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After performing an abortion in 1973, Dr. Kenneth Edelin was indicted and convicted of manslaughter. Dr. Edelin’s conviction was reversed 50 years ago. However, the conflict between the medical and legal systems, the use of abortion prosecution to control patients and providers, and the framing of a fetus as a person feel just as relevant to today’s abortion landscape.
Nutrition is crucial for the growth of children and adolescents. This study investigated multiple nutritional problems and influencing factors among 2,423 students aged 6-17 in Guizhou Province, using questionnaire surveys, physical examinations, and blood tests. Multifactorial logistic and Poisson regression analyses were used to identify determinants of overnutrition and undernutrition. The results showed a distinct profile compared to national averages: wasting was more prevalent (9.6%), while overweight (8.6%) and obesity (5.0%) were less common. Notably, hyperuricemia (27.6%) and zinc deficiency (17.9%) were elevated, whereas classical metabolic syndrome (2.3%) was lower, delineating a regional pattern that prioritizes these emerging and micronutrient issues. Marginal vitamin A deficiency (17.2%) and vitamin D inadequacy (50.9%) remained significant. Older age (11-17 years) was a strong risk factor for overnutrition-related disorders and hyperuricemia (All p<0.001). Overweight/obesity increased risks of hyperuricemia and metabolic syndrome (All p<0.001). Being female was a major risk factor for undernutrition (PR=1.27, 95%CI: 1.19-1.35, p<0.001) and vitamin D deficiency (AOR=2.51, 95%CI: 2.10-3.00, p<0.001), but a protective factor against hyperuricemia (AOR=0.34, 95%CI: 0.27-0.41, p<0.001). Frequent sugary drink consumption (≥3/week) elevated hyperuricemia risk (AOR=1.33, 95%CI: 1.05-1.69, p=0.020). This study underscores a complex double burden of malnutrition in western China, characterized by specific priority areas, and necessitates tailored, multi-component interventions such as limiting sugary drinks and focusing nutrition support on adolescent girls.
To explore cancer patients’ understanding of Advance Care Planning (ACP) and identify the main barriers hindering its effective implementation in clinical practice.
Methods
This qualitative descriptive study included Brazilian women with breast cancer aged 18–75 years, all with preserved functional status, recruited by convenience sampling. Exclusion criteria were difficulty using online calls or significant communication impairment. Data collection involved a sociodemographic questionnaire and a follow-up interview. After receiving an informational brochure, participants were contacted by video call 14 days later and asked, “How do you understand what ACP is?” Interviews were conducted confidentially at home, transcribed, and analyzed according to qualitative research reporting guidelines.
Results
Sixty-one women participated. Most had difficulty understanding ACP; nearly 40% could not define it. Main barriers included cultural resistance to discussing death, reliance on family members or physicians for decision-making, and lack of clear information. Many participants confused ACP with preventive care. A conceptual multilevel model was developed, showing how cultural taboos, family dependence, and systemic inertia interact to sustain barriers through a feedback loop in which cultural avoidance reinforces structural gaps and institutional neglect.
Significance of results
This study provides evidence on how ACP is understood and misinterpreted by cancer patients in a middle-income Latin American setting, an area that remains underrepresented in the literature. By demonstrating that misconceptions, cultural taboos, and systemic barriers operate through a reinforcing multilevel process, the findings offer a conceptual framework that explains why ACP remains marginal in routine oncology care. The model highlights critical points for intervention, including patient education, professional communication, and institutional support, and is directly applicable to similar sociocultural contexts characterized by strong family involvement and biomedical dominance. These results have clear implications, supporting the integration of ACP as a proactive, relational, and value-based process rather than a late end-of-life intervention.
Suicide is a significant global public health concern, particularly among adolescents, with substantial implications for economies, societies and individuals’ mental well-being. Understanding its patterns and intention and psychosocial determinants in a given context can suggest potential intervention points. This population-based cross-sectional study aimed to document suicidal ideas, behaviors and intensity among youths aged 14 to 25 in the Nairobi metropolitan area and associated socio-economic position, demographic indicators and potential intervention points. A diverse sample of 1,972 participants was recruited from urban and peri-urban settings within the Nairobi metropolitan area. Data analysis included descriptive statistics, chi-square tests and logistic regression. Our findings confirm a high prevalence of suicidal ideas and behavior in the youth (19.9% and 3.6%, respectively), with very few significant differences between the urban and peri-urban areas. The severity of suicidal ideation and behavior reported methods and reasons, and the socio-demographic profile of participants, point to multiple potential intervention targets. These findings ought to be used to design, manage and evaluate suicide prevention programs.
