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In a normal pregnancy, glucocorticoids (GC), such as cortisol, play an essential role in early heart development. GC concentrations surge in late gestation to facilitate the maturation of fetal systems in preparation for birth. However, pregnancy complications related to stress, lifestyle factors, disease, and commonly used antenatal care treatments (GC therapy and artificial reproductive technology) can lead to prematurely increased GC concentrations that are detrimental to the heart before it is mature enough to benefit. These findings underpin the hypothesis that GC play a double-edged role that benefits normal heart development but is potentially harmful when dysregulated. However, the mechanisms by which both physiological and pathological elevations in GC concentrations influence the fetal cardiometabolic pathways that lead to detrimental long-term cardiovascular outcomes remain unclear. This review will, firstly, describe how cortisol regulates different aspects of cardiac development and, secondly, compare findings from different animal models that have provided mechanistic insight into how excess cortisol/GC during pregnancy impacts cardiac health across the life course.
Mental health symptoms pose a significant vulnerability to stressful life events among currently married women, adversely impacting their overall well-being and quality of life. This study explores the spatial patterns and factors associated with anxiety, depressive symptoms and the co-occurrence of both symptoms among currently married women of reproductive age in Bangladesh. This study utilised data from 13,372 (weighted) currently married women aged 15–49 years in the Bangladesh Demographic and Health Survey (BDHS) 2022, which used a cross-sectional design. Multivariable logistic regression models determined the associated factors. Additionally, spatial distribution and hotspot analysis were conducted using ArcGIS version 10.8. The weighted prevalence of moderate to severe anxiety, depressive symptoms and co-occurrence of anxiety and depressive (CAD) symptoms among currently married women of reproductive age was 4.1% (95% confidence interval [CI]: 3.8%, 4.5%), 4.8% (95% CI: 4.7%, 5.4%) and 2.2% (95% CI: 2.1%, 2.6%), respectively. Clustering of anxiety symptoms (Moran’s I = 0.063, p < 0.001), depressive symptoms (I = 0.091, p < 0.001) and CAD symptoms (I = 0.082, p < 0.001) were observed, with hotspots in Rangpur, Sylhet and Chittagong regions. Logistics regression analysis shows that currently married women who were living in the Barishal, Khulna, Rangpur and Sylhet regions, who belong to households with a higher wealth index, who experienced high levels of intimate partner violence (IPV), have completed high school, who are sexually inactive and whose husbands are unemployed, were more likely to experience CAD symptoms. Additionally, currently married women of reproductive age, whose age was 25–34 years, who are labourers, whose pregnancies are terminated and who have ≥5 children ever born, are at a higher risk of having anxiety symptoms. Besides, currently married women aged 25–34 years and 35–44 years, who are underweight, were more likely to have depressive symptoms. The findings highlight a significant regional disparity in the burden of anxiety, depressive and CAD symptoms among currently married women of reproductive age in Bangladesh. These findings can help design site-specific programmes and actions for women in the hot spot areas of Rangpur, Sylhet and Chittagong.
There is substantial international variation in recommended vitamin C intake levels. In the USA, the recommendation is 90 mg/d for men and 75 mg/d for women, while in the UK, the current recommendation – established in 1991 – is only 40 mg/d for adults. This UK level was based on the 1953 Sheffield study, which found that 10 mg/d prevents scurvy, with 40 mg/d chosen as the recommended level for yielding somewhat higher plasma levels. In this commentary, we argue that the UK recommendation overlooked key evidence available at the time. Specifically, at least six controlled trials published before 1991 reported benefits from vitamin C supplementation in participants whose baseline vitamin C intake was already 40 mg/d or higher. One randomised controlled trial, published in 1993, found benefits from vitamin C supplementation even at a baseline intake of about 500 mg/d; however, this trial involved ultramarathon runners, and the findings should not be broadly generalised. Nonetheless, such results challenge the assumption that 40 mg/d is universally adequate to maintain full health. We also highlight that the UK recommendations were narrowly focused on preventing dermatological symptoms of scurvy, despite strong evidence – even at the time – that vitamin C deficiency can also cause cardiac dysfunction and greater morbidity due to respiratory infections. We conclude that the current UK vitamin C recommendation should be re-evaluated in light of controlled trial evidence and broader clinical outcomes.
