Febrile neutropenia is a life-threatening oncologic emergency requiring rapid recognition and intervention. In emergency departments, nurses are central to patient assessment, triage, and care coordination, yet the extent and focus of nursing-led research remain unclear. This study aimed to map global research trends in the nursing care and management of febrile neutropenia over a 25-year period. A descriptive bibliometric analysis was conducted on 347 peer-reviewed articles published between 2000 and 2025, retrieved from the Web of Science Core Collection on October 5, 2025. Analyses in Bibliometrix (R/Biblioshiny) and VOSviewer examined publication trends, authorship, institutional output, international collaboration, keyword co-occurrence, and thematic evolution. Scientific production increased steadily from 2000, peaking in 2021. The United States contributed the most publications, followed by China, South Korea, and the UK. Febrile neutropenia, chemotherapy, and neutropenia were dominant themes, whereas nursing care, emergency nursing, and evidence-based practice appeared less frequently and in peripheral positions. Only 8.1% of publications appeared in nursing-classified journals, 6% involved nursing-affiliated authors, 4.3% were nurse-led, and 2.6% described specific nursing interventions. Over time, the focus shifted from infection control and pharmacologic management toward outpatient care, guideline implementation, and risk-adapted pathways. Although nursing practice is critical to the management of febrile neutropenia, nursing-led research remains underrepresented, with most studies embedded in multidisciplinary frameworks. Future research should prioritize nursing-sensitive outcomes, implementation science approaches, and nurse-led models that strengthen patient safety, triage precision, and continuity of care.
This study analyzed temporal trends, the impact of the COVID-19 pandemic, and projections up to 2030 for oral cancer incidence and mortality rates in Brazil, stratified by sex and macro-region. This population-based observational study used secondary data from the Department of Informatics of the Brazilian Unified Health System (DATASUS) and the Hospital Information System (SIH/SUS), covering the period from 2013 to 2022. Malignant neoplasms of the oral cavity and major salivary glands (C00-C08, ICD-10) were included. Age-standardized incidence (ASIR) and mortality (ASMR) rates were analyzed using Prais-Winsten linear regression and classified according to the Annual Percentage Change (APC), with significance set at p < 0.05. Projections to 2030 were estimated using double exponential smoothing, and the pandemic's impact was assessed through the ratio of observed-to-predicted rates (RR) for 2020-2022. The study recorded 40,078 deaths and 92,411 cases, 70.8% of which occurred in men, with the highest concentration in individuals aged 55-64 years. The trends revealed a significant increase in incidence across all macro-regions, particularly in the North and South regions, whereas mortality rates remained stable. During the pandemic, an apparent reduction in cases (RR <1) was observed, suggesting underreporting and diagnostic delays. The projections indicate a continuous increase in incidence and a slight rise in mortality through 2030. Limitations include reliance on secondary data that are subject to underreporting and delays, especially during the pandemic. These findings highlight the worsening of regional inequalities and underscore the urgency to strengthen prevention, screening, and early diagnosis policies, particularly in socially vulnerable contexts.
Gastric cancer (GC) is a leading contributor to cancer-related illness and death globally, presenting a significant public health concern in Iran. There is a lack of extensive data regarding long-term trends at both national and regional levels for GC incidence and its anticipated future impact. This research aimed to investigate the changes in gastric cancer rates in Iran from 1990 to 2021 and to forecast incidence rates through 2030 by gender, age groups, and provinces. This research used secondary ecological data from the GBD 2021 research to investigate the incidence of GC in Iran from 1990 to 2021. Temporal trends were assessed with Joinpoint Regression to determine the Average Annual Percent Change (AAPC). Also, a Bayesian age-period-cohort model was then applied to project new cases and incidence rates up to 2030. We used from R and Joinpoint software for all analyses. From 1990 to 2021, Iran saw nearly a twofold increase in new GC instances; however, the age-standardized incidence rate (ASIR) significantly fell from 23.12 to 14.37 per 100,000 individuals. The most significant decreases were observed in the northwestern provinces and among females. Forecasts for 2030 show that the absolute number of cases will likely increase to around 12,070, yet the ASIR is predicted to see a slight drop to 13.44, with a stagnation in decrease for individuals over 80 years old, suggesting a gradual slowdown in the overall trend. Although there has been a persistent reduction in the age-standardized incidence rate of GC in Iran over the last thirty years, the sheer number of cases is still increasing owing to demographic growth and an aging population. To combat this rising challenge, future initiatives should focus on implementing targeted screening in high-risk areas and for elderly populations, improving geriatric healthcare, and addressing inequalities in healthcare access through better collaboration across sectors.
