搜索结果：Demography

The red fox (Vulpes vulpes), which is widely distributed across the Northern Hemisphere, including Japan, has been studied for its distribution patterns and migration timing, but its population demography remains poorly understood. To solve it, this study conducted double-digest restriction-site-associated DNA sequencing (ddRAD-seq) on 118 samples from Japan, continental Eurasia, and Sakhalin. Based on single nucleotide polymorphisms (SNPs) detected by ddRAD-seq, this study revealed large genetic differentiation among populations of western Eurasia and four Japanese islands (Hokkaido, Honshu, Shikoku, and Kyushu). The eastern Eurasian population, including Sakhalin, was admixed with the western Eurasian and Hokkaido populations. Our results are consistent with previous reports based on mitochondrial DNA analyses that the Hokkaido and Honshu/Shikoku/Kyushu populations migrated from the continent independently. Demographic simulations showed that the Honshu/Shikoku/Kyushu population could have diverged first from the eastern continental Eurasian population, and that subsequently the Hokkaido population diverged. The simulation results are consistent with the geological record in that Honshu/Shikoku/Kyushu islands were the first to separate from continental Eurasia, followed by the isolation of Hokkaido. We propose a scenario in which the two fox populations in the Japanese archipelago became differentiated genetically as the result of geographical isolation from continental Eurasia by straits. In addition, a clustering analysis showed that foxes on Hokkaido could have become genetically divided into two subpopulations, northeastern and southwestern, suggesting that the Ishikari Lowland located between the two subpopulations served as a barrier to fox dispersal.

Real-world longitudinal data documenting the diagnostic impact of DNA methylation array (MA) profiling in pediatric ependymoma remain sparse. We report a single-center retrospective analysis evaluating MA-driven reclassification, molecular subgroup distribution, and long-term survival outcomes in a national pediatric referral cohort. Sixty-three pediatric patients with a histological ependymoma diagnosis treated at Motol and Homolka University Hospital (2010-2025) were included. DNA methylation profiling, RNA sequencing, copy number variation and t-SNE analysis were performed. Survival was estimated by the Kaplan-Meier method. MA confirmed ependymoma in 48 patients (76.2%) and reclassified 15 (23.8%) as non-ependymoma entities, including newly described tumor types. The reclassification rate was 36.1% in the pre-2019 cohort versus 7.4% post-2019. Posterior fossa group A (PFA) ependymoma was the predominant subgroup (n = 26). Ten-year overall survival (OS) was 69.6% and event-free survival (EFS) 47.7%. Gross total resection was the only factor significantly associated with improved survival (OS 75% vs. 40%, p = 0.017). Chromosome 1q gain, identified exclusively in PFA patients, was associated with a high relapse rate despite standard therapy. MA-driven reclassification affected nearly one quarter of patients, with substantially higher rates in the pre-molecular era, confirming that integrated molecular diagnosis is indispensable in all pediatric CNS tumors referred with a histological diagnosis of ependymoma.

Childhood mortality is affected by major congenital anomalies and socio-economic status (SES). To our knowledge, their combined impact has not been explored to age 10. We analysed the population-based EUROlinkCAT cohort to ascertain the impact of SES on mortality by ages 1 and 10 amongst children with congenital anomalies in ten congenital anomaly registers in seven European countries. Four countries defined SES according to maternal education, and two used their national index of multiple deprivation. The ten registers used a common script to generate data on survival by ages 1 and 1-10 (365-3651 days). Eight registers analysed deaths according to their SES criteria, categorised as low, intermediate and high SES. Linked data were combined in random effects meta-analyses. Finland and Emilia-Romagna held data on single motherhood and EU-nationality. We analysed mortality in relation to SES using data on 47,134 live-born children with major congenital anomalies classified and recorded 1996-2014. Mortality by age 1 and ages 1-10 was higher amongst the most than the least deprived, hazard ratios (HR) and 95% confidence intervals (CI) 1.47, 1.19-1.83 and 2.00, 1.32-3.02. Differences between intermediate and least deprived groups were smaller. Differences were statistically significant for all four analyses only in Ukraine and Wales. Mortality rates were higher for children of non-EU nationals, but not single mothers. Deprivation was more strongly associated with death at ages 1-10 than in infancy. These analyses of the most ill children in Europe indicate that, to achieve sustainable development goals, more resources are needed for the most vulnerable children.

