Search Results (569)

Background and Objectives: A provegetarian (PVG) food pattern, also known as a plant-based food pattern, which prioritizes the consumption of plant-based foods without completely excluding animal-based foods has been associated with health benefits. However, not all plant-based foods are healthy. We prospectively evaluated the association between different PVG food patterns and the risk of total mortality in the “Seguimiento Universidad de Navarra” (SUN) cohort. Methods: The SUN Project is a Mediterranean cohort study involving Spanish university graduates. A validated 136-item semi-quantitative food frequency questionnaire was used. A PVG food pattern, as previously proposed, was calculated assigning positive scores to plant-based foods and inverse scores to animal-based foods. Participants were categorized into quintiles based on their adherence to this pattern. Additionally, healthy and unhealthy PVG food patterns were derived. Results: Data from 17,989 participants with a mean baseline age (standard deviation) 38 (±12) years were analyzed. Over a mean follow-up period of 12 years, 460 deaths (2.6%) were recorded. Participants with higher adherence to the PVG food pattern (Q5) exhibited a 32% lower risk of total mortality [hazard ratio (HR): 0.68 (95% CI: (0.50–0.93); p for trend = 0.020] as compared to those with lower adherence (Q1), after adjusting for multiple confounders. This inverse association persisted for the healthy PVG food pattern [HR: 0.65 (95% CI: 0.47–0.90); p for trend = 0.016]. In contrast, the unhealthy PVG food pattern did not show any significant association with mortality [HR: 1.31 (95% CI: 0.94–1.83)]. Conclusions: Higher adherence to a PVG food pattern, which emphasizes the consumption of plant-based foods, reduces the risk of total mortality in the SUN cohort. Full article

Antimicrobial resistance (AMR) has emerged as one of the most pressing global health challenges of our time. Alarming projections of increasing mortality from resistant infections highlight the urgent need for innovative solutions. While many candidates have shown promise in preliminary studies, they often encounter challenges in terms of efficacy and safety during clinical translation. This review examines cutting-edge approaches to combat AMR, with a focus on engineered antimicrobial peptides, functionalized nanoparticles, and advanced genomic therapies, including Clustered Regularly Interspaced Short Palindromic Repeats-associated proteins (CRISPR-Cas systems) and phage therapy. Recent advancements in these fields are critically analyzed, with a focus on their mechanisms of action, therapeutic potential, and current limitations. Emphasis is given to strategies targeting biofilm disruption and quorum sensing interference, which address key mechanisms of resistance. By synthesizing current knowledge, this work provides researchers with a comprehensive framework for developing next-generation antimicrobials, highlighting the most promising approaches for overcoming AMR through rational drug design and targeted therapies. Ultimately, this review aims to bridge the gap between experimental innovation and clinical application, providing valuable insights for developing effective and resistance-proof antimicrobial agents. Full article

Background/Objectives: Vertebral fractures (VFs) are a global health issue caused by traumatic or pathological factors that compromise spinal integrity. The burden of VFs is increasing, particularly in older adults. Methods: Data from the Global Burden of Disease 2021 were analyzed to estimate the prevalence, mortality, and years lived with disability due to VFs from 1990 to 2021. Estimates were stratified according to age, sex, and region. Bayesian meta-regression models were used to generate age-standardized rates, and projections for 2050 were calculated using demographic trends and the sociodemographic index. Das Gupta’s decomposition assessed the relative contributions of population growth, aging, and prevalence changes to future case numbers. Results: In 2021, approximately 5.37 million people (95% Uncertainty Interval [UI]: 4.70–6.20 million) experienced VFs globally, with an age-standardized prevalence of 65 per 100,000. Although the rates have declined slightly since 1990, the absolute burden has increased owing to population aging. VF prevalence was the highest in Eastern and Western Europe and in high-income regions. Males had higher VF rates until 70 years of age, after which females surpassed them, reflecting postmenopausal osteoporosis. Falls and road injuries were the leading causes of VF. By 2050, the number of VF cases is expected to increase to 8.01 million (95% UI: 6.57–8.64 million). Conclusions: While the age-standardized VF rates have decreased slightly, the global burden continues to increase. Targeted strategies for the early diagnosis, osteoporosis management, and fall prevention are necessary to reduce the impact of VFs. Full article

