Year Of Life Research Articles

Exploring the experiences of traditional practitioners while managing hypertension in Rwanda

BackgroundHypertension (HTN) is a major global health concern, affecting approximately 1.28 billion adults worldwide. In Rwanda, hypertension contribute to 2.81 of the disability adjusted life years (DALYs) and 1.87% of hypertensive heart disease mortality. Traditional medicine remains popular in Africa with some herbal remedies which have shown antihypertensive properties. However, no study was done to explore traditional Practitioners’ approach to hypertension in Rwanda.ObjectiveTo explore the experience of traditional Practitioners while managing hypertension in Rwanda.MethodologyThis qualitative study utilized an ethnographic approach to explore the experience of traditional Practitioners (TPs) while managing HTN in Rwanda. Semi- structure interviews were conducted with 20 traditional Practitioners from three districts known for their popular use of traditional medicine in Rwanda. Participants were purposively selected, and interviews were guided by a pretested semi-structured interview guide in local language. Thematic analysis was used to generate the key themes.ResultsThree main themes emerged from analysis: first, traditional medicine is often undervalued by modern medical providers, resulting in limited collaboration and communication between traditional Practitioners and modern medical providers. Despite this, TPs are trusted by the community, often receiving referrals from patients dissatisfied with modern treatment. Second, TPs face challenges in diagnosing HTN due to lack of diagnostic tools, often relying on their observation, patients’ description of symptoms and patient’s response to treatment. TPs expressed desire for collaboration with modern medicine and access to diagnostic tools. Third, lack of legal framework and standardized practices for traditional medicine remains a challenge.ConclusionThe study highlights the need to promote collaboration between traditional and modern medicine in Rwanda. To enhance HTN management, we recommend training of traditional Practitioners, setting standardized practice and legal framework to guide traditional Practitioners in Rwanda as well as improving their access to HTN diagnostic tools.

Cost-Effectiveness Analysis of Adjuvant Pertuzumab and Trastuzumab in Human Epidermal Growth Factor Receptor 2-Positive Early Breast Cancer in Japan.

Human epidermal growth factor receptor 2 (HER2)-positive breast cancer presents considerable treatment challenges owing to its aggressive nature. Global guidelines have endorsed a full year of HER2-targeted therapy for early-stage breast cancer. However, previous cost-effectiveness analyses of dual HER2-targeted therapies have been limited. This study aimed to examine the cost effectiveness of dual HER2-targeted therapy for early-stage breast cancer within the Japanese healthcare system context. In the Markov model-based study, the cost effectiveness of dual anti-HER2 therapy, combining pertuzumab and trastuzumab, was assessed in comparison to trastuzumab monotherapy. Patients in whom treatment was initiated at a median age of 51 years were included. The study utilized quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) as comparison units. Subgroup analyses were conducted to explore variations in cost effectiveness, focusing on node-positive and node-negative patients. Both one-way deterministic and broader probabilistic sensitivity analyses using Monte Carlo simulations with 10,000 samples were performed from the Japanese healthcare payers perspective. Dual HER2-targeted therapy led to 0.17 QALYs increment at an additional cost of $US15,289, resulting in an ICER of $US92,232 per QALY. In the subgroup of node-positive patients, the benefit of the dual HER2-targeted therapy was more pronounced, with an increase of 0.64 QALYs and an ICER of $US24,561 per QALY. Sensitivity analyses revealed the model's susceptibility to changes in the transition probabilities from invasive disease-free survival to death, from invasive disease-free survival to first-line metastatic breast cancer, and to costs associated with pertuzumab. Probabilistic sensitivity analysis suggests that for node-positive patients, dual HER2-targeted therapy may be a cost-effective option. The economic viability of dual HER2-targeted therapy was most pronounced in patients with node-positive high-risk early breast cancer. This study highlights the potential of dual HER2-targeted therapy as a cost-effective addition for these cases.