Compared to annual crops, the domestication of perennial fruit trees remains poorly understood, and tracing the maternal origins and dispersal history significantly advances our understanding of the domestication process. Peach (Prunus persica) is a vital economic fruit crop with a long and intricate history of human domestication, resulting in diverse varieties and wide dispersal, making it an excellent model for tracing the maternal origin and domestication history. Here, we aim to investigate the peach's maternal origins and elucidate its domestication history in China. We investigated peach phylogeography by analyzing 714 peach individuals representing diverse germplasm types across its distribution range, using the whole chloroplast genome and nuclear ribosomal DNA sequences to further infer its maternal origin and domestication history. Genetic structure analyses of both datasets revealed two distinct clades within peach populations (Clade I and Clade II), each associated with similar geographic distributions and containing various germplasm types with diverse fruit phenotypes, suggesting that peach is derived from two distinct maternal ancestors (dual maternal origin). Notably, genetic diversity and private haplotype analysis identified multiple regions with high diversity (the Yellow River, the middle and Yangtze River, and the Pearl River basin) where the oldest fossil records are concentrated, suggesting that peach might exist in multiple domestication regions (diffuse origins). Peach populations experienced two major bottlenecks and sequential founder events during the domestication process, likely shaped by human-driven selection and dispersal: the first occurred around 6,000 years ago, and the second approximately 2,000 years ago. This study highlights a dual maternal origin and multiple domestication regions of peach within China, resolving a key issue in the history of peach domestication. Our integration of chloroplast and nuclear data, along with other lines of evidence, establishes a clear framework for inferring complex lineages, refining our understanding of the peach demographic history, and offering valuable insights for breeding strategies and conservation efforts.

Long COVID is associated with poor health-related quality of life (QoL), with substantial interindividual variations. This study aimed to investigate the association between QoL and a diagnosis of functional somatic disorder (FSD) among patients seeking care for long COVID. Data were drawn from the CASPer-COVID program, a multidisciplinary tertiary care program for patients with persistent symptoms following COVID-19. QoL was evaluated with the 36-Item Short-Form health survey (SF-36), yielding a Physical Component Summary (PCS) and a Mental Component Summary (MCS). Multivariable linear regression analyses were performed to investigate the associations between PCS or MCS scores and a diagnosis of FSD, adjusting for age, gender, body mass index, comorbidities, hospitalization for acute COVID-19, core persistent symptoms, symptom duration, depressive and anxiety symptoms, and physical activity. The analyses included 773 patients (median age [interquartile range (IQR)]: 44 [36-55] years; 64% women). QoL was markedly impaired (median PCS [IQR]: 44 [31-60]; median MCS [IQR]: 39 [31-49]). A diagnosis of FSD (76.5% of patients) was not associated with MCS (β [95% CI]: 1.11 [-1.30, 3.53]) or PCS (β [95% CI]: -1.60 [-3.88, 0.67]) scores in adjusted analyses. Lower PCS and MCS scores were associated with higher depressive and anxiety symptoms, lower physical activity levels, and pain. In addition, lower PCS scores were associated with female gender, hospitalization for acute COVID-19 and longer symptom duration. In patients seeking care for long COVID in a tertiary care setting, QoL did not differ significantly between those diagnosed with FSD and other patients.

