Early Detection Treatment Research Articles

Pediatric coronary cameral fistula in a structurally normal heart: a case report and review of the literature

IntroductionCoronary cameral fistulas (CCFs) are rare congenital anomalies characterized by abnormal connections between a coronary artery and one of the cardiac chambers. These abnormal connections can lead to significant clinical implications, including heart failure and myocardial ischemia, necessitating timely diagnosis and intervention.Case presentationA 5-year-old Iranian boy was brought to the emergency room at Heart Hospital Center complaining of chest pain and dyspnea on exertion. He had experienced similar episodes over the past 4 months, which had not been evaluated. Physical examination revealed stable vital signs and no remarkable findings. Transthoracic echocardiography demonstrated a dilated left coronary artery with a large aneurysm and a small orifice to the right ventricular body. The left ventricular ejection fraction was 55%. Cardiac computed tomography angiography confirmed the diagnosis. Cardiac angiography showed a dilated left coronary artery and a coronary cameral fistula to the right ventricular . The aneurysm was successfully occluded using two Amplatzer™ devices.ConclusionThis case underscores the critical role of multimodal imaging in diagnosing and managing coronary cameral fistulae. Early detection and appropriate intervention are paramount in preventing the progression of symptoms and potential complications such as heart failure and myocardial ischemia. The successful closure with Amplatzer™ devices highlights the efficacy of minimally invasive techniques in treating complex cardiovascular anomalies. Regular follow-up and careful monitoring are essential to ensure long-term success and to manage any potential recurrences.Clinical key messageTimely identification and management of coronary cameral fistulae are crucial to prevent complications. Advances in imaging techniques and minimally invasive treatments, such as transcatheter closure, offer effective solutions. A multidisciplinary approach and regular follow-up are essential for comprehensive care and successful long-term management.

Metastatic brainstem medulloblastoma: a clinical case report

Medulloblastoma (MB) is one of the most common tumors of the central nervous system (CNS) of embryonic origin. MB is a malignancy that is quite common in pediatric patients; it represents a small proportion of brain tumors in young people, with an incidence of 0.6 per million per year. The peak age of diagnosis among the pediatric population is 3-6 years, while patients between 15 and 44 years old account for only 25%. The purpose of the study: to demonstrate a clinical case of surgical treatment of a patient with CNS metastasis of brainstem medulloblastoma. Methods. The article presents our clinical case of surgical treatment of a patient with medulloblastoma metastasis to the right temporal lobe. Results. Medulloblastoma is a heterogeneous brain tumor that is very rare in adults, especially those over 40 years of age, and accounts for less than 1% of all primary brain tumors in adults. Medulloblastoma metastases are most often found in the spinal cord and its membranes, less often in the cerebral hemispheres and ventricular system, which is associated with cerebrospinal fluid pathways. In foreign and Russian literature, there are relatively few publications on studies of metastatic lesions of medulloblastoma in adults; these studies are either considered as separate clinical observations or in conjunction with the development of medulloblastoma metastases in children. Non-specific neurological symptoms of medulloblastoma in adults can lead to later instrumental studies and specific therapy, and can also act as an unfavorable prognostic factor for the disease. Conclusion. Early detection and neurosurgical intervention are the key to preventing mortality and improving patient outcomes. Currently, only a few cases of medulloblastoma in adults are known; to prevent patient mortality, more detailed genetic and molecular studies of MB, including cerebrospinal fluid, risk stratification, description of oncological treatment, and monitoring of results to analyze MB sensitivity to chemotherapy and EBRT, as well as maintaining a registry of patients over 18 years old with brain medulloblastoma and dynamic observation of their family members in connection with oncological vigilance are needed.

Identifying priority populations for lung cancer screening intervention using neighborhood-level factors and cancer registry data.