Life years lost by childhood cancer treatment and health related late effects among childhood cancer survivors

BackgroundIdentifying risk factors contributing the most to mortality of childhood cancer survivors is essential to guide harm reduction efforts in childhood cancer treatments, and long-term follow-up of childhood cancer survivors. MethodsWe assessed Life Years Lost from childhood cancer treatments and their health-related late effects among the French Childhood Cancer Survivors Study, a cohort of 7670 5-year childhood cancer survivors. Using a landmark strategy, we also assessed time-varying effects of risk factors, and how the multi-morbidity affects life years lost. ResultsWe found subsequent malignant neoplasm (9.0 years [95 %CI: 4.3–13.7]), severe cardiac disease (8.0 years [95 %CI: 1.2–14.9]), and the use of radiotherapy (6.0 years [95 %CI: 4.7–7.3]) to be the highest contributors to Life Years Lost among childhood cancer survivors. We found no interaction impact on life years lost between health related late effects considered. ConclusionsThose findings suggest that radiotherapy is the root cause of early mortality among childhood cancer survivors. Moreover patients experiencing a subsequent malignant neoplasm or a cardiac disease should be monitored closely after the event, as comorbidity is common and causes premature deaths.

Child health, nutrition and gut microbiota development during the first two years of life; study protocol of a prospective cohort study from the Khyber Pakhtunkhwa, Pakistan

Recent evidence suggests that the development of gut microbiota during infancy affects several metabolic, immune, and endocrine pathways in humans. An imbalance in gut microbiota diversity or function, also known as dysbiosis, not only affects early child growth and development, but is also linked with the development of chronic, non-communicable diseases in later life. The Child Health And Microbiome Development Study – Pakistan (CHAMP) study aimed to longitudinally assess gut microbiota development and associated factors (maternal, child, and demographic) during early childhood in populations residing in malnutrition-endemic communities in Pakistan. A prospective cohort of mother-infant pairs (n=70) will be recruited from District Swat, Pakistan, and followed for two years. Complete information about demographic characteristics, anti-natal and post-natal care, dietary intake, feeding practices, and child health will be collected at baseline and 3, 6, 12, 18, and 24 months. Anthropometric measurements (height, weight, mid-upper arm circumference, and head circumference), dry blood spots, and fecal samples were also collected. Ethical approval for the study was obtained from Khyber Medical University, Pakistan. The study is also registered on clincaltrial.gov (Ref no: NCT05793294). The study findings will help researchers understand gut microbiota development, associated factors, and their impact on longitudinal growth in infants during the first two years of life.

Early life adverse environmental, nutrition and infection factors are associated with lower developmental scores in Pakistani children at 5 years: a cohort study

BackgroundThe effects of multiple early adverse psychosocial and biological factors on child development at preschool age in deprived settings are not fully understood.MethodsThe ‘Etiology, Risk Factors and Interactions of Enteric...

Cost-effectiveness analysis of trifluridine/tipiracil in the treatment of heavily pretreated metastatic gastric cancer from the perspective of Chinese healthcare system

ObjectivesThe aim of this study was to evaluate the cost-effectiveness of trifluridine/tipiracil (FTD/TPI) for heavily pretreated metastatic gastric cancer from the perspective of the Chinese healthcare system.DesignsBased on the overall...

Trends in Twin Births and Survival in Rural Spain: Evidence from 18th to 20th Century.

This study examines the changes over time of the twinning rate and infant and child mortality across 17 rural villages in the province of Zaragoza (Spain) over a span of 200 years. The aim is to understand how the twinning rate evolved in conjunction with the processes of economic and social modernization, as well as the demographic transition. During the period analyzed, the twinning rate increased by 10%, rising from 1.26 per 1000 births in the second half of the 18th century to 1.38 per 1000 births in the first half of the 20th century. This rate varied due to hereditary issues, biological factors such as the mother's age and parity, and socioeconomic features like family occupation and the mother's education level. In terms of child mortality, twins historically faced a significantly higher mortality rate. However, they benefited greatly from the mortality transition, at least in absolute numbers. While nearly 60% of twins did not survive beyond 5 years of age in earlier periods, the mortality rate for twins decreased to 40% by the first half of the 20th century. The excess mortality was particularly severe for girls, driven by a widespread preference for sons, which led to higher mortality rates for girls in the first 5 years of life, especially in the earliest months. These findings help us understand the improvements in uterine and childhood survival rates for contemporary twins, which can be attributed to the socioeconomic and medical advancements of the 20th century.

