Sedentary time and television viewing time are associated with an increased risk for all-cause mortality: A systematic review of systematic reviews.

Community acquired bacteremia in older adults: International and prospective infectious diseases-international research initiative (ID-IRI) study.

Aedes albopictus (Skuse) is a major mosquito vector in Southeast Asia, especially in livestock farm environments. This study evaluated the susceptibility of laboratory and field-collected (Songkhla Province) Ae. albopictus to commercial insecticides. Laboratory colony and field population were tested against temephos larvicides, mosquito coils, and aerosol sprays following WHO protocols. Larvicidal efficacy and persistence were assessed in semifield conditions, while adult knockdown and mortality were measured in controlled assays. Both laboratory colony and field population exhibited high initial susceptibility to temephos (97.5-100% mortality), but residual efficacy declined rapidly, reaching 0-27% by 30 days. All adulticides achieved 100% mortality. Knockdown times (KT50) ranged 0.58-2.52 min for mosquito coils and 1.09-2.29 min for aerosol sprays. The coil containing 0.03% metofluthrin showed the fastest knockdown (KT50 = 0.58 min laboratory, 1.37 min field). Commercial insecticides remain effective against Ae. albopictus in livestock farm settings. However, rapid temephos degradation highlights the need for more frequent larvicide applications or the use of persistent formulations. Integrated approaches combining chemical and nonchemical interventions are recommended to optimize vector control and delay resistance development.

Depressive symptoms are common among adults with diabetes and are associated with adverse clinical outcomes, including mortality. Evidence from general populations suggests that physical activity (PA) and diet quality (DQ) may have a joint relationship with mental health and survival; however, evidence focusing specifically on adults with diabetes remains comparatively sparse. We analyzed data from 3451U.S. adults with diabetes in the NHANES 2007-2018 dataset. Depressive symptoms were assessed at the baseline examination using the Patient Health Questionnaire-9 (PHQ-9 score≥10), and all-cause mortality was ascertained through linkage to the National Center for Health Statistics linked mortality files up to December 31, 2019. PA (MET-min/week) and DQ (Healthy Eating Index-2015 [HEI-2015]) were examined using survey-weighted logistic regression for prevalent depressive symptoms and survey-weighted Cox proportional hazards models for subsequent mortality, with restricted cubic splines to assess dose-response relationships. Multiplicative and additive interactions between PA and DQ were evaluated. Additionally, complementary machine learning analyses were conducted to evaluate predictive performance and feature contributions. Higher PA and better DQ were generally associated with lower odds of depressive symptoms and lower hazards of all-cause mortality. A combined favorable PA and DQ profile was also associated with more favorable outcomes. PA showed a nonlinear inverse association with depressive symptoms, with lower predicted probabilities around 2000-3000 MET-min/week, whereas HEI-2015 did not demonstrate a nonlinear association. These findings highlight the potential importance of integrated lifestyle behaviors in relation to mental health and survival among adults with diabetes.

Patients with severe traumatic brain injury (TBI) are at risk of developing nonneurologic organ dysfunction. Acute kidney injury (AKI) has been associated with morbidity and mortality in adults with TBI, but the prevalence in children is poorly described. The objective of this study was to determine the prevalence of AKI among a multiinstitutional, international cohort of children with severe TBI and to explore the association of AKI with outcomes. An unplanned, secondary exploratory analysis of the Approaches and Decisions for Acute Pediatric TBI (ADAPT) study. Fifty-one institutions participating in ADAPT. Children with severe TBI who underwent intracranial pressure monitoring and were admitted to a participating institution from 2014 to 2017. None. AKI was considered to have occurred when a patient met either the ADAPT definition of AKI or the Kidney Disease: Improving Global Outcomes (KDIGO) AKI criteria. The daily urine output and worst creatinine within the first 12 hours of admission were reviewed to determine who met KDIGO criteria. One thousand children were included and 160 children (16%) had AKI. Of these, stage 1 AKI occurred in 78 of 160 patients (48%), stage 2 in 65 of 160 patients (41%), and stage 3 AKI in 17 of 160 patients (11%). After adjusting for covariates in regression analyses, AKI was associated with an increase in hospital length of stay (LOS) and a worse Glasgow Outcome Scale Extended-Pediatrics score, but we failed to identify an association with longer PICU LOS or prevalence of mortality. In the ADAPT cohort, AKI was present in 16% of cases. Although we found an association between AKI and two clinically important secondary outcomes, more contemporary studies are needed to better characterize AKI in children with severe TBI and to determine whether strategies aimed at preventing AKI can improve patient-centered outcomes.

