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Patients with chronic liver disease (CLD) often experience hypozincemia. The clinical factors associated with hypozincemia have not been established. We investigated clinical factors that may be useful to predict hypozincemia in patients with CLD. The serum zinc levels CLD patients were measured; Study 1 investigated the predictive factors of hypozincemia, and Study 2 was performed to validate the factors identified in Study 1. Study 1 included 197 participants, of whom 28 and 106 had serum zinc levels <60 µg/dL and <80 µg/dL, respectively. A multivariate analysis revealed that serum zinc levels <60 µg/dL or <80 µg/dL were associated with the albumin–bilirubin (ALBI) score and serum albumin level. A receiver operating characteristic curve analysis revealed that the ALBI score ≥ −1.83 and the serum albumin level ≤3.3 g/dL were the cut-off values for a serum zinc level <60 µg/dL, whereas the ALBI score ≥ −2.44 and the serum albumin level ≤3.6 g/dL were the cut-off values for a serum zinc level <80 µg/dL. In Study 2 (n = 177), the diagnostic accuracy rates for serum zinc <60 µg/dL were 81.9% for the ALBI score and 75.1% for the serum albumin level, and those for serum zinc <80 µg/dL were 70.1% for both parameters. Together these findings indicate that the ALBI score may serve as a predictive factor of hypozincemia in CLD patients.
This study aimed to evaluate adult women’s cooking (CS) and food preparation skills (FPS) and their nutrition literacy (NL) levels and to examine the relationship between these two concepts.
Design:
Data were collected via face-to-face interviews using a personal information form, the Cooking and Food Preparation Skills scale, and the Evaluation Instrument of Nutrition Literacy on Adults. Data were analysed with SPSS, with P < 0·05 considered significant.
Setting:
Female adults aged 20–64 years who participated in family support courses in Tepebaşı, Eskişehir, Turkey.
Participants:
The study sample consisted of 330 female individuals between the ages of 20 and 64 years who agreed to participate in the survey.
Results:
NL was generally adequate (91·8 %), though gaps were identified in portion knowledge (54·2 %) and food label reading (44·2 %, borderline). Higher literacy levels were associated with being younger, more educated and employed (P < 0·05). CS and FPS were higher among married women and those with children. Cooking frequency and enjoyment significantly influenced these skills (P < 0·05). Those who cooked more often had higher scores in food label reading and basic math (P < 0·001) and higher total scores (P = 0·049). Participants who enjoyed cooking had better reading comprehension (P = 0·030). A weak but significant correlation was found between FPS and general nutrition knowledge, but no strong relationship was observed between overall cooking skills (CS) and total NL.
Conclusion:
Although no strong link was found between NL and CS, these skills appear to support healthier eating behaviours. Promoting cooking and food preparation through nutrition education may help improve public health.
Both host identity and environmental factors are known to influence parasite species richness. Here, we analysed selected host traits and environmental variables associated with 3 aspects of helminth diversity in African ruminants. Based on the helminth faunas of 35 species of antelope and 1 species of giraffe, we studied drivers of species richness as well as taxonomic and functional diversity, combined for all helminths and separately for nematodes, cestodes and trematodes. A larger geographic host range and/or multiple habitats were associated with higher species richness in all helminths and each group individually as well as with functional diversity in all helminths, trematodes and cestodes. A wider host distribution range and larger relative brain size were both linked to higher taxonomic diversity in all helminths, and an increase in host longevity was linked to higher taxonomic diversity in nematodes. A higher level of climate moisture, relative humidity and primary production had a positive effect on trematode species richness and taxonomic diversity in all helminths, while trematode taxonomic diversity decreased in hosts from drier areas but increased in cestodes harboured by hosts from warmer areas. Our results highlight that patterns in parasite species richness and diversity emerge from an interplay of numerous factors, including host biology, environmental conditions and ecological traits of the parasites themselves. This points to the importance of carefully choosing the range of hosts considered for large-scale parasite diversity studies and underscores the need to avoid grouping too many types of parasites when looking for ecological patterns.