Evaluating temporal trends in foodborne outbreak and illness attribution to specific food types is important for understanding which foods may be emerging as sources of illness and whether prevention strategies are working to prevent these illnesses. Evaluating these trends can be difficult because foodborne outbreaks are uncommon, and attribution of these outbreaks to a specific food can be difficult. We present a Bayesian trend model looking at outbreaks and outbreak-associated illnesses linked to four Interagency Food Safety Analytics Collaboration (IFSAC) priority foodborne bacterial pathogens: Campylobacter, Shiga toxin-producing Escherichia coli O157, Listeria monocytogenes, and Salmonella using a categorization scheme IFSAC created to classify foods into 17 categories that closely align with the U.S. food regulatory agencies' classification needs. Outbreaks and outbreak-associated illnesses of listeriosis increased in dairy products during 1998-2018 while those linked to meat and poultry decreased. Outbreaks of campylobacteriosis linked to both dairy and poultry products also increased. STEC O157 outbreaks and outbreak-associated illnesses linked to meat decreased over the period. Outbreaks and outbreak-associated illnesses of salmonellosis linked to eggs also decreased over the period. This new approach to evaluating temporal changes in outbreaks and outbreak-associated illnesses may be a useful tool in understanding the epidemiology and impacts of prevention strategies for foodborne illness.
Mesenchymal stromal cells (MSCs) have demonstrated significant potential for various clinical applications; however, several challenges limit their therapeutic efficacy. These include donor variability, poor homing and survival after transplantation, reduced proliferative and differentiation potential during in vitro expansion, and the inflammatory microenvironment at the injury site. This review summarizes current strategies used to enhance the therapeutic potential of MSCs and discusses approaches to overcome these limitations. It also highlights key challenges and gaps in the existing literature that require further investigation. In addition, this structured review provides an overview of current research trends involving different MSC sources, disease models, preconditioning strategies, emerging gene modification approaches, and other methods to improve MSC function. Finally, regulatory considerations and the roles of global and regional regulatory authorities in ensuring the safety and quality of modified MSC-based therapies are briefly discussed.
This study aimed to estimate the distribution and temporal trends of refractive errors among spectacle wearers in Japan using a nationwide database of optical chain stores. Data from 4,525,689 individuals (53.0% women and 47.0% men; age range, 6-35 years) who purchased spectacles at 434 optical chain stores across Japan between 2021 and 2023 were analyzed. For individuals aged <15 years, prescriptions issued by ophthalmologists were used. The spherical equivalent (SE) was calculated, and its distribution was described according to age, sex, and geographic region. The annual progression rate of refractive error was estimated for individuals with multiple purchases. Linear mixed models and generalized additive mixed models were applied for the analyses. The SE shifted in the myopic direction with advancing age and stabilized at approximately 30 years in men and 29 years in women (median SEs, -3.3 diopter [D] and -3.5 D, respectively). Hyperopia accounted for approximately 30% of cases at the age of 6 years but decreased significantly by the early teenage years. High myopia (SE ≤ -6 D) was observed in 1.3% of children aged <10 years. The most rapid myopic progression occurred at the age of 7 years (median, -1.1 D/year). Joinpoint analysis indicated that myopia progression decelerated between 9 and 19 years, with an additional inflection point at 12 years in women. Myopia progression becomes significant at the age of 6 to 7 years, highlighting the need for early surveillance and timely intervention to limit progression.
