Quality sexual relationships predict higher marital satisfaction and lower emotional distress in cancer patients. However, no studies have investigated the sexual satisfaction of patients visiting a psycho-oncology clinic. In this study, I examined characteristics of non-respondents to a sex-related question and identified characteristics and correlates of sexual satisfaction in patients visiting a psychooncology outpatient clinic in a tertiary hospital in a sex-stratified format. For 417 female and 169 male, those who answered the single sexual satisfaction item of the Functional Assessment of the Cancer Therapy-General (FACT-G) were categorized as "respondents," and others as "non-respondents" by sex. After adjusting for age, cancer diagnosis, and time after diagnosis, sex-stratified linear regression models were established using the FACT-G except the sexual item and the Hospital Anxiety and Depression Scale. Female were 1.466 times more likely to decline to answer about sexual satisfaction. Older patients, and female with active diseases or recent chemotherapy, also tended to avoid answering. Among female and male, 24.5% and 26.0%, respectively, reported no sexual satisfaction, with no between-sex difference. Lower age, a longer time since diagnosis, greater social/family well-being, and lower depressive symptoms for female and greater physical well-being for male contributed to sexual satisfaction. Psycho-oncologists should sensitively address sexual issues among older female in poor health. Paying equal attention to sexual issues for both sexes is necessary. For recently diagnosed older female with lower social/family well-being and higher depressive symptoms and male experiencing lower physical well-being, sexual issues should be thoroughly assessed.
Human Immunodeficiency Virus (HIV) Viral load non-suppression (VNS) among women engaged in commercial sex (WECS) is unknown even with persistent new HIV infections in the general population. The objective of this study was to find out the factors correlated with VNS among WECS living with HIV (WECS-LHIV) in Uganda. Cross-sectional data were collected through respondent driven sampling (RDS) in Kampala Capital City and 11 upcountry towns. All consented WECS-LHIV reporting commercial sex 3 months prior to the surveys were tested for HIV and viral load (VL), active syphilis and high-risk human papilloma virus (hr.HPV) which was based on genotypes 16 and 18 that are highly associated with all cervical cancer cases. VNS was defined as any VL measure < 1,000 copies/ml. Analysis of correlates of VNS were restricted to WECS-LHIV with VL results irrespective of their antiretroviral therapy (ART) status. We examined variables including - age, marital status, education, active syphilis, hr.HPV and reported ART use to identify correlates of VNS. Sampling weights to reflect the complex sampling design were applied. Of 2,674 WECS-LHIV (median age 32 years, interquartile range (IQR) 27-37), 667 (24.9%) had VNS. The findings show that 19.2% and 29.7% of WECS-LHIV with VNS had active syphilis and hr.HPV co-infections respectively. WECS-LHIV had reduced odds of VNS if they were aged 30-49 years ([adjusted odds ratio (aOR): 0.46, 95% confidence interval (CI): 0.30-0.69, p < 0.001)] vs. 18-24 years and if they self-reported ART use [aOR: 0.38, 95% CI: 0.28-0.52, p = < 0.001 vs. non-self-reporting ART]. Young women engaged in commercial sex(YWECS) and none ART disclosure WECS may increase risk of new HIV infections in general population. Increase on frequency of ART adherence and viral load monitoring of YWECS including continuous surveillance of the second and third 95 HIV continuum of care and treatment for hidden populations may aid in reduction of new HIV infections burden in Uganda and other low- and middle-income countries.