Mother-infant interactive processes and infant behavioral and vagal stress recovery: Associations at 3, 6, and 9 months of age.

Mother-infant interactive processes, including matching social behaviors and repairing interactive ruptures, are proposed to foster infant stress functioning. However, little is known about the extent to which the concurrent relations between these dyadic processes and infant behavioral and vagal stress recovery change over the first year of life. In this study, 116 mother-infant dyads (55 girls) from a midwestern city in the United States completed the still-face paradigm at 3, 6, and 9 months. Using microcoding of infant and maternal behaviors (i.e., facial expressions, vocalizations, and gaze directions), we defined two dyadic states (positive match and mismatch) and measured dyadic matching as a composite of (a) the proportion of positive match and (b) latency to interactive repair (i.e., the average duration of mismatches), for the play and reunion episode, separately, at each time point. Infant behavioral and vagal stress recovery were assessed as the proportion of social engagement during the reunion episode and increases in respiratory sinus arrhythmia from the still-face to reunion episodes, respectively. At 6 and 9 months, higher levels of dyadic matching during the play episode were related to better infant behavioral and vagal stress recovery, controlling for matching during the reunion episode. At 3 months, the relation only emerged for infant behavioral stress recovery. These findings suggest that the dynamics of mother-infant interaction may play a key role in infant stress recovery, particularly during the second half of the first year when infants become more actively engaged in social interactions and their vagal systems become more mature. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Analysis of Stroke Burden in China from 1990 to 2021 and Projections for the Next Decade.

This study aims to describe the temporal trends of stroke burden in different age and sex groups in China from 1990 to 2021, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and to compare these data with global figures. Using data from the Global Burden of Disease (GBD) database from 1990 to 2021, we analyzed changes in stroke burden in China and globally. The average annual percentage change (AAPC) was calculated using Joinpoint software to reflect trends. Stroke burden differences across various age groups and sexes were compared, and the ARIMA model was utilized for future projections. Between 1990 and 2021, the age-standardized incidence rate (ASIR) of stroke in China decreased from 226.938 to 204.753 per 100,000, while the global ASIR decreased from 180.973 to 141.553 per 100,000. The age-standardized prevalence rate (ASPR) in China increased from 1167.425 to 1301.42 per 100,000, whereas the global ASPR decreased from 1201.111 to 1099.31 per 100,000. The age-standardized mortality rate (ASMR) in China fell from 242.18 to 138.029 per 100,000, while the global ASMR decreased from 144.313 to 87.454 per 100,000. China's age-standardized DALY rate (ASDR) declined from 4834.791 to 2648.025 per 100,000, whereas the global ASDR decreased from 3078.952 to 1886.196 per 100,000. The AAPCs for ASIR, ASPR, ASMR, and ASDR in China were -0.370%, 0.326%, -1.793%, and -1.933%, respectively, compared to -0.291%, -0.807%, -1.601%, and -1.570% globally from 1990 to 2021. Age and sex significantly influenced the stroke burden, with higher incidence and mortality rates in males than in females. Projections for the next decade indicate that stroke incidence in China will remain stable, with an expected rise in ASPR, and declines in ASMR and ASDR. Globally, ASIR is expected to decline, while ASPR will rise, and ASMR and ASDR will continue to decrease. From 1990 to 2021, the incidence, mortality, and DALYs of stroke in China have decreased, while the prevalence has increased. Stroke burden is age-related, with higher prevalence in older adults and higher mortality in the elderly. Males are more susceptible to stroke and have a higher risk of death. Over the next decade, stroke prevalence in China is expected to rise, posing challenges due to population aging, even as mortality and disability rates decline. Sustained public health efforts will be necessary.

