Ileal pouch anal anastomosis can be performed via 2- and 3-stage techniques, with similar short- and long-term clinical outcomes. 2-stage ileal pouch anal anastomosis became the predominant approach in the 2000s; whether this trend has continued remains unknown. To compare trends in the utilization of 3-stage, traditional 2-stage, and modified 2-stage IPAA for ulcerative colitis as well as markers of disease severity over time. Retrospective cohort. Privately insured patients from an administrative database. Non-elderly adults with a diagnosis of ulcerative colitis who underwent ileal pouch anal anastomosis between 2007 and 2023 and remained enrolled in their insurance plan for ≥ 6 months after surgery. Proportion of patients undergoing 3-stage, traditional 2-stage, and modified 2-stage ileal pouch anal anastomosis; annualized change in disease severity at the time of ileal pouch anal anastomosis creation. Four thousand thirty-nine patients underwent IPAA during the study period (2,179 traditional 2-stage; 1,107 3-stage; and 753 modified 2-stage). The proportion of patients undergoing a traditional 2-stage IPAAs decreased steadily (1.3% points per year [95% CI -1.7 to -0.9]) with a commensurate rise in both 3-stage (0.3% points per year [95% CI -0.02-0.7]) and modified 2-stage operations (0.9% points per year [95% CI 0.6-1.2]). Patients undergoing 3-stage or modified 2-stage IPAA had a more rapid increase in exposure to advanced therapies in the year before surgery (+ 2.9 vs + 2.0% points). Limitations: potential misclassification, generalizability. More patients are undergoing 3-stage and modified 2-stage operations than traditional 2-stage ileal pouch anal anastomosis. This shift parallels an increase in multiple markers of disease severity at IPAA creation, especially exposure to advanced therapies. See Video Abstract.
BackgroundThe aging of the French population is a highly inertial process, meaning we can already draw the age pyramid of 2050 with a fairly high degree of certainty. According to the French National Institute of Statistics (Insee), the French population is expected to peak at 69.3 million in 2044, before beginning to slow gradually. Focusing on the working population, the level of uncertainty increases, but we know that its decline is likely to occur even earlier, from 2036 onwards. These demographic shifts put the social protection system under pressure, and particularly pension schemes. The main response by public authorities is to postpone the retirement age in order to maintain a sustainable ratio of contributors to beneficiaries. Indeed, since life expectancy is increasing, it would be possible to work longer, while still enjoying a period of retirement. However, several factors complicate the equation, not least the issue of occupational hazards, which play a decisive role in determining workers' health and ability to remain on the labour market. This is the purpose of this foresight study.ObjectiveEven if these demographic trends are unavoidable up to 2050, they can however lead to a range of possible futures. Therefore, as part of its foresight activity, the French research institute for occupational health (INRS) has conducted a study to explore how demographic changes might reshape the world of work by 2050, and the implications on workers' health and safety.MethodsThis paper summarises the methodological approach adopted in the study and presents the findings achieved on the following questions: what opportunities and threats do these changes represent for occupational risk prevention? What sectoral issues are affected? How can the occupational health professionals involved prepare? More specifically, it describes how structural changes that will undoubtedly impact French society can give rise to different adaptation strategies, which may lead to the emergence or worsening of various occupational risks.ResultsThis project has produced two contrasted scenarios, which were then applied to 5 sectors, selected for the specific situations of tension they present. Those Initial results were then submitted to a panel of occupational safety and health (OSH) experts.ConclusionsThis study led to a list of sectoral and transversal courses of action to the prevention stakeholders, that could improve de working conditions and contribute to maintain people at work.