Sexually transmitted infections remain a significant concern among people living with HIV (PLHIV), with syphilis emerging as a common coinfection globally, particularly among men who have sex with men (MSM) and anti-retroviral therapy (ART)-naïve individuals. Understanding the socio-demographic and behavioural characteristics of HIV-syphilis coinfected individuals is important for guiding targeted prevention strategies. This study aimed to examine the associations between socio-demographic characteristics, sexual behaviour patterns, and treatment status among HIV-syphilis coinfected individuals, with a focus on gender differences and MSM versus non-MSM. This secondary data analysis included 2,209 PLHIV coinfected with syphilis registered at 27 designated sexually transmitted infections/reproductive tract infection clinics (DSRCs) in Mumbai under the National AIDS and STI Control Programme from April 1, 2022, to March 31, 2025. Socio-demographic, behavioural, and clinical variables were extracted from programme records and analyzed in R, with associations assessed using chi-square or Fisher's exact tests, as applicable, and multivariable logistic regression was performed, at a significance level of p<0.05. Ethical approval was obtained from the Mumbai District AIDS Control Society, and data were anonymized before analysis. Among the 2,209 coinfected individuals, 1822 (82.5%) were males, 273 (12.4%) were females, and 114 (5.2%) were transgender individuals. The majority belonged to the 26-35 year age group (n = 767, 34.7%). Significant differences were observed across gender groups in education, marital status, sexual practices, partner types, condom use, and treatment status (p < 0.05). Vaginal intercourse was the most common sexual act overall (n = 1434, 76.6%), while anal and oral sexual practices were more frequently reported among males and transgender individuals (p < 0.001). Spousal partners were the most commonly reported type of partner (n = 886, 51.0%), followed by commercial (n = 808, 45.9%) and casual partners (n = 794, 44.3%). Consistent condom use was highest with casual partners (n = 377, 49.2%) but lower with regular partners (n = 71, 30.6%). Among males, 398 (21.8%) identified as MSM, who were significantly younger, more educated, and more likely to report anal sex and casual partners (p < 0.05). Overall, 60.3% (n = 1332) of participants were ART-experienced. In multivariable analysis, MSM status was independently associated with unmarried status, higher education, and anal intercourse. Increasing age, male and transgender identity were associated with higher odds of being ART-experienced, while engagement in commercial partnerships and anal intercourse were associated with lower odds. HIV-syphilis coinfection in our study appears to be sustained through overlapping sexual networks involving casual, commercial, and marital partnerships combined with inconsistent condom use. Strengthened screening for syphilis, targeted prevention interventions, and behavioural counselling for risk reduction among PLHIV are essential to reduce ongoing transmission.
Advanced chronic kidney disease (ACKD) severely impairs health-related quality of life (HRQoL). Comparative HRQoL outcomes across renal replacement therapy (RRT) modalities and stratified by sex remain poorly characterized in Latin American settings. We compared HRQoL between women and men undergoing peritoneal dialysis (PD), hemodialysis (HD), or kidney transplantation (KT) in Mexico City. A cross-sectional study that examined 300 adults (100 per RRT group; 50 women and 50 men in each) was conducted at the Instituto Mexicano del Seguro Social. HRQoL was measured using the validated Spanish version of the Kidney Disease Quality of Life-36 (KDQoL-36) questionnaire. Multivariable generalized linear models with robust standard errors were used to estimate adjusted marginal means while controlling for age, education, marital status, BMI, and disease duration. Pairwise comparisons were Bonferroni-adjusted. KT patients showed higher SF-12 Physical Composite scores than PD and HD patients. PD scored lower than HD and KT on the Symptoms/Problems and Effects of Kidney Disease subscales (all p <0.001). HD showed the highest SF-12 Mental Composite score. Sex differences were modest. Within the HD group, women scored higher on the Effects of Kidney Disease subscale (Δ +9.0 [95% CI 1.5-16.4], p = 0.018) but lower on SF-12 Mental Composite subscale (Δ -4.4 [95% CI -8.1 to -0.8], p = 0.018). KT was associated with the best HRQoL and PD showed the lowest scores. Sex differences were limited to mental health and kidney disease burden among HD patients, underscoring the need for modality-specific, sex-sensitive approaches in RRT care.
Women with hypoactive sexual desire disorder (HSDD) lack the thoughts, desire, or receptivity to sexual desire, causing personal difficulty and distress (DSM IV-TR). However, HSDD clinical trials evaluating testosterone therapy, flibanserin, and bremelanotide spanning nearly a decade show women with HSDD, encompassing low to no sexual desire, are still engaging in sexual activity. We aimed to define this sexual activity as "mercy sex", quantify its frequency, and provide hypothetical explanations for this behavior. We reviewed baseline data on sexually satisfying events (SSEs) from a representative convenience sample of published, peer-reviewed, prospective, randomized, placebo-controlled trials of women with HSDD. Baseline data were assessed across time, age, reproductive status, and geography. Women in these studies engaged in "mercy sex" about 2.5 times/month despite their documented HSDD. These results have important implications for further HSDD clinical research, as mercy sex frequency may skew therapeutic efficacy while having significant implications in calculating trial sample size, and assessing a clinically meaningful response to therapy, when SSEs are used as a primary endpoint. Although this paper explores only a biopsychosocial explanation for the phenomenon of mercy sex in clinical trials of HSDD therapies, it provides a valuable understanding that will benefit patients, clinicians, and researchers.