Dyslipidemia is prevalent among Nigerians with diabetes mellitus (DM), but its treatment has not been well-studied. The objective of this study was to determine the prevalence, treatment rates and control of dyslipidemia among DM patients in northern Nigeria. We conducted a multicenter, cross-sectional study of dyslipidemia in DM patients, and noted cardiovascular disease (CVD) risk factors, lipid-lowering treatments, body mass index, blood pressure, HbA1c, lipid profile, glomerular filtration rate and proteinuria. Outcome measures were the rate and treatment of dyslipidemia and attainment of low density lipoprotein cholesterol target for primary prevention of CVD. Binomial logistic regression was used to analyze associations between participant characteristics and dyslipidemia. Hosmer-Lemeshow goodness-of-fit test was used to evaluate the model fit. Statistical analysis was performed with the SPSS version 25 program. The study enrolled 403 participants (58.8% females), of whom 59.6% had dyslipidemia. Besides DM and dyslipidemia, other risk factors for CVD were hypertension (56.8%), obesity (52.6%), chronic kidney disease (36.5%), atrial fibrillation (7.9%), heart failure (5.0%), cigarette smoking (4.7%), excess alcohol use (2.0%), and previous CVD (14.4%). Logistic regression analysis showed dyslipidemia was significantly associated with female gender (odds ratio = 1.68, P = 0.029) and proteinuria (odds ratio = 2.26, P = 0.004). Among those with dyslipidemia, 51.3% took lipid-lowering treatments comprising statins (50.8%) and clofibrate (2.9%). None took other lipid-lowering treatments, and only 17.1% attained the target for primary prevention of CVD. Three-fifths of patients had dyslipidemia, but only a sixth attained the treatment target. Treatment for dyslipidemia included statins and fibrates, but not niacin, ezetimibe, bempedoic acid, icosapent ethyl, inclisiran or PCSK9 inhibitors recommended for those who failed intensive statin therapy. There is the need for better access to non-statin treatment and physician adherence to clinical practice guidelines.

Ethnic disparities in stroke incidence and recurrence are well-known but there is conflicting evidence regarding post-stroke care and recovery. In the UK, stroke-survivors are recommended a six-month specialist review but fewer than half receive this review, potentially exacerbating health inequities. Using data from the Sentinel Stroke National Audit Programme (SSNAP) from inception to August 2023 across four regions in England with varying ethnicity profiles we conducted a retrospective descriptive analysis to assess ethnic differences in six-month care and outcomes for stroke-survivors. A total of 80,413 (26.2%) stroke-survivors attended their 6-month review (whites: 26.5%, Black patients: 27.9%; Asian patients: 26.1%; Mixed patient: 27.6%; other: 23.5% other; unknown: 23.1%) with a higher proportion of reviews taking place via telephone for Black and Asian patients (X = 955.7, p = 0.001). After adjustment, non-White patients were significantly more likely to be followed up at 6 months (Black patients OR 1.29 (95%CI 1.21-1.38), Asian patients OR 1.10 (95% CI: 1.04-1.15). The odds of having a further stroke (Black OR 1.49 (95% CI: 1.21-1.84), Asian OR 1.25 (95% CI 1.03-1.52)) or other illness requiring hospital readmission (Black OR 1.25 (95% CI: 1.12-1.40), Asian OR 1.15 (1.05-1.27)) were significantly higher in Black and Asian patients following adjustment for age and stroke severity. At six months lipid therapy was significantly lower in Black patients (OR 0.79 (95% CI: 0.72-0.87)). Black and Asian stroke-survivors experience worse outcomes and lower use of secondary prevention despite similar clinic attendance. Culturally sensitive interventions are needed to reduce post-stroke complications.