Pancreatic ductal adenocarcinoma (PDAC) remains among the most lethal malignancies, with a five-year survival rate below 12%, largely attributable to its asymptomatic onset, late-stage diagnosis, and limited curative treatment options. Although PDAC accounts for approximately 3% of all cancers, it is projected to become the second leading cause of cancer-related mortality in the United States by 2030. A major contributor to its dismal prognosis is the lack of validated early detection strategies for asymptomatic individuals. In this review, we present a comprehensive synthesis of current advances in the early detection of PDAC, with a focus on the identification of high-risk populations, novel biomarker platforms, advanced imaging modalities, and artificial intelligence (AI)-driven tools. We highlight high-risk groups—such as those with new-onset diabetes after age 50, pancreatic steatosis, chronic pancreatitis, cystic precursor lesions, and hereditary cancer syndromes—as priority populations for targeted surveillance. Novel biomarker panels, including circulating tumor DNA (ctDNA), miRNAs, and exosomes, have demonstrated improved diagnostic accuracy in early-stage disease. Recent developments in imaging, such as multiparametric MRI, contrast-enhanced endoscopic ultrasound, and molecular imaging, offer improved sensitivity in detecting small or precursor lesions. AI-enhanced radiomics and machine learning models applied to prediagnostic CT scans and electronic health records are emerging as valuable tools for risk prediction prior to clinical presentation. We further refine the Define–Enrich–Find (DEF) framework to propose a clinically actionable strategy that integrates these innovations. Collectively, these advances pave the way for personalized, multimodal surveillance strategies with the potential to improve outcomes in this historically challenging malignancy. Full article

Depensation (or an Allee effect) has recently been detected in stock–recruitment relationships (SRRs) in four Atlantic herring stocks and one Atlantic cod stock using a Bayesian statistical approach. In the present study, we define the Allee effect threshold (B_AET) for these five stocks and propose B_AET as a candidate limit reference point (LRP). We compare B_AET to traditional LRPs based on proportions of equilibrium unfished biomass (B₀) and biomass at maximum sustainable yield (B_MSY) assuming a Beverton–Holt or Ricker SRR with and without depensation, and to the change point from a hockey stick SRR (B_CP). The B_AET for the case studies exceeded 0.2 B₀ and 0.4 B_MSY for three of the case study stocks and exceedances of 0.2 B₀ were more common when the Ricker form of the SRR was assumed. The B_AET estimates for all case studies were less than B_CP. When there is depensation in the SRR, multiple equilibrium states can exist when fishing at a fixed fishing mortality rate (F) because the equilibrium recruits-per-spawner line at a given F can intersect the SRR more than once. The equilibrium biomass is determined by whether there is excess recruitment at the initial projected stock biomass. Estimates of equilibrium F_MSY in the case studies were generally higher for SRRs that included the depensation parameter; however, the long-term F that would lead the stock to crash (F_crash) in the depensation SRRs was often about half the F_crash for SRRs without depensation. When warranted, this study recommends exploration of candidate LRPs from depensatory SRRs, especially if Allee effect thresholds exceed commonly used limits, and simulation testing of management strategies for robustness to depensatory effects. Full article

Maternal mortality and morbidity are critical health challenges in the U.S., and building the perinatal workforce is a key to providing high-quality maternal medical care and services. Texas Southern University (TSU), home to a Doctor of Pharmacy program, launched the first Maternal Health Education and Research Training (MHERT) program to educate a cohort of high school, pharmacy, and health sciences students. Aiming to raise awareness of maternal health issues, build research skills, and promote action-based solutions. MHERT integrated online self-paced interactive lessons with hands-on research or community projects. Topics included maternal health epidemiology, causes of morbidity and mortality, research methods, literature reviews, and the development of action plans addressing maternal health challenges. Assessment tools included quizzes, open-ended reflection responses, training surveys, and course evaluations. Running from 3 June to 26 July 2024, the program enrolled 22 students. All participants completed both course components. Course evaluations showed strong and consistent satisfaction with the program, with teaching effectiveness rated at 95% and 96% for mid-program and final evaluations, respectively. MHERT enhanced participants’ understanding of maternal health, improved research skills, and encouraged community engagement and interdisciplinary collaboration. It offers a scalable model to strengthen public health education among high school, pharmacy, and health sciences students. Full article