This systematic review and meta-analysis synthesize the evidence on the effectiveness of pharmacological, non-pharmacological, and complementary interventions for improving sexual function in women with infertility. Databases searched included PubMed, EMBASE, Web of Science, and ULAKBIM up to January 2026. Data were pooled using Review Manager 5.4 with random-effects models in the presence of heterogeneity. Sexual function outcomes were measured with validated instruments and reported as standardized mean differences (SMDs). Risk of bias was assessed with RoB 2 for RCTs and ROBINS-I for non-randomized studies. A meta-analysis of 11 studies (n = 722) showed no baseline differences in sexual function between intervention and control groups (SMD = -0.07; p = 0.64). Post-intervention, interventions significantly improved sexual function (SMD = 1.53; p < 0.00001), with the largest effects observed for sex therapy-based and pharmacological/herbal interventions. Psychotherapeutic and counseling/education-based interventions also showed significant benefits, while behavioral/lifestyle interventions were not effective. Both short- and long-term interventions were effective, and results were consistent across study designs, although non-randomized trials had higher risk of bias. Interventions are associated with improvements in sexual function among infertile women. More pronounced effects were observed for sex therapy-based and pharmacological/herbal approaches, while psychotherapeutic and counseling interventions also demonstrated beneficial effects.
The demographic structure of China's HIV-1 epidemic is rapidly shifting toward an aging population. This study aims to analyze the molecular transmission network characteristics of newly diagnosed HIV-1 infected individuals aged 50 and above in Taizhou, China, by combining sociodemographic information. Plasma samples were collected from newly diagnosed HIV-1 patients aged ≥50 years who were not receiving antiretroviral therapy (ART) in Taizhou between 2023 and 2025. HIV-1 subtypes were determined and pairwise genetic distances were calculated based on the HIV-1 pol gene sequences amplified by nested PCR and sequenced by Sanger sequencing. A molecular transmission network was constructed using a genetic distance threshold of 0.010. Logistic regression was subsequently used to identify factors associated with molecular clustering. Of the 506 samples, 473 (93.5%) were successfully sequenced. The predominant HIV-1 subtypes identified were CRF07_BC (34.0%), CRF08_BC (33.8%), and CRF01_AE (23.5%). Univariate analysis showed that molecular clustering was associated with marital status, education level, heterosexual transmission, and viral subtype. Subsequent multivariate analysis revealed that clustering was significantly correlated with heterosexual contact (aOR = 2.71, 95%CI: 1.46-5.25) and infection with either the CRF08_BC (aOR = 5.90, 95%CI: 3.39-10.46) or CRF07_BC (aOR = 1.85, 95%CI: 1.10-3.14) subtypes. Overall, 264 cases (55.8%) formed 64 distinct molecular clusters, comprising 6 large clusters and 58 small clusters. Notably, four of the six largest clusters belonged to the CRF08_BC subtype. Within the CRF08_BC clusters, 95.2% (120/126) of individuals had junior middle school education or lower, and female sex workers (FSWs) were identified in the two largest clusters. Additionally, a large cluster of 11 individuals comprising the minor subtype CRF85_BC was detected. Molecular transmission networks and sociodemographic data indicate that older, less-educated individuals are facilitating the spread of the HIV-1 CRF08_BC subtype in Taizhou via contact with FSWs. Therefore, targeted interventions focusing on elderly men with low education levels are essential.
Concerns about sexual desire are a frequent reason couples seek therapy. Consequently, researchers, clinicians, and educators have increasingly focused on understanding issues related to sexual desire. However, most existing research has primarily examined low desire and partner discrepancies, leaving individuals' personal perceptions and concerns about level of libido largely unexplored. To address this gap, the current study explored individuals' experiences and concerns about perceived levels of desire. Additionally, the study examined differences in perceived sexual desire and related concerns across gender, sexual orientation, relationship status, and age. Participants were recruited through the Science Vs podcast team's social media platforms to complete a mixed-method online survey. Of 1,317 participants, more than half (57.1%, N = 752) reported concerns about their libido, with the most common concerns being libido that seemed too low (47.5%, N = 357) or did not match their partner's (42.4%, N = 319). Fewer participants reported concerns about high libido (7.6%, N = 57). Thematic analysis of open-ended questions revealed the following common themes: low libido, fluctuations in desire, and uncertainty about what constitutes "normal" libido. Findings underscore the importance of education on sexual desire variability, as well as strategies for effectively communicating about sexual desire in different contexts.
