Post-traumatic stress disorder (PTSD) may shorten life expectancy, but evidence for Asian populations and cause-specific mortality remains limited. The aim of this study is to investigate the association between PTSD and mortality risk in an Asian population. We used Taiwan's National Health Insurance Research Database (2000-2022) to assemble a cohort of 28,777 individuals with incident PTSD and 115,108 age- and sex-matched unexposed individuals, plus a sibling cohort of 13,305 affected patients and 22,030 unaffected siblings. Cox models estimated adjusted hazard ratios (AHRs) for all-cause, unnatural-cause (suicide and accidents) and natural-cause mortality, with progressive adjustment for sociodemographic factors, comorbidity and familial confounding. Subgroup analyses addressed five psychiatric comorbidities, sex and age (youth, adulthood and older adults). Over a mean follow-up of 8years, PTSD was associated with excess all-cause mortality (AHR=1.32, 95% CI 1.24-1.41) driven by markedly increased unnatural deaths (AHR=5.93, 5.13-6.85), especially suicide (AHR=10.36, 8.41-12.76) and accidental deaths (AHR=2.18, 1.67-2.86). Natural-cause mortality showed no consistent increase (AHR=0.91, 0.85-0.98). In sibling analyses, excess risks persisted for all-cause (AHR=2.48, 2.04-3.01), unnatural deaths (AHR=4.76, 3.58-6.34) and suicide mortality (AHR=7.90, 5.21-11.97), but not for accidents or natural causes. The risk patterns were similar across different psychiatric comorbidity strata and genders; suicide and unnatural-cause excess remained evident in all age groups. PTSD was associated with elevated premature death risk in Taiwan, primarily through suicide and unnatural causes. Integrating targeted suicide-prevention into PTSD care pathways may be essential to reducing this avoidable mortality burden.

Regrettably, glioblastoma multiforme (GBM) remains the deadliest form of brain cancer, with a very unfavorable prognosis for life expectancy for the patient. We report, for the first time, the green colloidal synthesis of cobalt-doped magnetic iron oxide nanoparticles (Co-MNPs) as aqueous ferrofluids, using two anionic polysaccharide biopolymers, hyaluronic acid (HA) and carboxymethyl cellulose (CMC), as surfactants. These ferrofluids based on magnetite nanoparticles (HA@Co-MNP and CMC@Co-MNP) demonstrated superparamagnetic properties and magnetic-to-thermal conversion upon exposure to an alternating magnetic field (AMF), with the extent of conversion dependent on surfactant type. In addition, the ferrophase acted as a nanozyme, mimicking peroxidase-like activity in response to hydrogen peroxide, which is present at higher levels in tumor cells. The coupling of magnetic-heat capabilities with biocatalytic behavior enhances glioblastoma cell elimination and suppresses 3D neurospheroid growth. The results also showed that active targeting based on the HA biopolymer shell, due to its affinity for CD44 membrane receptors overexpressed in GBM, outperformed CMC-coated ferrofluid analogs. These magnetocatalytic-responsive nanoplatforms offer a broad avenue for the diagnosis and therapy of numerous cancers, potentially improving patients’ quality of life and prognoses.

Objectives Extending healthy life expectancy represents a critical public health priority in Japan. Achieving this goal requires Community Comprehensive Support Center (CCSC) staff to develop competencies in building and managing community-based integrated care systems that promote mutual resident support. This study aimed to identify training challenges and future needs related to community development among CCSC staff nationwide.Methods Focus group interviews (FGIs) were conducted with CCSC staff. Verbatim transcripts underwent thematic analysis to extract and categorize staff-identified training needs.Results Twenty-four staff members (mean age: 44.6 years; seven public health nurses, eight care managers, six social workers, one occupational therapist, one physical therapist, one nurse) from five CCSCs (two directly managed, three commissioned) participated in the study. Analysis of the FGI transcripts yielded 132 codes organized into five categories: (1) fostering resident independence, mutual support relationships, and community acceptance to establish integrated care systems; (2) advancing community activities using the Plan-Do-Check-Act (PDCA) cycle; (3) developing skills to secure community resources and engage in continuous self-improvement; (4) enhancing skills to support individuals with complex, challenging problems; and (5) promoting inclusive society by addressing regional disparities.Conclusion CCSC staff require enhanced skills in fostering resident independence and mutual support to reduce regional disparities and promote social inclusion. Findings emphasize the need for practical, on-the-job training methods, including case studies, to strengthen data-driven PDCA implementation and improve ethical decision-making in complex cases. Developing and implementing targeted training programs is essential to address identified needs and effectively advance community-based integrated care systems.