In many medical specialties, robot-assisted surgery has become a crucial option for surgical interventions. However, its adoption in vascular surgery remains limited, with this discipline lagging behind other fields in both research and application of this technology. The rapid advancement of robot-assisted surgery presents both an opportunity and a challenge for the development of vascular surgery. Bibliometrics can systematically and quantitatively summarize research achievements, key research directions, and emerging trends in this field, thereby guiding future research efforts on the application of robot-assisted surgery in vascular surgery. All eligible literature in this research was retrieved from the Web of Science Core Collection, covering publications released from 1997 to 2025 that focus on the clinical applications of robot-assisted surgery within vascular surgery. Two bibliometric software programs, VOSviewer 1.6.20 and CiteSpace 6.4.R2, were adopted to implement multiple analytical procedures, including author collaboration analysis, literature co-citation analysis and keyword co-occurrence analysis. Meanwhile, the citation burst detection function embedded in CiteSpace was applied to pinpoint prevailing research hotspots and emerging frontiers in this discipline. This study included 375 eligible publications from 1,777 researchers across 503 institutions in 39 countries. Annual publication output showed a steady increase, with two notable peaks in 2022 and 2025 after a marked rise post-2020. The United States led globally with 130 papers (34.6%) and 3,687 citations, followed by China, Japan, Italy, and the UK. The Beijing Institute of Technology was the most prolific institution. Key scholars including Shuxiang Guo, Norihiko Ishikawa, and Go Watanabe shaped the field's foundation, while the International Journal of Medical Robotics and Computer Assisted Surgery and The Annals of Thoracic Surgery were the primary publishing venues. Keyword clustering identified five major research themes: robotic surgery, angioplasty, force sensing, abdominal aortic aneurysm, and percutaneous coronary intervention. Temporal keyword analysis revealed a clear shift from traditional open cardiovascular procedures (e.g., coronary artery bypass grafting, laparoscopic aortic bypass) toward robotic-assisted endovascular and extravascular interventions, such as percutaneous coronary intervention and integrated robotic revascularization. Over the past twenty-nine years, China's research institutions and scholars have achieved certain accomplishments in the application research of robot-assisted surgical techniques in the field of vascular surgery. Vascular surgery has evolved from traditional open cardiovascular procedures to novel robot-assisted surgical methods suitable for both intravascular and extravascular operations.
Despite expectations that emergency medical services (EMS) transport following a gunshot wound (GSW) would improve 30-day mortality compared to transport by private vehicle, the opposite has been found in several studies. In response, EMS has adopted interventions over the past decade to reduce patient mortality. We compared mortality of GSW patients transported by EMS versus private vehicle as these field practice advancements became widespread. We conducted a retrospective cohort study using data from the National Trauma Data Bank (NTDB) from 2007-2021. We included adults (≥ 16 years of age) with GSW injuries transported solely by ground EMS (≤ 2 hours) or by personal vehicle to a Level I or Level II trauma center. The primary outcome was 30-day in-hospital mortality. We also aimed to describe demographic changes over time in these patient populations. A multivariable logistic regression model was developed to estimate the adjusted odds ratio (aOR) of mortality, with demographic and clinical controls. To describe change over time, we performed the multivariable logistic regression model separately within three-year periods. To determine whether the change was significant, we performed the multivariable logistic regression model with the same controls and the addition of an interaction term for transport mode with year group. Of 355,913 patients, 83.7% were transported by EMS and 16.3% by private vehicle. Unadjusted mortality was consistently higher for EMS patients, ranging from 18.8% (vs 3.7% private vehicle) in 2007-2009 to 19.3% (vs 4.3% private vehicle) in 2019-2021. The aOR for mortality in the EMS cohort decreased from 2.2 (95% CI, 1.7-2.8) in 2007-2009 to 1.6 (95% CI, 1.3-1.8) in 2019-2021. However, this temporal trend was not statistically significant (P = .17). Our analysis suggests EMS transport remains associated with higher odds of mortality compared to private vehicle transport for patients with gunshot wounds. This may suggest that improvements in EMS clinical and transport practices have not yet proved sufficient to reduce relative mortality, or that there may be differences in injury severity or type of injury that are not adequately accountable from the NTDB data.
Radiotherapy is one of the most basic clinical tumor treatment methods, yet its efficacy is often limited by radioresistance and off-target toxicity. Nanoradiosensitizers have emerged as a promising strategy for enhancing local dose deposition and regulating tumor microenvironment (TME). Despite the rapid development of the nanoradiosensitizer field, a comprehensive roadmap describing its evolution remains lacking. We analyzed 1,866 publications on nanoradiosensitizers in the Web of Science Core Collection (WoSCC) database up to 2024. The global landscape is drawn using advanced visualization tools, including Bibliometrix, VOSviewer, CiteSpace, and Scimago Graphica. Our analysis reveals that the field has undergone exponential growth and a distinct paradigm shift, with research focus evolving from initial material synthesis (e.g., high-Z metals for physical dose enhancement) to complex biological regulation (e.g., hypoxia relief, TME regulation). Notably, keywords and trend analysis have identified that the integration of nanoradiosensitizers with immunotherapy has become the frontier of the current research field, such as enhanced immunogenic cell death (ICD) and immune checkpoint blockade (ICB). Overall, this study highlights the shift of nanoradiosensitizers from material-driven exploration toward mechanism-based biological and translational studies. Future research must prioritize overcoming translational barriers, including biosafety, large-scale manufacturing, and clinical evaluation, to enable the clinical application of radioimmunotherapy strategies.