Global, regional, and national burden and trends of Low back pain in middle-aged adults: analysis of GBD 1990–2021 with projections to 2050

ObjectiveThis study aims to systematically evaluate the burden of low back pain(LBP) in the middle-aged population across global regions and between genders, assess the major risk factors and their impacts, and project the burden to 2050, providing a scientific basis for global preventive actions.MethodsThis study utilized The Global Burden of Disease(GBD) 2021 database. First, we integrated the population data of the 45–49, 50–54, and 55–59 age groups provided by the GBD using a weighted average method to calculate the Disability-adjusted life years(DALYs) rate for the middle-aged population aged 45 to 59 years. Subsequently, we analyzed the trends in the burden of LBP globally and across regions from 1990 to 2021, with a focus on stratified data by country, risk factors (e.g., high BMI), and gender. Finally, we employed the Bayesian Age-Period-Cohort(BAPC) model to predict future trends in LBP burden from 2021 to 2050.ResultsGlobally, from 1990 to 2021, the DALY rate for the 45–59 age group with LBP decreased from 875.45(95%UI: 534.57-1340.68) per 100,000 people to 747.92 (450.55-1,161.66), with an EAPC of -0.46 (95%UI: -0.50 to -0.43). Despite the decline in DALY rates, the total number of DALYs due to LBP increased from 5,515,080.64 (95%UI: 3,367,626.11–8,445,931.67) in 1990 to 9,816,401.64 (95%UI: 5,913,142.33–15,249,187.03) in 2021, a rise of 4,301,321. High Socio-Demographic Index (SDI) regions were the most affected, with a DALY rate of 933.03 (95%UI: 557.90–1,420.60) per 100,000 in 2021. Among risk factors, high BMI showed the most significant increase, with DALY rates rising from 153.64 (95%UI: 15.94–334.63) per 100,000 in 1990 to 209.09 (95%UI: 22.16–452.58) in 2021, and an EAPC of 1.08 (95%UI: 1.02 to 1.14). Gender differences revealed a DALY rate of 705.39 (95%UI: 431.21–1,078.96) per 100,000 for males and 803.62 (95%UI: 471.69–1,266.63) per 100,000 for females in 2021. Projections based on the BAPC model suggest that by 2050, global DALYs due to LBP will increase to 11,626,643.07, with females expected to account for 6,725,763.24 and males for 4,900,879.84, indicating a greater burden for females.ConclusionThis study highlights the global burden and trends of LBP in the middle-aged population. Although the DALY rate for the 45–59 age group decreased from 1990 to 2021, the total number of DALYs increased significantly due to population aging. In this context, the burden of LBP in low-middle SDI regions has remained largely unchanged and remains substantial, while high-SDI regions, despite some decline, continue to bear the highest overall burden. High BMI continues to contribute significantly to the rising LBP burden, particularly in middle-aged populations, and demands urgent attention. Gender differences indicate that females bear a greater LBP burden than males, with the gap widening over time. Effective preventive and intervention measures are urgently needed to mitigate the future burden of LBP.

Cost-effectiveness of radiofrequency echographic multi-spectrometry (REMS) for the diagnosis of osteoporosis in the United States

Abstract Radiofrequency echographic multi spectrometry (REMS) is an innovative, non-ionizing diagnostic technique that has shown high accuracy and precision, making it a promising alternative to dual-energy X-ray absorptiometry (DXA) for osteoporosis diagnosis in clinical settings. With economic considerations playing an increasingly crucial role in healthcare decisions, this study aims to evaluate the cost-effectiveness and economic impact of improved osteoporosis diagnosis using REMS followed by treatment in the United States (US). A microsimulation-based Markov model was constructed to estimate the cost per quality-adjusted life year (QALY) gained (in US$2022) for REMS followed by treatment versus no diagnosis and treatment in US women aged 50 years and older with osteoporosis. Women were categorized as high risk (receiving alendronate monotherapy for 5 years) or very high risk (receiving an 18-month course of anabolic treatment, abaloparatide, followed by 5 years of alendronate). The study evaluated two medication adherence scenarios: one assuming full adherence to treatment and the other reflecting real-world adherence. The results indicate that REMS followed by treatment is associated with improved health outcomes, including more QALYs and fewer fractures, and reduced fracture-related costs compared to no diagnosis and treatment. The incremental cost-effectiveness ratio of REMS was estimated at $33 891 and $49 198 per QALY gained, under the full adherence and real-world adherence scenarios, respectively. These values are below the US cost-effectiveness thresholds of $100 000 to $150 000 per QALY. Moreover, a 5% increase in the diagnosis and treatment of women over 50 years at high and very high risk of fractures using REMS is projected to save approximately 30 000 life years, 43 500 QALYs, and prevent 100 000 fractures over a lifetime under real-world medication adherence. In conclusion, this study suggests that REMS is a cost-effective strategy for the diagnosis and management of osteoporosis in US women, offering substantial potential economic benefits and improved health outcomes.