To evaluate the association of neighborhood level economic, environmental, and social indicators with lung cancer (LC) incidence and mortality. Data for adult incident LC cases in Allegheny County, Pennsylvania, diagnosed between 2015-2019 were obtained from Pennsylvania cancer registry. Cases were summarized at census-tract level. Publicly available data on neighborhood deprivation index (NDI), built environment, and racial isolation at census-tracts were linked to cases. Poisson regression was used to compute relative risk (RR) for LC incidence and mortality, adjusting for covariates. A total of 3256 LC cases were included in the analyses. About 68% were ≥65 years, 54% female, 14% Black or African American, and 63% deceased. Results of the multivariable model found that increasing quintiles (Q) of NDI were significantly associated with increasing risk of LC incidence and mortality. The RRs (95% confidence interval) of LC incidence for Q2, Q3, Q4 and Q5 were 1.36 (1.21-1.52), 1.55 (1.40-1.72), 1.68 (1.51-1.87), 2.08 (1.82-2.38), respectively, compared with Q1 (P trend <0.01). The corresponding RRs for LC mortality were 1.46 (1.27-1.68), 1.63 (1.42-1.88), 1.74 (1.51-2.01), 2.04 (2.02-2.88) (P trend <0.01). Targeted interventions for LC prevention and early detection in high NDI neighborhoods may be more effective to reduce LC health disparities.

Child mental health: Early detection and interventions in anxiety disorders and depression

Introduction: Child mental health is a critical public health issue, with disorders such as anxiety and depression affecting up to 20% of children worldwide. Early detection and effective interventions are essential to mitigate the effects of these disorders and improve the quality of life of affected children. This study conducted a systematic review to identify the most effective strategies for early detection and interventions in childhood anxiety disorders and depression. Methods: The systematic review was conducted in the PubMed, Scopus, PsycINFO, and Web of Science databases, using descriptors such as “Child Mental Health,” “Early Detection,” “Anxiety Disorders in Children,” and “Childhood Depression.” Empirical studies published between 2010 and 2024 were included. Study selection was performed by two independent reviewers, and methodological quality was assessed using the AMSTAR tool and the Newcastle-Ottawa Scale. Results: Thirteen studies were included that indicate the effectiveness of instruments such as the "Spence Children's Anxiety Scale" (SCAS) and the "Child Depression Inventory" (CDI) in the early detection of anxiety and depression in children. Interventions based on Cognitive-Behavioral Therapy (CBT) and multidisciplinary approaches were effective in reducing symptoms and improving the quality of life of children. However, the implementation of these strategies faces significant challenges, such as lack of resources and the need for cultural adaptations. Conclusion: Early detection and timely interventions are essential for the effective management of anxiety disorders and depression in children. The importance of public policies for training professionals and intersectoral collaboration to ensure quality mental health care is reinforced. Future research should focus on culturally adapted interventions and evaluate their long-term effectiveness.

Healthcare professionals perceptions towards the determinants of effective emergency health care services in public health centres of Addis Ababa, Ethiopia

IntroductionEmergency healthcare services enable early detection and life-saving interventions for time-sensitive acute injuries and illnesses. The aim of this paper was to assess health care professional's perception towards determinants of effective emergency healthcare services in public health centers of Addis Ababa, Ethiopia, in 2023. MethodsA facility-based cross-sectional study was conducted at public health centers in Addis Ababa with a sample of 422 study participants. Study participants were selected using simple random sampling techniques. To identify factors associated with the outcome variable, bi-variable and multi-variable logistic regression analyses were conducted. Variables having a p-value less than 0.05 in multi-variable logistic regression analysis were declared determinants of positive perception towards emergency medical services effectiveness. ResultsAmong the study participants, 76.3 % (95 % CI: 72.3, 80.6) had a positive perception towards the public health centers effectiveness in providing emergency healthcare services. Moreover, training (AOR: 4.05; 95 % CI: 1.97, 8.32), ICT service implementation (AOR: 6.55; 95 % CI: 3.37, 12.73), resource availability in the emergency department (AOR: 5.07; 95 % CI: 2.51, 10.25), and management support (AOR: 3.22; 95 % CI: 1.66, 6.25) were determinant factors associated with the perception of effectiveness in emergency medical care services. ConclusionNearly three-fourths of healthcare providers in Addis Ababa perceived that the emergency healthcare services were effective. Furthermore, training on patient service delivery, ICT service implementation, availability of resources in emergency departments, and management support were independent determinants of positive perception towards effective emergency healthcare services.