HIV-associated neurocognitive disorders (HAND) remain prevalent among adults living with HIV, even in the era of sustained antiretroviral therapy (ART). Accurate screening for HAND remains a challenge in resource-limited settings like Ethiopia, as comprehensive neuropsychological assessments thought effective are often limited by their high demands for time, specialized personnel, and logistical resources. The International HIV Dementia Scale (IHDS) and the Montreal Cognitive Assessment (MoCA) are brief cognitive screening tools commonly used in clinical settings; however, their diagnostic accuracy for detecting HAND in the Ethiopian population has not been well established. This study aims to evaluate and compare the sensitivity and specificity of the IHDS and MoCA in identifying HIV-associated neurocognitive disorder among adults living with HIV in Ethiopia. A multicenter, cross-sectional study was conducted among 290 adults living with HIV attending three primary hospitals in Ethiopia. Participants aged ≥ 18 years were recruited using systematic random sampling. Clinical data, including baseline CD4⁺ T-cell counts and recent viral load measurements, were extracted from medical records. Cognitive function was assessed using the IHDS and MoCA, with the Frascati criteria used as the diagnostic reference standard, and factors independently associated with IHDS scores were identified through multivariable linear regression. The study included 290 adults living with HIV, with a mean age of 40.6 ± 8.04 years. Based on the Frascati criteria, 43.4% of participants exhibited HIV-associated neurocognitive disorders (HAND), with asymptomatic neurocognitive impairment being the most common subtype (25.4%), followed by mild neurocognitive disorder (13.3%) and HIV-associated dementia (4.7%). Using the International HIV Dementia Scale (IHDS), 47.9% of participants were identified as cognitively impaired, indicating possible HAND, whereas the Montreal Cognitive Assessment (MoCA) identified 36.2% as impaired. The IHDS demonstrated superior diagnostic performance, with an optimal cutoff score of ≤ 10 (sensitivity 85.3% and specificity 77%), compared to the MoCA at a cutoff score of 21 (sensitivity 62.1% and specificity 81%). Multivariable linear regression analysis revealed that higher educational attainment (β = 0.30, p = 0.005) and male sex (β = 0.41, p = 0.045) were independently associated with better neurocognitive performance, while being unmarried (β = -0.29, p = 0.01) and a longer duration of antiretroviral therapy (β = -0.26, p = 0.04) were significantly associated with poorer cognitive outcomes. HIV-associated neurocognitive disorders remain highly prevalent among adults living with HIV in Ethiopia. The IHDS demonstrated better sensitivity than the MoCA for detecting HAND, making it a more suitable screening tool in resource-limited settings. Educational status, sex, marital status, and duration of ART were significant predictors of cognitive performance. Integrating routine cognitive screening using IHDS may improve early identification and management of HAND.
ObjectivesDeep brain stimulation (DBS) is a well-established treatment for Parkinson's disease (PD). Despite its proven efficacy, women are less likely to receive DBS. This study examined sex differences across the multistage clinical pathway to identify stage-specific factors contributing to disparities in utilization.DesignRetrospective cohort study using longitudinal clinical data from a single, high-volume neurological care center.MethodsData were drawn from 4,308 patients with PD treated between 2012 and 2024. Progression through the DBS pathway was modeled as four conditional stages: (S1) referral, (S2) multidisciplinary evaluation among those referred, (S3) recommendation among those evaluated, and (S4) DBS surgery among those recommended. Stage-specific Firth penalized logistic regression models were used to estimate sex differences while adjusting for demographic and clinical characteristics, including age, race, comorbidities, marital status, levodopa use, and tremor status. Sex-by-predictor interactions were assessed to identify differential effects across stages.ResultsAmong the cohort (2,866 males, 1,442 females), 186 (4.3%) received a referral for evaluation; 180 (97%) received an evaluation; and 159 (88%) received DBS. Adjusting only for sex, compared to males, females were less likely to be referred (OR=0.97, CI=0.71, 1.32), evaluated given referral (OR=0.88, CI=0.1, 5.17), and receive DBS given recommendation (OR=0.61, CI=0.17, 2.38), but more likely to receive a recommendation after evaluation (OR = 1.55, CI = 0.59-4.70). Sex-Predictors odds ratios differed [male- S1: age (OR=0.95, CI=0.93, 0.97), comorbidities (OR=1.19, CI=1.00, 1.41); S2: comorbidities (OR=0.51, CI=0.20, 0.87); S3: age (OR=0.91, CI=0.84, 0.97), non-white (OR=0.29, CI=0.09, 0.88), comorbidities (OR=1.90, CI=1.09, 3.73); S4: non-white (OR=0.15, CI=0.02, 0.91); [females- S1: unmarried (OR=0.71, CI=0.38, 0.92); S2: levodopa (OR=1.24, CI=1.06, 1.90); S3: non-white (OR=0.01, CI=0.00, 0.31); S4: tremors (OR=1.55, CI=1.04, 1.87)].ConclusionStage-specific regression showed that differential characteristics were associated with sex disparities in DBS utilization, highlighting potential targets for equity interventions. Parkinson’s disease (PD) is a condition that affects movement and can make everyday activities difficult. For some people, a treatment called deep brain stimulation (DBS) can greatly improve symptoms when medications no longer provide symptom relief. DBS is a type of brain surgery that helps control movement problems such as tremors and stiffness. Even though DBS is effective, women are less likely than men to undergo this treatment. This study examined why sex differences DBS receipt occur by analyzing data from over 4,000 patients with PD who received care at a specialized neurological center. Following patients through four key steps: being referred for DBS, completing a detailed evaluation, being recommended for surgery, and ultimately receiving the procedure. This analysis showed that differences between men and women occured at multiple points along this pathway. For example, women were less likely to be referred for evaluation, and social factors such as marital status appeared to play a role. At later stages, clinical factors such as medication use and symptom type influenced whether patients moved forward with surgery, and these factors affected men and women differently. Overall, these findings suggest that unequal access to DBS is not caused by a single issue but instead resulted from a combination of social, clinical, and healthcare system factors. Understanding where these differences occur can help doctors and health systems design targeted strategies to ensure that all patients who could benefit from DBS have an equal opportunity to receive it.