Reliable biomarkers may allow early risk stratification for mortality in older adults. Post-translational modification-derived products (PTMDPs), such as homocitrulline, and the tissue accumulation of advanced glycation end products (AGEs), measured by skin autofluorescence, have been suggested as potential biomarkers of adverse outcomes in older and frail individuals. The aim of this study was to assess their association with 3-year mortality following hospitalisation. We followed a cohort of 250 hospitalised patients over 3years. Serum PTMDPs (homocitrulline, carboxymethyllysine, pentosidine, and MG-H1) were measured using liquid chromatography coupled with tandem mass spectrometry, and AGEs were quantified by skin autofluorescence. We examined associations with mortality using bivariable analyses and a multivariable Cox regression model. An exploratory cut-off for homocitrulline was established at the third quartile of its distribution within the study population. During follow-up, 92 deaths occurred. In bivariable analyses, all biomarkers were associated with mortality. In the multivariable model, homocitrulline levels of >400 μmol/mol Lys were significantly associated with mortality (hazard ratio 1.73, 95 % confidence interval 1.06-2.82), after adjustment for age, frailty, and comorbidities. The model's predictive performance, with an area under the curve (AUC) of 0.76, was only slightly affected by the exclusion of homocitrulline (AUC=0.755). These results indicate that although elevated homocitrulline was independently associated with mortality, its incremental value for risk prediction was modest. Larger studies are needed to further evaluate the clinical utility of PTMDPs, especially homocitrulline, for risk prediction and clinical decision-making.

Even single-domain decline in physical performance predicts short- and long-term mortality in older adults.

Stage-dependent susceptibility of the ring-legged earwig Euborellia annulipes to entomopathogenic nematodes and diatomaceous earth.

Heart failure (HF) is the leading cause of morbidity and mortality in adults with congenital heart disease (ACHD), yet evidence-based pharmacological options remain limited. Sodium-glucose cotransporter 2 inhibitors (SGLT2I) have demonstrated robust benefits across the heart failure spectrum in acquired cardiovascular disease. This review is summarizing emerging data on the use of SGLT2I in ACHD, a population characterized by unique pathophysiology and unmet therapeutic needs. Recent literature, predominantly comprising case reports, retrospective cohorts, and small prospective studies, suggests that SGLT2I are generally safe and well tolerated in adult congenital heart disease heart failure (ACHD-HF). Across heterogeneous ACHD populations, including those with a systemic right ventricle (SRV) and Fontan circulation, SGLT2I use has been associated with improvements in natriuretic peptides, functional status, exercise capacity, and reductions in HF hospitalizations. Early data support favourable safety and low discontinuation rates. The use of SGLT2I in ACHD-HF is feasible, well tolerated and with potential clinical benefit. Further ACHD-specific randomized clinical trials to define efficacy, optimal patient selection, and long-term outcomes are warranted.

Entomopathogenic fungi such as Beauveria bassiana are promising biocontrol agents against the desert locust, Schistocerca gregaria, but their performance is strongly influenced by temperature and relative humidity (RH). In this study, native B. bassiana isolates recovered from soils in Isiolo and Laikipia Counties, Kenya, were molecularly identified and evaluated under factorial combinations of temperature (20, 25, 30, and 35°C) and RH (50, 75, and 90%) to determine their effects on conidial germination, vegetative growth, sporulation, and pathogenicity against adult S. gregaria. Three native isolates and six conidial formulations were assessed, comprising oil-based, whey-based, and diatomaceous earth (DE)-based carriers. Temperature, RH, and their interaction significantly influenced all measured traits (p < 0.0001). Vegetative growth and sporulation were highest at 25-30°C and 90% RH. Across environmental treatments, isolate 341 consistently showed the highest germination and vegetative growth, followed by isolate 334, whereas differences among isolates were less pronounced under optimal conditions (25-30°C) than at thermal extremes (20°C and 35°C). Among formulations, oil-based products consistently outperformed whey-based and DE-based formulations in germination, vegetative growth, sporulation, and insect mortality (p < 0.05). Adult mortality at 14 days ranged from 57.8% to 100%, with the shortest median lethal time (LT₅₀) recorded at 30°C and 90% RH. Overall, the findings demonstrate that the performance of native B. bassiana isolates and formulations is strongly modulated by temperature, RH, and carrier type under controlled conditions. These results provide a basis for selecting promising isolate-formulation combinations for further validation under field-relevant conditions.

Joint Association of Healthy Behaviors and Grip Strength With All-Cause Mortality Among European Middle-Aged and Older Adults: A 16-Year Cohort.

Association between socioeconomic and health variables and community-acquired pneumonia mortality rates in Chile from 1990 to 2021.

Association of depression severity and transition patterns of cardiometabolic multimorbidity.