Congenital heart disease cardiac catheterization at Uganda Heart Institute, a 12-year retrospective study of immediate outcomes

BackgroundCardiac catheterization is an invasive diagnostic and treatment tool for congenital heart disease (CHD) with potential complications.ObjectiveTo describe the immediate outcomes of patients who underwent cardiac catheterization for CHD at the Uganda Heart Institute (UHI).MethodsThe study was a retrospective chart review of 857 patients who underwent cardiac catheterization for CHD at UHI from 1st February 2012 to 30th June 2023. Precardiac catheterization clinical data, procedure details, and post-procedure data were recorded. The statistical software SPSS was used for data analysis.ResultsWe studied 857 patients who underwent cardiac catheterization for CHD at UHI. Females comprised 62.8% (n = 528). The age range was 3 days to 64 years, with a mean of 5.1 years (SD 7.4). Advanced heart failure was present in 24(2.8%) of the study participants. The most common procedures were patent ductus arteriosus device closure (n = 500, 58.3%), diagnostic catheterization (n = 194, 22.5%), and balloon pulmonary valvuloplasty (n = 114, 13.0%). PDA device closure had 89.4% optimal results while BPV had 75.9% optimal performance outcome.Adverse events occurred in 52 out of 857 study participants (6.1%). Clinically meaningful adverse events (CMAES) occurred in 3.9%, (n = 33), high severity adverse events in 2.9% (n = 25) and mortality in 1.5% (n = 13).Advanced heart failure at the time of cardiac catheterization, was significantly associated with clinically meaningful adverse events (OR 52 p-value < 0.001) and mortality (OR 564, p value < 0.001).ConclusionMany patients with CHD have benefited from the cardiac catheterization program at UHI with high optimal procedure outcome results. Patients with advanced heart failure at the time of cardiac catheterization have less favorable outcomes emphasizing the need for early detection and early intervention.

Incidence and risk factors for acute kidney injury after traumatic hemorrhagic shock: A 10-year retrospective cohort study.

Acute kidney injury (AKI) is a common complication of traumatic hemorrhagic shock. Therisk factors for AKI aftertraumatic hemorrhagic shockremain unclear. The aim of this study was to investigate the risk factors for AKI after traumatic hemorrhagic shock. This was a ten-year retrospective cohort study of patients who experiencedtraumatic hemorrhagic shock between January 2013 and April 2023. Patient characteristics and clinical data were recorded for 417 patients. The outcome was the occurrence of AKI, defined as a serum creatinine increase of ≥ 0.3mg/dL (≥ 26.5μmol/L) within 48h, or an increase to 1.5 times the baseline, or a urine volume of <0.5mL/(kg h.). Risk factors for AKI were tested by logistic regressionmodels. The incidence of AKI after traumatic hemorrhagic shockwas 29.3% (122/417 patients). Multivariable analysis revealed that the independent risk factors for AKIincluded age (OR, 1.048; 95% CI, 1.022-1.074; p < 0.001), B-type natriuretic peptide (OR, 1.002; 95% CI, 1.000-1.004; p = 0.041), sepsis (OR, 4.536; 95% CI, 1.651-12.462; p = 0.030) and acute myocardial injury (OR, 2.745; 95% CI, 1.027-7.342; p = 0.044). Road traffic accidents (OR, 0.202; 95% CI, 0.076-0.541; p = 0.001), mean arterial pressure (OR, 0.972; 95% CI, 0.950-0.995; p = 0.017), and base excess (OR, 0.842; 95% CI, 0.764-0.929; p = 0.001) were negatively correlated with AKI. The area under the receiver operating characteristic (ROC)curvefor prediction by thismodel was 0.85(95% CI, 0.81-0.90). The incidence of AKI aftertraumatic hemorrhagic shockwas 29.3%in our series. Indicators of bloodperfusion, sepsis and acute myocardial injury may be independent risk factors for AKI aftertraumatic hemorrhagic shock. Early detection and effective intervention on these risk factors could reduce the occurrence of AKI and improve outcomes.