In team science, invitation to writing groups can be subjective and secretive. Confronted with this challenge in the ISCHEMIA trial, with 320 participating sites, 4 coordinating centers, 6 core laboratories, and numerous committees, we adapted an existing model to develop a transparent, objective, and equitable method for determining authorship eligibility.
Methods:
We developed a scoring system based on site performance of tasks critical to trial success that meet the ICJME criteria for authorship. Sites were ranked according to points earned, and points required for potential authorship were communicated to all sites. Site investigators were surveyed for their manuscript topic preferences for writing groups. Beyond the point-based system, authorship positions were also reserved for trial contributors who were not site investigators.
Results:
To date, 50 original, peer-reviewed ISCHEMIA trial manuscripts have been published. In total, 208 authors from 33 countries participated in at least one publication. Of the 87 sites that randomized at least 15 participants over a mean of 5 years, 72% had authorship positions across published manuscripts. Surveys were sent to 334 site investigators and 27% responded. Among respondents, 61% indicated that ISCHEMIA was the first trial they had worked on with performance-based criteria for authorship invitation. Respondents agreed the system was transparent (81%), objective (83%), and equitable for early career researchers (70%) and underrepresented minorities in research (57%).
Conclusions:
ISCHEMIA employed a point-based authorship eligibility system that most authors found objective, merit-based, transparent, and equitable. Implementation of such a system should be considered for team science publications.
This study aimed to investigate (1) the longitudinal associations between food patterns and body weight in young adulthood and (2) how food patterns of young adults relate to food consumption in early, middle and late childhood. The study sample includes 700 participants of the Québec Longitudinal Study of Child Development. During childhood, frequency of consumption of various foods was reported on ten occasions between 1·5 and 13 years. At age 22 years, food frequency questions (with quantities) were used to derive four food patterns (labelled healthy, beverage rich, protein rich and high energy density) through exploratory factor analysis. Self-reported height and weight were collected at 22 and 23 years. Regression analyses were performed to assess the associations between (1) food patterns and weight outcomes a year later (BMI, BMI change and overweight status) and (2) frequency of consumption of eight food groups in childhood and food patterns in adulthood. Dietary habits characterised by the consumption of vegetables, fruit, plant-based sources of protein and whole-grain cereal products were related to a lower risk of obesity a year later. Conversely, dietary habits characterised by a high consumption of energy-dense foods, of animal sources of proteins and, among women, of high quantities of liquids were associated with higher risk of excess weight a year later. Healthier food choices in childhood were associated with healthier food patterns in young adulthood. These findings reinforce the value of preventive dietary interventions in the early years to foster eating environments that favour healthy eating and healthy weights in adulthood.
Radiotherapy (RT) is a highly effective breast cancer treatment. However, RT can deliver radiation dose to the healthy tissues of the shoulder, increasing the potential for long-term shoulder morbidity. This study compared the dose delivered to key shoulder muscles between common RT techniques and patient positioning.
Methods:
The treatment plans of 54 patients were analysed, including those treated in the prone and supine positions. Eight shoulder muscles were contoured on each patient’s computer tomography scan. The following breast treatment techniques were analysed: hybrid-intensity-modulated RT (hybrid IMRT), wedged field, two partial arcs volumetric-modulated arc therapy (VMAT), hybrid VMAT, and 3-field supraclavicular technique. Moreover, the effect of patient positioning was also evaluated (supine versus prone). Muscle radiation exposure was compared for the mean dose and the percent muscle volume exposed to V15 Gy and V30 Gy.
Results:
The mean dose and exposed volume for the pectoralis major and pectoralis minor were similar between hybrid IMRT, wedged field, VMAT, and hybrid VMAT. VMAT and hybrid VMAT delivered a greater mean dose to most posterior shoulder muscles compared to hybrid IMRT, though overall exposure remained generally low for these muscles. The 3-field supraclavicular technique increased radiation exposure to all shoulder muscles, particularly to the pectoralis major, the pectoralis minor and the supraspinatus. Prone positioning significantly reduced V15 Gy and V30 Gy exposure for both anterior and posterior shoulder muscles.