Mobile stroke units services in Germany: A cost-effectiveness modeling perspective on catchment zones, operating modes, and staffing.

Investigating the cost-effectiveness of future mobile stroke unit (MSU) services with respect to local idiosyncrasies is essential for enabling large-scale implementation of MSU services. The aim of this study was to assess the cost-effectiveness for varying urban German settings and modes of operation. Costs of different operating times together with different personnel configurations were simulated. Different possible catchment zones, ischemic stroke incidence, circadian distribution, rates of alternative diagnoses, as well as missed cases were incorporated to model case coverage and patient numbers. Based on internationally reported clinical outcomes of MSUs, a 5-year Markov model was applied to analyze the cost-effectiveness for the different program setups. Compared with standard stroke care, MSUs achieved an additional 0.06 quality-adjusted life years (QALYs) over a 5-year time horizon. Assuming a catchment zone of 750,000 inhabitants and 8 h/7 day operation resulted in an incremental cost-effectiveness ratio (ICER) of €37,182 per QALY from a societal perspective and €45,104 per QALY from a healthcare perspective. Lower ICERs were possible when coverage was expanded to 16 h service on 7 days per week and larger populations. Sensitivity analyses revealed that missing ischemic strokes significantly deteriorated economic performance of MSU. Major determinants of cost-effectiveness should be addressed when setting up novel MSU programs. Catchment zones of more than 500,000-700,000 inhabitants and operating times of at least 12-16 h per day, 7 days per week could enable the most cost-effective MSU services in the German healthcare system.

Loss in Overall and Quality-Adjusted Life Expectancy for Patients With Chronic-Phase Chronic Myeloid Leukemia.

The introduction of tyrosine kinase inhibitors has considerably improved the life expectancy (LE) for patients with chronic myeloid leukemia (CML). Evaluating health-related quality of life within the treatment pathway remains crucial. Using the Swedish CML register, we included 991 adult patients with chronic-phase (CP) CML diagnosed 2007 to 2017, with follow-up until 2018. We developed a multistate model to estimate the loss in LE (LLE) and loss in quality-adjusted life expectancy (LQALE) for the patient population compared to the general population, along with the respective proportions of losses relative to the general population. All patients with CP-CML had a relatively low reduced LE but with larger LQALE. The maximum LLE within age/sex subgroups was 5.7 years (general population LE: 43.2 years vs. CP-CML LE: 37.5 years) for females diagnosed at age 45 years, with LQALE of 12.0 quality-adjusted life years (QALYs) (general population QALE: 38.2 QALYs vs. CP-CML QALE: 26.3 QALYs). Across all ages, the proportions of LLE ranged from 9% to 15%, and the proportions of LQALE were 29% to 33%. Despite a low LLE, our findings reveal a greater LQALE for patients with CP-CML. Further improvements in management of CP-CML are thus warranted to successfully address the prevailing medical needs.

Cost-Effectiveness of Radiofrequency Renal Denervation for Uncontrolled Hypertension in Japan.