Background/Objectives: Cigarette smoking has been causally linked to 90% of all cases of lung cancer, contributing to its high mortality rate. Lung cancer screening centers offer low-dose computed tomography, the only recommended diagnostic screening tool for lung cancer detection. A previous Texas-based study found that centers with lung cancer screening programs failed to consistently provide evidence-based tobacco cessation and relapse prevention interventions recommended by clinical practice guidelines to their patients, who are primarily people who currently or previously smoked. This represents a missed opportunity to assist patients by providing evidence-based tobacco use care during a particularly relevant clinical encounter. Methods: To improve cigarette smoking cessation care delivery and relapse prevention in this setting, this protocol paper seeks to provide a framework for adapting Taking Texas Tobacco Free, a comprehensive, evidence-based tobacco-free workplace program, to lung cancer screening centers. The adapted program, Project SWITCH, will be developed through a formative evaluation process with center stakeholders to identify proactive adaptations to programming based on center-specific contexts. Project SWITCH is expected to be implemented in at least nine lung cancer screening centers in Texas and will be disseminated more broadly to centers statewide. Results: Quantitative and qualitative data will be collected from multiple stakeholders throughout the intervention using a convergent parallel mixed methods design to make additional program adaptations and comprehensively evaluate the achievement of the project’s implementation and dissemination goals. Conclusions: Results from this project’s implementation and dissemination phases are expected to reduce lung cancer morbidity and mortality in Texas by providing an evidence-based, sustainable framework for tobacco-free workplace programs in this specific setting that improves cancer prevention and control practices. Full article

Background: Clostridioides difficile infection (CDI) poses substantial clinical and economic challenges worldwide. This study aimed to evaluate the global burden, trends, and inequalities of CDI from 1990 to 2021, with projections extending to 2040. Methods: We conducted a systematic analysis of the Global Burden of Disease Study 2021 data for 204 countries and territories. CDI-related mortality and disability-adjusted life years (DALYs) were analyzed from 1990 to 2021. Joinpoint regression assessed the trends, a decomposition analysis identified the contributing factors, and cross-country inequalities were measured with slope and concentration indices. A log-linear age–period–cohort model projected future burden to 2040. Results: Global CDI-related deaths increased from 3047 (95% uncertainty interval [UI], 2550–3609) in 1990 to 15,598 (95% UI, 13,418–18,222) in 2021. The age-standardized mortality rate rose from 0.10 to 0.19/100,000 population (average annual percent change [AAPC], 2.26%; 95% confidence interval [CI], 1.77–2.76%), and the age-standardized DALY rate increased from 1.83 to 3.46/100,000 (AAPC, 1.94%; 95% CI, 1.43–2.45%). Epidemiological changes were the primary driver of this burden, contributing 45.46%. Inequalities were intensified, particularly in high sociodemographic index countries, evidenced by increases in the slope index from 2.00 to 4.17 and concentration index from 0.52 to 0.69. The projections suggest that mortality and DALY rates among populations aged ≥80 years will continue to rise through 2040. Conclusions: The global CDI burden has increased significantly over three decades, disproportionately affecting high sociodemographic index countries. The projected rise in CDI burden among older adults through 2040 underscores the urgent need for targeted interventions and strategic planning. Full article

Capital investment in longevity science—research targeting the biological processes of aging through interventions like cellular reprogramming, AI-driven drug discovery, and biological age monitoring—may create significant divergence between traditional actuarial projections and emerging mortality improvements. This paper examines how accelerating investment in life extension technologies affects mortality improvement trajectories beyond conventional actuarial assumptions, building on the comprehensive investment landscape analysis documented in “Investors in Longevity” supported by venture capital databases, industry reports, and regulatory filings. We introduce an Investment-Adjusted Mortality Model (IAMM) that incorporates capital allocation trends as leading indicators of mortality improvement acceleration. Under high-investment scenarios (annual funding of USD 15+ billion in longevity technologies), current insurance products may significantly underestimate longevity risk, creating potential solvency challenges. Our statistical analysis demonstrates that investment-driven mortality improvements—actual reductions in death rates resulting from new anti-aging interventions—could exceed traditional projections by 18–31% by 2040. We validate our model by backtesting historical data, showing improved predictive performance (35% reduction in MAPE) compared to traditional Lee–Carter approaches during periods of significant medical technology advancement. Based on these findings, we propose modified insurance structures, including dynamic mortality-linked products and biological age underwriting, quantifying their effectiveness in reducing longevity risk exposure by 42–67%. These results suggest the need for actuarial science to incorporate investment dynamics in response to the changing longevity investment environment detailed in “Investors in Longevity”. The framework presented provides both theoretically grounded and empirically tested tools for incorporating investment dynamics into mortality projections and insurance product design, addressing gaps in current risk management approaches for long-term mortality exposure. Full article