Conclusion:
Shoulder muscle exposure was similar between hybrid IMRT, wedged field, VMAT and hybrid VMAT. The anterior shoulder muscles were consistently exposed to radiation with all RT techniques investigated in this study. In comparison, the 3-field supraclavicular technique substantially increased the radiation exposure to the posterior shoulder muscles. Lastly, delivering radiation in the prone position spared the anterior and posterior shoulder muscles. These findings inform treatment planning decisions aimed at mitigating the risk of long-term shoulder dysfunction.
The current study examined perceptions of and experiences with Flint Families Cook, a virtual cooking and nutrition programme for youth and families.
Design:
Families were invited to participate in virtual focus groups after completing the 5-week Flint Families Cook programme. The research study was guided by Social Cognitive Theory. Researchers used thematic analysis to examine the transcribed focus groups, identify patterns across transcripts and develop emerging themes.
Setting:
Families living in Flint and surrounding Genesee County, Michigan, USA, engaged in virtual focus groups via Zoom.
Participants:
Youth (n 32; 59 % female, 53 % African American) and adult caregivers (n 31; 90 % female, 39 % African American) participated in focus groups between October 2020 and February 2022.
Results:
Five themes were generated from the focus group discussions: (i) general cooking challenges; (ii) class format; (iii) family support; (iv) provision of food; and (v) instruction and learning.
Conclusions:
In addition to perceived positive impacts on cooking skills and nutrition education, many participants shared that Flint Families Cook encouraged family cohesion and support. Most caregivers felt the programme, which included instruction by a chef and dietitian as well as ingredient box delivery, had important impacts on the emotional health of youth and family resilience. Flint Families Cook, and similar virtual scalable programmes, could broadly reach children and families to support physical and psychosocial health, especially in low-resource communities where such interventions may be most beneficial.
Biomphalaria straminea (Gastropoda: Planorbidae) and Physa acuta (Gastropoda: Physidae), both invasive species in southern China, are important vectors for zoonotic diseases. However, the lack of information on the infection dynamics of Angiostrongylus cantonensis in these snails leaves gaps in understanding the compatibility mechanisms between the snails and the parasite. This study aims to reveal differences in A. cantonensis infection between B. straminea and P. acuta from Guangdong, southern China, and to investigate the potential interaction mechanisms between A. cantonensis and P. acuta. We found that both phenotypic color variants of B. straminea snails were highly susceptible to A. cantonensis (100%). The load of the L3 larvae ranged from 243 to 765 per snail, and it was positively correlated with the infection dosage. Based on the comparison of third-stage larvae quantities, B. straminea is more suitable than P. acuta for establishing the life cycle of A. cantonensis in the laboratory. In contrast, geographic isolates of P. acuta exhibited variable susceptibility (13–91%) and markedly lower parasite loads, with 6–32 third-stage larvae per snail. Diverse strains of P. acuta exhibit distinct immune responses to A. cantonensis, characterized by varied expression patterns of immune-related genes such as TEP1, HSP70, FREP2, Cu-Zn_SOD1, Fe-Mn_SOD2, MIF and Galectin. Our findings establish B. straminea as both a high-risk vector and a laboratory model for studying the life cycle of A. cantonensis, while highlighting P. acuta as a model for investigating parasite-snail interactions, thereby enhancing our understanding of snail-parasite dynamics in southern China.
End-of-life dreams and visions (ELDVs) and delirium frequently occur near death but differ in core features. Clinical differentiation becomes challenging when they co-occur. This case report illustrates the interplay between ELDVs and delirium, examines the limits of current diagnostic criteria in mixed cases, and outlines a nuanced approach to distinction.