Estimate bacterial pathogen contamination of healthcare workers’ (HCW) long-sleeved attire.
Design:
Prospective observational study.
Setting:
Tertiary care hospital.
Participants:
HCWs wearing long-sleeved attire providing direct inpatient care.
Intervention:
Sampling of both sleeves of HCWs wearing long-sleeved attire was performed using a swab and cultured for aerobic bacterial growth classified as potential pathogens or presumptive skin commensals. Potential predictors of sleeve contamination, including participant survey responses related to attire and infection prevention practices, were analyzed using univariate analyses. Whole genome sequencing compared isolates to a genomic surveillance database of patient clinical isolates.
Results:
Among 280 samples, 81.1% (n = 227) demonstrated any bacterial growth and 20.7% (n = 58) grew ≥1 potential pathogen. Speciated organisms included alpha-hemolytic streptococci (n = 28), Bacillus sp. (n = 20), and Pantoea/Mixta sp. (n = 8), gram-negative bacilli (n = 6), and Staphylococcus aureus (n = 2). Univariate analysis demonstrated that sleeves sampled on non-intensive care units (P = .038) were significantly associated with any bacterial growth, and attire type (P = .002) and sleeve material (P = .004) were associated with growth of ≥1 potential pathogen. Fleece attire and material were more likely to be contaminated than other attire and material types. Sequenced isolates from sleeve samples were not genetically related to any patient isolates.
Conclusions:
HCW long sleeve contamination occurs frequently, including with potential pathogens. Changing trends in attire type may have an impact on bacterial transmissibility. While this study could not infer transmission events associated with clinically diagnosed patient infections, the potential benefit of a “bare below the elbows” attire policy warrants further investigation.
This study aimed to systematically review the evidence on functional outcomes following dorsal preservation rhinoplasty, with a focus on nasal obstruction.
Methods
A systematic review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. PubMed, Embase, Scopus and Cochrane databases were searched up to March 2025. Studies reporting nasal airway outcomes following dorsal preservation rhinoplasty using subjective or objective measures were included.
Results
Six studies comprising 662 patients were included. Patient-reported outcomes (Nasal Obstruction Symptom Evaluation, Standardized Cosmesis and Health Nasal Outcomes Survey and Visual Analogue Scale) consistently demonstrated significant post-operative improvement. Objective measures (acoustic rhinometry, rhinomanometry and cone-beam computed tomography) showed maintained or improved airway dimensions. dorsal preservation rhinoplasty was functionally equivalent to traditional structural techniques, with low complication (<5 per cent) and revision rates (<2 per cent).
Conclusion
Dorsal preservation rhinoplasty maintains or improves nasal airway function while preserving structural integrity and reducing the need for grafting. It is a safe and effective alternative to traditional dorsal reduction techniques.
This position statement provides guidelines for health professionals who are considering online or direct-to-consumer genetic testing for their patients. It presents the major issues around online and direct-to-consumer (DTC) testing including how it is accessed, motivations for accessing testing and how to return these results. Online or DTC recommendations include: (1) DTC testing should only be done by individuals/consumers who are well informed, aware of the risks, benefits and limitations of testing, and able to consent for their DNA to be collected, analyzed and potentially stored. Where possible, individuals/consumers should also be aware of the alternative option of undertaking testing through healthcare professionals in a clinical context, and the benefits of this. (2) Decisions about having a child tested should be based on peer-reviewed, published evidence. Genomics testing for children should be within a clinical context where parents are informed, have access to clinical support and professional genetic counseling about this decision, as well as support for the range of results received. (3) Parents considering direct-to-consumer testing on their newborn are counselled, or given information, to encourage them to have standard government funded newborn bloodspot screening testing on their newborn. (4) When choosing an online genomic test, preference should be given to tests undertaken in accredited laboratories offering tests accredited with the Therapeutic Goods Administration. (5) Results obtained through methods other than direct analysis from a laboratory accredited to perform genomic testing to inform human health and wellbeing should be interpreted with caution. The HGSA recommends that such results must be confirmed in an accredited diagnostic laboratory prior to relying on them to inform options for treatment, surveillance or risk reduction, or before undertaking cascade testing in family members. (6) When individuals are concerned about their health, they should consult an appropriate healthcare professional to decide whether an online genomic test is appropriate and discuss how useful test results could be to make health-related decisions.