Since the first report of erythromycin-resistant Bordetella pertussis (B. pertussis) in Arizona in 1994, macrolide-resistant strains have emerged worldwide, threatening pertussis control. This systematic review and meta-analysis aimed to quantify the prevalence and temporal trends of this resistance. Four databases (PubMed, Embase, Cochrane Library, Web of Science) were searched for studies on B. pertussis antimicrobial susceptibility through December 2024. Among 57 included studies (1994–2024), pooled resistance rates (breakpoint ≥32 mg/L) were: erythromycin 21% (95% CI 11–32%), azithromycin 25% (95% CI 12–40%), clarithromycin 15% (95% CI 4–30%), and clindamycin 49% (95% CI 28–70%). Subgroup analyses by country, year, and test method are presented. No trimethoprim/sulfamethoxazole (STX) resistance was reported. Six Japanese isolates showed high-level nalidixic acid resistance (MIC >256 mg/L). Seventy-seven studies contributed to MIC90 data for carbapenems, tetracyclines, aminoglycosides, quinolones, macrolides, cephalosporins, and others. Selected penicillins and intravenous third-generation cephalosporins demonstrated strong in vitro activity, suggesting alternative treatment options. Macrolide-resistant B. pertussis has increased significantly over the past decade. Due to the high burden of antibiotic resistance in China, enhanced surveillance is warranted, while continued monitoring in other countries also remains necessary.
This study aimed to evaluate the agreement between three body composition devices and dual-energy X-ray absorptiometry (DXA) in assessing segmental body composition among healthy Iranian adults. This comparative study recruited 62 healthy adults (33 men and 29 women) from Tehran, Iran, using a convenience sampling approach. Socio-demographic data were collected, and segmental body composition was assessed using several devices, including the InBody 770, Anea Bioelectrical Impedance Analysis (BIA), Tanita BC-418, and DXA. Agreement between DXA and the BIA devices was evaluated using Lin’s concordance correlation coefficient. Additionally, Bland–Altman plots and mean percentage error were applied to assess the consistency between the two methods. The Anea, InBody 770, and Tanita BC-418 devices showed strong correlation with DXA for all segmental measurements (r≥0.74, p<0.05). Moderate agreement (concordance correlation coefficient (CCC): 0.90 ≤ CCC < 0.95) with the DXA method was found for some segments using the Anea (trunk fat mass, arms fat-free mass, legs fat-free mass, and trunk fat-free mass) and the InBody 770 (trunk lean body mass and trunk fat mass) devices. The estimation of legs fat mass was the least accurate across all BIA devices. Furthermore, subgroup analyses showed that the BIA devices provided more precise results in men and in individuals with a Body Mass Index (BMI) <25.00 kg/m2. The Anea BIA and InBody 770 devices show relatively acceptable validity for segmental body composition assessment. More research is needed to confirm these findings.
This study aims to assess whether there was any excess mortality among the Aboriginal and non-Aboriginal populations in the Northern Territory (NT), Australia, during the COVID-19 pandemic. A time-series analysis using death data (1997–2023) was applied separately to the monthly and yearly death counts to develop an excess mortality surveillance model (using Auto-Regressive Integrated Moving Average (ARIMA)) for the NT population. Excess mortality was calculated by comparing expected deaths with actual deaths. In 2022, there was a statistically significant excess mortality of 193 (p < 0.01), compared with 82 recorded COVID-19 deaths. Excess mortality was significant for both the Aboriginal (N = 91) and non-Aboriginal (N = 102) populations in 2022. Even though some months had significant excess mortality among both Aboriginal and non-Aboriginal populations, the recorded COVID-19 deaths were not high in these months. This was associated with the peak of COVID-19 fatalities. The ARIMA model demonstrates deviations from expected deaths and helps understand the pandemic’s impact on the NT. Excess deaths occurred in 2022; however, no large spikes in most of the months suggest public health success in the NT.