We evaluated trends in MRSA hospitalizations and antimicrobial use from 2016-2024 across 40 U.S. children's hospitals. The rate of MRSA cases per 1000 hospitalizations decreased over time, while the rate of MRSA cases requiring ICU care remained constant. There was a marked inter-hospital variability in anti-MRSA antibiotic prescribing.
Triple-negative breast cancer (TNBC) is an aggressive breast cancer subtype with a high risk of early central nervous system dissemination and poor outcomes after brain metastasis (BM). This systematic review summarizes current evidence on incidence, treatment strategies, outcomes, guidelines, and ongoing trials in TNBC-associated BM. The review followed PRISMA guidance and was registered in the Open Science Framework (OSF.IO/6TDRF). MEDLINE, Scopus, Web of Science, DOAJ, and ClinicalTrials.gov were searched through January 17, 2026. Eligible records comprised randomized trials, prospective, retrospective, and ambispective cohorts, registry analyses, case series, guideline or consensus documents, and registered clinical trials reporting TNBC-specific CNS data. Data were extracted independently and synthesized descriptively because clinical and methodological heterogeneity precluded quantitative meta-analysis. Forty-three records met the inclusion criteria: 27 clinical studies (25 addressing parenchymal brain metastases and two addressing leptomeningeal metastases), seven guideline or consensus documents, and nine ongoing clinical trials. Across clinical studies, 67,290 patients were included; 2,555 patients had TNBC and developed CNS involvement. SRS achieved 1-year local control rates of 90-99% in selected patients with limited intracranial disease, but distant intracranial relapse remained frequent. Whole-brain radiotherapy was commonly used for extensive disease and was associated with poorer survival in observational cohorts. Among systemic options, sacituzumab govitecan had the most consistently reported TNBC-specific intracranial signal, although current evidence did not establish comparative superiority. TNBC-associated BM remains linked to substantial morbidity, mortality, and limited prospective evidence. SRS is preferred for appropriately selected patients with limited disease. Sacituzumab govitecan has the most consistently reported TNBC-specific CNS activity, but no systemic agent has established superiority in prospective TNBC-specific CNS trials. Not applicable.
BackgroundThe Paper and Paper Products Manufacturing Sector (PPMS) in Türkiye faces unique occupational health and safety (OHS) challenges, ranging from chemical exposures to heavy machinery hazards. Although OHS Law No. 6331 aimed to modernize the national safety framework, its specific impact on the PPMS remains to be fully quantified through long-term empirical data.ObjectiveThis study aims to evaluate the effectiveness of Law No. 6331 within the PPMS by conducting a 22-year longitudinal analysis (2002-2023), specifically comparing accident frequency, severity, and probability rates between the pre-enactment and post-enactment periods.MethodsAccident rates (AFR, ASR, and APR) derived from Social Security Institution SGK data were analyzed using SPSS 26.0. Statistical evaluations included Shapiro-Wilk for normality, Independent Samples T-Tests for period comparisons, and Pearson Correlation for employment-accident relationships, with significance set at p < 0.05.ResultsThe findings reveal that while Law No. 6331 contributed to a 19% reduction in fatal accidents in the PPMS, non-fatal accidents increased by 178%, significantly driven by reporting formalization. Statistical analysis showed a significant rise in AFR and APR (p < 0.001), whereas ASR values remained stagnant (p = 0.918), indicating persistent injury severity. A strong positive correlation (r = 0.94) was identified between insured workforce expansion and total accidents.ConclusionThe study highlights that generic regulations fail to address the specific risks of the PPMS. To reduce persistent severity rates, we advocate for a shift from passive compliance to proactive systems, such as mandatory ISO 45001 certification and Safety by Design models.