Individuals with inflammatory bowel disease (IBD) are at higher risk of depression. However, data on depression-related hospitalizations and suicide death remain limited. This population-based study used administrative data to identify annual prevalent cohorts of individuals with IBD and matched controls between fiscal years 2005/2006 to 2021/2022. The primary outcomes were hospitalization for depression and suicide death. An IBD incident cohort was used to estimate the 1-, 3-, and 5-year cumulative incidence with 95% confidence intervals (CIs). Temporal trends were evaluated by calculating the average annual percent change (AAPC) using Poisson or negative binomial regression models. Conditional logistic regression estimated the odds ratio (OR) for depression-related hospitalizations between individuals with and without IBD. Individuals with IBD had higher odds of depression-related hospitalization than matched controls (OR = 1.52; 95% CI, 1.38, 1.67). Over time, depression-related hospitalizations decreased in those with IBD (AAPC: -3.38%; 95% CI, -4.72, -2.03), driven by Crohn's disease (AAPC: -4.76; 95% CI, -7.06, -2.39), whereas rates were stable in ulcerative colitis (AAPC: -1.71%; 95% CI, -4.46, 1.11). Hospitalization rates for depression in IBD declined in adults but were stable for pediatric patients (2.56%; 95% CI, -7.17, 13.30). Suicide deaths occurred in 0.21% (95% CI, 0.17, 0.25) of those with IBD and were stable over time (AAPC: -0.99%; 95% CI, -2.44, 0.48). The 1-, 3-, and 5-year cumulative incidence of depression-related hospitalization in the IBD incident cohort was 0.16% (95% CI, 0.12, 0.22), 0.41% (95% CI, 0.33, 0.50), and 0.63% (95% CI, 0.52, 0.75), respectively. Depression-related hospitalizations declined among individuals with IBD, particularly those with Crohn's disease, whereas suicide rates were stable.
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The National Family Health Survey-6 fact sheets (NFHS-6, 2023-2024) released by the Ministry of Health and Family Welfare, Government of India, reveal persistent undernutrition, rising urban overweight, widening rural-urban and tribal inequities, and declining exclusive breastfeeding rates, albeit with significant progress in national immunization coverage, antenatal care, and reduction in common childhood illnesses like diarrhea and pneumonia. The absence of mortality indicators limits comprehensive analysis of healthcare utilization and its impact. Persistent regional inequities and gaps in quality of care seen in this data should guide urgent, targeted action.
BackgroundErgonomics is important for improving nurses' working conditions and preventing work-related health problems. Research on ergonomics in nursing has grown significantly, becoming a major interest for nurse health, patient safety, and work processes.ObjectiveThis study aims to establish a direct conceptual link between ergonomic risk dimensions and the bibliometric approach.MethodsA comprehensive search of the Web of Science database was conducted, and 1292 studies published between 1981 and 2025 were analysed. Bibliometric analysis was conducted to evaluate performance analysis, scientific mapping, thematic mapping, and thematic evolution. Data were analyzed using RStudio (Bibliometrix/Biblioshiny) and VOSviewer software. Authors' keywords were used in the analyses.ResultsThe findings showed that the field has grown considerably in recent years and that the literature has mainly focused on musculoskeletal disorders, patient handling, physical workload, and patient safety. Keyword co-occurrence analysis demonstrated that physical ergonomics themes remained dominant, while psychosocial, organizational, and technology-oriented concepts such as burnout, teamwork, safety culture, usability, telehealth, and artificial intelligence became increasingly visible. The thematic evolution analysis suggested increasing attention to patient safety, systems-oriented approaches, and digital healthcare technologies, while traditional themes related to occupational exposures and work tasks remained prominent throughout the study period.ConclusionNursing ergonomics research has increasingly incorporated physical, cognitive, organizational, and technology-oriented dimensions over time, reflecting a more multidimensional understanding of ergonomics. While physical ergonomics themes continue to dominate the literature, cognitive, organizational, and technology-oriented dimensions are becoming increasingly prominent, highlighting the need for more systems-based and interdisciplinary ergonomic approaches in future research.