Gambling disorder (GD) is a growing public health concern, with emerging evidence suggesting potential sex differences in clinical presentation, gambling preferences, and treatment-seeking patterns. Furthermore, non-Western countries/cultures and women's clinical populations are understudied. Therefore, this study aimed to examine sex-related sociodemographic characteristics, gambling behaviors, and psychiatric symptoms among treatment-seeking individuals with GD in Türkiye. Data from 12,505 treatment-seeking individuals who registered for Green Crescent Counselling Center between 2021 and 2024 were analyzed. A total of 330 women participants who met the inclusion criteria were identified and compared with a sample of 990 men participants (matched on age, marital status, and education). Sociodemographic and clinical features, gambling preferences, and psychiatric symptoms were compared between groups. A notable increase in the number and proportion of women seeking-treatment for GD was observed between 2021 and 2024. Women reported beginning gambling at a later age and engaging in it for a shorter duration compared to men. They showed a distinct gambling pattern, with a strong preference for online casino games, whereas men primarily engaged in sports betting. Women also exhibited higher rates of co-occurring psychiatric concerns, including depression, anxiety, PTSD, along with greater impulsivity. Our findings highlight meaningful sex-related differences in the clinical presentation and gambling behaviors of treatment-seeking individuals with GD. The sizable representation of women suggests the need for sex-sensitive prevention and intervention strategies. Tailored approaches that address co-occurring psychiatric concerns, gambling preferences, and speculative motivations, may enhance treatment outcomes and inform future service provision in the treatment of GD, particularly for women.
Testing for sexually transmitted infections (STIs) is a routine component of prenatal care. Treating partners is challenging and the inconsistency contributes to maternal reinfection and neonatal morbidity. This study evaluated documentation of partner treatment among pregnant women diagnosed with different STIs. This retrospective cohort study included pregnant women who received care at two safety-net hospitals in Harris County, TX, between 2019 and 2022. Electronic health records were reviewed for documented partner treatment among patients with chlamydia, gonorrhea, hepatitis B infection (HBV), or syphilis during pregnancy. Patients with chlamydia and gonorrhea are typically offered expedited partner therapy by physicians, whereas the local health department coordinates partner treatment of HBV and syphilis. Gaps in hospital and health department records were supplemented through brief patient interviews. Multivariable Poisson regression models with robust error variance examined associations between STI and physician counseling on partner treatment, adjusting for age, race and ethnicity, marital status, preferred language, and substance use. Adjusted relative risk (aRR) with 95% confidence intervals (CI) were calculated. P<0.05 was considered statistically significant. Among 369 eligible patients, physician documentation of partner treatment was highest for patients with chlamydia only (54%), followed by gonorrhea only (46%), syphilis (43%), and lowest for HBV (1%). Documented barriers to partner treatment included lack of partner contact (gonorrhea only 75%, chlamydia only 43%, syphilis 34%) and partner refusal (HBV 43%). Physician counseling on partner treatment was documented for ≥80% of patients with STIs except HBV (56%, aRR=0.68 compared to chlamydia only, 95% CI 0.51-0.91). Sufficient prenatal care was associated with higher partner treatment for chlamydia only (67% vs. 45%, p=0.023). Partner treatment and physician counseling vary by STI. Physician reliance on public health-managed partner treatment may hinder completion and sustain high rates of STIs during pregnancy.