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Understanding changes in opioid overdose-related emergency department (ED) visits and ED-based opioid use disorder (OUD) treatment post-coronavirus disease 2019 (COVID-19) pandemic can inform ongoing efforts to address the opioid crisis. We aimed to examine trends in opioid overdose-related ED visits, ED-based medication for OUD (MOUD) treatment, and appendicitis-related ED visits (as a control) before and after the initial COVID-19 peak in April 2020. We conducted an interrupted time series analysis of monthly ED visits from January 2017-December 2022 at three hospitals in California. We modeled pre- and post-COVID-19 visit trends and the change in trend from pre- to post-COVID-19 peak using linear regression controlling for study site. Our primary outcome included monthly rates of opioid overdose-related ED visits, with monthly rates of ED visits with MOUD treatment as a secondary outcome. Appendicitis-related visits served as a control for temporal trends. Of the 781,488 ED visits across the entire study period, there were 2,536 (0.32%) opioid overdose-related visits, 9,755 (1.25%) MOUD treatment visits, and 1,123 (0.14%) appendicitis-related visits. Pre-pandemic, monthly increases were observed in opioid overdose-related visits (6.7 visits/10,000 per month, 95% confidence interval [CI] 2.6-10.8, P = .001), MOUD-positive visits (34.9 visits/10,000 per month, 95% CI, 26.0-43.7, P < .001), and appendicitis visits (2.5 visits/10,000 per month, 95% CI, 1.2-3.9, P < .001). After April 2020, only MOUD-positive visits showed an immediate (level change) increase (49 visits/10,000 or 34% of April 2020 projected pre-COVID-19 visit rates, 95% CI, 26.1-71.9, P < .001), with opioid overdose-related visits subsequently declining (-4.6 visits/10,000 per month or -11% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -7.2 to -2.0, P = .001). Across the entire pre- to post-COVID-19 period, significant decreases in overall visit trends were observed across all visit types, greatest for MOUD-positive visits (-39.2 visits/10,000 per month, or -27% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -51.5 to -26.8, P < .001), followed by opioid overdose visits (-11.3 visits/10,000 per month, or -27% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -16.1 to -6.5, P < .001) and appendicitis visits (-4.2 visits/10,000 per month, or -23% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -7.2 to -1.2, P = .01). From pre- to post-initial COVID-19 peak, absolute ED-based MOUD treatment trends declined over three times faster than those of opioid overdose-related ED visits (although percentage changes relative to expected April 2020 rates were both -27%). These findings may reflect reduced perceived urgency as overdose presentations decreased and a shift away from crisis-driven implementation, underscoring the need for intentional integration of MOUD into routine ED practice to sustain treatment capacity.
Lung adenocarcinoma (LUAD) in young adults may represent a distinct entity with sex and ancestry-related differences. Population-level data on incidence and survival remain limited. We assessed age- and stage-specific trends in early-onset LUAD and evaluated racial and sex disparities in presentation and outcomes. We used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients aged 15-49 years diagnosed with LUAD. Age-adjusted incidence and stage-specific trends were assessed using joinpoint regression. Cause-specific survival was analyzed using Kaplan-Meier methods and multivariable Cox regression, focusing on non-Hispanic Asian or Pacific Islander (NHAPI) females. Among 14,109 patients, 1,149 (8.1%) were NHAPI females. Incidence trends were heterogeneous across groups, with relatively stable patterns in NHAPI females and variable trends in other populations. NHAPI females more frequently presented with distant-stage disease than non-Hispanic White patients (73.6% vs. 68.0%; p = 0.001). Despite this, they demonstrated superior survival. Five-year cause-specific survival was higher in NHAPI females, with a median survival of 38.0 versus 24.0 months in non-Hispanic White patients (log-rank p < 0.001). In multivariable analysis, non-Hispanic White patients had increased mortality risk compared with NHAPI females (HR 1.25, 95% CI 1.12-1.41). Stage remained the strongest prognostic factor, with higher risk in regional (HR 3.51) and distant disease (HR 12.41) versus localized disease (both p < 0.001). Young NHAPI females represent a distinct LUAD subgroup characterized by a paradox of advanced-stage presentation but improved survival. These findings highlight clinically meaningful heterogeneity and support targeted strategies for early detection and prevention.