The phenomenon of the sandwich generation has become an increasingly visible social reality in the modern era, particularly as individuals face simultaneous responsibilities toward their aging parents and their dependent children. This dual burden places individuals in a unique socio-economic and emotional position where financial obligations, caregiving duties, and professional demands intersect. This study analyzes the multidimensional roles, challenges, and coping strategies experienced by the sandwich generation in navigating work, family, and mental well-being. The research highlights contributing factors such as rising living costs, increasing life expectancy, insufficient financial planning across generations, and strong cultural expectations of filial duty. Findings show that sandwich generation individuals often experience chronic stress, emotional fatigue, and role conflict due to overlapping responsibilities. However, effective time management, social support systems, self-care practices, and the utilization of digital tools can help mitigate the psychological strain. This study emphasizes the necessity of structural support both within families and through workplace policies to promote mental health and enhance resilience among the sandwich generation. Ultimately, strengthening awareness about intergenerational financial literacy, caregiving readiness, and mental-health preservation is crucial in reducing the long-term burden faced by this demographic group.

Global variation in dementia incidence reflects demographic and socioeconomic forces, yet the role of staple dietary patterns remains less defined. While population ageing is a key determinant of dementia burden, differences in cereal consumption, particularly rice, wheat, and maize, have received limited attention. This ecological study examined whether national cereal consumption patterns are associated with dementia incidence across countries independent of confounding factors. Country level data from 204 nations were compiled, with complete case analyses conducted in 184 countries. Alzheimer's disease and other dementias incidence in 2021 served as the outcome variable. Predictors included per capita consumptions of total cereals, rice, wheat, and maize, alongside genetic predisposition, economic affluence, urban living, ageing indexed by life expectancy at age sixty, and meat consumption. Pearson and partial correlations, principal component analysis, and stepwise multiple regression were applied. Wheat consumption was positively associated with dementia incidence, affluence, and longevity, whereas rice and maize consumption showed inverse associations. Partial correlations confirmed a persistent inverse association for rice consumption and a weaker inverse association for total cereal consumption after adjustment. Principal component analysis identified a socioeconomic component aligned with wheat consumption and ageing, while rice and maize loaded inversely. Stepwise regression demonstrated that ageing was the strongest predictor of dementia incidence, while rice and total cereal consumption retained small independent inverse associations. Global dementia incidence is driven primarily by population ageing and socioeconomic development. Cereal type reflects distinct developmental contexts, with rice-based patterns associated with a modestly lower dementia burden.

Tobacco smoking is still one of the most important avoidable risk factors for early morbidity and mortality. Smokers lose roughly one decade of life, whereas the cessation of smoking leads to an increase in the quality of life and years of life. In Germany the life expectation is disproportionately low in view of the well-developed social security system and the number of heathy years is reduced in the younger generations. An essential reason is considered to be the previous focus on curative instead of preventive medicine, among others caused by the lack of a superordinate strategy for prevention. In the past measures for individual prevention were shown to be less effective than measures for behavioral prevention, such as tobacco tax and smoking bans. The cessation of smoking is an essential component of secondary prevention but is currently insufficiently promoted and implemented by those responsible in the healthcare system and is additionally poorly funded. New products containing nicotine are infiltrating the market, which among other things are unsuitable for smoking cessation due to the high potential for dependency and the cardiovascular and pulmonary risk profiles. Additional measures, such as the limitation of the influence by the tobacco industry, the implementation of the "Strategy for a tobacco-free Germany 2040" and the complete remuneration of costs for tobacco cessation are necessary in the future to fulfil the minimum standard for prevention, to sustainably reduce the foreseeable cost explosion in the healthcare system and to enable a sustainable society.

The role of cardiovascular risk factors on educational and regional inequalities in mortality in Spain 2016-2022: An analysis using multiple causes of death.