To assess the nursing and midwifery students' knowledge and practice regarding fluid resuscitation during the acute phase of burn management. A cross-sectional, descriptive design was employed. The data were collected using an online-administered questionnaire at a governmental university among nursing and midwifery students, who were selected purposively. The instrument consisted of three sections. The first section covered participants' characteristics, including age, sex, marital status, academic program, level of study, grade point average (GPA) and residency. The second section is self-reported and composed of 10 questions to assess the students' knowledge domains, and the third section is also self-reported and composed of 11 questions to assess participants' practice regarding practice; each question received a binary response based on whether or not students completed a specific practice. The study of midwifery and nursing students reported that they had an average knowledge (73.58%) of fluid monitoring, with 96% comprehending fluid balance, but only 28.4% being able to calculate fluids using the Parkland formula. In practice, participants demonstrated a high level of compliance (94.89%) with documentation of fluid administration; however, adherence was notably lower (85.7%) for the application of the rule of nines during assessment. Midwives and nurses draw clinical judgements based on their academic and professional experience, as well as scientific facts. Theoretical knowledge can help support and improve health practices. A strong intellectual background is essential for providing appropriate care throughout the acute phase of burn management. Future research could incorporate direct observation methods to validate self-reported findings and assess the translation of theoretical knowledge into clinical practice.
Sport fans can experience a variety of dysfunctional emotions and maladaptive behaviors, including anger, hatred, depression, anxiety, and violence. For many years, rational emotive behavioural therapy (REBT) has used the concepts of rational and irrational beliefs to explain the emotions and behaviours exhibited by different groups, such as athletes, students and employees. The current study examines the relationships between rational and irrational fan beliefs, and psychological distress (depression, anxiety, and stress), in football fans. It also investigates the moderating role of gender, marital status, and match outcomes in these relationships. The study involved 256 football fans, aged between 23 and 48 (Mage = 26.34). Moderator effect analysis was performed using PROCESS Macro. The analyses revealed that psychological distress was negatively correlated with rational fan beliefs and positively correlated with irrational fan beliefs. The moderating role of gender, marital status and match outcome was not significant. Male gender, single status, and losing a match were risk factors for mental health. Overall, the findings indicate that psychological distress is positively associated with irrational beliefs and negatively associated with rational beliefs, regardless of gender, marital status, or match outcome. The results are discussed in relation to REBT and fan studies.
BACKGROUND: This study aimed to analyze mortality trends, causes of death, and key prognostic factors among people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Huangshi, Hubei Province, from 2003 to 2025, to inform the optimization of clinical management and public health policy. METHODS: A retrospective cohort analysis was conducted, collecting demographic characteristics, WHO clinical stage, CD4 counts, initial ART Regimen, and follow-up information. The primary outcome was all-cause mortality. First, a univariable Cox regression analysis was performed. The proportional hazards assumption was then tested using the Schoenfeld residual test. If time dependency was detected, a time-stratified Cox model was constructed. Kaplan-Meier (KM) survival curves were used for visual presentation of survival patterns across different groups. RESULTS​: After screening, 2,494 ART-treated PLWH were included, of whom 671 died. Mortality peaked in 2017 and 2022, followed by a subsequent decline. The leading causes of death were opportunistic infections and cardiovascular diseases. Univariate analysis indicated that age, sex, marital status, transmission route, presence of AIDS-related symptoms, WHO clinical stage, CD4 count, and initial ART regimen were associated with mortality risk. In the time-stratified Cox model, age, transmission route, AIDS-related symptoms, baseline CD4 count, recent CD4 count, and initial ART regimen were significantly associated with mortality risk (P < 0.05). KM survival curves demonstrated lower survival rates among older individuals, those infected via heterosexual transmission, patients with clinical symptoms, those with low CD4 levels, and NVP-based regimen groups. CONCLUSION: In the ART era, mortality among PLWH is influenced by multiple factors. Opportunistic infections remain the primary cause of death, while the rise in cardiovascular disease reflects the evolving chronic disease profile of HIV. Enhancing early diagnosis, immune monitoring, and opportunistic infection prevention, and integrating chronic disease management are pivotal for improving survival and quality of life.