This case report details the diagnosis and surgical management of a 7 cm aortic root aneurysm occurring in a 12-year-old with cutis laxa type B, an extremely rare connective tissue disorder. Our patient underwent a Bentall procedure as primary treatment for the aneurysm and had a successful interventional treatment of a postoperative pseudoaneurysm.
Despite the high frequency and severity of fatigue among patients with advanced cancer receiving immunotherapy, there are limited treatment options available. The aim of the study was to explore the effects of the methylphenidate (MP) with standardized physical activity (PA) on cancer related fatigue (CRF).
Methods
In this pilot study, patients with advanced cancer with clinically significant CRF (<34 on Functional Assessment of Cancer Illness Therapy – fatigue scale, FACIT-F), on anti-PD1 immunotherapy were eligible. Patients were randomized to standardized PA with either patient-controlled MP 5 mg (MP + PA arm) or matching Placebo (Pl + PA arm) twice daily for 14 days. The primary outcome was the change in the FACIT-F score. Secondary outcomes included changes in fatigue dimensions (Multidimensional Fatigue Symptom Inventory-Short Form (MSFI-SF), Functional Assessment of Cancer Therapy – General (FACT-G), Patient-Reported Outcome Measurement Information System-Fatigue (PROMIS-F), and hospital anxiety and Depression Scale (HADS).
Results
Of the 40 randomized patients, 34 were evaluable. The FACIT-F scores significantly improved in both the arms with mean (SD) change, effect size (ES) of 11(14), 0.87(P < .001); and 9(12), 0.74(P = .04) in MP + PA, and Pl + PA arms respectively. We also found significant improvements in PROMIS-F, ES − 1.05(P = .003), MFSI-SF(global), ES − 1.32(P < .001), and HADS-depression, ES − 0.92(P = .004) in the MP + PA arm; There were no significant differences in adverse events between groups.
Significance of results
Our preliminary study found MP + PA was associated with significant improvement in CRF scores. The fatigue dimensions and depression scores significantly improved in the MP + PA arm. Further comparative studies using MP + PA for CRF are justified.
Although many online-based dietary surveys have been developed in recent years, systems that easily survey the dietary balance based on the Japanese diet are insufficient. This study aimed to evaluate the relationship between dietary balance scores from an online survey system based on the Japanese Food Guide Spinning Top, and nutrient/food intake calculated using the weighing method from dietary records (DRs), as well as to assess the system’s utility and applicability. An online dietary balance survey and semi-weighted DR assessment with food photographs were conducted in Japanese participants (n = 34). Registered dietitians entered the balance scores into the system based on the participants’ food photographs, and the scores were calculated using the system. Significant positive correlations (p < 0.001) were found between the online dietary balance scores and nutrient/food intake from DRs; especially for ‘grain dishes’ and carbohydrates (r = 0.704); ‘vegetable dishes’ and the vegetable dish group (sum of potatoes, vegetables, mushrooms, and algae) (r = 0.774); ‘main dishes’ and protein (r = 0.661); ‘milk’ and the milk and milk products group (r = 0.744); and ‘fruits’ and the fruits group (r = 0.748). Bland–Altman analysis showed that the dietary balance scores obtained by this system tended to underestimate the intake compared with the weighing method. Although there are limitations to the accurate estimation of nutrient and food intake, the online dietary balance scores obtained from the online dietary balance survey system were useful for understanding the dietary balance in the Japanese diet.
Dynamic, data-driven predictors of perioperative mortality risks in preterm/early-term neonates with CHD undergoing cardiac surgery in the first 24 months of life are limited.