The almost complete eradication of fire from grasslands in North America has led to non-linear hysteretic transitions to shrub- and woodlands that the reintroduction of low-intensity fire is unable to reverse. We explore the ability of the extreme ends of variation in fire behavior to help overcome hysteretic threshold behaviors in huisache (Vachellia farnesiana) encroached grasslands. We contrasted experimental fire treatments with unburned control areas to assess the ability of extreme fires burned during drought to alter the density and structure of huisache. We found that extreme fires reduced the density of huisache by over 30% compared to control plots, both through driving huisache mortality and reducing the number of new recruits following treatments. For instance, extreme fire drove 48% huisache mortality compared to 4% in control treatments. For surviving plants, the number of stems increased but the crown area did not significantly change. Prescribed fire, conducted under the right conditions, can drive high mortality in one of the most notorious encroaching species in the southern U.S. Great Plains. With the fire conditions observed in this study likely to increase under future climate projections, utilizing extreme fire as a management tool for huisache will help scale up management to meet the growing extent of woody encroachment into grasslands. Full article

Background/Objectives: Malnutrition is a key contributor to poor outcomes in older adults with fragility fractures, increasing the risk of complications, functional decline, prolonged hospital stays, mortality, and healthcare costs. Substantial evidence limited to hip fracture supports early, interdisciplinary nutrition care. However, global audits reveal that most hip fracture patients do not receive recommended interventions. This quality improvement (QI) project aimed to co-create and test a pathway and toolkit to help apply evidence-based nutrition care in different fragility fracture settings globally. Methods: The SIMPLER Pathway and toolkit (SIMPLER) were developed through a multiphase, co-creation QI initiative (2018–2025), guided by the Knowledge-to-Action framework. Global experts and clinical teams synthesized evidence, identified the “know-do” gap, and adapted SIMPLER to context through iterative action–reflection cycles. The Model for Improvement guided team building, goal setting, testing changes, and measuring outcomes at pilot sites. Results: Over 100 co-creation activities between 2018 and 2025 engaged staff and patients to shape and refine SIMPLER. A global clinician survey (n = 308, 46 countries), two bi-national audits (n = 965, 63 hospitals), and qualitative interviews (n = 15) confirmed a widespread evidence-practice gap. The pathway and toolkit were pilot-tested in five hospitals across four countries, with action–reflection cycles enabling continuous refinement of prioritized nutrition improvements tailored to the local context. Following endorsement in late 2024, 46 healthcare services in 23 countries have formally committed to implementing SIMPLER. Conclusions: The SIMPLER Nutrition Pathway provides a scalable, adaptable framework to support the delivery of evidence-based nutrition care in fragility fracture settings. A global evaluation is underway. Full article

Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality rates globally, presenting a severe threat to human health and life. Acute myocardial infarction (AMI) is one of the most common and extremely severe disorders within CVDs, causing an estimated 17.5 million deaths each year. Cardiac troponin I (cTnI) is considered a biomarker for myocardial infarction and a “gold standard” method for diagnosing AMI due to its high specificity and sensitivity. The ability to rapidly detect cTnI with high sensitivity is critical throughout the diagnosis and treatment process of AMI. It is a necessary precursor for doctors to quickly assess the disease and initiate subsequent therapies. This work comprehensively explores various techniques for the analysis and detection of cTnI. We systematically review current cutting-edge technologies used for cTnI detection. According to optical, electrical, and intelligent technology dimensions, this study meticulously classifies and elaborates on the research progress of related sensors. Based on current research findings and technological development trends, we further project the future research directions and application prospects of cTnI sensors. This is geared towards providing valuable references for the further development of this field. Full article

