Chronic subdural hematoma (cSDH) is a prevalent neurosurgical condition, particularly in the elderly. In cases of surgical evacuation, there is conflicting evidence regarding the impact of early versus late mobilization on patient outcomes.

To understand the current state of the literature, we performed a comprehensive systematic review of studies comparing early and late mobilization protocols in cSDH patients following surgical evacuation. We conducted a supplementary meta-analysis to assess the effects of early versus late mobilization for recurrence and postoperative complication outcomes.

Of the 1295 identified articles, 4 studies comprising 622 patients were included. Early mobilization (EM) was typically defined as ambulation ≤ 48 hours post-surgery and late mobilization as bed rest for ≥48 hours or more, though definitions varied between studies. EM did not increase cSDH recurrence in any study. Two studies reported decreased medical complications in the EM group. Two studies suggested a shorter hospital stay with EM, and one study reported significantly better functional recovery on follow-up. A supplementary meta-analysis did not find any significant differences in recurrence or medical complications across studies.

EM after cSDH surgery may reduce postoperative complications and potentially improve recovery without appearing to affect recurrence rates. However, data interpretation was limited by heterogeneous study designs, definitions of mobilization and outcome measures. Further multicenter trials with consistent protocols and outcome scales are warranted to further establish optimal mobilization strategies.

Health care workers (HCWs) are vital in disaster response. This study explores HCWs’ experiences delivering care in the earthquake-affected zone in Türkiye.

A qualitative study with a phenomenological design was conducted. Eighteen HCWs, including physicians, nurses, and National Medical Rescue Team (UMKE) members, were selected through maximum variation sampling. Data were collected through semi-structured interviews and analyzed thematically using Braun and Clarke’s 6-phase approach, following COREQ guidelines.

Three periods (pre-arrival, in the earthquake zone, and post-departure) and 8 themes were identified. In the pre-arrival phase, emotional symptoms and general organization were the main themes. In the earthquake zone, physical symptoms, basic needs, health care organization, health care delivery, and other services were prominent. The post-departure phase focused on emotional symptoms and return to routine work. Overall, emotional difficulties persisted throughout all phases, while organizational problems were concentrated in the pre-arrival and in the earthquake zone periods.

HCWs experienced emotional challenges across all periods and organizational problems in the pre-arrival and in the earthquake zone period. Clear information before arrival, structured orientation upon arrival, balanced staff distribution, and continuous psychological support throughout all phases are essential to protect HCWs’ well-being and sustain health care delivery during disasters.

Diagnosing clinically uncertain parkinsonian syndromes (CUPS) is challenging. Dopamine transporter (DaT) SPECT imaging (DaTscan) aids in differentiation, but its real-world impact on management in Canada, where it is not publicly funded, is unclear. The objective was to determine the impact of DaTscan results on clinical management for patients with CUPS in a Canadian tertiary care movement disorder service.

We conducted a retrospective chart review of 42 patients with CUPS referred for a DaTscan from a tertiary clinic in London, Ontario. DaTscan result was categorized as “Abnormal” (positive scan) or “Normal” (negative scan). The primary outcome was a change in management (Present/Absent). The association was assessed using Fisher’s Exact test.

Forty-two patients were included (median age 63 years; 50% female). Twenty-seven scans (64%) were abnormal, and 15 (36%) were normal. Overall, clinical management was changed in 13 patients (31%; 95% CI: 18% to 47%). A change in management was significantly more likely after a normal scan (60%, 9/15 patients) compared to an abnormal scan (15%, 4/27 patients) (p = 0.009). Changes after a normal scan primarily involved discontinuing dopaminergic therapy (7/9, 78%).

In this specialized clinic, DaTscan results informed management in 31% of CUPS patients. A normal scan provides the objective evidence needed to withdraw unnecessary dopaminergic medications confidently.

Malignant otitis externa is a life-threatening infection in which facial nerve palsy is a morbid complication. This TriNetX study identified predictors of facial nerve palsy in malignant otitis externa.