Papulopustular rosacea (PPR) is a chronic inflammatory facial dermatosis with a need for well-tolerated and effective topical therapies. Clascoterone cream 1% is an androgen receptor inhibitor and a promising novel treatment for PPR. In this single-center, single-arm, phase 2 pilot study, adults with PPR applied clascoterone cream 1% twice daily to the face. The primary endpoint was biopsy-proven change in mean sebaceous gland number and diameter over 12 weeks. Secondary endpoints included Dermatology Life Quality Index (DLQI), patient-reported outcomes (PROs), and prevalence of adverse events. Twenty participants were enrolled, and 18 completed the study. Mean sebaceous gland count decreased significantly (4.94 ± 1.98 to 3.61 ± 2.33; P=0.012). Mean gland diameter also decreased, although not significantly (P=0.182). Mean DLQI scores significantly improved (7.5 ± 5.8 to 3.3 ± 5.6; P=0.029). PRO scores were favorable for papules/pustules (3.2 ± 1.1), facial redness (2.7 ± 1.0), general skin appearance (2.7 ± 1.1), and overall treatment satisfaction (3.1 ± 0.7). The treatment was well tolerated, with no serious adverse events. Mild, transient dryness (n=1) and eye irritation (n=1) resolved without intervention. Clascoterone cream 1% demonstrated favorable tolerability, safety, and efficacy in PPR, with significant improvements in sebaceous gland count and patient-centered outcomes. These findings support the therapeutic potential of clascoterone cream 1% for the treatment of PPR. &nbsp.

Epilepsy is a serious chronic neurological condition with no permanent cure. Continual self-management is important to mitigate seizure frequency and optimize quality of life in people with epilepsy who have greater disparities in accessing epilepsy care. The Management Information & Decision Support Epilepsy Tool (MINDSET [UTHealth, University of Arizona, and Radiant Digital]) was developed to enhance accessibility to epilepsy self-management (ESM) assessment and treatment. The purpose of this formative usability pilot study was to assess the user experience and functionality of MINDSET 2.0, an enhanced cross-platform online version of MINDSET, among a sample of patients with epilepsy prior to feasibility testing within neurology clinic settings. MINDSET 2.0 comprised an updated cross-platform architecture for easier accessibility and added quality of life, cognitive function, and social determinants assessments. User experience and functionality were assessed in January 2022. Six patients with epilepsy in Texas (n=4) and Arizona (n=2) participated in individual online usability sessions, completing a sociodemographic survey, accessing all components of MINDSET, and then completing usability rating scales and an exit interview. Logical inconsistencies in embedded algorithms were examined for the usability sample and in user case challenges to ensure functional fidelity. Patients reported low adherence to ESM behaviors in each of the management domains. More than 80% of patients agreed that MINDSET 2.0 was acceptable, easy to use, likable, credible, of appropriate duration, and motivationally appealing. Patients agreed that the program helped them think about and manage their epilepsy more carefully, and that it improved decision-making between them and their health care providers (100%). Patients provided lower ratings (≤50%) and reported the greatest number of difficulties with their understanding of how to select goals and strategies, and develop an action plan due to constraints of item response options leading to user confusion. An inconsistency in algorithm branched logic was identified that related to translating depression scores into recommendations for depression self-management programming. The results replicated usability findings from earlier versions of MINDSET but also catalyzed adjustments to user survey response options and algorithm repair. The value of the formative user experience functionality assessment was demonstrated to ensure a high-fidelity program prior to feasibility testing in neurology clinic settings.

Alcohol use disorder (AUD) is a prevalent, relapsing condition. Despite well-documented links between alcohol misuse and adverse health outcomes, the role of AUD in orthopaedic surgery is underexplored, and systematic screening remains uncommon. The aim of this study was to examine the incidence of alcohol use and potential misuse among orthopaedic patients and assessed whether patients flagged for risk engaged in documented discussions about alcohol use with their care teams. We retrospectively reviewed intake data from orthopaedic trauma, spine, bone health, and general registries between May 2020 and April 2025. Alcohol use was initially assessed with a nonstandardized intake questionnaire and later with the validated Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) tool. Patients meeting thresholds for possible misuse were flagged. Clinical notes were reviewed to determine whether flagged patients had alcohol use discussed by their orthopaedic team. Among 99,269 patients screened, 67.9% reported some alcohol use, and 2.5% reported a personal history of AUD. Of 1040 patients completing the AUDIT-C, 29.2% screened positive for potential misuse; 11.1% of bone health patients also met criteria for at-risk drinking. Only 80 of 718 flagged patients (11.1%) had a documented alcohol-related discussion, with higher rates in bone health registries and among older patients. Alcohol use and misuse are common among orthopaedic patients, yet systematic screening and discussion are infrequent. Integrating validated screeners such as AUDIT-C into routine intake and supporting clinicians with training and referral pathways represent critical opportunities to improve patient safety and orthopaedic outcomes.