Prognostic factors in patients with intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma (ICC) is the second commonly-seen liver malignancy and one of the most fatal cancers in Taiwan. Survival after diagnosis of ICC remains poor. This study aimed to investigate the survival and prognostic factors in patients with ICC. All patients with newly diagnosed ICC during 2004 to 2018 were identified from a national cancer database and followed until December 2020. Estimates of overall survival (OS) were conducted using the Kaplan–Meier method and Cox proportional hazards model. Hazard ratios with 95% confidence intervals were calculated. Initially, 7940 patients with ICC disease (stage IV: 55.6%, 4418/7940) were eligible for this study. Only 32.3% (2563/7940) patients with ICC underwent liver resection. After Propensity score matching, 969 pairs (N = 1938) of patients were matched and selected (mean age 62.8 ± 11.0 years, 53.1% were male, 29.7% had cirrhosis). The median follow-up time was 80.0 months (range 25–201 months). The 3-, 5-year OS rates were 44.0%, 36.4% in the surgical group and 26.0%, 23.7% in the non-surgical group, respectively. Surgery, young patients (≤ 54 years), small tumor size, no vascular invasion and chemotherapy were associated with better OS in patients with stages I–III disease. Surgery benefit was maximum in stage I disease followed by stage II. In patients with stage IV disease, factors such as surgery, young patients (≤ 64 years), single tumor, and no vascular invasion were associated with better OS. Chemotherapy was insignificantly associated with better OS. Long-term survival in patients with ICC is very poor. Compared to non-surgical patients, surgery conveys approximately 18% and 12% better OS rates at 3-year and 5-year, respectively. Early detection and surgical intervention may improve OS substantially in patients with ICC.

Abstract We088: Spatiotemporal analysis of cardiac progenitor cells reveals migratory characteristics during epithelial-mesenchymal transition

Introduction: Congenital heart defects (CHD) are one of the most common types of birth defects, with a rising prevalence in mild types. The most frequent CHDs include anomalies in the cardiac outflow tract (OFT), which mainly derives from multipotent cardiac progenitor cells termed second heart field (SHF). Hence, dysregulation of highly synchronized, chronological sequence of proliferation and differentiation of SHF cells could lead to severe CHDs. As the SHF contributes entirely to the OFT, mutations in the SHF-related genes lead to major arterial pole defects which account for one third of CHDs in newborn children. Investigating how these genes regulate cell-cell behavior and communication is of vital importance. Hypothesis and Methods: In this study, we employed a multidimensional approach to assess the hypothesis that the dynamic behavior of SHFs is regulated by key genes implicated in CHD pathogenesis. Leveraging single-cell RNA sequencing (RNA-seq) data obtained from experimentally dissected mouse OFT, we delineated distinct epithelial-to-mesenchymal transition states within SHF cell populations. Additionally, we developed a quantitative metric to assess SHF cell’s migratory level and integrated it with spatial transcriptomic analyses to map the developmental trajectory of SHFs. Results and Conclusion: Through spatiotemporal analysis, we identified a panel of key genes associated with SHF migration, shedding light on the molecular mechanisms underlying OFT development during early embryonic stages. Furthermore, we leveraged the data from The Pediatric Cardiac Genomics Consortium (PCGC) study (phs001194.v3.p2) which comprises a large cohort of CHD patients (13716 participants) and a proportion of 21.68% identified with OFT obstruction in its sub-study. In conclusion, using these datasets and quantitative metric being developed, we validated the SHF-derived genes in the PCGC participants and revealed specific expression patterns of these genes associated with OFT-specific CHDs. These results would benefit the understanding of the genetic regulation of SHF proliferation and differentiation, which is crucial for early detection and precise surgical intervention in CHD patients.