Advance care planning (ACP) is essential for respecting patient autonomy and improving end-of-life care quality. However, the level of ACP readiness and its determinants among individuals receiving peritoneal dialysis (PD) in China remain insufficiently explored. This study employed a cross-sectional descriptive-analytical design. From January to June 2025, 129 adults receiving PD were recruited using convenience sampling from two tertiary hospitals in Sichuan Province, China. Demographic characteristics, including age, sex, marital status, educational level, employment status, disease duration, dialysis duration, and comorbidities, were collected. ACP readiness was assessed using the Chinese version of the Advance Care Planning Readiness Scale (ACPRS), which has demonstrated good reliability and validity in Chinese chronic disease populations. Death anxiety and social support were measured using the Chinese versions of the Templer Death Anxiety Scale (CT-DAS) and the Social Support Rating Scale (SSRS), respectively. Multiple linear regression analysis was conducted after verifying assumptions of normality, homoscedasticity, and absence of multicollinearity. The mean ACP readiness score was 65.89 ± 14.07 (range: 22–110), indicating a moderately low level of readiness. In the final regression model, longer dialysis duration (B = 3.43, p = 0.015), a greater number of comorbidities (B = 2.72, p = 0.028), and higher social support (B = 0.55, p = 0.040) were positively associated with ACP readiness, whereas higher death anxiety was negatively associated with ACP readiness (B = − 1.03, p = 0.026). The final model explained 31.6% of the variance in ACP readiness (adjusted R² = 0.270). ACP readiness among individuals receiving PD in China remains suboptimal and is shaped by clinical burden, psychosocial resources, and death-related emotional responses. Reduced ACP readiness may hinder timely end-of-life decision-making and increase the decisional burden on families. Interventions should focus on strengthening social support, addressing death anxiety, and integrating culturally sensitive ACP discussions into routine PD care. These findings underscore the importance of context-specific ACP strategies within the sociocultural framework of China.
Timely initiation of disease-modifying antirheumatic drugs (DMARDs) is critical for achieving disease control, preventing irreversible joint damage, and improving the long-term outcomes of rheumatoid arthritis (RA). Despite guideline recommendations, real-world delays remain common and may be influenced by demographics, clinical, and geographical factors. Therefore, this study aimed to evaluate initiation patterns and identify demographic, clinical, and regional predictors associated with time to first DMARD initiation and assess differences in timing by drug class and age group among adults with RA in a large US electronic health record (EHR) cohort. A retrospective cohort study was conducted using EHR data of adults with incident RA diagnosed between November 2012 and August 2024. The primary outcome was the time from confirmed RA diagnosis to the first DMARD prescription. Covariates included age, sex, race and ethnicity, marital status, geographic location, and comorbidity. Descriptive analyses of initiation patterns were performed using Kaplan-Meier curves. Furthermore, multivariable Cox proportional hazards ratio (HR) regression models along with 95% confidence intervals (CI) were used to evaluate factors associated with time to DMARD initiation. Among 197,107 patients with incident RA, 57.53% initiated DMARD within the first 3 months of diagnosis, with a mean delay of 18.18 months (SD 41.8); 28.6% initiated treatment after 12 months of diagnosis. Compared with the age group 18-29 years, initiation rates increased across older age groups, reaching an HR of 1.390 (95% CI 1.340-1.442) among patients aged ≥ 80 years. Furthermore, higher comorbidity burden was associated with a faster initiation (HR 1.045, 95% CI 1.042-1.047). Female sex was associated with slower initiation than male patients (HR 0.945, 95% CI 0.934-0.955). American Indian/Alaska Native patients showed 22% faster initiation compared with white patients (HR 1.292, 95% CI 1.219-1.369; p < 0.001). Moreover, longer delays were observed among patients in the Northeast and South than in the West (19% and 4% lower, respectively). Patients who were initiated on biologic DMARDs (bDMARDs) or targeted synthetic DMARDs (tsDMARDs) experienced a delay compared to conventional synthetic DMARDs (csDMARDs) initiation (bDMARD: HR 0.807, 95% CI 0.798-0.817; tsDMARD: HR 0.732, 95% CI 0.711-0.754). In this real-world study, patients with RA experienced a substantial delay in DMARD initiation, despite the availability of effective therapies and compelling evidence supporting early treatment. Furthermore, demographic, clinical, geographic, and treatment class characteristics were independently associated with the timing of DMARD initiation. These findings emphasize the need for targeted interventions to address treatment delays and ensure equitable access to early and effective RA therapy.