Radiofrequency renal denervation (RF RDN) is a novel therapy for uncontrolled hypertension. In the recent sham-controlled SPYRAL HTN-ON MED study, office-based systolic blood pressure (oSBP) and nighttime BP were reduced significantly. This study examined the cost-effectiveness of RF RDN in the context of the Japanese healthcare system based on this latest clinical evidence. Clinical events, costs, and quality-adjusted life-years (QALYs) were projected using a decision-analytic Markov model adjusted to Japanese incidence data. Risk reduction in clinical events from changes in oSBP was calculated based on a published meta-regression of 47 trials of intentional hypertension treatment. Demographics and results from the SPYRAL HTN-ON MED trial (oSBP effect size -4.9mmHg vs. sham) were utilized in the base case analysis. Additional scenarios were explored including the potential added benefit of improved night-time control. Costs were sourced from claims data and published literature. The incremental cost-effectiveness ratio (ICER) was evaluated against a cost-effectiveness threshold of ¥5000000 per QALY gained. RF RDN was projected to reduce clinical events (10-year relative risks: 0.80 for stroke, 0.88 for myocardial infarction, and 0.75 for heart failure). Over lifetime, RF RDN added 0.36 QALYs at the incremental cost of ¥923723, resulting in an ICER of ¥2565236 per QALY gained. Under the assumption of added night-time benefit, the ICER decreased to ¥2155895 per QALY. Cost-effectiveness findings were robust across all tested scenarios. The findings of this model-based analysis suggest that RF RDN can provide meaningful clinical event reductions and is a cost-effective treatment option in the Japanese healthcare system.

Short-Term Effects of an Outdoor Activities Intervention on Children’s Stress, Socio emotional, Behavioral, and Cognitive Regulation Skills

ABSTRACT Research Findings: In recent years, interest has grown in the potential benefits of outdoor activities (OA) for children’s development, particularly in promoting socioemotional, behavioral, and cognitive regulation skills and reducing stress. However, empirical evidence on the effects of OA programs for children in the first three years of life on these outcomes still needs to be provided. To address this gap, our study involved 95 infants and toddlers (girls = 48, M age = 23.3 months) attending child care centers in north and south Italy and their teachers. Participants were divided into two groups: the Outdoor group (n = 55), actively involved in the OA program for four months, and the Control group (n = 40), who followed the standard curriculum. We assessed the children’s cortisol levels and emotional, behavioral, and cognitive regulation skills before (T1) and after (T2) the implementation of the OA intervention. After the 4-month intervention, improvements in the children’s adaptive behavior (particularly in social interaction) and cognitive-behavioral regulation skills were observed only in the Outdoor group. Children’s stress levels remained stable. Practice or Policy: Our findings show the benefits of daily OA on young children’s self-regulation, suggesting to schools and families that increasing OA from the first years of life may support cognitive and social growth.

Response to amoxicillin and perampanel in infantile Alexander disease.

Type I Alexander disease (AxD) presents with paroxysmal neurodegeneration, refractory epilepsy, and encephalopathy in the first years of life and is associated with a poor prognosis. Although there is no treatment, mild symptomatic improvement has been reported in one case of adult Alexander treated with ceftriaxone, given its interaction with the mutant glial fibrillary acid protein (GFAP) responsible for the disease's pathogenesis. We describe a patient presenting with irritability starting at 2 months of age, initially attributed to gastroesophageal reflux. A ventriculoperitoneal shunt was placed at 3 months of age due to hydrocephalus secondary to aqueduct stenosis detected through an MRI scan, but the irritability persisted. At 5 months, a new brain MRI was performed due to irritability worsening, onset of abnormal ocular movements and seizures. In addition genetic testing was performed. AxD was diagnosed due to the mutation c.716G>A (p.Arg239His) in GFAP. Since irritability had worsened and had not responded to levomepromazine, treatment with amoxicillin (80 mg/kg/day) was attempted to modulate glutamate levels. The patient showed a striking improvement of irritability in 48 h that persisted over the next months. The patient had frequent daily seizures which did not respond to valproate, clonazepam, or phenobarbital. Perampanel, a postsynaptic AMPA receptor antagonist, was added to phenobarbital and he was seizure free for more than 3 months. Drugs modulating glutamate levels in the central nervous system, including β-lactam antibiotics and perampanel, may have an important role in the symptomatic treatment of AxD and other neurodegenerative diseases where glutamatergic excitotoxicity is a pathogenic determinant. PLAIN LANGUAGE SUMMARY: Alexander disease is a rare and serious condition that affects the brain, often leading to neurodegeneration (brain damage), seizures, and other problems in early childhood. The disease is caused by a mutation in a gene called GFAP. There is no cure, and current treatments mainly focus on relieving symptoms. This article discusses the case of a baby who showed signs of irritability and seizures from a young age. The baby was diagnosed with Alexander disease after brain scans and genetic testing. Despite treatment with various drugs, the baby continued to experience seizures and irritability. The doctors decided to try amoxicillin, a common antibiotic, because of its potential to help control the disease by affecting a brain chemical called glutamate. Surprisingly, the baby's irritability improved within 2 days of starting amoxicillin, and the improvement lasted for several months. However, the seizures persisted until another medication, perampanel, was added. This combination controlled the baby's seizures for over 3 months. Unfortunately, the baby passed away at 13 months due to complications from the disease. However, doctors believe that drugs like amoxicillin and perampanel could be promising treatments for managing symptoms of Alexander disease and other similar brain conditions in the future, especially where excess glutamate plays a role in the damage. This case suggests that these treatments may help control irritability and seizures, offering hope for better management of this challenging disease.