Disparities and Determinants of Testing for Early Detection of Cervical Cancer among Nepalese Women: Evidence from a Population-Based Survey.

Cervical cancer presents a considerable challenge in South Asia, notably in Nepal, where screening remains limited. Past research in Nepal lacked national representation and a thorough exploration of factors influencing cervical cancer screening, such as educational and socioeconomic disparities. This study aims to measure these gaps and identify associated factors in testing for early detection of cervical cancer among Nepalese women. Data from the 2019 Nepal Noncommunicable Disease Risk Factors survey (World Health Organization STEPwise approach to noncommunicable risk factor surveillance), involving 2,332 women aged 30 to 69 years, were used. Respondents were asked if they had undergone cervical cancer testing through visual inspection with acetic acid, Pap smear, or human papillomavirus test ever or in the past 5 years. The slope index of inequality (SII) and relative concentration index were used to measure socioeconomic and education-based disparities in cervical cancer test uptake. Only 7.1% [95% confidence interval (CI): 5.1-9.9] Nepalese women had ever undergone cervical cancer testing, whereas 5.1% (95% CI: 3.4-7.5) tested within the last 5 years. The ever uptake of cervical cancer testing was 5.1 percentage points higher (SII: 5.1, 95% CI: -0.1 to 10.2) among women from the richest compared with the poorest households. Education-based disparities were particularly pronounced, with a 13.9 percentage point difference between highly educated urban residents and their uneducated counterparts (SII: 13.9, 95% CI: 5.8-21.9). Less than one in ten women in Nepal had a cervical cancer testing, primarily favoring higher educated and wealthier individuals. Targeted early detection and cervical cancer screening interventions are necessary to address these disparities and improve access and uptake.

Machine Learning and Vision: Advancing the Frontiers of Diabetic Cataract Management.

This comprehensive review explores the integration of machine learning (ML) in managing diabetic cataracts. It discusses the potential application of ML to identify novel methodologies for early detection, diagnosis, and therapeutic interventions. The review also addresses clinical translation challenges, including pharmacokinetics properties and ethical considerations. The approach toward cataractogenesis, therefore, has to be from a holistic viewpoint, bringing oxidative stress and metabolic disturbances to the top of importance. It outlines the important requirements, including continued research, diversified datasets, and uses interdisciplinary collaborations in making improvements in ML models and thereafter bridging the gap between computational promise and clinical implication, with the aim to help in the maximization of patient care in the management of diabetic cataract. A literature search through databases like PubMed and Scopus focusing on understanding of current innovations, challenges, and future directions in employing ML in diabetic cataract management was undertaken. This review has exploredboth recent and foundational studies in order to explain the development and gaps of current research with an aim to enhance outcomes of patient care by promoting future investigation. Key findings revealed a wide application of ML in ophthalmology including treatment identification, cataract detection and grading, and improving the surgical outcomes. However, this is accompanied by some obstacles, including risk of bias, concerns regarding artificial intelligenceapplication as a diagnostic tool, and legal regulations. ML promises extraordinary developments in the treatment of diabetic cataracts through betterment in diagnosis, treatment, and patient care. With this, it is full of clinical translation and ethical challenges, yet there is recognition in general that continuous model refinement and interdisciplinary collaboration, along with the expansion of the two identified key elements in enhancing patient outcomes, are essential for this to continue.