Chronic pain is increasingly recognised as a disease with substantial morbidity, yet large-scale data on chronic pain-associated mortality trends and disparities are lacking. To examine nationwide temporal trends and demographic disparities in chronic pain-associated mortality in the US from 1999 to 2023. Death certificate data from the Centres for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) database (1999-2023) were extracted. All deaths with chronic pain listed as a contributing cause were included (n = 67,417), reporting chronic pain (ICD-10 codes R52.1 and R52.2). Age-adjusted mortality rates (AAMRs) per 1,000,000 population, standardized to the 2000 US population. Trends were analysed using Joinpoint regression and represented by annual percentage changes (APCs) with 95% confidence intervals. Among 67,417 chronic pain-associated deaths (61.5% female), AAMR increased from 1.97 per 1,000,000 in 1999 to 10,72 per 1,000,000 in 2023 (average APC, +6.3%; 95% CI5.8% to 6.8%). Increases in AAMR were noted across both sexes (females; average APC, 6.1%; males: 6.6%), age groups (≥ 55 years: average APC, 6.5%; < 55 years: 4.7%), race/ethnicities (non-Hispanic White; average APC, 6.3%; non-Hispanic Black: 10.4% to 2019 then stable; Hispanic: similar acceleration), and regions (all average APCS, 5.3% to 6.3%). Females and those ≥ 55 years had higher AAMRS; the South had the highest burden (33.9% of deaths). These findings revealed a marked rise in chronic pain-associated mortality, disproportionately affecting females, older adults, non-Hispanic White individuals, and the South, signalling chronic pain as a public health concern. Enhanced documentation, interventions targeting comorbidities and disparity-focused policies are urgently needed to mitigate this burden.
Chronic pain is a significant global health challenge, often resistant to conventional treatments, which has led to increased interest in minimally invasive interventions such as radiofrequency (RF) techniques. Over the past 2 decades, clinicians and researchers have extensively studied and utilized RF for chronic pain management. Despite its growing clinical use, the evidence supporting the efficacy of RF remains inconsistent, with outcomes varying due to differences in study design, patient selection, and procedural techniques. To improve the understanding of the current research landscape, this study conducts a bibliometric analysis with the aim of summarizing and visualizing the evolution of, research hot spots within, and future trends in the use of RF for chronic pain treatment. The findings aim to inform directions for future research and optimize the application of RF techniques in clinical practice. This research endeavors to perform a comprehensive bibliometric analysis of global research on the use of RF in chronic pain treatment, focusing on identifying major contributing countries, institutions, journals, and authors, assessing the knowledge base, tracking trends in research hot spots, and exploring emerging topics within the field. A bibliometric analysis. We searched the Web of Science (WoS) database for articles published between January 1, 2004, and December 31, 2024. CiteSpace and VOSviewer were utilized to perform bibliometric analysis and visualization. After all the data were gathered, 719 documents in total were classified and subjected to a detailed analysis that employed the aforementioned tools. The annual number of publications about the use of RF in chronic pain treatment showed a continuous growth trend that reached its peak in 2020. The United States, China, and South Korea were recognized as the most productive countries. Key institutions driving advancements included Yeungnam University, the University of Wisconsin, and Harvard Medical School. Among the authors, Min Cheol Chang and Alaa Abd-Elsayed led in productivity, while Steven P. Cohen stood as the most influential co-cited author, reflecting his foundational contributions to RF clinical applications and guidelines. Among all the journals, Pain Physician and Pain Medicine published the greatest number of relevant papers. Keyword bursts included "radiofrequency ablation," "pain management," and "postherpetic neuralgia," which were hot topics and frontiers in the research field. We analyzed only publications indexed in the WoS because most indicators required for bibliometric analysis could be extracted efficiently from its Web site. This bibliometric analysis synthesizes 2 decades of global research on the use of RF for chronic pain, highlighting contributions from leading nations, institutions, journals, and authors. Keyword trends reflect a shift from foundational studies on thermal mechanisms to clinical validation and innovation in precision targeting and refractory pain subtypes. Further randomized controlled trials, interdisciplinary collaboration, and long-term outcome assessments are warranted to boost the therapeutic potential of RF for diverse chronic pain populations.