Methods
We report the case of an elderly Brazilian woman with metastatic cancer who exhibited both ELDVs and delirium. Mental status was serially assessed using the Confusion Assessment Method (CAM). ELDV accounts were prospectively triangulated across patient, family, and clinician reports to enhance reliability and contextual understanding.
Results
The patient’s experiences showed ELDV hallmarks – vivid, realistic encounters with deceased relatives, biographical relevance, and preparatory themes – yet many were affectively distressing and occurred alongside fluctuating attention and consciousness consistent with delirium. CAM effectively identified delirium but could not, on its own, distinguish ELDVs within delirious states. When co-occurring, ELDVs often emerged during “windows of lucidity” marked by preserved autobiographical context, intact recall with subsequent coherent narration, and insight, despite intense emotional valence. Distress alone was not discriminatory, probably being shaped by psychosocial and cultural factors. These observations indicate the need to supplement CAM with qualitative and phenomenological criteria, including content, vividness, biographical meaning, insight, cultural fit, and acuity/recall.
Significance
To our knowledge, this is the first case to map evolving end-of-life mental status using serial CAM while prospectively documenting ELDVs via triangulated reports. The findings highlight the complexity of differentiating co-occurring ELDVs and delirium and challenge the sufficiency of CAM alone. An integrated approach – combining CAM screening with structured ELDV assessment – may prevent misclassification and support holistic, dignified palliative care. As a single case in an underexplored domain, these insights require confirmation in larger, prospective studies to assess generalizability.
We estimated the vaccine effectiveness (VE) of second monovalent and bivalent booster vaccines containing Omicron BA.1 or BA.4/BA.5 and the protection conferred by natural immunity against SARS-CoV-2 infection in Luxembourg. We conducted a test-negative case–control study among residents aged 60 years or older by integrating national socio-demographic, COVID-19 vaccination, and testing data, achieving full population coverage. Using conditional logistic regression, we estimated absolute and relative VE of monovalent and bivalent boosters and natural immunity from prior infection. Our analysis included 5,390 test-positive cases and 11,048 test-negative controls matched by week of testing between September 2022 and April 2023. Absolute VE for monovalent and bivalent boosters decreased from 64.8% and 66.6% in the first month to 1.5% and 16.5% after 5–6 months, respectively. The bivalent was superior to the monovalent booster only in individuals without natural immunity (relative VE 25.7%, 95% confidence interval 11.4%; 37.7%). Natural immunity lasted longer than vaccine-induced immunity with 80.7% protected at 4–8 months and 44.9% at 15–25 months post-infection. Both second booster vaccines provided temporary protection against SARS-CoV-2 infection; bivalent boosters offered a slight benefit over monovalent boosters. Natural immunity appears to confer longer-lasting protection.
This study aimed to evaluate the characteristics, difficulties, and outcomes of patients who underwent transcatheter ablation treatment due to arrhythmia with a diagnosis of CHD.
Methods:
A total of 166 patients (189 substrates) with CHD who underwent catheter ablation between November 2013 and 2023 were evaluated retrospectively. EnSite™ (St Jude Medical Inc., St Paul, MN, USA) was used in all patients.
Results:
The mean age was 14.8 ± 7.9 years (2.9–43 years). The most common CHD’s were Ebstein anomaly (n: 40), tetralogy of Fallot (n: 31), atrial septal defect (n: 25), ventricular septal defect (n: 22), great artery transposition (D/L TGA, n: 12), and complex CHD in single ventricle physiology (n: 9). The most common arrhythmia mechanisms were Wolf-Parkinson-White syndrome (WPW, n: 50), intraatrial reentrant tachycardia (IART, n: 39), typical atrioventricular nodal reentrant tachycardia (AVNRT, n: 37), and ventricular tachycardia-ventricular extrasystoles (VT/VES, n: 23). There was more than one arrhythmia in 23 patients and multiple manifest accessory pathways in 10 patients. The average procedure time was 174 ± 69.3 minutes, and the average fluoro time was 8.3 minutes. While successful ablation was performed in 176/189 (acute success 93.1%) substrates, the procedure was unsuccessful in five patients and suboptimal in eight patients. Recurrence was observed in 11 patients (6.4%) during a mean follow-up period of 49.2 ± 30.1 months. A second ablation was performed on 13 patients. Acute success was achieved in all except one patient. A total of 11 patients are being followed up with medical treatment.