Morphofunctional Features of Glomeruli and Nephrons After Exposure to Electrons at Different Doses: Oxidative Stress, Inflammation, Apoptosis

Kidney disease has emerged as a significant global health issue, projected to become the fifth-leading cause of years of life lost by 2040. The kidneys, being highly radiosensitive, are vulnerable to damage from various forms of radiation, including gamma (γ) and X-rays. However, the effects of electron radiation on renal tissues remain poorly understood. Given the localized energy deposition of electron beams, this study seeks to investigate the dose-dependent morphological and molecular changes in the kidneys following electron irradiation, aiming to address the gap in knowledge regarding its impact on renal structures. The primary aim of this study is to conduct a detailed morphological and molecular analysis of the kidneys following localized electron irradiation at different doses, to better understand the dose-dependent effects on renal tissue structure and function in an experimental model. Male Wistar rats (n = 75) were divided into five groups, including a control group and four experimental groups receiving 2, 4, 6, or 8 Gray (Gy) of localized electron irradiation to the kidneys. Biochemical markers of inflammation (interleukin-1 beta [IL-1β], interleukin-6 [IL-6], interleukin-10 [IL-10], tumor necrosis factor-alpha [TNF-α]) and oxidative stress (malondialdehyde [MDA], superoxide dismutase [SOD], glutathione [GSH]) were measured, and morphological changes were assessed using histological and immunohistochemical techniques (TUNEL assay, caspase-3). The study revealed a significant dose-dependent increase in oxidative stress, inflammation, and renal tissue damage. Higher doses of irradiation resulted in increased apoptosis, early stages of fibrosis (at high doses), and morphological changes in renal tissue. This study highlights the dose-dependent effects of electrons on renal structures, emphasizing the need for careful consideration of the dosage in clinical use to minimize adverse effects on renal function.

Global health inequalities in the burden of interstitial lung disease and pulmonary sarcoidosis from 1990 to 2021

BackgroundInterstitial lung disease and pulmonary sarcoidosis remain serious medical problems worldwide. This study aims to assess the global burden and health inequalities of interstitial lung disease and pulmonary sarcoidosis between 1990 and 2021.MethodsData on disability-adjusted life years (DALYs) due to interstitial lung disease and pulmonary sarcoidosis were obtained from the Global Burden of Diseases, Injuries and Risk Factors Study 2021. The slope index of inequality (SII) and concentration index were used to assess cross-national health inequality.ResultsThere were 2,237,269 (95% uncertainty interval: 1,839,500 to 2,555,200) DALYs due to interstitial lung disease and pulmonary sarcoidosis in males and 1,804,881 DALYs (1,465,707 to 2,216,376) in females in 2021. The age-standardized DALY rate of interstitial lung disease and pulmonary sarcoidosis increased from 37.1 (30.6 to 45.4) per 100,000 in 1990 to 47.6 (41.3 to 53.2) per 100,000 in 2021. Countries with high socio-demographic index (SDI) showed the greatest increase in the age-standardized DALY rate of interstitial lung disease and pulmonary sarcoidosis during the past 32 years (53.4%, 45.1 to 62.2%). The SII increased from 19.6 (95% confidence interval: 11.6 to 27.5) in 1990 to 53.4 (39.7 to 67.1) in 2021. The concentration index increased from 0.15 (0.08 to 0.21) in 1990 to 0.23 (0.16 to 0.32) in 2021.ConclusionThe burden of interstitial lung disease and pulmonary sarcoidosis increased and remained high in the high-SDI quintile. More attention must be given to reducing the burden of interstitial lung disease and pulmonary sarcoidosis.