Chronic Kidney Disease-associated Pruritus is a chronic itching condition experienced by patients during and between dialysis sessions. The individualised nature of the condition makes prevalence and severity difficult to measure. The study aimed to identify the prevalence of Chronic Kidney Disease-associated Pruritus amongst patients receiving dialysis in Ireland, characterise symptom burden, severity, and frequency, factors associated with worsening symptoms, and to examine patient experiences of itching. A quantitative study with a qualitative free-text element was employed. 689 patients undergoing dialysis completed a national survey. Patients undergoing haemodialysis and peritoneal dialysis completed the 5-D itch scale and a qualitative assessment of itching experiences. Regression analyses examined associations between domains of the 5-D itch scale, patient clinical characteristics and the occurrence of moderate-severe itching. Content analysis was used to report qualitative findings. Sixty-two percent (85% haemodialysis; 15% peritoneal dialysis) experienced Chronic Kidney Disease-associated Pruritus; 66% reported moderate-severe itching, with body/trunk region most affected (73%); however, the scalp/face region was most associated with moderate-severe itching (OR = 2.08, 95% CI 1.11-3.870). Four themes were identified: (1) the physical impact of Chronic Kidney Disease-associated Pruritus; (2) the psychological burden of itching; (3) variability in treatment success; (4) itch resolving over time. Two-thirds of Irish patients experience moderate-severe Chronic Kidney Disease-associated Pruritus; a prevalence rate higher than international estimates. This condition is psychologically distressing - impacting sleep, overall quality of life, and risk of infection. Patients require improved clinical attention and greater pratitioner education on management of this condition.

Ticks are among the most important ectoparasite of cattle, causing economic losses through reduced productivity, skin damage and the transmission of tick-borne pathogens. Information on tick epidemiology, community awareness and attachment-site preferences remains limited in many parts of Ethiopia, including Tigray Region. To determine the prevalence, species composition, risk factors, community knowledge and attachment-site preferences of bovine ticks in selected districts of Tigray, northern Ethiopia. A cross-sectional study was conducted in three districts of Tigray, northern Ethiopia. A total of 1023 cattle were clinically examined for tick infestation, and collected ticks were identified using standard morphological keys. Household surveys were administered to 422 cattle owners to assess knowledge and control practices. Logistic regression analysis was used to identify factors associated with tick infestation. Overall, 41.5% (424/1023) of cattle were infested with ticks. A total of 2952 ticks were collected and identified as Rhipicephalus (75.9%), Hyalomma (21.7%) and Amblyomma variegatum (2.4%), with Rhipicephalus evertsi evertsi (26.2%), Rhipicephalus decoloratus (25.9%) and Rhipicephalus pulchellus (23.8%) being the predominant species. Tick infestation varied significantly among kebeles. In the multivariable analysis, poor housing (odds ratio [OR] = 10.54), poor body condition (OR = 7.72), herd management practices and cattle breed were significantly associated with infestation, whereas owner literacy was protective (OR = 0.55). Most respondents (91.5%) recognized tick infestation, but only 28.0% associated ticks with disease transmission. Tick infestation remains widespread among cattle in Tigray and is influenced by animal-, management-, and environment-related factors. Limited awareness of tick-borne diseases highlights the need for improved farmer education. Integrating community knowledge with species-specific tick ecology could enhance the effectiveness of targeted tick control strategies.