Smoking and the comorbidity trajectory of cardiometabolic and mental disorders: A multi-state model.

The high rate of people with chronic kidney disease on dialysis is a public health problem, especially in developing countries. To evaluate demographic and socioeconomic changes related to dialysis treatment in Brazil from 2002 to 2019. This descriptive, analytical study reviewed retrospective documentary data. A comparative analysis was conducted on demographic, economic, and social trends, as well as changes in dialysis service provision in Brazil between 2002 and 2019. Correlation analysis between Municipal Human Development Index (HDI-M) and the number of dialysis units was performed. There was an increase in the percentage of the older population (5.3% vs. 9.25%) and in life expectancy at birth (70.8 vs. 75.9 years). The gross domestic product (GDP) increased by 453%; the percentage of investment in public health (below 4%) was stable and the ranking of global Human Development Index decreased (73 vs 84). The increase in the prevalence of patients on chronic maintenance dialysis was greater than the increase in the number of patients in new centers (117.3% vs. 43.9%), with fewer patients receiving treatment in the North and Northeast regions. There was a positive linear correlation between the HDI-M values and the number of dialysis units (R = 0.52; 95% CI: 0.75-0.18; p = 0.006). Despite Brazil's strong economic growth and the drastic demographic changes that occurred during the study period, this progress did not translate into a higher investment in health and equitable access to dialysis treatment across the country.

Introduction:The high rate of people with chronic kidney disease on dialysis is a publichealth problem, especially in developing countries.Objectives:To evaluate demographic and socioeconomic changes related to dialysistreatment in Brazil from 2002 to 2019.Methods:This descriptive, analytical study reviewed retrospective documentary data. Acomparative analysis was conducted on demographic, economic, and socialtrends, as well as changes in dialysis service provision in Brazil between2002 and 2019. Correlation analysis between Municipal Human DevelopmentIndex (HDI-M) and the number of dialysis units was performed.Results:There was an increase in the percentage of the older population (5.3% vs.9.25%) and in life expectancy at birth (70.8 vs. 75.9 years). The grossdomestic product (GDP) increased by 453%; the percentage of investment inpublic health (below 4%) was stable and the ranking of global HumanDevelopment Index decreased (73 vs 84). The increase in the prevalence ofpatients on chronic maintenance dialysis was greater than the increase inthe number of patients in new centers (117.3% vs. 43.9%), with fewerpatients receiving treatment in the North and Northeast regions. There was apositive linear correlation between the HDI-M values and the number ofdialysis units (R = 0.52; 95% CI: 0.75–0.18; p = 0.006).Conclusion:Despite Brazil’s strong economic growth and the drastic demographic changesthat occurred during the study period, this progress did not translate intoa higher investment in health and equitable access to dialysis treatmentacross the country.

Chalazion and hordeolum in paediatric patients with cystic fibrosis on elexacaftor/tezacaftor/ivacaftor.

Treatments for human immunodeficiency virus (HIV) have advanced considerably and people living with HIV have longer life expectancies, yet many continue to experience stigma and discrimination. Our research examines HIV-related knowledge and attitudes in aged residential care (ARC) staff. Aged Residential Care facilities in one urban area in New Zealand were involved in (1) a staff survey, and (2) qualitative interviews with nurse managers. Survey questions included the HIV-K18 knowledge questionnaire scaled from 0 (low) to 13 (high), 30-item Health Care Provider Stigma Scale from 30 (low) to 180 (high), worry about HIV scaled from 4 (low) to 16 (high), and demographic characteristics. Analysis used multiple imputation and regression models accounting for clustering within facilities. Thematic analysis was employed for qualitative interviews. Eleven of 26 eligible facilities participated and 184 staff completed the survey. The mean knowledge score was 7.6 (SD 2.6), stigma 82.2 (SD 29.3), and worry 7.6 (SD 3.0). In adjusted analysis, higher education and experience caring for someone with HIV were favourably associated with higher HIV knowledge, which was in turn associated with a lower stigma score, which was in turn associated with less worry about HIV. Five nurse managers were interviewed. Most expressed hesitation in caring for someone with HIV; however, overriding this was acknowledgement of the importance of delivering good holistic care in a respectful manner. Ongoing professional development for ARC staff about HIV and increased collaboration between the HIV and ARC sectors at the organisational level could increase their HIV knowledge and improve their care for residents with HIV.