Aims:
To identify risk factors of mortality in the first 24 months of life for pre/early-term neonates with CHD.
Methods:
Retrospective cohort study of patients <39 weeks of gestation undergoing cardiac surgery within 24 months of life from 2013–2020 at a tertiary care centre. Independent risk factors of mortality within 24 months of life were determined by multivariable Cox regression analysis.
Results:
Among the 205 neonates, 33 (16.1%) died within 24 months. Multivariable analysis revealed that high-frequency ventilation (hazard ratio = 5.15; 95% confidence interval): 2.51, 10.6; p < 0.001), extracorporeal membrane oxygenation support (hazard ratio = 5.77; 95% confidence interval: 2.67, 12.5; p < 0.001), and CHD with a palliated circulation (hazard ratio = 6.07; 95% confidence interval: 2.84, 13; p < 0.001) were significant independent risk factors of mortality at any time during the index hospitalisation or the first 24 months of life.
Conclusions:
Identifying and re-evaluating risk factors of mortality for preterm/early-term neonates with CHD at any time during the index hospitalisation or the first 24 months of life may guide resource allocation and therapeutic interventions.
Trial registration number and date of registration: IRB P00028833 5/2/2018. Retrospectively registered.
Despite increasing global respect for disability rights since the 2008 entry into force of the UN Convention on the Rights of Persons with Disabilities (CRPD), the equal right to live in the world for disabled people continues to be undermined. This undermining stems from a range of factors, not least the selective prevention and termination of disabled lives, along with long-standing barriers to life-sustaining care, including restricted access to controlled substances and experimental treatment. Investigating the problem of disability discrimination at the margins of life and death, Tony Bogdanoski draws on a range of materials, including international human rights law, reports of UN treaty monitoring bodies and special rapporteurs, and laws largely from the US, UK, and Canada to explore how selective reproduction, assisted dying, and drug control impact struggles for disability equality. His insights are broad in consequence, spanning the fields of disability studies, human rights, law, and bioethics.
Anxiety and depressive disorders are global health challenges, placing a significant burden on adults and healthcare systems in low- and middle-income countries (LMICs), such as Ghana. Social determinants of mental health, including poor healthcare access and poverty, may be associated with their prevalence. However, a paucity of prevalence data poses challenges for intervention planning and resource allocation. This review aimed to (1) examine the prevalence of anxiety and depressive disorders and symptoms among adults in Ghana, and (2) explore social determinants of mental health potentially associated with anxiety and depressive disorders and symptoms. We searched electronic databases and secondary sources from inception until September 30, 2024. Meta-analyses were performed to estimate the pooled prevalence. Narrative synthesis explored social determinants potentially associated with anxiety and depressive disorders and symptoms.
We included 38 studies (22,587 adults). Pooled point prevalence of anxiety and depressive disorders and symptoms was 40.3% (95% confidence interval [CI]: 31.8–49.4%) and 33.0% (95% CI: 27.7–38.8%), respectively. Most studies (37 studies) reported the prevalence of symptoms and not disorders. Social determinants of mental health, including educational attainment and urban environment, were associated with higher levels of anxiety symptoms, while ethnicity and traumatic experiences were associated with higher levels of depressive symptoms. There was a high degree of heterogeneity, and the majority of studies used self-report screening tools, which may have skewed prevalence estimates. More than a third of adults in Ghana were found to experience anxiety and depressive symptoms, and social determinants of mental health may be associated with prevalence. High-quality research and contextually appropriate interventions targeting the identified social determinants of mental health associated with anxiety and depressive symptoms are needed to reduce disparities and improve the mental well-being of adults in Ghana.
The position paper ‘The development of services for treatment of personality disorder in Adult Mental Health Services’ was published by the College of Psychiatrists of Ireland Personality Disorder Special Interest Group (PDSIG) in 2021. Following this, we are advocating for the development of a national treatment strategy for personality disorders in Ireland. As part of this process, we have examined international evidence and best practice guidelines for establishing personality disorder services. Key recommendations from the literature include access to services, continuity of care, a multidisciplinary approach, tiered models of care, collaboration with service users, staff training and supervision, and delivery of evidence-based interventions. These recommendations should form the backbone of a national personality disorder strategy for Ireland.