Retrospective analysis compared malignant otitis externa-only (n = 12 032) versus malignant otitis externa plus facial nerve palsy (n = 719) cohorts for demographics, biochemical markers and co-morbidities using t-tests and odds ratios (p < 0.05).

Male gender (p = 4.65 × 10−15) and Hispanic and/or Latino ethnicity (17.66 vs 13.02 per cent, p = 0.0014) predicted facial nerve palsy. The significant biochemical markers were albumin, blood urea nitrogen (p < 10−18), glucose, erythrocyte sedimentation rate (ESR), creatinine, iron and activated partial thromboplastin time. The key co-morbidities were hypertension (odds ratio = 3.72, p = 6.95 × 10−55), chronic kidney disease (odds ratio = 3.12, p = 1.44 × 10−49), malnutrition (odds ratio = 3.44) and electrolyte imbalances (odds ratio = 2.59). Migraines and/or headaches were non-significant.

Male sex, Hispanic and/or Latino ethnicity, hypoalbuminemia, elevated blood urea nitrogen and/or glucose and/or ESR, and co-morbidities (hypertension, chronic kidney disease, malnutrition) strongly predict facial nerve palsy in malignant otitis externa. Early risk factor management may prevent facial nerve palsy.

A high rate of food insecurity among college students has been documented in various studies. Knowledge gaps exist regarding food insecurity and cultural food access among international college students. We explored the demographic correlations of food insecurity and cultural food access and affordability for international college students.

Cross-sectional online survey from 2 to 16 November 2022.

A public university in the southwestern USA.

Three hundred and thirty-five international undergraduate and graduate students.

About 22 % of the sample reported high food security, 18 % marginal food security, 30 % low food security and 31 % very low food security. Twenty-seven percent reported that they were able to find cultural foods at the university, and 29 % reported that they were able to afford the cultural foods available on campus. Enrolment status, primary caregiver status, housing location and vehicle ownership predicted food security status. Region of origin, gender, being a primary caregiver for an adult with special needs and vehicle ownership were associated with access to cultural foods. Region of origin, being a primary caregiver for children, housing location and vehicle ownership were associated with being able to afford cultural foods on campus. The predictors differ between undergraduate and graduate international students.

Researchers and student services professionals who develop programmes and resources to support international students should consider differences within the group of international students, especially differences by region of origin and degree status (undergraduate v. graduate), and work to ensure students have access to reliable transportation.

A semi-automated surveillance system for surgical site infections (SSIs), SPICMI (Surveillance and Prevention Program for Infectious Risk in Surgery and Interventional Medicine), has been implemented in French hospitals, leveraging data from electronic health records (EHRs).

To evaluate the performance of the SPICMI algorithm in detecting SSIs in orthopedic and digestive surgery.

Surveillance data were collected annually from the EHRs. The algorithm identified suspected SSIs based on two criteria: (1) surgical revision during the index stay or readmission, (2) positive microbiological samples from the wound. Suspected SSIs identified were subsequently validated by surgeons.

A stochastic modeling approach was used to estimate probability intervals for performance indicators. Various detection scenarios were constructed based on SPICMI criteria. Logistic regression analysis was performed using surveillance data. Data unavailable in the database were estimated through a literature review and expert opinions.

The probability of surgical revision following an SSI varied significantly between surgical specialties, ranging from 92% in orthopedic surgery to 45.2% in gynecology. In orthopedic and digestive surgery, the SPICMI algorithm demonstrated good reliability for detecting SSIs in minimizing false-negative and false-positive cases (Youden index: 0.96 and 0.79, respectively). Sensitivity (Se) was lower in digestive surgery (0.7–0.9) compared to orthopedic surgery (0.9–1), while specificity (Sp) remained high (0.9–1) in both specialties.

The SPICMI algorithm shows potential to support efficient use of time and resources in SSIs surveillance management. Further evaluation is needed with a broader panel of surgery procedures.

Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), presents increasing global health burdens. Despite advancements in therapy, disparities in mortality trends across demographic and geographic lines persist in the United States.

To analyze IBD-associated mortality trends in the U.S. from 2018 to 2023 using CDC WONDER data, highlighting demographic, regional, and sex-based disparities.