Poyang Lake in China is the most critical habitat and final refuge for the Yangtze finless porpoise (Neophocaena asiaeorientalis), YFP. In 2022, its population reached approximately 492 individuals, an increase of 35 from the 457 individuals recorded in 2017, showing a steady upward trend. The infrequent movement of YFPs between Poyang Lake and the Yangtze River represents a considerable threat to the long-term viability of this population. Additionally, serious water shortages in the lake during the dry season have led the government to consider the establishment of a hydraulic project. Therefore, a reliable risk assessment and quantitative analysis of conservation scenarios are urgently needed for this population. Population viability analysis of the YFP population in Poyang Lake was conducted using the VORTEX software. The baseline model predicted a probability of extinction of 0.241 over the next 100 years, with no probability of extinction in the first 30 years; the genetic diversity would be on a continuous downward trend and decline by 91.5%. The comprehensive protection model predicted a probability of extinction of 0.0028 and that the genetic diversity would be maintained at about 0.996 in 100 years. Breeding rate, sex ratio at birth, mortality rate, and gene flow were the factors that were sensitive to maintaining population viability. The results showed that the population of YFPs in Poyang Lake was at a high risk of extinction due to the decline in genetic diversity and the higher mortality and lower birth rate caused by habitat degradation. A total ban on productive fishing and the rescue and interchange of YFPs are conducive to enhancing the viability of the YFP population in Poyang Lake. Full article

Background/Objectives: Randomised trials show that screening with prostate-specific antigen (PSA) and systematic prostate biopsies can reduce prostate cancer mortality but leads to high rates of overdiagnosis. Today, improved diagnostic methods more selectively detect potentially lethal, high-grade prostate cancer. Methods: This is a narrative review of modern diagnostic methods, ongoing trials, national policies and knowledge gaps related to screening and early detection of prostate cancer. Results: Screening intervals can be prolonged in men with PSA values below around 1 ng/mL as these men are at very low long-term risk of prostate cancer death. Overdiagnosis can be reduced by magnetic resonance imaging (MRI) and lesion-targeted prostate biopsies. Risk calculators and ancillary biomarkers can select men for further investigation and thereby reduce resource needs. These new methods are evaluated in large, randomised screening trials. The remaining knowledge gaps include optimal PSA cut-offs, screening intervals, start and stop ages, and the long-term balance between benefits and harm. Until recently, almost no national healthcare authority recommended population-based screening for prostate cancer. Now, the European Union Council recommends an evaluation of the feasibility of organised, risk-stratified screening. This has led to several pilot projects. In some other parts of the world, such as sub-Saharan Africa and the Caribbean, such initiatives are lacking despite high prostate cancer mortality rates. Conclusions: Risk-stratified prostate cancer screening including MRI and targeted biopsy reduces overdiagnosis. Results from ongoing research are needed to optimise screening protocols and to define long-term benefits and harms. Initiatives for early detection and screening are emerging across the world but are still lacking in many countries with high prostate cancer mortality. Full article

Since the onset of the COVID-19 pandemic, Japan has experienced a significant rise in mortality, with excess deaths surpassing historical projections. Statistical data indicate a sharp increase in mortality rates from 2021 onward, attributed to COVID-19, aging demographics, cardiovascular diseases, and malignancies. Preliminary 2024 data suggest continued excess mortality, fueling public debate. This review analyzes national and municipal mortality trends using official Japanese statistics and comparative data from South Korea, the U.S., and the EU. Findings reveal a sharp mortality rise post-2021 in Japan and South Korea, while Western nations experienced peak deaths in 2020, followed by declines. The review explores contributing factors, including potential vaccine-related adverse effects, declining healthcare access, pandemic-induced stress, and demographic shifts. Notably, older adults’ reluctance to seek medical care led to delayed diagnoses, treatment interruptions, and preventable deaths. Although some argue that declining COVID-19 vaccination rates in 2023 may have contributed to rising mortality in 2024, available data suggest a multifactorial causation. Japan’s rapidly aging population, coupled with increasing mortality and declining birth rates, presents profound social and economic challenges. A nuanced approach, avoiding simplistic causal claims, is crucial for understanding these trends. This review highlights the need for a sustainable societal framework to address demographic shifts and improve healthcare resilience. Future pandemic strategies must balance infection control measures with mitigating unintended health consequences to ensure a more adaptive and effective public health response. Full article