In India, the carrier frequency of the β-thalassemia trait (βTT) is substantially higher than the global average, estimated at 3.3% compared with 1.5% worldwide. The prevalence of βTT across India shows marked geographic variation, ranging from 0.5% to 17%, largely influenced by population migration, endogamy, and intercaste marriages. This genetic and demographic diversity makes India a complex conglomerate of multiple biological populations. The present study aimed to evaluate the spectrum of hemoglobinopathies and thalassemia in a region of Eastern India using cation-exchange high-performance liquid chromatography (CE-HPLC), while also analyzing associated demographic characteristics and hematological parameters. This was a two-year (June 2022-May 2024), single-center, retrospective observational study involving 2,329 subjects who were screened for thalassemia and other hemoglobinopathies using CE-HPLC at the Department of Hematology of a tertiary care center in Northern India. Of the 2,329 subjects screened, 2,067 (88.7%) were diagnosed as normal, 167 (7.1%) had βTT, and 35 (1.5%) were double heterozygous for HbE and βTT. The mean red blood cell (RBC) count among individuals with βTT was 4.58 ± 1.11 million/cumm, the highest among all hemoglobinopathies except for two cases of HbD-Punjab trait, which demonstrated a mean RBC count of 4.62 ± 0.36 million/cumm. HbF fractions were highest in cases of β-thalassemia major/intermedia, followed by individuals with double heterozygous HbE and βTT. Categorical variables were expressed as percentages, while numerical variables were summarized as mean ± standard deviation (SD). Statistical analysis was performed using SPSS version 25. This study underscores the high prevalence of β-thalassemia trait and other hemoglobinopathies in Eastern India, emphasizing the need for widespread screening programs and the adoption of improved diagnostic modalities.
In modern healthcare systems, the role of advanced practice providers (APPs), including nurse practitioners (NP) and physician assistants (PA), has increased in many settings, in step with the increased demand for healthcare services. The purpose of the present investigation was to evaluate trends in the prevalence, reimbursement, and characteristics of care provided by APPs in the treatment of spinal disorders in the United States from 2013 to 2022. A retrospective cohort study using the publicly available Medicare Provider Utilization and Payment database from the Centers for Medicare and Medicare Services was conducted on diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2022. Provider-type and billing codes were used to identify healthcare professionals providing care for spine patients, such as ordering radiographs, assisting in surgical procedures, or performing office visits. Trends were analyzed using linear regression modeling with projections generated through 2030. Over the study period, the number of surgeons involved in spine care decreased from 3953 (71.2%) in 2013 to 3951 (66.7%) in 2022. The number of APPs who billed for the care of spine patients increased 23.3% from 1600 in 2013 to 1974 in 2022. The most common services billed for by APPs included radiographs and office visits. There were increased odds (OR: 1.20, 95% CI, 1.03-1.41, P < 0.001) of a spine provider in rural areas being an APP versus spine surgeon. Forecasting analysis for 2030 demonstrated continuation of these trends regarding the number of providers, services, and geographic distribution. Increased utilization of APPs in the care of patients with spinal pathology is likely to continue with the growing prevalence of patients with spinal disorders.
Infectious disease-specific health literacy (IDSHL)-the capacity to obtain, process, and understand basic infectious disease information needed to make appropriate health decisions-is a critical determinant of public health outcomes. The COVID-19 pandemic created an unprecedented global public health education context; yet, its long-term association with population-level IDSHL beyond the pandemic remains unclear. In China, stringent public health measures and digital information campaigns were implemented, yet their lasting impact on IDSHL across different disease domains has not been systematically evaluated over a full pandemic cycle. This study aimed to evaluate the longitudinal trends in IDSHL among residents of Zhejiang Province, China, from 2019 (prepandemic) to 2024 (postpandemic), and to assess whether the pandemic period was temporally associated with sustained improvements in IDSHL. Six annual cross-sectional surveys were conducted from 2019 to 2024 across 30 counties in Zhejiang Province using consistent multistage stratified random sampling. A validated 12-item IDSHL questionnaire assessed knowledge, behavior, and skills. Annual sample sizes ranged from 17,131 to 19,257 (N=112,917). Data were weighted to the 2020 census population by age and urban or rural residence. Joinpoint regression identified inflection points in the annual proportion of residents with adequate IDSHL (score≥12). Multivariate logistic regression estimated adjusted odds ratios (ORs) for adequate IDSHL by year, with 2021 as the reference (the peak acute pandemic phase), controlling for sociodemographics. All analyses incorporated sampling weights. Population-weighted overall IDSHL scores increased from 2019 (mean 10.46 SD 3.09) to 2024 (mean 11.40 SD 2.88; P<.001). All subscale scores (knowledge, behavior, and skills) showed upward trends (all P<.001). Joinpoint regression revealed a rapid annual increase in adequate IDSHL during 2019-2021 (annual percent change 9.42%, 95% CI 6.10-13.45; P<.001), which slowed post-2021 (annual percent change 2.28%, 95% CI -0.38 to 3.73; P=.07). Correct response rates surged for pandemic-salient items (eg, respiratory etiquette from 28.44% to 39.67%), while hepatitis B transmission knowledge fluctuated (63.28% in 2019, 60.71% in 2022, 63.84% in 2024), indicating that not all non-COVID-19 content improved monotonically. Adjusted logistic regression showed the lowest odds of adequate IDSHL in 2019 (OR 0.74, 95% CI 0.71-0.78) and highest in 2024 (OR 1.10, 95% CI 1.05-1.15) compared to 2021. The COVID-19 pandemic was temporally associated with significant and sustained population-level improvements in IDSHL, particularly for pandemic-relevant knowledge and behaviors. However, gains were time-sensitive and not uniform across all disease domains or demographic groups. These findings underscore the need for postpandemic health strategies that reinforce comprehensive IDSHL through sustained education and address digital divides to bridge persistent equity gaps. Policymakers should prioritize low digital-literacy populations through hybrid (offline+online) educational interventions, and sustain routine surveillance of IDSHL to detect declines in nonpandemic disease knowledge. This study is the first to document six-year population-level IDSHL trends across the full pandemic cycle, providing evidence for future crisis communication and routine health promotion.
Background and objectives A considerable proportion of the older populations have been suffering from stroke multimorbidity. Post-stroke complications often affect the overall well-being of individuals. This study assesses the trends, patterns, and determinants of stroke multimorbidity. Methods We used data from three waves of the World Health Organization study on global ageing and adult health (WHO-SAGE) and analysed individuals aged 50 and above years (Wave I, 7,150 individuals, Wave II, 6,823 individuals, and Wave III, 6,719 individuals) who reported a physician diagnosis of stroke. We analysed trends and patterns of stroke multimorbidity across three waves of WHO-SAGE. Stroke multimorbidity was also analysed with respect to the socioeconomic characteristics of study participants. Results We found a significant increase in the prevalence of stroke multimorbidity over one and a half decade (1,050 per 100,000 to 2,410 per 100,000). The burden of stroke multimorbidity increased steadily, mainly among individuals suffering from two or more long-term conditions. Prevalence of stroke multimorbidity was much higher among older people aged 80 yr and above in wave 3 as compared with wave 1, a relative increase of around 200%. An older individual with no formal education showed an increased prevalence of stroke multimorbidity, a relative change of 102% in last one and a half decade. Interpretation and conclusions This study demonstrated a significant increase in the prevalence of stroke multimorbidity over the last one and a half decade (2007-2020), which considerably varied by age group, sex, place of residence, education, and wealth quintile.
Simulation-based interprofessional education is widely used to foster collaborative competencies among health professions students; however, evidence from underrepresented and minority-serving academic health settings remains limited. We conducted a retrospective program evaluation of simulation-based IPE implemented from 2014 to 2024 at a U.S.-based minority-serving academic health sciences institution, defined here as an institution with a historical mission to educate students underrepresented in medicine and other health professions and to serve diverse communities. Student-reported post-simulation surveys from medical, nursing, pharmacy, and physician assistant students were analyzed descriptively, with trend analyses over time. Open-ended reflections were reviewed thematically to contextualize quantitative findings. This evaluation was not designed as a prospective research trial or pre-post intervention study. The survey was locally developed for program evaluation and had not undergone formal psychometric testing; therefore, findings are interpreted as student-reported perceptions rather than validated measures of interprofessional competence. Data from 452 students demonstrated consistently favorable student-reported perceptions. Significant positive trends were observed for decision-making (p = .01), educational value (p = .04), and desire for more time with simulation scenarios (p = .03). Communication/teamwork (p = .10), appropriateness for educational level (p = .09), and perceived time value (p = .15) showed positive but non-significant trends. Qualitative themes highlighted enhanced interprofessional communication, increased confidence, and persistent challenges related to role clarity. Sustained exposure to simulation-based IPE was associated with positive student-reported perceptions of interprofessional learning in a minority-serving academic health context. Findings highlight the importance of role clarification, structured pre-briefing, competency-aligned simulation objectives, and reflective debriefing to strengthen IPE outcomes.