A retrospective analysis of death certificate data from the CDC WONDER database was performed. Age-adjusted mortality rates (AAMRs) were calculated and stratified by sex, race/ethnicity, and region. Trends were evaluated via join-point regression, with the annual percentage change (APC) and average annual percentage change (AAPC) calculated to assess statistical significance.

A total of 25,153 IBD-related deaths were recorded. The AAMR increased from 8.269 (2018) to 10.761 (2023), with a notable increase until 2022 (APC: +8.91), followed by a decline in 2023 (APC: −7.55). Men presented higher AAMRs than women did (10.882 vs. 9.838). Non-Hispanic White individuals had the highest AAMR (11.401), whereas Non-Hispanic Black and Asian populations presented the steepest increases (APC: 10.49 and 13.45, respectively). Regionally, the Midwest had the highest AAMR (11.531), with Oregon demonstrating the highest state-level mortality.

This study reveals increasing IBD mortality in the U.S., with significant sex, racial, and geographic disparities. These findings highlight systemic inequities in healthcare access, particularly in access to biologic therapy and specialty care. Targeted public health strategies are crucial for reducing disparities and enhancing outcomes in high-risk populations.

Identifying diagnoses from noncoded healthcare visit records presents logistical challenges when large number of records are screened. This study aimed to develop a screening process to identify otitis media (OM) diagnoses in free-text primary care visit records.

The free-text primary care records of 200 children aged 0 to 4 years were reviewed independently by three clinicians to determine whether OM was a diagnosis considered during each visit. Terms (abbreviations, words, and phrases) identifying visits where OM was considered or excluded were documented. These terms were used to design a software algorithm subsequently used to detect OM diagnosis within these primary care records. The diagnostic performance of the software algorithm was determined against the gold standard clinicians’ review and described using sensitivity, specificity, predictive values (PVs), and likelihood ratios (LRs) with 95% confidence intervals (CIs).

The 200 children had 10,034 primary care visits. Clinician review identified 917 (9%) visits where OM was considered, and 9117 (91%) visits where OM was excluded. The software algorithm identified 801/917 visits where OM was considered and 8705/9117 visits where OM was excluded. The algorithm sensitivity was 87% (95% CI 85–89), specificity 96% (95% CI 95–96), positive PV 66% (95% CI 63–69), negative PV 99% (95% CI 98–99), positive LR 19.33 (95% CI 17.54–21.31), and negative LR 0.13 (95% CI 0.11–0.16).

Software algorithms can assist in screening healthcare visit records. When combined with clinician review, they enable accurate identification of OM visits from non-coded records.

Cumulative stress exposure is extensively involved in carcinogenesis. However, cancer risk associated with allostatic load (AL), a valid measure of chronic stress, has not been comprehensively evaluated in large cohorts, and the combined effect of AL and personality trait on cancer risk remains unknown.

This prospective cohort study was conducted based on 245,683 participants from the UK Biobank, with a median follow-up of 13.5 years. The AL score was calculated based on 11 biomarkers. Personality traits were constructed and categorized into two clusters. Multivariable Cox regression model was used to assess the risk of incident cancer according to AL and personality clusters, and multiplicative and additive interactions were evaluated.

High AL was associated with an increased cancer risk compared to low AL (hazard ratio [HR] = 1.06, 95% confidence interval [CI]: 1.04–1.09), particularly for cancers of stomach, liver, kidney, esophageal, lung, colorectal, breast, and leukemia (HR ranged from 1.08 to 1.43). Personality clusters was associated with risk of lung cancer (HR = 1.14, 95% CI: 1.05–1.23), but not overall cancer. Significant synergistic interaction was observed between high AL and ‘nervous-dominant’ personality for overall cancer risk, with the strongest association observed for liver cancer (HR = 1.58, 95% CI: 1.24–2.02).

High AL was related to higher risks of overall cancer and site-specific cancers, particularly when combined with nervous-dominant personality, highlighting the interplay between chronic physiological stress and psychological factors in cancer development.