Immune checkpoint inhibitors (ICIs) have transformed cancer therapy, yet cancer-related fatigue (CRF) remains a frequent but poorly characterized adverse effect. We evaluated CRF incidence during ICI treatment in neoadjuvant and adjuvant settings. We conducted a systematic review of prospective cohort studies and phase 2 or higher trials investigating FDA-approved ICIs in adjuvant or neoadjuvant settings, reporting fatigue as an adverse event or via patient-reported outcomes (PROs). Searches conducted across four databases and ClinicalTrials.gov through September 2024 followed PRISMA guidelines using Covidence software. Studies not in English, lacking full text, or insufficient for meta-analysis were excluded. Data on fatigue incidence and quality of life were extracted. Risk of bias was assessed using the Cochrane tool, and certainty of evidence was graded using GRADEPro. Meta-analysis was performed on all included studies. Forty-three studies met inclusion criteria, primarily involving melanoma, breast, lung, renal, and gastroesophageal cancers. Common ICIs included nivolumab, pembrolizumab, ipilimumab, and durvalumab. Fatigue was more frequent with ICIs versus placebo (risk ratio [RR] 1.21, 95% CI 1.08-1.35), and PROs indicated higher fatigue levels (standardized mean difference 0.12, 95% CI 0.01-0.23). No significant difference was observed between ICIs and chemotherapy (RR 0.81, 95% CI 0.36-1.82). Risk of bias was high due to allocation concealment and open-label designs. ICI monotherapy is associated with modestly increased CRF compared with placebo, as reported by clinicians and patients. These findings underscore the need for patient counseling and further research on the severity and trajectory of ICI-related CRF.

Background and objectives Large-scale studies on the prevalence of substance use disorder among people in prisons from developing countries such as India are limited, despite a sizeable number of individuals lodged in prisons. The present study aimed to assess the prevalence of various psychoactive substance use among people in prisons in India, and to assess factors associated with psychoactive substance use in prison. Methods Seventeen prisons from 9 States representing different geographical regions of the country were selected. 7004 incarcerated people selected by systematic sampling were interviewed using a structured questionnaire. Results Majority were incarcerated for the first time (n=5372, 77%) and were under remand awaiting trial or sentencing (n=4537, 65%). The proportion of incarcerated persons with lifetime use of alcohol, cannabis, and opioids was 51% (n=3579), 20% (n=1383), and 11% (n=758), respectively. 21% (n=752) of alcohol users, 30% (n=411) of cannabis users, and 45% (n=340) of opioid users used alcohol, cannabis, and opioids respectively daily in the one month before their current imprisonment. 5.9% (n=412) used a psychoactive substance (including alcohol and illicit drugs) during their current imprisonment, most commonly, cannabis (3.9%, n=273). Multivariable regression showed that psychoactive substance use in prison was significantly associated with younger age [odds ratio (OR): 1.4, 95% confidence interval (CI): 1.1, 1.8], multiple imprisonment (OR: 1.6, 95% CI: 1.3, 2.0), cannabis use before imprisonment (OR: 5.5, 95% CI: 4.1, 7.4), and substance withdrawals inside prison (alcohol OR: 1.8, 95% CI: 1.4, 2.4, cannabis OR: 2.9, 95% CI: 2.1, 4.1, opioids OR: 3.1; 95% CI: 2.3, 4.2). Interpretations and conclusions The study documents high lifetime substance use among individuals in prisons in India and identifies various factors associated with substance use during current imprisonment.

Musculoskeletal pain (MSP) is among the most common occupational health problems for nurses. The purpose of this study was to evaluate the prevalence and severity of work-related MSP in clinical nurses. This cross-sectional and descriptive study was conducted with individuals who had been working as clinical nurses for at least 6&#x2009;months. The study included 312 clinical nurses who were directly involved in patient care and met the eligibility criteria. Clinical nurses were assessed with the Ergonomic Risks Questionnaire (Ergo-Nurse), and work-related MSP was assessed with the Cornell Musculoskeletal Disorder Questionnaire (CMDQ). Spearman correlation, independent samples t-test, and hierarchical regression analysis were used to determine the relevant factors. Work-related MSP is a major health problem in clinical nurses, with MSP severity ranging from low lumbar&#x2009;>&#x2009;back&#x2009;>&#x2009;neck. Hierarchical regression analysis showed that biomechanical factors were the most important ergonomic factor associated with work-related MSP in clinical nurses (R2&#x2009;Change: 17.178 p < 0.05), and other ergonomic subdimensions did not contribute significantly to the model (p > 0.05). In the gender variable, being female was found to be a significant risk factor for work-related MSP (p < 0.05). Biomechanical ergonomic risks and female sex were the main factors associated with work-related MSP among clinical nurses. These findings highlight the need for targeted ergonomic interventions, safe patient-handling practices, workload regulation, and institutional strategies to reduce musculoskeletal strain in clinical nursing settings.

