerns persist regarding false-negative results, reported in up to 7%-10% of cases in some series, with anecdotal reports of rates up to 27%. Undetected nodal disease represents a missed opportunity for cure, and most patients with an isolated groin recurrence ultimately succumb to their disease. Therefore, the potential benefits of morbidity reduction must be carefully balanced against the risk of undertreatment. This review summarizes the historical evolution of groin management in vulvar cancer, critically appraises the current evidence supporting SLN mapping, and discusses its clinical limitations, patient preferences, and implications for practice. Emphasis is placed on surgical expertise, the importance of ultrastaging, structured surveillance, and ongoing prospective research to achieve the best survival with the lowest morbidity.
Human-in-the-loop oversight is widely invoked as a safeguard against potential harm from artificial intelligence (AI) used in health care, yet it functions more as symbolic reassurance than substantive protection. We argue that human-in-the-loop fails for three interconnected reasons: AI used in health care can amplify existing structural inequities at unprecedented scale, intersectional harms elude detection by oversight models premised on neutral singular reviewers, and clinicians operate under constraints that preclude meaningful interrogation of algorithmic outputs. Drawing on actor-network theory, feminist epistemology, and political philosopher Iris Marion Young's social connection model of justice, we show that current governance individualises responsibility while obscuring institutional complicity. We propose three pathways towards more substantive accountability: co-reasoning frameworks that position AI as one voice in clinical deliberation, community-owned governance with authority to suspend harmful systems, and institutional liability structures that redistribute responsibility from clinicians to the organisations that design and deploy these tools.
Recurrent pregnancy loss (RPL) is defined as two or more clinically confirmed pregnancy losses occurring before 20 weeks of gestation. It not only imposes severe psychological distress on women of childbearing age but also affects approximately 2.5% of individuals of reproductive potential. Although the etiology of RPL involves multiple aspects such as genetics, anatomy, immunity, and infections, more than 50% of cases remain unexplained, and their underlying pathogenesis has not been fully elucidated. Recent studies have indicated that trophoblast dysfunction, impaired placental angiogenesis, and dysregulated inflammatory responses at the maternal-fetal interface are key pathological processes involved in the development of RPL, with aberrant regulation of multiple signaling pathways playing a central role in these processes. This review systematically summarizes the current research progress on signaling pathways associated with RPL, focusing on three core dimensions: trophoblast function regulation, placental angiogenesis mechanisms, and inflammatory response balance. It provides an in-depth analysis of their roles and molecular mechanisms in the pathogenesis of RPL. By organizing the crosstalk and regulatory networks of these pathways, this review aims to offer a comprehensive reference for uncovering the complex etiology of RPL and lay a theoretical foundation for the development of precise diagnostic biomarkers and effective therapeutic strategies.
Dostarlimab+carboplatin-paclitaxel (CP) demonstrated significant improvement in progression-free survival (PFS) and clinically meaningful improvement in overall survival (OS) vs CP alone among patients with dMMR/MSI-H primary advanced/recurrent endometrial cancer (EC) in Part 1 of the randomized phase 3 RUBY trial (NCT03981796). We report updated efficacy and safety data with approximately 4 years of follow-up. Patients were randomized 1:1 to receive dostarlimab+CP or placebo+CP followed by dostarlimab or placebo up to 3 years or until disease progression. Descriptive analyses of OS and PFS were conducted in the dMMR/MSI-H population (median follow-up, 55.6 months). Post hoc conditional survival analyses and a mixture cure model (MCM) fitted to PFS data to estimate the proportion of patients who had curative potential are presented to provide prognostic insights into long-term survival. Dostarlimab+CP demonstrated sustained OS and PFS benefits. Median PFS and OS were not reached with a 66% reduction in risk of death vs placebo+CP. PFS curve plateauing (only 4 progression events with additional 2.5 years follow-up since the previous PFS analysis at interim analysis 1) demonstrated durable disease control. Patients alive at the 1- and 2-year landmarks had >80% probability of remaining alive an additional 3 and 2 years, respectively. At 4 years, the MCM analysis estimated a cure rate with dostarlimab of 54% (95% CI 35%-72%). No new safety signals were observed. At 4 years, RUBY demonstrated sustained remission and long-term survival benefit, suggesting the potential for curative intent with dostarlimab+CP in patients with dMMR/MSI-H primary advanced or recurrent EC.
Pancreatic ductal adenocarcinoma (PDAC) is one of the leading cause of cancer-related deaths and has a dismal prognosis due to late-stage diagnosis. Early detection, improves survival, but remains a challenge due to nonspecific symptoms and lack of population-level screening tools. Current guidelines recommend surveillance in individuals with >5% lifetime risk. Imaging modalities form the cornerstone of screening and surveillance, while serum biomarkers show promise. Emerging technologies in imaging are demonstrating potential to detect subtle changes years before clinical diagnosis. Together, multidisciplinary surveillance strategies may have the potential to shift the paradigm towards early detection in high-risk groups to improve outcomes.