Climate change is reshaping global plant biogeography, and understanding the distribution dynamics of dominant species is critical for sustainable ecosystem management. Stipa species dominate the grasslands of Central Asia, constitute a major component of regional steppe ecosystems, and provide essential forage resources for livestock production. Four constructive Stipa species sensitive to temperature and precipitation changes (S. breviflora, S. bungeana, S. grandis, and S. klemenzii) were selected for analysis. Current and future habitat suitability and distribution trends were predicted using the ensemble modeling framework in Biomod2 (ensemble AUC/TSS > 0.9; individual model selection based on TSS > 0.8). Under future climate scenarios, the suitable habitat centroids of all four species were projected to shift westward. The warm- and dry-adapted S. breviflora exhibited a relatively stable distribution range, with its changes being primarily driven by elevation. In contrast, the warm- and humid-adapted S. bungeana showed a continuous northwestward expansion, mainly influenced by the mean temperature of the coldest quarter. Conversely, the cold- and humid-adapted S. grandis and cold- and dry-adapted S. klemenzii, were predicted to experience significant habitat contraction under future climate scenarios. The distributions of both species were primarily influenced by precipitation during the coldest quarter. Overall, cold-adapted species such as S. grandis and S. klemenzii are expected to be more vulnerable to future climate change, despite a gradual slowdown in the rate of suitable habitat contraction over time. Therefore, grassland conservation and management in Central Asia should dynamically adjust conservation priorities, with greater attention given to the contraction and migration trends of these cold-adapted species in order to enhance ecosystem stability and adaptive capacity.
This article examines the representation of unplanned pregnancy in contemporary Spanish cinema between 2014 and 2024, with the aim of identifying the dominant narratives surrounding this experience. Drawing on a mixed-methods approach that combines quantitative and qualitative analysis of a selected corpus of films, the study investigates the narrative evolution of unplanned pregnancy, the diversity of the characters depicted, the reproductive agency of female protagonists, and the visibility of voluntary termination of pregnancy. The findings reveal that socio-economic conditions exert a decisive influence on how protagonists experience and negotiate unplanned pregnancy, shaping both their interpretive frameworks and their available choices. Despite this, the socio-demographic diversity of characters remains notably limited, particularly in relation to class, race, and other structural determinants, reflecting a homogenised representation of reproductive experiences in Spanish cinema. A key result of the study is the marginalisation of abortion as a reproductive option: legal abortion is explicitly represented in only two of the 14 films analysed, while most narratives emphasise either motherhood that is ultimately accepted or failed attempts to end the pregnancy. This pattern suggests that Spanish cinema continues to privilege conventional reproductive frameworks, offering few portrayals that normalise abortion as a legitimate and accessible choice. By critically engaging with these cinematic trends, the article contributes to broader debates on reproductive rights, gendered agency, and media representations of women's health. It highlights the need for more diverse and realistic depictions of unplanned pregnancy to challenge dominant narratives and expand cultural understandings of reproductive justice. This article analyses how contemporary Spanish cinema portrays unplanned pregnancy. We used a mixed methods approach to examine how this situation is described in 14 feature films. We looked at how diverse the characters are and how visible abortion is. The characters’ economic situation had a strong effect on how they felt about unplanned pregnancy and dealt with it. The diversity of characters was very limited, especially in relation to class, race and economic status. Abortion was only included as an option in two of the films. Most of them showed the characters accepting motherhood, or failing to end the pregnancy. This suggests that Spanish cinema still favours conventional stories about reproduction. There was little mention of abortion as a legitimate and accessible choice. This article contributes to broader debates on reproductive rights, gender, and women's health in the media. It highlights the need for more diverse and realistic depictions of unplanned pregnancy. This would challenge dominant narratives and expand cultural understandings of reproductive justice.