Depression and anxiety are a major contributor to the global burden of mental disorders, disproportionately affecting women of reproductive age (15-49 years). This study examined the global trends for depression and anxiety in women of reproductive age, allowing for the variation in social development, profiles of risk factors, and public policies. We analyzed Global Burden of Disease Study (1990-2021) data, estimating age-standardized rates (ASRs) and applying age-period-cohort (APC) analysis to assess trends in depressive and anxiety disorders by sociodemographic index (SDI). We also calculated the slope index of inequality (SII) to measure disparities in disability-adjusted life years (DALYs) and examined correlations with policy performance indicators. From 1990 to 2021, the global age-standardized prevalence of depressive and anxiety disorders rose from 55.98 (95% UI: 55.96-55.99) to 62.21 (62.20-62.22) and 58.66 (58.65-58.67) to 70.97 (70.96-70.98) per 1,000 reproductive-aged women, respectively, with the steepest increase in high SDI regions. Socioeconomic disparities in depression shifted from lower SDI regions in 1990 to near convergence by 2021, while anxiety disparities persisted in higher SDI regions. Intimate partner violence and bullying victimization drove a high burden of depression and anxiety among younger women in Eastern Europe and Sub-Saharan Africa. Migration and financial policies correlated strongly with rising depressive disorder burdens (r = 0.40-0.41). The global burden of depression and anxiety in women of reproductive age necessitates the concerted action targeting their social lives and mental wellness. Integration of mental health services into broader development strategies is encouraged to build sustainable and inclusive societies.
Population-level data on people with limb loss (PwLL) are needed for effective prosthetic provision and rehabilitation. These data are rare in low- and middle-income countries, and low- and middle-income countries are routinely dealt with as homogenous entities. Here, we investigate intranational variation in PwLL populations in Sri Lanka using long-term routinely collected data from prosthetic and orthotic (P&O) clinics. Retrospective study. Until 2009, Sri Lanka experienced a 26-year civil war affecting primarily northern/eastern districts. Published data from 2 P&O centers in northern (Jaffna Jaipur Centre for Disability Rehabilitation, JJCDR; 1987-2018) and central (Centre for Handicapped, CFH; 1987-2024) districts were compared to investigate intranational variation in PwLL demographics and temporal trends. Summative statistics, χ2, and Mann-Whitney U tests (α < 0.05) were used to quantify differences. Major differences included a larger population of males at the CFH (88.8%) compared with the JJCDR (77.4%) and-although war-related amputations were most common at both clinics-there were relatively more war-related amputees at the JJCDR (CFH: 44.8%; JJCDR: 62.7%). In addition, the JJCDR had a higher proportion of patients registered and injured in the same district (CFH: 62.22%; JJCDR: 66.11%). Intranational variation in PwLL populations exists in Sri Lanka as evidenced by differences in populations between northern and central P&O clinics. This points toward differences in provisional needs and temporal health/societal trends underlying limb loss, which must be considered when provisioning health services.
Breast cancer (BC) is the leading cause of cancer in women worldwide with rising incidence in low- and middle-income countries (LMIC). We examined trends in reproductive and lifestyle factors for breast cancer across birth cohorts of Nigerian women. We conducted a cross-sectional analysis of 2,309 female control participants (mean age, 42.5 ± 13.0 years) recruited between 1998 and 2017 as part of the Nigerian Breast Cancer Study (NBCS), an ongoing case-control study. Birth cohort was modeled as an ordinal predictor to evaluate temporal trends. Reproductive and lifestyle factors were analyzed across six birth cohorts (< 1940, 1940-1949, 1950-1959, 1960-1969, 1970-1979, and ≥ 1980). Analyses of reproductive variables were repeated among women aged ≥ 40 years, and hormonal contraceptive use was additionally evaluated among women aged ≥ 30 years. Among all women, mean age at menarche declined from 16.0 years among women born before 1940 to 15.1 years among those born in or after 1980 (P for trend = 0.001), whereas age at thelarche remained stable across birth cohorts. Among women aged ≥ 40 years, mean parity declined from 6.1 to 4.1 live births, and cumulative lifetime breastfeeding duration decreased from 114 to 75 months (both P for trend < 0.001). Mean breastfeeding duration per live birth showed only a modest decline. Among women aged ≥ 30 years, the prevalence of ever hormonal contraceptive use increased from 7.2% to 55.8% across birth cohorts (P for trend < 0.001). Among all women, alcohol consumption remained low throughout (≤ 9% in every birth cohort). Modest generational changes were observed in several reproductive and lifestyle factors traditionally associated with breast cancer risk among Nigerian women. These findings describe temporal changes in breast cancer risk factor profiles across successive birth cohorts. Future studies should examine environmental and other contextual exposures that may contribute to the evolving epidemiology of breast cancer in Nigeria and other low- and middle-income countries.