Prediksi Dini Penyakit Diabetes Pada Ibu Hamil Dengan Algoritma Random Forest

Diabetes in pregnant women, otherwise known as gestational diabetes, is a serious health condition that can negatively affect the mother and fetus. Early detection and appropriate intervention are essential to reduce the risk of complications during pregnancy and childbirth. This study aims to develop a prediction model that can detect the risk of diabetes in pregnant women using the Random Forest algorithm. The data used in this study included relevant clinical and demographic parameters of pregnant women, such as age, body mass index, family history, and laboratory test results. The Random Forest model was chosen because of its ability to handle complex data and provide accurate prediction results. The results of this study show that the model developed has an accuracy rate of 98% in predicting the risk of gestational diabetes. In addition, important features that contribute to diabetes risk prediction have also been identified, providing additional insights for medical practitioners in conducting risk evaluations. The implementation of this model is expected to help in efforts to prevent and manage gestational diabetes, thereby improving maternal and infant health.

Adverse Effects Associated with Dermal Filler Treatments: Part II Vascular Complication.

Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected fillers compress adjacent blood vessels, leading to ischemia and potential necrosis, while intravascular emboli result from fillers entering blood vessels, causing blockages. The study emphasizes the importance of anatomical knowledge, careful injection techniques, and early intervention. Management strategies include the use of hyaluronidase to dissolve HA fillers, vasodilators to improve blood circulation, and hyperbaric oxygen therapy. The regions most susceptible to complications align with major arterial pathways, particularly the nasolabial folds and nasal region. The study also highlights the need for meticulous injection techniques, the use of cannulas over needles in high-risk areas, and the aspiration test to detect vessel penetration. Early detection and immediate intervention are crucial to mitigate adverse outcomes. Continuous education and training for practitioners, along with advancements in filler materials and injection methods, are essential for improving the safety of cosmetic procedures. This comprehensive understanding aids in preventing and managing vascular complications, ensuring better patient outcomes. The field of dermal filler treatments is advancing with new techniques and technologies, such as High-Resolution Ultrasound, Infrared Imaging, self-crossing hyaluronic acid filler, biodegradable microspheres, and microinjection.

Medical costs of lung cancer by stage, histology and first-line treatment modality in the Netherlands (2012–2021)

IntroductionLung cancer is a leading cause of mortality worldwide, with lung cancer treatment presenting a significant financial burden. The treatment landscape has recently shifted, seeing an increase in targeted- and immunotherapies. Such treatments are expensive, but estimates of the medical costs of the lung cancer treatment pathway largely predate their introduction. MethodsWe link medical expenditures of individuals resident in the Netherlands (n = 19.2 m) for 2013–2021 to tumour-level (n = 137,129, incident 2012–2021) Netherlands Cancer Registry data. We estimate lung cancer-attributable costs by phase of care (initial, continuing and terminal), stratified by cancer stage and histology, and observe trends in medical costs over time. ResultsWe estimate mean costs over the lung cancer treatment pathway to be €48,443 per patient. Total medical costs are highest in the initial phase, followed by the terminal and continuing phase. Monthly treatment for stage IV lung cancer is significantly more expensive than for early-stage disease (€8293 per month of initial care relative to €3228 for stage IA). Stage IV lung cancer has become significantly more expensive to treat 2018–2021 relative to 2013–2017, with monthly expenditures rising 55 % in initial care and 148 % in continuing care. Population-wide, we find €900.6 million spent on lung cancer care in 2021, €433 million more than in 2016, of which €307.3 million is attributed to per-patient expenditure trends. ConclusionsTreatment advances are quickly inflating medical costs for late-stage lung cancer. Policy makers should carefully evaluate the cost-effectiveness of novel treatments, and incorporate stage-specific treatment costs in evaluating interventions for early detection.

The cost of adding rapid screening for diabetes, hypertension, and COVID-19 to COVID-19 vaccination queues in Johannesburg, South Africa