Kids SIPsmartER is a school-based behavioural intervention for rural Appalachia middle school students with an integrated two-way short message service (SMS) strategy for caregivers. When tested in a cluster randomized controlled trial, the intervention led to significant improvements in sugar-sweetened beverage (SSB) consumption among students and caregivers. This study explores changes in secondary caregiver outcomes, including changes in caregiver SSB-related theory of planned behaviour constructs (affective attitudes, instrumental attitudes, subjective norms, perceived behavioural control, and intentions), parenting practices, and the home environment. Participants included 220 caregivers (93% female, 88% White, 95% non-Hispanic, mean age 40.6) in Virginia and West Virginia at baseline and 7 months post-intervention. Relative to control caregivers (n = 102), intervention caregivers (n = 118) showed statistically significant improvements in instrumental attitudes (Coef.= 0.53, 95% CI [0.04, 1.01], p = 0.033), behavioural intentions (Coef.=0.46, 95% CI [0.05, 0.88], p = 0.027), parenting practices (Coef. = 0.22, 95% CI [0.11, 0.33], p < 0.001), and total home SSB availability (Coef. = –0.25, 95% CI [–0.39, –0.11], p < 0.001), with specific improvements for sweetened juice drinks (Coef. = –0.18, 95% CI [–0.35, –0.01], p = 0.043) and regular soda/soft drinks (Coef. = –0.31, 95% CI [–0.55, –0.07], p = 0.010). In contrast, there were no significant between group changes for affective attitudes, subjective norms, or perceived behavioural control. Our findings highlight future research areas and fill gaps in intervention literature. This study is among the few to develop and evaluate a scalable, theory-based caregiver SMS component in a rural, school-based intervention. Combined with evidence that Kids SIPsmartER improved SSB behaviours, our results emphasize the potential of theory-guided SMS interventions to impact SSB-related outcomes.
Chronic pain research studies are important for both finding new treatments and improving existing treatments for individuals with chronic pain. For clinical trials to be effective, participants need to be engaged and willing to participate in treatment groups. Our research applies the theory of planned behavior (TPB) to understand how attitudes, perceived social norms, and perceived control over intervention engagement are associated with willingness to participate in interventions for chronic low back pain (CLBP).
Methods:
Adult Michigan Medicine patients were identified using electronic medical records and emailed a link to an online, cross-sectional survey. Participants who self-reported CLBP, ability to read and write in English, and consented to participate were able to complete the survey (N = 405).
Results:
The results showed more positive attitudes, positive social norms, and higher perceived behavioral control related to specific chronic low back pain interventions are associated with greater willingness to participate after controlling for demographic and pain-related characteristics.
Conclusion:
The findings suggest that TPB constructs may be useful in guiding recruitment efforts for chronic pain intervention trials.
General Practitioners (GPs) in Australia continue to provide primary medical care for patients enrolled in specialist-led clinical trials (CTs), yet research on GPs’ experiences in this role remains limited. This study explored Australian GPs’ experiences managing CT patients and their perspectives on primary care involvement in clinical research.
Methods:
This phenomenological study involved 11 semi-structured interviews with GPs in New South Wales, Australia, between July to October 2024, who previously managed patients enrolled in other non-GP subspecialist CTs. The recruitment applied purposive, snowballing and convenience sampling approaches. Interviews were transcribed, inductively coded and thematically analyzed.
Results:
Analysis revealed four themes: (i) lack of communication from CT teams, (ii) patients’ insufficient understanding about their CTs, (iii) time and resource barriers to GP involvement in CTs, (iv) varied opinions about GPs playing an active role as researchers in CTs.
Conclusions:
This exploratory study highlighted the lack of proper communication gaps between CT teams and GPs, potentially compromising the quality of patient care. Digital health records (such as Australia’s My Health Record) could facilitate information sharing. While GPs support primary care research, barriers include limited research training, time constraints, and inadequate resources. Integrating research education into GP training and establishing practice-based research networks could enhance GP participation in CTs.