Australian studies investigating parental factors often lack meaningful inclusion of Aboriginal and Torres Strait Islander families, limiting our understanding of current influences on positive developmental trajectories within communities. There is growing recognition of the need for culturally safe and responsive longitudinal research that is co-designed and co-led by the community for the community. An Indigenous-led birth cohort study of Aboriginal and Torres Strait Islander families in Queensland, Australia, has therefore been developed to better understand health across generations. The Strong Families Study is a co-designed prospective longitudinal birth cohort study that will follow 400 Indigenous families in Queensland from pregnancy until the child reaches 5 years of age. Eligible participants include pregnant individuals (<28 weeks' gestation) whose children may identify as Aboriginal and/or Torres Strait Islander, along with their partners (if applicable). Data will be collected at multiple timepoints: during gestation, at delivery, postpartum, every 6 months until the child is 36 months (corrected age, CA) and annually until age 5 years. These will be collected by Aboriginal health workers using validated and culturally appropriate tools across different health themes. The study will incorporate health literacy throughout, as well as referrals to two nested family support programmes to support families and assist with the developmental outcomes of their children when and if required. Effects across health themes will be analysed with a focus on strengths, positive trajectories and holistic well-being of Indigenous families, moving beyond deficit-based narratives. This study was approved by the Mater Misericordiae Ltd Human Research Ethics Committee (HREC/MML/105191) and ratified by the University of Queensland Human Research Ethics Committee (2025/HE001924). Endorsement letters were secured from partner services at each study site. Findings will be shared with partnering hospitals and funding bodies at conferences and through reports and peer-reviewed publications.
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The current study examined 13-year-old adolescents' self-reports regarding the prevalence, frequency, and emotional experiences of harsh discipline (psychological aggression, corporal punishment, severe assault) from both mothers and fathers. We further investigated how mothers' childhood experiences of physical discipline were associated with their current disciplinary practices through parental attitudes and emotional dysregulation in the context of physical punishment. Embedded in a Singapore-based birth cohort study, 542 mother-adolescent dyads were surveyed. Adolescents' reports of harsh discipline from mothers and fathers were obtained using the Parent-Child Conflict-Tactics Scale, with prevalence defined as exposure to at least one form of harsh discipline at any frequency. The prevalence of adolescents experiencing at least one form of harsh discipline from either parent was 87.5% at age 13 and 92.9% over their lifetime. Physical forms of harsh discipline, including corporal punishment and severe assault, were more frequently experienced by boys than girls. Adolescents reported adverse emotional experiences of physical discipline, including feelings of anger and hurt. Focusing on maternal behaviours, path analyses revealed that mothers' attitudes toward physical discipline consistently explained the association from mothers' past exposure to physical discipline and their current use of both physical and non-physical harsh disciplinary practices (β = 0.028-0.042). Our findings underscore the adverse experiences of adolescents' exposure to harsh discipline, and identify parental attitudes as a key modifiable factor that perpetuates the intergenerational continuity of physical discipline. This highlights the need to address parents' maladaptive beliefs about the acceptability and effectiveness of physical disciplinary methods.
Severe carbamazepine intoxication in children may cause coma, seizures, respiratory failure, and hemodynamic instability. When gastrointestinal decontamination and supportive care are insufficient, extracorporeal blood purification may be considered to enhance drug elimination. Hemoadsorption has recently emerged as a potential option, but pediatric evidence remains very limited. To report the first pediatric case successfully managed with hemoadsorption and to systematically review extracorporeal removal strategies in pediatric carbamazepine intoxication. CINAHL, Cochrane Library, Embase, MEDLINE via PubMed, Scopus, Web of Science, ClinicalTrials.gov, and reference lists of eligible articles were searched through April 6, 2025. Articles reporting pediatric patients (≤ 18 years) with acute carbamazepine intoxication who were treated with extracorporeal blood purification techniques were included. Eligible studies were randomized controlled trials, observational studies, case series, and case reports. Reports without extractable individual patient data were excluded. Twenty studies provided individual data for 27 children (16 months-18 years) treated with charcoal hemoperfusion, hemodialysis, continuous kidney replacement therapy, therapeutic plasma exchange, or sequential/combined approaches. We additionally report one index case of acute carbamazepine overdose managed with isolated hemoadsorption using a CytoSorb cartridge. Records were screened, full texts were reviewed for eligibility, and individual patient data were extracted. Methodological quality was assessed using Joanna Briggs Institute critical appraisal checklists. Because of substantial heterogeneity, findings were summarized descriptively only, without meta-analysis, formal comparison, or ranking of extracorporeal modalities. Case report A 