BackgroundNon-communicable diseases (NCDs) are responsible for 51% of total mortality in South Africa, with a rising burden of hypertension (HTN) and diabetes mellitus (DM). Incorporating NCDs and COVID-19 screening into mass activities such as COVID-19 vaccination programs could offer significant long-term benefits for early detection interventions. However, there is limited knowledge of the associated costs and resources required. We evaluated the cost of integrating NCD screening and COVID-19 antigen rapid diagnostic testing (Ag-RDT) into a COVID-19 vaccination program.MethodsWe conducted a prospective cost analysis at three public sector primary healthcare clinics and one academic hospital in Johannesburg, South Africa, conducting vaccinations. Participants were assessed for eligibility and recruited during May-Dec 2022. Costs were estimated from the provider perspective using a bottom-up micro-costing approach and reported in 2022 USD.ResultsOf the 1,376 enrolled participants, 240 opted in to undergo a COVID-19 Ag-RDT, and none tested positive for COVID-19. 138 (10.1%) had elevated blood pressure, with 96 (70%) having no prior HTN diagnosis. 22 (1.6%) were screen-positive for DM, with 12 (55%) having no prior diagnosis. The median cost per person screened for NCDs was $1.70 (IQR: $1.38-$2.49), respectively. The average provider cost per person found to have elevated blood glucose levels and blood pressure was $157.99 and $25.19, respectively. Finding a potentially new case of DM and HTN was $289.65 and $36.21, respectively. For DM and DM + HTN screen-positive participants, diagnostic tests were the main cost driver, while staff costs were the main cost driver for DM- and HTN screen-negative and HTN screen-positive participants. The median cost per Ag-RDT was $5.95 (IQR: $5.55-$6.25), with costs driven mainly by test kit costs.ConclusionsWe show the cost of finding potentially new cases of DM and HTN in a vaccine queue, which is an essential first step in understanding the feasibility and resource requirements for such initiatives. However, there is a need for comparative economic analyses that include linkage to care and retention data to fully understand this cost and determine whether opportunistic screening should be added to general mass health activities.

Diagnosis and management of frailty

Background: Frailty, a syndrome characterized by reduced physiological reserve and heightened susceptibility to stressors, impairs homeostasis across physical, psychological, and physiological domains in older adults. Approximately 50% of older Korean adults are frail or pre-frail, which highlights the need for targeted interventions in community healthcare and primary care settings.Current Concepts: Various methods, including use of physical and biological markers and health deficit analysis are available for frailty assessment; the Frailty Phenotype and Frailty Index are widely used screening tools. Following advances in technology, electronic health records and big data play a key role in identifying potential biomarkers. Considering the multifaceted nature of frailty, comprehensive geriatric assessments are recommended for holistic evaluation and management, based on a patient’s medical, psychological, and functional capabilities. Effective management can reverse frailty, which emphasizes the importance of early detection and multidisciplinary interventions. International and national guidelines propose a comprehensive approach focusing on modifiable risk factors, physical activity, a balanced diet, chronic disease management, social participation, and regular review of medication regimens. Personalized care plans based on comprehensive assessments are essential to enhance or maintain the residual function of frail older adults to improve their quality of life and reduce the need for long-term care.Discussion and Conclusion: Timely and effective management of potentially reversible frailty highlights the importance of prompt detection and a multidisciplinary approach to care. International and national guidelines recommend a holistic management strategy. Tailored care plans based on comprehensive geriatric assessments are pivotal in improving or maintaining the functional capabilities of frail elderly individuals to enhance their quality of life.

Twenty-year changes of adolescent mental health and substance use: a Finnish population-based time-trend study.

This time-trend study assesses changes in mental health and substance use among Finnish adolescents from 1998 to 2018. Representative samples of adolescents (N = 6,600) aged 13-16 years participated in school-based, almost identical cross-sectional studies in 1998 (n = 1,446), 2008 (n = 2,009), 2014 (n = 1,800) and 2018 (n = 1,345), respectively. The Strengths and Difficulties Questionnaire was used to assess mental health. When comparing mental health in the clinical range between 1998 and 2018, the main finding was the significant increase of emotional symptoms among females. The percentage of females in the clinical range increased from 17.5 to 30.1% during the twenty-year period. When psychopathology measures were analyzed as continuous variables, the finding of increased emotional problems was confirmed. The study clearly illustrates a linear trend, with a consistent increase in emotional problems among females and decrease in substance use among both genders. An alarming finding of steady increase of self-reported emotional problems indicates the importance of early detection and evidence-based interventions for adolescent with anxiety and depression to prevent adversities associated with these disorders.