Conclusion:
Despite the complex anatomy, age, operations, and limited vascular access possibilities in patients diagnosed with CHD, transcatheter ablation treatment with advances in electrophysiology, the introduction of different energy types, special ablation catheters, multipolar mapping catheters, and 3D nonfluoroscopic mapping systems seems to be a safe and effective option.
This study has investigated the relationship between the gut microbiota compotision and the growth performance in pigs from birth to the finishing stage, focusing on nutrient metabolism. Of 59 crossbred pigs [(Landrace × Large Yorkshire) × Duroc] from seven sows, individuals with high and low daily gain (DG) were assigned to high DG (HDG, n = 11) and low DG (LDG, n = 8) groups. Fecal samples collected at weaning (21 days), growing (95–106 days) and finishing (136–152 days) stages were analyzed for amino acids, short-chain fatty acids, and microbial composition using 16S rRNA sequencing. Although birth and weaning weights were similar in both groups, the HDG group had significantly higher weights in the growing and finishing stages (P < 0.01). The microbial composition of the LDG group revealed a higher abundance of f_Lachnospiraceae;__ at weaning (P < 0.05), whereas the HDG group contained higher abundance of g_Streptococcus and g_Prevotella 7 at the finishing stage (P < 0.05). Functional analysis revealed increased amino acid metabolism in the HDG group at the finishing stage (P < 0.05). During the growing stage, total free fecal amino acid content was low in the HDG group (P < 0.05); at weaning, levels of isobutyric and isovaleric acids, key amino acid fermentation products (P < 0.05, P < 0.01), were higher. These findings indicate growth stage-specific differences in the gut microbiota and metabolic profiles between groups with different growth performance, suggesting microbial and metabolic characteristics may influence growth performance.
This systematic review and meta-analysis was a study that enquired into the prevalence and epidemiology of depression in university students in Pakistan, between 2000 and 2025. Depression is a significant global mental illness with high prevalence in young adulthood. University students are the most susceptible to this risk because of the factors related to it, i.e., academic stress, financial hardships, social pressure, and cultural stigma of mental illness. Although the concerns have been on the increase, the prevalence rates of depression have been widely varied among Pakistani students, with some studies reporting as low as 2.5% to as high as 85%, primarily because of the sampling techniques, assessment instruments, and geographical settings. The present review is based on the findings of 35 studies involving over 11,000 students and suggests that the prevalence rate is approximately 51% in a pooled form, meaning that about 50% of university students in Pakistan are subjected to depressive symptoms. The high level of heterogeneity of the selected studies highlights the acute necessity of the formulation of a standard-based diagnostic criteria and culturally competent mental health assessment instruments. Moreover, systemic challenges, such as the shortage of trained mental health professionals and the general unawareness of the disorder, are continuing to affect the diagnosis and treatment of the disorder at an early stage. According to the results, the necessity of a multi-faceted approach toward mental health, including the establishment of counseling facilities in universities, the development of stress management training, and the federal stigma-reduction campaign, is pressing. The most significant elements of enhancing the well-being of students and the mental health landscape of Pakistan as a whole are early intervention and empowering mental health infrastructure.