Monocrotaline (MCT) induces lung injury and pulmonary hypertension (PH) by a mechanism that is in part due to oxidative stress. The purpose of this study was to determine how MCT affected nutrient antioxidants retinol and alpha-tocopherol in a rat lung and liver. Rats were fed a purified diet (AIN-93G) one-week prior to a subcutaneous injection of MCT (60 mg/kg) and remained on the diet throughout the study. Three weeks after injection, the animals were euthanized, and the lungs and livers were analyzed for retinol, alpha-tocopherol, phospholipid (PL), and cholesterol content. Lung retinol concentrations were significantly lower in MCT-treated rats, 2.0 ± 1.2 (nmol/g lung) vs. vehicle control (VEH), 5.8 ± 1.4 (P < 0.01). However, liver retinol concentrations were not significantly different, 3.3 ± 1.3 vs. 2.5 ± 0.9 nmol/g liver. Alpha-tocopherol was significantly greater in MCT-treated rats in the lung, 145 ± 24 vs. 99 ± 13 nmol/g lung (P < 0.001), and liver, 107 ± 30 vs. 47.7 ± 4.8 nmol/g liver (P < 0.001). Phospholipid and cholesterol were significantly lower in the lung of the MCT-treated group, but not significantly different in the liver. In conclusion, retinol along with phospholipid, and cholesterol were decreased in the lungs whereas alpha-tocopherol was elevated in the lungs and liver in response to MCT. These findings along with others suggest a novel mechanistic link between MCT-induced oxidative stress, lung vitamin A depletion, inflammation and the impairment of alveolar cell proliferation and repair. Pulmonary retinol is important in the pathogenesis of MCT-induced lung injury.
We report a 24-year-old male with functional single ventricle who developed ventricular dysfunction associated with strangulation by a previous epicardial pacemaker lead. During conversion to dual-chamber pacing, the constricting ventricular lead was removed, with intraoperative echocardiography demonstrating improvement in apical contraction. Relief of mechanical compression, together with restoration of atrioventricular synchrony, likely contributed to the recovery of ventricular function.
This study evaluated the growth trajectories of twins from birth to school age, focusing on weight and height z scores of children born in São Paulo. The longitudinal study comprised 188 healthy twins (M = 9.13 years; SD = 2.16). Weight data were obtained from birth records and reassessed at school age, and height at school age. Singleton birth weights and standard growth curves were used as reference points. Overall, the proportion of children with z scores below the median decreased significantly, from 98.3% at birth to 31.4% at school age. At birth, the dispersion of z-scores below the median was significantly greater among monochorionic compared to dichorionic twins (2.051 vs. 1.701), but this difference was no longer observed at school age (1.861 vs. 0.976). In total, 68.8% of the twins showed improved weight development, with no cases of deterioration. While monozygotic (MZ) and dizygotic (DZ) twin pairs exhibited comparable intertwin birth-weight differences, by school age MZ pairs exhibited more similar weights, whereas DZ pairs showed significantly greater weight discrepancies. For height at school age, mean height z scores were within the expected range for singletons. No significant differences were observed between monochorionic and dichorionic twins, whereas MZ pairs showed smaller within-pair height differences than DZ pairs. These findings suggest that although chorionicity plays an important role during the perinatal period — particularly due to the lower birth weights observed among monochorionic twins — its influence diminishes over time. By school age, weight and height differences are primarily determined by zygosity.
Neurodevelopmental models regard impulsivity as a central risk factor for adolescent substance use. However, the practical utility of impulsivity in predicting substance use is complicated by variability among measures that encompass multiple methods and theoretical domains. Prior research has been constrained by cross-sectional designs, small sample sizes, and/or the use of a narrow subset of impulsivity measures.
Method
Leveraging the ABCD dataset (n = 11,868), we identified and replicated correlations among impulsivity measures and assessed their prospective longitudinal and concurrent predictive utility regarding adolescent substance use outcomes before 15 years old. We then used simulation to inform how associations between impulsivity and substance use vary across sampling strategies (population vs. high-risk cohorts) and sample sizes.
Findings
Correlations between questionnaire and behavioral measures of impulsivity were small, and questionnaires significantly outperformed behavioral measures in predicting substance use initiation, largely due to the contribution of the CBCL externalizing scale. Predictions of substance use based on impulsivity were statistically detectable but small according to clinical standards (AUCs 0.6–0.76), exhibiting sensitivity to sample size and base rate of substance use, and thus, poor absolute predictive performance. Large samples (n > 1,000) were needed to achieve adequate power for impulsivity measures to predict substance use initiation.
Conclusion
These results support a significant but small contribution of impulsivity in predicting the onset of early adolescent substance use, indicating that these factors alone are insufficient for clinically deployable prediction. In community samples, large sample sizes are needed for reproducible impulsivity prediction of adolescent substance use.