7-year-old girl was admitted to our hospital after ingestion of carbamazepine at a dose of 182 mg/kg, with an initial serum carbamazepine concentration of 144 µmol/L. She was unresponsive and hypotensive, with respiratory acidosis requiring endotracheal intubation. Isolated hemoadsorption using a CytoSorb cartridge on a multiFiltrate monitor was initiated 6.5 h after ingestion, and serum carbamazepine concentration decreased to the therapeutic range (17-51 µmol/L) within 18 h post-ingestion. The patient was extubated on day 2 and discharged on day 5 without neurological sequelae. Twenty studies met the inclusion criteria and provided extractable individual data for 27 patients (16 months-18 years). Ingested doses ranged from 47 to 1077 mg/kg, with peak serum carbamazepine concentrations between 85 and 584 µmol/L. Manifestations included coma (85%), respiratory failure (56%), seizures (52%), and hypotension (26%). Management required mechanical ventilation (48%) and inotropic-vasopressor support (22%). Hemodialysis (56%), continuous veno-venous hemodiafiltration (26%), charcoal hemoperfusion (22%), therapeutic plasma exchange (19%), continuous veno-venous hemodialysis (7%), and continuous veno-venous hemofiltration (4%) were used. Documented time to normalization ranged from 4.5 to 84 h. Serum carbamazepine concentrations decreased across the included reports, and no deaths were reported. Pediatric intensive care unit and hospital lengths of stay ranged from 2 to 9 and from 2 to 26 days, respectively. The evidence consisted of heterogeneous case reports and small case series, precluding causal inference or formal comparisons across extracorporeal modalities. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Extracorporeal techniques may play an important role in severe pediatric carbamazepine intoxication when supportive measures are insufficient. Hemoadsorption may be feasible in carefully selected children. However, current pediatric evidence remains too limited to determine whether it offers any advantage over other extracorporeal modalities. Prospective registries, pharmacokinetic studies, and comparative evaluations are warranted to define indications, timing, and modality selection. PROSPERO CRD420251236374.
Disseminated intravascular coagulopathy (DIC) in pregnancy is a severe maternal morbidity that is associated with short- and long-term complications. However, information regarding the causes of DIC treatments and outcomes in pregnancy is based on local reports. To address this gap, two Scientific and Standardization Committees, the Women's Health Issues in Thrombosis and Hemostasis and Disseminated intravascular coagulation of the International Society on Thrombosis and Hemostasis, joined to establish an international global registry. This registry was developed to examine the current definitions, clinical presentations, and current practices around laboratory diagnosis and management of DIC worldwide. We collected data between 2018 and 2024; there were 148 data entries to the registry (13 countries), 104 of them included patients' clinical and laboratory information. Placental abruption is the leading cause for ante and intrapartum DIC, especially when associated with stillbirth. The leading etiology for postpartum DIC was uterine atony, especially following/during caesarean sections. The contribution of abnormally implanted placenta (i.e., placenta accreta and/or previa) to the development of DIC is increasing. The leading pregnancy complications associated with DIC were placental abruption in HIC and preeclampsia in LMIC. Hemostatic parameters differed between women who had a positive pregnancy-specific DIC score and those who did not meet that criterion. Women with placental-mediated pregnancy complications had a lower median pregnancy-specific DIC score than those without such complications at diagnosis of DIC and following recovery, suggesting a different mechanism of disease in the two groups.
Workplace violence (WPV) in clinical settings is a global issue in healthcare. Recent studies have shown that attitudes toward WPV are evolving. According to the World Health Organization, WPV affects between 8% and 38% of healthcare workers, especially in culturally diverse nations like the Middle East. The emergency department (ED), as one of the busiest and most critical hospital units, has been reported as the most common focal point for WPV. Thus, this study describes the WPV experiences of maternity nurses and emphasizes the importance of understanding this phenomenon to inform effective interventions. The study followed a descriptive phenomenology approach. Fifteen ED nurses were selected and interviewed with a semistructured interview guide and an audio recorder. Participants were recruited via telephone invitations based on confirmed WPV reports. One-on-one interviews were conducted until data saturation was reached. Audio recordings were transcribed, and data were analyzed using Colaizzi's thematic analysis method, ensuring trustworthiness and rigor in accordance with Lincoln and Guba's criteria. Data analysis identified 10 subthemes and 5 emerging themes describing maternity nurses' WPV experience in a tertiary care setting. Themes include demanding emergency care through verbal aggressiveness; sociocultural differences influencing nurse-patient interaction and emergency nursing care; misaligned expectations and policy awareness; nurses' adaptation and competing care demands; and managing WPV with manpower resources and collaboration. The study reveals that WPV has multiple drivers: system-based, situation-grounded, and contextual. This evidence, along with the body of current literature, supports the plea to have a zero-tolerance policy for WPV, especially in maternity settings where the safety of the woman and her child is the utmost priority.
Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.
Current research in precision oncology focuses on progression-free survival (PFS) and overall survival (OS) as the key outcomes. This stands in stark contrast to the primary outcomes guiding cancer treatment in the clinic- dynamic changes in tumor size in response to treatment. While PFS and OS are meaningful, highly interpretable and easily collected, we hypothesize that revealing associations between somatic mutations and tumor size dynamics can uncover genetic factors that can influence treatment response and generate hypotheses for future clinical investigation, while further improving our understanding of tumor biology. We propose and benchmark a new statistical framework - Andersen-Gill based Tumor Dynamics (AG-TD) to model recurrent outcomes and apply it to data from ~ 17 K radiology reports of patients with non-small cell lung cancer undergoing routine treatment at the Dana-Farber Cancer Institute. Our approach enables modeling recurrent outcomes while considering the time-dependent nature of biomarker-treatment interaction, patient mortality, and loss to follow-up. We identify 27 somatic mutations that lead to differential response to common treatments including both protective and hazardous effects. Among these, deletions in MYBL1 and GATA3 were independently validated by replication in an external EGFR-TKI drug sensitivity screen, reaching Bonferroni correction significance. We also identify 13 somatic mutations associated with differential rates of progression and response during the entire treatment course, of which 9 are undetectable using conventional OS or PFS models. We further verify that the results are consistent in a homogeneous sub-cohort of advanced stage (3 and 4) patients only. Overall, we demonstrate the potential for using longitudinal outcomes in cancer genetic studies to complement traditional survival-based analyses, and to enable systematic identification of candidate gene-treatment interactions for future validation.
Traumatic distress is a major global public health concern requiring cross-cultural understanding. Using nationally representative data from the Global Flourishing Study (N = 202,898; 22 countries), we estimated country-specific prevalence of traumatic distress and examined 9 sociodemographic and 13 childhood predictors. Random-effects meta-analyses assessed cross-country variation and associations. Here we show that the prevalence of traumatic distress ranges from 16% (Poland) to 53% (Egypt). Higher prevalence of distress is observed among younger individuals, gender-diverse groups, those separated from partners, unemployed, less educated, those born outside their country and those who attend religious services regularly. Several childhood experiences at age 12 are associated with a higher risk of traumatic distress, including abuse, family financial insecurity, feeling like an outsider, parental divorce, and poor health. Childhood abuse is a significant predictor in 21 countries. Traumatic distress prevalence and predictors vary across countries and are shaped by both current sociodemographic and early-life factors. Many people experience frightening or life-threatening events during their lives, and some continue to feel distressed by them long afterwards. We wanted to understand how common this lasting distress is in different countries, and which life circumstances make it more likely. We analyzed survey answers from more than 200,000 adults in 22 countries who took part in the Global Flourishing Study. We found that the share of people still bothered by a past traumatic event varies widely across countries, from about one in six in Poland to more than one in two in Egypt. People who were abused, felt like an outsider in their family, lived with financial hardship, or had poor health as a child were more likely to feel this distress as adults. These findings can help guide support for children and adults in all societies.
Lack of diversity in healthcare teams can lead to poorer patient outcomes and quality of care. This study analyzed fellowship trainee demographics to examine current gender and racial diversity trends among hand surgery fellowship programs. American Medical Association Graduate Medical Education reports from 2007 to 2024 were queried to determine diversity trends among hand surgery fellowships. Trainees from 3 primary residency types were evaluated: plastic, orthopedic, and general surgery. Microsoft Excel and IBM SPSS were used to trend and analyze the data using χ2 analysis, Fisher-Freeman-Halton exact tests, and Cochran-Mantel-Haenszel tests. Hand fellowship programs increased 42% from 2007 to 2024. Female trainees rose to 38% in 2024 but remained significantly fewer than males (P < 0.01). Gender distribution was similar across orthopedic and plastic programs (P = 0.06). Programs had significantly smaller percentages of Asian (2007 = 12.9%, 2024 = 17.8%; P < 0.01), Pacific Islander (2007 = 0%, 2024 = 0%; P < 0.01), African American (2007 = 3.1%, 2024 = 5.2%; P < 0.01), American Indian (2007 = 0.0%, 2024 = 0.0%; P < 0.01), and Hispanic trainees (2007 = 5.3%, 2024 = 0.6%; P < 0.01) compared with White trainees (2007 = 68.9%, 2024 = 64.3%). Osteopathic (2007 = 8.3%, 2024 = 8.9%) and international medical graduate trainees (2007 = 13.6%, 2024 = 1.3%) also remained low. Although hand fellowship programs have improved female representation, trainees underrepresented in medicine remain low.