Graduate student well-being is an emerging public health priority, yet the role of pre-university structural background, particularly rural versus urban origin, remains poorly understood. This study examined whether rural-urban disparities in life satisfaction persist among students at an elite Chinese university, and to what extent health behaviors account for any observed gap. In a cross-sectional survey, 497 master's and doctoral students at a Double First-Class university in eastern China completed the Satisfaction with Life Scale (SWLS), the IPAQ short-form physical activity questionnaire, and items on insomnia, sleep duration, and sociodemographic characteristics, including monthly disposable income. Two hierarchical linear regression models were constructed: Model 1 (sociodemographic variables only) and Model 2 (adding sleep, physical activity, and insomnia). Because Model 1 is a proper subset of Model 2, the attenuation of the rural-origin coefficient between model estimates the share of the gap associated with health behaviors. After adjustment for sociodemographic covariates, rural-origin students scored 1.95 points lower on the SWLS than urban-origin peers (Model 1, p&#x202f;=&#x202f;0.003). Adding health behaviors to the model reduced this gap by roughly half (p&#x202f;=&#x202f;0.088). Insomnia showed a pronounced graded association with life satisfaction (p&#x202f;<&#x202f;0.001). Physical activity and sleep duration (p&#x202f;<&#x202f;0.001) were independently associated with higher SWLS. Being in a relationship or married was also associated with greater well-being. Health behaviors accounted for approximately half of the rural-urban gap in life satisfaction. The other half persisted independently, suggesting that structural disadvantage exerts effects on well-being that are not reducible to individual health practices. Campus interventions targeting sleep and physical activity are warranted, but closing the remainder of the gap will likely require strategies that address the cultural and institutional dimensions of rural-to-urban educational mobility.

Falls among older people are common, and they may have consequences such as fractures and injuries. Falls may also reduce older people's independence and wellbeing and increase demand for both healthcare and social care services. This research aims to investigate whether older people living in the community who experience poor housing conditions face a greater risk of falls than those living in better-quality housing after controlling for other risk factors. In particular, we aimed to (i) identify housing-related drivers of falls, and (ii) estimate associated costs. Using data from the English Longitudinal Study of Ageing (ELSA), covering the period from 2002/03-2021/23, we performed a combination of cross-lag and Heckman selection models to address endogeneity and selection bias. We also developed a decision tree model to estimate associated healthcare and social care costs. We found that those living in homes with electrical or plumbing problems, as well as those lacking space, are more likely to experience a fall. Similarly, we found that older people living in homes that are 'too dark' are more likely to experience a fall and to visit a healthcare service as a consequence. We estimated that the annual cost of falls attributable to poor housing conditions is &#xa3;1.2 billion. Poor housing conditions significantly increase the risk of falls among older people. Associated costs could be avoided. Viewing housing improvements as part of an integrated, neighbourhood-level falls prevention strategy could yield significant benefits for individuals and for the sustainability of health and care systems.