In the ecologically diverse metropolitan area of Seoul, raccoon dogs (Nyctereutes procyonoides) coexist with humans and domestic animals, creating opportunities for vector-borne parasite transmission. Climate-driven shifts in mosquito populations may further enhance these risks, highlighting the need to monitor Dirofilaria immitis in urban wildlife for veterinary and public health. Among 51 raccoon dogs examined, D. immitis was identified in the pulmonary arteries and right ventricle of 13 animals (25.5%) by necropsy, with worm burdens ranging from 2 to 9. Lung tissue PCR revealed 4 additional subclinical infections, resulting in a final confirmed prevalence of 17 positives (33.3%). In contrast, whole-blood PCR detected only 11 positives (21.6%), all confirmed by necropsy, indicating higher sensitivity of lung tissue PCR. Phylogenetic analysis of cytochrome c oxidase subunit 1 sequences showed all isolates clustered with reference D. immitis across Asia and Europe, and haplotype analysis revealed low genetic diversity among Korean isolates. Wolbachia 16S ribosomal RNA sequences from raccoon dogs consistently grouped in supergroup C, confirming their association with D. immitis. These findings confirm natural infections of D. immitis and Wolbachia in wild raccoon dogs and highlight their potential role as urban wildlife reservoirs, while lung tissue-based molecular detection offers synergistic advantages for detecting subclinical infections and improving estimates of heartworm occurrence.
This paper addresses the challenges and preparedness strategies for health care systems in responding to nuclear and radiological emergencies. It emphasizes the critical role of medical centers in pre-incident preparedness, immediate response, and long-term care, focusing on the need for coordinated efforts between local, state, and federal agencies. Key components include specialized training, resource allocation, triage protocols, and the integration of networks like the Radiation Injury Treatment Network and the American Burn Association. This paper highlights the importance of resilience through collaboration, infrastructure planning, and community support to manage mass casualties and mitigate long-term health consequences. It underscores the lessons learned from historical responses and contemporary challenges, advocating for a proactive approach to enhance health care system readiness in the face of catastrophic events.
The Mediterranean and a low carbohydrate diet are two popular dietary approaches recommended for cardiovascular and metabolic health, respectively. This trial will compare the combined effect of these diets to either approach alone for the treatment of the metabolic syndrome (MetS). Males and females (n=222), 30-75 years, with at least three MetS risk factors will be randomised to one of 3 diets: i) Traditional Mediterranean (∼55% of energy carbohydrate [CHO]:15% Protein [Pro]: 30% Fat), ii) Lower Carbohydrate (∼35%CHO:20%Pro:45%Fat), or iii) Lower Carbohydrate Mediterranean (∼35%CHO:20%Pro:45%Fat) diet for 12-weeks. The primary outcome measure is the MetS Severity Z Score (MetS-Z), a composite score of risk factors, sex and ethnicity. MetS-Z will be calculated pre and post intervention using fasted blood samples for plasma triglycerides, HDL-cholesterol and glucose, systolic blood pressure, body weight and waist circumference measures. The findings from this trial will offer new insights into the most effective dietary strategy for managing diabetes and reducing cardiovascular risk in individuals with metabolic syndrome.
Responsive feeding characterised by recognising and appropriately addressing children’s hunger and satiety signals, plays a key role in health. Despite children’s innate ability to self-regulate food intake, caregivers can override these cues, especially in child care settings. The study determined the effects of a 6-month coaching intervention on the responsive feeding environments of child care centres. CELEBRATE Feeding was a 6-month, coaching, pre-post intervention design conducted in eight child care centres across Nova Scotia and Prince Edward Island, Canada. Child care centres’ feeding environments and educator practices were observed using a modified Environment and Policy Assessment and Observation tool at baseline and follow-up in two rooms per centre (n = 16). Twenty-one responsive feeding components were scored from 0–3 (3 as best practice). The average centre scores were summed for an overall score ranging from 0–63 at each time point. Paired samples t-tests and Wilcoxon signed rank tests were conducted to assess the impact of the intervention on overall rooms’ and individual responsive feeding components’ scores. There was an increase in scores from baseline (M = 38.16, SD = 6.55) to follow-up (M = 45.75, SD = 5.87), t (15) = 4.91, P < 0.001. All but one score improved, where 3 of the 21 scores were significantly more responsive after the intervention after applying a Bonferroni correction (P < 0.002). The score with the greatest positive change was ‘Educators provide gentle comments or nudges towards feeding’, with a mean difference of 1.33, P < 0.001. The CELEBRATE Feeding coaching intervention was successful in improving responsive feeding practices and environments in child care settings.