Dialysis patients suffer from anemia, muscle fatigue and atrophy, decreased aerobic capacity resulting in reduced physical activity, and decreased quality of life (QoL). The end-stage kidney disease patients often experience reduced QoL due to physical and psychological burdens. This study aims to evaluate the effect of intradialytic resistance exercise (IRE) on QoL, dialysis adequacy, muscle cramps, and physical function of dialysis patients. A quasi-experimental study was conducted at Al Khor Dialysis Unit. Participants performed supervised TheraBand exercises during dialysis, including warm-ups, IREs, and stretching. WHO QoL - BREF (World Health Organization Quality of Life- (Brief Version)) questionnaires and physical function tests, including a 10-m walk test and a 30-second sit-stand test, were performed. The exercise was performed within the first 2 hours of the dialysis session for 6 months. Twenty-four patients were followed for a period of 6 months. The mean QoL score at baseline was 67.9 ± 20.9, which increased to 70.3 ± 17.2 after 3 months and 74.5 ± 15.8 after 6 months. There were 71% male and 29% female in the average age group of 59.9 years. No significant correlations were observed between QoL and demographic factors such as gender, education, or income. Additionally, muscle cramps improved slightly from 4% at baseline to 8% post intervention. Kt/V, a measure of dialysis adequacy, remained stable after the intervention. Physical performance improved, with sit-to-stand test repetitions increasing from 7.2 ± 2.9 to 10.1 ± 4.5, though the time for the 10-m walk test improved slightly. The resistance exercise intervention demonstrated modest numerical improvements in quality of life and physical function, although these trends should be interpreted cautiously.
Human papillomavirus (HPV) vaccination represents an important opportunity for cervical cancer prevention, yet knowledge gaps among healthcare students may limit its potential impact. Nursing students, as future health advocates, require comprehensive understanding to effectively promote vaccination programs. The aim of the study was to know how mobile-based blended learning could enhance nursing students' knowledge and attitudes toward HPV vaccination. This experimental study involved 200 B.Sc. nursing students studying in selected institutes of India. Using a pretest-post-test design, we assessed knowledge (12 items) and attitudes (5 items) through validated questionnaires. Using a blended learning approach, 2-week intervention combined mobile-delivered educational videos via social media platforms with interactive classroom discussions. Follow-up evaluation occurred 15 days postintervention. The intervention demonstrated encouraging outcomes. Knowledge scores increased significantly by 24.1% (5.76 ± 2.60 to 7.15 ± 2.60, P = 0.001) with a moderate effect size (Cohen's d = 0.54). Four knowledge domains remained significant after Bonferroni correction. Attitude scores showed positive trends (9.81 ± 2.63 to 11.28 ± 3.68, P = 0.214) without reaching statistical significance. Mobile-based blended learning appears to offer a valuable approach for enhancing nursing students' HPV vaccination knowledge with sustained benefits. These findings suggest that technology-enhanced educational strategies may help prepare future healthcare providers to more effectively support cervical cancer prevention efforts.