While China has achieved significant milestones in controlling infectious diseases, how mortality patterns have shifted across different life stages remains poorly understood. This study aims to delineate the evolving burden of infectious disease mortality to inform age-specific public health strategies. We analyzed national death surveillance data from China spanning 2004 to 2021. "Combined infectious mortality" was defined as the aggregate of communicable and parasitic diseases plus respiratory infections. Focusing on four key categories-respiratory infections, tuberculosis, viral hepatitis, and HIV/AIDS-we calculated crude and age-standardized mortality rates (ASMR). Log-linear regression models estimated annual percentage changes (EAPCs). Primary trend inferences were restricted to 2013-2019 (stable post-expansion period); 2020-2021 was treated separately due to the absence of a COVID-19 code. During 2013-2019, mortality declined substantially faster in younger than in older age groups: EAPC was -14.70% (95% CI -16.96 to -12.38) for children aged 0-4&#x202f;years, but only -1.62% (95% CI -3.66 to 0.46) for adults aged 75&#x202f;+&#x202f;(interaction p&#x202f;<&#x202f;0.0001). In 2021, over half (55.04%) of combined infectious deaths occurred in adults aged 75+. Cause hierarchy varied by age: respiratory infections dominated at both extremes; HIV/AIDS ranked highest among young adults (20-39&#x202f;years), though its advantage was narrow; viral hepatitis predominated in middle-aged adults (40-59&#x202f;years). HIV/AIDS mortality rose among 60-74&#x202f;year-olds (EAPC 5.90% per year), with higher burden in rural and western regions. China is undergoing a distinctive epidemiological transition: infectious deaths are increasingly concentrated in older age groups, driven primarily by divergent age-specific mortality trends rather than population ageing alone. Public health strategies must extend beyond maternal-child health frameworks to address growing vulnerabilities in older populations-particularly respiratory infections and HIV in ageing rural communities.

Patients receiving hemodialysis are at risk of creatine deficiency due to impaired endogenous synthesis and losses during dialysis. Creatine deficiency is associated with lower health-related quality of life and higher mortality. We investigated the feasibility, tolerability and safety of intradialytic creatine supplementation during hemodialysis. In this double-blind, randomized, placebo-controlled pilot study (ClinicalTrials.gov ID: NCT05148208), 16 hemodialysis patients were included into four sequentially initiated groups, with each group receiving a fixed creatine concentration in the dialysate (0.5 mmol/L, 1.0 mmol/L, 1.5 mmol/L and 2.0 mmol/L, respectively), with block randomization in a 3:1 ratio (creatine:placebo) per group. Dropouts were replaced. Intra-dialytic creatine was administered during a 6-week period. Primary outcomes were changes in pre-dialytic intra-erythrocytic and plasma creatine concentrations, which were analyzed with linear mixed models. 16 hemodialysis patients (aged 27-78 years, 9 female) completed the study. Creatine supplementation was generally well tolerated. One patient receiving 1.5 mmol/L creatine dropped out due to a potential side effect. No serious adverse events occurred. The median (minimum-maximum) baseline pre-dialytic intra-erythrocytic and plasma creatine concentrations were 963 (407-1822) and 35 (13-287) &#xb5;mol/L, respectively. At 6 weeks, the changes in pre-dialytic intra-erythrocytic creatine concentration compared to placebo (95% CI) were +399 (-269, 1066),&#x2009;+&#x2009;685 (+17,&#x2009;+&#x2009;1352),&#x2009;+&#x2009;1146 (+431,&#x2009;+&#x2009;1766) and +1098 (+431,&#x2009;+&#x2009;1766) &#xb5;mol/L for the increasing dosage treatment groups respectively (overall treatment effect p&#x2009;<&#x2009;0.001). The changes in pre-dialytic plasma creatine concentration compared to placebo were -16 (-301,&#x2009;+&#x2009;270),&#x2009;+&#x2009;21 (-264,&#x2009;+&#x2009;307),&#x2009;+&#x2009;119 (-264,&#x2009;+&#x2009;307) and +163 (-122,&#x2009;+&#x2009;449) &#xb5;mol/L for the increasing dosage treatment groups respectively (overall treatment effect p&#x2009;=&#x2009;0.002). Intra-dialytic creatine supplementation is a feasible, safe, well-tolerated method to increase circulating creatine concentrations in patients treated with hemodialysis. These findings support the rationale for a larger randomized controlled trial to investigate its potential to improve health-related quality of life and reduce mortality risk in this population. Trial Registration: ClinicalTrials.gov ID NCT05148208, date of first registration 08/12/2021.