This study systematically evaluates the effects of probiotic interventions on gut microbiota and clinical outcomes in diabetic patients to determine the optimal target population and conditions for effective use, with an emphasis on precision treatment. A comprehensive search was performed across PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Internet (CNKI), and Wanfang databases until April 2024. Randomized controlled trials (RCTs) assessing probiotics as adjunctive therapy for diabetes were included. The control group received standard care, and the intervention group received probiotics alongside standard care. Data were managed with Endnote and Excel, and analyses were conducted using Revman 5.3 and Stata 16. Twelve RCTs involving 1,113 participants were included. Probiotics significantly increased fecal Lactobacillus (standardized mean difference (SMD) 1.42, P < 0.0001, I2 = 95%) and Bifidobacterium levels (SMD 1.27, P < 0.0001, I² = 90%) and reduced fasting plasma glucose (SMD -0.35, P = 0.004). Subgroup analysis showed that shorter intervention durations (≤3 months) improved FPG, HbA1c, and Bifidobacterium levels, while younger patients (≤60 years) experienced the most significant improvements in Bifidobacterium levels. In conclusion, probiotics improve gut microbiota and clinical outcomes in diabetic patients, with intervention duration and patient age as key factors influencing treatment effectiveness.
Overweight and obesity have become a global public health concern, with prevalence rising sharply in low- and middle-income countries. This study analyzed temporal trends in overweight and obesity among schoolchildren in the largest capital city of Brazil, from 2006 to 2024.
Design:
Repeated cross-sectional.
Setting:
Schoolchildren aged 6 to 19 from Porto Velho, Rondônia, Brazil.
Participants:
A total of 12,646 participants were evaluated. To assess the body mass index z-score, standardized body mass and height measurements were used, stratified by sex (male and female) and age group (6-10 and 11-19 years). Temporal trends were assessed using joinpoint regression analysis.
Results:
Overall, 17.8% of participants were classified with overweight, and 8.6% were classified with obesity. The study also found that obesity prevalence was consistently higher among younger age groups compared to adolescents. The results revealed a significant increase in obesity prevalence among girls (annual percentage change [APC] = 5.81%; 95% confidence interval [95%CI] = 1.03-10.81; p-value = 0.021) and children aged 6 to 10 years (APC = 5.20%; 95%CI = 1.17-9.39; p-value = 0.017), while no significant trends were observed for overweight or for male adolescents or adolescents aged 11 to 19 years.
Conclusions:
Our findings indicate rising obesity among girls and children aged 6–10 and support the need for urgency. We recommend targeted action, including implementing mandatory quality physical education and school nutrition standards, enforcing restrictions on marketing to children, and prioritizing municipal policies that increase access to healthy foods.
A better understanding of calcitonin gene-related peptide (CGRP) inhibitor use is in migraine treatment needed.
Methods:
A retrospective, observational, population-based cohort study was conducted using administrative data. Adults (≥18 years) who received ≥1 prophylactic CGRP inhibitor in Canada (six provinces) between 2018 (first approved) and 2023 were identified. CGRP inhibitor use was described; migraine-related acute medication and healthcare use were compared pre–post CGRP inhibitor initiation (independent and paired t-tests).
Results:
12,851 adults were identified. CGRP inhibitor use increased from 11.8 (incident/prevalent) to 22.4 (incident) and 57.3 (prevalent) per 100,000 adults. Erenumab use decreased over time, as use of newer agents increased. During the 1-year period after CGRP inhibitor initiation, 57.4% had concomitant use with a different prophylactic migraine medication class (onabotulinumtoxinA injection: 23.2%; oral non-CGRP inhibitor: 34.2%), and 30.4% stopped use (21.3% switched to a different prophylactic migraine medication class; 9.1% discontinued all prophylactic migraine medication). During the 1-year period after CGRP inhibitor initiation (versus before), days of supply for migraine-related acute medication was lower (mean [standard deviation]: 129 [191] versus 145 [197] days; mean difference [95% confidence interval]: −16: [−22, −11] days), as were the number of healthcare visits (7.36 [8.70] versus 9.18 [10.10]; −1.82 [−2.06, −1.58]).
Conclusion:
CGRP inhibitor use increased from 2018 to 2023. After CGRP inhibitor initiation, most patients had concomitant use with a different prophylactic migraine medication class, and some stopped use; migraine-related acute medication and healthcare use were lower (versus before). Findings provide a real-world description of the evolving landscape of CGRP inhibitor use in Canada.