Despite decades of mass Ivermectin distribution, onchocerciasis transmission persists in Cameroon. Comorbidities with non-communicable diseases (NCDs) and gaps in treatment uptake may contribute to the sustained transmission of this disease. This study assessed the prevalence of onchocerciasis, its comorbidity with selected NCDs, and determinants of continued transmission in Bafut Health District, Cameroon. A community-based cross-sectional study with health facility-based recruitment was conducted from June to July 2024 among 282 adults aged 30 years or older who had resided in Bafut for at least 5 years. Data on sociodemographic, NCD history, onchocerciasis knowledge, and ivermectin uptake were collected using a structured questionnaire. Laboratory investigations included skin snip microscopy, nodule palpation, blood pressure measurement, and venous blood tests for diabetes and rheumatoid arthritis. The relationship between categorical variables was analysed using the Chi-square test and logistic regression at the 5% significance level. Of the 282 participants examined, 43 (15.2%) had palpable nodules, 17 (6.0%) were positive on skin snip for Onchocerca volvulus, and 6 (2.1%) had both palpable nodules and positive skin snip results. Onchocerciasis infection showed significant associations with sex, age group, marital status, and educational level (p < 0.05). Hypertension (27.8%) and rheumatoid arthritis (25.9%) were the most common comorbidities among infected individuals. Ivermectin uptake was high, with 94.3% of participants reporting that they had ever taken ivermectin at least once during previous community-directed treatment with ivermectin (CDTI) rounds. In comparison, a small proportion (5.7%) declined due to illness or blurred vision. Participants with tertiary education had approximately five times higher odds of taking ivermectin compared to those with no formal education (aOR = 4.62, 95% CI: 1.18-18.12, p = 0.028). Similarly, individuals who had lived in the community for more than 10 years had five times higher odds of adhering to ivermectin treatment than recent residents (aOR = 5.03, 95% CI: 1.11-22.8, p = 0.036), primarily due to a refusal of ivermectin, mainly because of side effects. Nearly half of the participants (48.9%) demonstrated poor knowledge of onchocerciasis. Onchocerciasis remains present in Bafut, with ongoing transmission. Infection was associated with socio-demographic and behavioral factors. Non-communicable diseases were observed; however, no causal relationship can be inferred. Strengthening ivermectin uptake and health education may improve control. Not applicable.
Importance Understanding sex-based differences in vaping-related perceptions and behaviors is critical for informing targeted public health interventions, particularly in regions where e-cigarette use is emerging. Objective To examine sex differences across multiple vaping-related domains, including behavioral context, perceived utility, risk perception, social norms, and media influence among young adults in Saudi Arabia. Design, Setting, and Participants This cross-sectional study was conducted among 388 young adults aged 18-24 years in Jeddah, Saudi Arabia. Data were collected using a structured, theory-informed questionnaire adapted from established tobacco-use instruments. Exposure Sex (male vs. female), monthly income, and marital status. Main Outcomes and Measures Domain-specific scores were derived from 12 vaping-related items grouped into 5 conceptual domains. Scores were categorized into low, medium, and high levels using tertiles. Associations were assessed using ordinal logistic regression. Results Among 388 participants, 228 (58.8%) were male and 160 (41.2%) were female. Males consistently demonstrated higher levels of endorsement across domains. In adjusted models, females had significantly lower odds of higher domain scores across situational use (OR, 0.62; 95% CI, 0.45-0.86), perceived utility (OR, 0.58; 95% CI, 0.41-0.81), risk perception (OR, 0.54; 95% CI, 0.39-0.75), social norms (OR, 0.63; 95% CI, 0.45-0.88), and media influence (OR, 0.49; 95% CI, 0.35-0.69). Lower income was also associated with reduced endorsement across multiple domains. Conclusions and Relevance Significant sex-based differences exist in vaping-related perceptions and behaviors among young adults. These findings highlight the need for sex-specific prevention strategies addressing perceived benefits and marketing exposure in emerging vaping contexts.
The proportion of elderly patients with non-small cell lung cancer (NSCLC) undergoing surgical treatment is low. However, the prognostic factors influencing the outcomes of nonsurgical patients have not been systematically studied. Therefore, we aim to construct a prognostic prediction model for this patient population to provide a more accurate survival prediction. We conducted a retrospective analysis of patients with pathologically diagnosed NSCLC. We constructed nomograms for overall survival (OS) and cancer-specific survival (CSS) at 1, 3, and 5 years using least absolute shrinkage and selection operator regression and Cox regression analysis. The performance of the predictive models was evaluated using consistency indices, calibration curves, receiver operating characteristic curves, and decision curve analysis. Both internal and external validations were performed. A total of 18,939 NSCLC patients were included, divided into training and validation sets in a 7:3 ratio. The chi-square test indicated no statistically significant difference between the 2 datasets regarding baseline information (P > .05). Through least absolute shrinkage and selection operator regression and Cox regression analyses, we identified age, sex, marital status, American Joint Committee on Cancer stage, radiotherapy, chemotherapy, and distant metastasis as influencing factors for OS. We used these factors to construct a nomogram for OS. Similarly, we identified independent prognostic factors affecting CSS, which included sex, American Joint Committee on Cancer stage, radiotherapy, chemotherapy, and distant metastasis, and constructed a nomogram for CSS. After construction, we validated the prognostic models for OS and CSS using receiver operating characteristic curves, consistency indices, calibration curves, and decision curve analysis, which demonstrated the accuracy and reliability of our models. Finally, we confirmed the feasibility of using these models in different populations through external validation sets. This predictive model can provide a more accurate prognostic assessment for non-operated NSCLC patients over 70 years old.