Program Pengabdian Masyarakat Tentang Pentingnya Skrining Vitamin D Dalam Mencegah Sarkopenia Pada Lanjut Usia

Sarcopenia is a progressive degenerative condition characterized by a decrease in muscle mass, strength, and musculoskeletal function, affecting the quality of life of the elderly. This activity aims to screen for vitamin D and educate the elderly about sarcopenia. Community service activities were carried out in nursing homes, involving education and screening of vitamin D levels. The results showed that the majority of respondents were women (79.6%) with an average age of 74.05 years. Most respondents experienced vitamin D deficiency, with 87.1% deficient, 3.2% adequate, and only 9.7% having good levels, with it being found that more women experienced vitamin D deficiency than men. Education regarding the importance of vitamin D and preventing sarcopenia is provided through outreach sessions and poster media. This activity emphasizes the importance of early detection and comprehensive intervention including physical exercise, proper nutritional intake, and lifestyle modification to prevent sarcopenia and improve the quality of life of the elderly. Community-based interventions are needed to address vitamin D deficiency and promote musculoskeletal health in the aging population.

Prevalence of depression and its associated factors among medical students of a rural medical college in Karnataka

Introduction: Depression among medical students is an overlooked public health issue in India. Addressing this problem is crucial to prevent its negative impact on educational performance and career development through early detection and appropriate interventions. This study aimed to assess the prevalence of depression and its associated factors among medical students. Materials and methods: 305 medical students selected randomly were assessed for depression using the Beck Depression Inventory. The relationships between depression and various factors, including academic year, social influences such as addictive habits, family issues, a history of depression, and living away from home were assessed. Results: 137 (44.91%) students were found to have some degree of depression according to Becks Inventory Scale. Majority (81.02%) of them were found to have mild to moderate depression while the prevalence of severe and very severe depression was 6.10% and 2.25% respectively. The difference between the grade of depression and year of studying was found to be statistically significant. Factors such as being coerced into the MBBS program instead of choosing it, academic performance during the course, and a history of previous depression had a significant impact on the likelihood of developing depression. Conclusion: Depression is notably common among medical students in this region. Our results highlight the need for widespread screening and psychiatric counseling for this vulnerable group. Keywords: medical students; depression; Becks depression; inventory scale

Influence of frailty status on the health-related quality of life in older patients with chronic low back pain: a retrospective observational study.

Understanding the influence of frailty on health-related quality of life (HRQoL) in older individuals experiencing chronic low back pain can provide valuable insights into the impact of frailty. Therefore, the aim of our study is to assess how different frailty statuses among older outpatients with chronic low back pain affect their HRQoL. Patients aged 60 and above with chronic low back pain were recruited from March 2022 to February 2023. Frailty was assessed via the frailty phenotype questionnaire, and HRQoL was evaluated using the EQ-5D-5L. Multiple regression models were used to explore the influence of frailty status on the EQ-5D-5L index and EQ-VAS. Logistic regression was used to determine odds ratios for the impact of frailty status on belonging to the lowest EQ-5D-5L index quartile. A total of 1,054 participants were classified into robust (29.8%), pre-frail (47.7%), and frail (22.5%) groups. Frailty was significantly associated with declining HRQoL. Pre-frail and frail statuses were inversely linked to the EQ-5D-5L index, with significantly higher odds of scoring in the lowest quartile compared to robust individuals. Stratification analysis identified sex as an effect modifier, emphasizing a more substantial association between frailty and the lowest EQ-5D-5L index quartile in female patients. A significant association exists between frailty and reduced HRQoL in patients with chronic low back pain. This association was predominant in female patients. Furthermore, considering the dynamic nature of frailty, early detection and effective interventions targeting pre-frailty are essential to delaying the transition to full frailty and improving HRQoL.