Chronic cough, particularly prevalent in post-COVID condition (PCC, also known as long COVID), remains a significant medical challenge. Recently, extracellular vesicles (EVs) have gained significant attention for their therapeutic potential. In this study, we explore the therapeutic effects of EVs derived from mesenchymal stem cells (MSCs) cultured in a 3D system (3D-EVs) in treating chronic cough, with a focus on post-COVID-19 patients. Our in vitro experiments demonstrated that 3D-EVs promote angiogenesis and cell migration, crucial processes in tissue repair and regeneration. Notably, 3D-EVs exhibited a robust suppressive effect on lymphocyte proliferation in human PBMCs, indicating their potential immunomodulatory role. At day 6, nebulized 3D-EVs treatment group showed significantly higher rates of significant improvement (22.5% vs. 5.0%, P = 0.023) and total effectiveness (67.5% vs. 47.5%, P = 0.035), as well as a shorter mean time to cough resolution (13.83 vs. 19.90 days, P = 0.037). By day 14, total effective rates were comparable (85% vs. 80%, P > 0.05). No safety concerns were observed. RNA sequencing revealed altered B cell receptor signaling and downregulation of the mitotic cell cycle pathway, while exploratory immunophenotyping identified a significant reduction in plasma cells (P < 0.05) and directional trends in other immune subsets, providing preliminary evidence that 3D-EVs may modulate B cell differentiation and immune responses. These findings demonstrate the feasibility and preliminary efficacy of 3D-EVs for rapid relief of post-COVID-19 chronic cough, supporting larger controlled trials to validate their role in this and related respiratory diseases.
Embolisation represents the primary therapeutic intervention for pulmonary arteriovenous malformations (PAVMs); however, post-procedural recanalisation remains a recognised complication. This study aimed to identify anatomical and morphological factors associated with PAVM recanalisation, while also describing embolisation modalities used. A retrospective, observational analysis was conducted on 40 patients with PAVMs embolised. Demographic variables, angiographic measurements (supplying artery, vein, sac diameters), embolisation modalities including coils, Amplatzer vascular plugs (AVPs), microvascular plugs (MVPs), or combinations, and the presence of recanalisation (defined as < 70% reduction in linear sac diameter on follow-up CT angiography) were collected. Logistic regression analysis was performed. A total of 109 pulmonary arteriovenous malformations (PAVMs) were embolised across 40 patients, with follow-up imaging available for 86 PAVMs. Larger feeding artery diameter (OR 1.410, p = 0.008) and complex PAVM morphology (OR 5.464, p = 0.002) were significantly associated with recanalisation on univariate analysis. Male sex and greater sac diameter were also associated on univariate analysis but did not remain significant in the multivariable model. On multivariable logistic regression, complex PAVM morphology (OR 4.00, 95% CI 1.27-12.66, p = 0.018) and larger feeding artery diameter (OR 1.29 per mm, 95% CI 1.01-1.65, p = 0.044) were independently associated with recanalisation. Although not reaching statistical significance, there was a trend toward higher recanalisation rates in lesions treated with coil embolisation (OR 1.926, p = 0.166). Embolisation with vascular plugs was associated with less risk of recanalisation but was insignificant (AVP [OR 0.782, p = 0.654], MVP [OR 0.342, p = 0.078]). Larger feeding artery diameter and complex PAVM morphology were independently associated with recanalisation on multivariable analysis. Male sex showed a univariable association that did not persist after adjustment and should be considered exploratory. Device type showed trends but was not a primary determinant. Larger, prospective studies are needed to validate these findings and optimise embolisation strategies.