Having a child with a psychiatric diagnosis is associated with parents’ greater risk of subsequent mental disorders but no immediate change in their annual labour market metrics. This discrepancy could be explained by shorter absences from work. We examined first-time psychiatric sickness absences in parents whose children have psychiatric diagnoses.
Methods
Using several linked nationwide Finnish registers, in this cohort study we examined time to first psychiatric sickness absence in parents whose children were born in 2001–2012 (early-childhood-onset diagnoses) or 2005–2016 (late-childhood-onset diagnoses). Exposure was having a child with a psychiatric diagnosis. Follow-up started when the parent’s eldest turned 1 (early-childhood-onset diagnoses) or 5 (late-childhood-onset diagnoses) and ended at psychiatric sickness absence, emigration, 68th birthday, death, or 31 December 2020, whichever occurred first.
Results
The 2001–2012 and 2005–2016 cohorts included 357 135 and 397 874 parents followed for 3.31 and 3.70 million person-years. Having a diagnosed child was associated with greater risk of psychiatric sickness absence in all except men whose children had substance use or psychotic disorder diagnoses. Time-varying analyses showed the greatest associations for women (HR: 4.92; 95% CI: 3.97–6.10) and men (HR: 2.48; 95% CI: 1.61–3.80) within 6 months of a child’s eating disorder diagnosis.
Conclusions
Parents of children with psychiatric diagnoses may be at a greater risk of a psychiatric sickness absence. Associations differed by child’s diagnosis, parent’s gender and time since diagnosis.
Although extensive research has been conducted on the impact of the COVID-19 pandemic on global mental health, a systematic synthesis of the cross-time dynamics of suicidal ideation (SI) remains lacking. This study aims to systematically synthesise the global aggregated prevalence of SI before and after the pandemic, investigate the potential association between pandemic exposure and the SI risk through meta-regression analysis of longitudinal studies, and explore key moderating factors.
Methods
A systematic search was conducted in Web of Science, PubMed, PsycINFO and ProQuest databases up to August 2025. Observational studies were included if they employed cross-sectional or longitudinal designs and reported the prevalence of SI before and after the pandemic across global regions.
Results
The analysis included 354 cross-sectional studies (N = 8,247,875) and 27 longitudinal studies. In cross-sectional studies, the pooled prevalence of SI was 13.20% [95% CI 12.06%–14.42%]. Pre-pandemic prevalence was 12.52% [95% CI 8.46%–18.14%], and post-pandemic prevalence was 13.24% [95% CI 12.07%–14.50%], with no significant difference. Meta-regression analysis identified three moderators. Specifically, larger sample sizes (n) were associated with lower prevalence (β = −0.232, P < 0.0001); higher study quality predicted lower prevalence (β = −0.278, P < 0.001); and studies on adults reported significantly lower prevalence than adolescents (β = −0.366, P < 0.05). Conversely, time progression during the pandemic, development level, geographical area, gender and measurement method did not show significant independent effects. Interaction analyses also found no significant moderating effect of economic development level or geographical area on the temporal trend of SI prevalence. Longitudinal analysis found no significant increase in prevalence from the pre-pandemic to the post-pandemic period (P = 0.101). However, a small but significant increase occurred between early and late stages within the pandemic (β = 0.265, P = 0.021). Subgroup analyses showed no significant moderation of these temporal changes.
Conclusions
The COVID-19 pandemic’s impact on SI was dynamic. While no significant prevalence change was found between pre- and post-pandemic periods, a significant increase occurred as the crisis progressed. This deteriorating trend was more pronounced in adolescents, identifying them as a key vulnerable group. Methodologically, findings were moderated by the measurement instrument, study quality and sample size, with evidence suggesting potential small-study effects. These findings underscore the need for robust mental health surveillance and targeted interventions for at-risk populations during prolonged public health crises.
The protocol was registered on PROSPERO (CRD42024603151).