The effectiveness of direct acting antiviral (DAA) therapy in patients with active hepatocellular carcinoma (HCC) is poorly defined. NHS England approved DAA therapy for all viraemic patients, including those with HCC. The aim of this retrospective study is to provide a real-life data of treatment outcomes in those with active HCC. Patients with HCV related HCC from the National Hepatitis C registry in South-East England between 2016 and 2023 were included. The primary outcome was to assess the HCV care cascade in patients with HCV related HCC (HCC cohort) in comparison with those with advanced fibrosis/cirrhosis without HCC (non-HCC cohort). 1518 HCV RNA-positive patients started DAA therapy. 92.4% (1403) were included in the non-HCC cohort and 7.6% (115) were included in the HCC cohort. The SVR rate in the HCC cohort was 87% (80/92) versus 94.5% (1126/1191) in the non-HCC cohort (p = 0.003). In the multivariate analysis, only the presence of HCC (OR 0.4 95% CI 0.2-0.9; p = 0.029) was associated with a lower probability of achieving SVR. SVR rates were 95.6%, 50%, 75% and 22.2% and the median overall survival (OS) was 80, 29, 17 and 3 months for BCLC 0-A/B/C/D respectively. OS was longer in those who achieved SVR. More than two thirds of patients with HCV-related HCC initiated and completed DAA therapies. This high level of treatment uptake has led to an acceptable cure rate. Treating patients with HCV and HCC should be viewed as an appropriate clinical standard to improve overall outcomes. However, DAA therapy should not be initiated in those with a short life expectancy.

Multiple sclerosis (MS) is a chronic, immune-mediated disorder that predominantly affects women, with an average age of onset between 20 and 50 years. As a result of the early age of onset and increasing life expectancies of women, owing to improvements in disease-modifying treatments (DMTs), recommendations regarding disease and symptom management may vary depending on their life stage and should be tailored to the individual. In addition, in recent years, new data regarding the management of MS from the preconception to postpartum period has led to evolving recommendations from both neuroimmunologists and national drug agencies alike. Similarly, an aging MS population has led to questions regarding the effect of menopause on MS and guidance regarding DMTs as patients age. The purpose of this review is to provide an up-to-date, comprehensive summary of the clinical course and management of the disease and commonly experienced symptoms during puberty, preconception and pregnancy, postpartum, menopause, and life after menopause.

Polycyclic aromatic hydrocarbons in PM2.5 and PM10 in Lagos, Nigeria: Sources, characteristics, and health risks.

Is there a compression of morbidity and does it vary across social strata among older European adults? A retrospective cohort study of two waves 15 years apart.

Venous thromboembolism is often underestimated in transfusion-dependent thalassemia (TDT) patients, as arterial thrombotic events are more commonly observed. Although therapeutic advancements have transformed this disease from a once-fatal childhood disease into a manageable chronic condition, some treatments may contribute to an increased risk of thrombosis. Additionally, the prolonged life expectancy of these patients further contributes to the overall thrombotic risk. Patients with thalassemia major present multiple challenges when considering anticoagulation therapy. The decision-making process is complicated by a delicate balance between thrombotic risk-driven by disease-related and treatment-associated factors-and potential bleeding tendencies, particularly in the presence of comorbid conditions such as liver dysfunction, hypersplenism, or thrombocytopenia. Therefore, ongoing assessment of both thrombotic and bleeding risk and the implementation of appropriate preventive strategies are essential to optimize patient outcomes. This document presents a consensus statement from the Steering Committee of the Hemostasis Working Group of the Hellenic Society of Hematology, offering guidance on thromboprophylaxis and anticoagulation management in adult TDT patients.

Quantifying lifetime productivity loss attributable to cigarette smoking in Taiwan.

A regional framework for the detection and management of ARIA with anti-amyloid therapies in early Alzheimer's disease in Asia.

The Era of Gene Therapy, Newborn Screening, and Improved Management in the Leukodystrophies: A Shifting Framework With Altered Expectations.