BackgroundAttention deficit hyperactivity disorder (ADHD) in children is a common neuropsychiatric disease in the world, which has a significant impact on children, families, and society.AimsThis study aims to examine the trends in ADHD incidence, prevalence, and disability-adjusted life years (DALYs) among children to guide preventive measures.MethodThis cross-sectional analysis used data from the Global Burden of Diseases (GBD) spanning 1990 to 2021 across 204 nations and territories. Children diagnosed with ADHD aged ≤14 years were incorporated into the analysis. The main outcome measures include incidence, prevalence, DALYs, case changes, and estimated annual percentage changes (EAPCs). The trends were categorized by location, nation, age, sex, and Socio-Demographic Index (SDI). Meanwhile, an age-period-cohort (APC) model is used to estimate net drifts, local drifts, longitudinal age curves, and the period relative risks. Bayesian APC (BAPC) models were used to anticipate the global burden of ADHD from 2022 to 2051. Data were analyzed from September 10, 2024, to September 25, 2024.ResultsA total of 33 429 324 children (73.14% male; 26.86% female) were included in the analysis. There were 4 111 621 children with ADHD cases globally in 2021. From 1990 to 2021, pediatric ADHD cases rose 9.92% (95% uncertainty interval [UI], 7.13%-13.16%). Over the past 32 years, the global incidence rate decreased from 215.08 (95% UI, 146.23-314.58) to 204.37 (95% UI, 137.94-295.99), whereas prevalent cases increased from 29 564 63 to 33 429 32. DALYs increased from 362 607 to 410 706, with the middle-SDI region having the highest incidence and DALY rate in 2021. Incidence increased most in Western Europe (EAPC, 0.50%), whereas prevalence increased most rapidly in South Asia (EAPC, 0.33%). In 2021, Australia had the highest national incidence (638.35), prevalence (5295.68), and DALYs (65.13) among 204 nations. High-SDI regions had the highest net drift in both incidence rate and prevalence rate (0.21% for each). APC analysis showed that the burden of ADHD exhibited significant age, period, and cohort dependencies, with notable sex and regional heterogeneity. Incidence and prevalence were significantly higher in males than females, although the gender gap has recently narrowed (eg, incidence rate ratio in 2019.5: male 0.97, female 0.96). Furthermore, incidence rates in high-SDI regions worsened over time and across birth cohorts. BAPC model predicts that ADHD incidence will continue to rise, reaching 247.68 incidence rate by 2051 and 4 468 925 incident cases. The number of prevalent cases is projected to reach 25 357 194, and the DALY rate will rise to 23.93.ConclusionsChildhood ADHD represents a growing global public health challenge, with projected increases in incidence, prevalence, and DALYs, particularly in high-middle-SDI regions. Concurrently, DALY rates are rising most rapidly in low-SDI areas. Enhanced understanding of the epidemiology of childhood ADHD may inform targeted prevention and management strategies.
Colorectal cancer (CRC) is a leading cause of cancer-related mortality worldwide. Organized screening programs using the fecal immunochemical test (FIT) have been implemented to reduce CRC mortality through early detection. To evaluate the association between an organized FIT-based screening program and CRC-specific mortality in a population-based setting. This retrospective, population-based cohort study included all residents of the Basque Country, Spain (approximately 2.2 million inhabitants) between 2004 and 2024. The FIT-based CRC screening program targeting individuals aged 50 to 69 years was initiated in 2009. Individuals aged less than 50 years were included in the study as a nonscreening reference group. Data analysis was performed in April 2026. Biennial screening of asymptomatic individuals aged 50 to 69 years using single-sample FIT. Age-standardized mortality rates (ASMRs) for CRC per 100 000 population (based on the European Standard Population 2013) and annual mortality trends from 2004 through 2024 were calculated. Segmented regression and counterfactual analyses estimated changes in CRC mortality after screening implementation. Screening participation, FIT positivity, colonoscopy adherence, CRC detection rates, and cancer stage distribution were also evaluated. Among 438 134 total deaths (50.9% in men) in a population of approximately 2.2. million, 16 298 (3.7%) were attributable to CRC. Age-standardized CRC mortality declined from 32.8 to 23.1 deaths per 100 000 population between 2004 and 2024 (reduction of 29.6%; P = .002). In individuals aged 50 to 69 years, CRC mortality declined by 50.1% (from 39.7 to 19.8 deaths per 100 000 population). Segmented regression identified a significant inflection point in the year 2012 (95% CI, 2011-2014; P < .001), 3 years after screening implementation. Counterfactual analyses estimated a 46.2% relative reduction in CRC mortality in the group aged 50 to 69 years compared with projected trends without screening. Among individuals aged 70 years or older, CRC mortality declined by 19.6% (from 165.4 to 132.9 deaths per 100 000 population), corresponding to a 45.4% relative reduction compared with projected rates. Overall, 3464 of 4892 screen-detected CRCs (70.8%) were diagnosed at stage I or II throughout the study period. In this retrospective, population-based, descriptive cohort study, organized FIT-based screening was associated with a sustained decline in CRC mortality, particularly among individuals aged 50 to 69 years. These findings support the long-term benefit of organized FIT-based screening programs as a public health strategy to reduce CRC-related mortality.