Particulate matter pollution and older adult health: global trends and disparities, 1991–2021

BackgroundParticulate matter pollution (PMP) is a major global health concern, with the older adult being particularly vulnerable. This study aimed to analyze global trends in PMP-related deaths and disability-adjusted life years (DALYs) among the older adult from 1991 to 2021.MethodsUsing data from the Global Burden of Disease Study 2021, we examined the impacts of ambient particulate matter pollution (APMP) and household air pollution from solid fuels (HAP-SF). We analyzed trends across different regions, socioeconomic development levels, age groups, and genders.ResultsAPMP-related older adult deaths increased from 1,745,000 to 3,850,000, and DALYs from 32,000,000 to 70,000,000. However, age-standardized mortality rate decreased from 384 to 337 per 100,000. HAP-SF-related deaths decreased from 2,700,000 to 2,100,000, and DALYs from 54,000,000 to 42,000,000. Age-standardized mortality rate for HAP-SF declined from 580 to 188 per 100,000. High APMP burden was concentrated in Asia, Africa, and the Middle East, while high HAP-SF burden was found in parts of Africa and South Asia. East Asia had the highest APMP-related older adult deaths (1,680,000) with an age-standardized mortality rate (ASMR) of 619 per 100,000. For HAP-SF, South Asia bore the heaviest burden with 1,020,000 deaths and an ASMR of 616 per 100,000. Females consistently experienced higher age-standardized DALYs rate than males for both APMP and HAP-SF across all regions and years. APMP burden showed a weak negative correlation with the Socio-demographic Index (SDI) at the regional level (r = −0.25, p < 0.001) but no significant correlation at the country level. HAP-SF burden exhibited strong negative correlations with SDI at both regional (r = −0.74, p < 0.001) and country levels (r = −0.83, p < 0.001).ConclusionDespite overall improvements, PMP continues to significantly impact older adult health globally, with substantial regional and gender disparities. These findings emphasize the need for targeted interventions, particularly in developing regions, and continued global efforts in air quality improvement and clean energy promotion.

Burden of major cancers in China attributable to modifiable risk factors: Predictions from 2012 to 2035.

The cancer burden continues to escalate in China. This study was designed to quantify the burden of deaths attributable to modifiable risk factors for major cancers in China from 2012 to 2035, and to provide evidence-based recommendations for cancer management. Using nationally representative data on risk factors and cancer mortality, a comparative risk assessment approach was employed to calculate the temporal trend of population-attributable fractions (PAFs) for 15 modifiable risk factors associated with major cancers in China. The PAF for modifiable risk factors decreased from 64.5% (95% uncertainty interval [UI]: 46.2%-75.3%) in 2012 to 59.3% (95% UI: 40.6%-71.2%) in 2035. Attributable deaths increased from 1,309,990 (95% UI: 938,217-1,529,170) in 2012 to 1,313,418 (95% UI: 898,411-1,577,189) in 2035, while attributable disability-adjusted life years (DALYs) rose from 28,488,120 (95% UI: 20,471,859-33,308,237) to 33,017,705 (95% UI: 22,730,814-39,564,735). Between 2012 and 2035, the top three risk factors contributing to cancer burden shifted from smoking, insufficient fruit intake and particulate matter <2.5 μm in diameter (PM2.5) exposure to smoking, physical inactivity, and inadequate fruit intake. Controlling modifiable risk factors at recommended levels by 2020 could have prevented around 890,000 deaths and 2.2 million DALYs by 2035. The proportion of cancer burden due to modifiable risk factors is projected to decrease, but the absolute number continues to rise. Adhering to an optimal lifestyle could prevent ~40% of cancer deaths by 2035. Key modifiable risk factors including smoking, physical inactivity, and insufficient intake of fruits require high attention.