BackgroundThe association between aspirin and mortality in patients with sepsis remains unclear. This study aimed to systematically evaluate the effects of aspirin on mortality and major bleeding in adults with sepsis.MethodsThis review was registered in Open Science Framework (DOI: 10.17605/OSF.IO/E5K87). We searched MEDLINE, Embase, CENTRAL, ICTRP, and ClinicalTrials.gov through May 9, 2025. We included one randomized controlled trial (RCT) and four non-randomized studies of interventions (NRSIs). Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for NRSIs. Random-effects meta-analysis was performed.ResultsFive studies involving 25 138 patients were included. Aspirin showed a possible reduction in mortality (RR 0.77, 95% CI 0.66-0.89; I2 = 61.9%), but the certainty of evidence was very low. No clear effect was observed on major bleeding (OR 1.20, 95% CI 0.46-3.11; I2 = 77.3%), also with very low certainty. Data for secondary outcomes (SOFA score, ICU length of stay) was sparse and very uncertain. Subgroup analyses showed no evidence of effect modification by aspirin timing or treatment setting, and sensitivity analyses limited to Sepsis-3 studies and exclusion of Wang et al produced similar results. Evidence was limited by the predominance of NRSIs, heterogeneity in sepsis definitions, and variability in dosing and timing of aspirin.ConclusionsThe evidence is very uncertain regarding the effect of aspirin on mortality or bleeding in sepsis. Routine aspirin use for patients with sepsis cannot be recommended. For patients already receiving aspirin before hospitalization, continuation should be guided by clinical judgment. Further high-quality RCTs are warranted.

Diagnostic uncertainty in sepsis contributes to both undertreatment (delayed antibiotics) and overtreatment (unnecessary early antibiotics in non-sepsis patients). We hypothesized hospitals with high relative performance on sepsis undertreatment and overtreatment measures have improved patient outcomes. We conducted a retrospective cohort study of hospitalized adults at 20 hospitals (Advocate Health, Michigan Medicine) between 2022-2024. Patients met ≥2 systemic inflammatory response syndrome criteria within 6 hours of presentation. Hospital-level diagnostic performance was characterized using risk-standardized rates (RSR) for undertreatment and overtreatment. "Diagnostic Excellence" (DxEx) was prespecified as top-tertile performance in one measure without bottom-tertile performance in the other. The primary outcome was hospital mortality or hospice discharge. Secondary outcomes were hospital-free days alive at 28 days (HFD), length of stay (LOS), and total antibiotic days. Among 152,779 patients, 49,109 (32.1%) received antibiotics within 3 hours and 16,361 (10.7%) ultimately met sepsis criteria. Undertreatment RSRs ranged 29.3%-46.8%. Overtreatment RSRs ranged 21.5%-37.2%. There was negative correlation between performance ranks (τ=-0.51, p=0.01). Four hospitals met DxEx criteria. Receiving treatment at DxEx hospitals was associated with lower odds of hospital mortality or hospice discharge (adjusted OR=0.61, 95% Confidence Interval [95%CI]=0.41-0.90; p=0.01), greater HFD (adjusted difference=0.59, 95%CI=0.04-1.14; p=0.04), reduced LOS (adjusted difference=-1.20, 95%CI=-2.23- -0.17; p=0.02), and fewer antibiotic days (adjusted difference=-0.62, 95%CI=-1.28-0.05; p=0.07), versus non-DxEx hospitals. Hospital performance that jointly minimizes sepsis undertreatment and overtreatment was associated with improved patient outcomes, after adjustment for patient and hospital factors. These findings highlight the importance of reducing diagnostic error in efforts to improve sepsis outcomes.

Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in older adults in Japan. Prolonged hospitalisation accelerates functional decline, promotes the progression of frailty and increases the need for long-term care. An early switch from intravenous to oral antibiotics helps achieve clinical outcomes comparable to those of continued intravenous therapy while shortening hospital stays. For older adults with frailty, avoiding unnecessary hospitalisation may help prevent further deterioration of functional status. Demonstrating non-inferiority of oral antibiotics for clinical cure would help clinicians recommend the use of switch therapy to shorten hospital stay and improve functional outcomes in this high-risk population. This study aimed to evaluate the non-inferiority of lascufloxacin switch therapy to intravenous ampicillin/sulbactam in older adults with frailty and CAP. This multicentre randomised open-label trial enrols older adults with mild to moderate CAP and frailty according to the Frailty Screening Index. Participants will be randomised using minimisation with the Age, Dehydration, Respiratory Failure, Orientation Disturbance and Low Blood Pressure score and Frailty Screening Index as allocation factors to receive either lascufloxacin switch therapy or ampicillin/sulbactam intravenous. The primary endpoint is the clinical cure rate at the test of cure. Secondary endpoints include early clinical response, end-of-treatment response, hospital stay, medical costs, clinical stability, 30-day mortality or recurrence and microbiological outcomes. The planned sample size is 80 patients per group. This study was approved by the Certified Review Board of Nagasaki University, Japan. These results will be disseminated through scientific presentations and publications. jRCTs071250072 (https://jrct.mhlw.go.jp/en-latest-detail/jRCTs071250072).

<sec><title>BACKGROUND</title>TB meningitis (TBM) is the most severe form of extra-pulmonary TB. This study evaluated the efficacy and safety of adjunctive steroid therapy in TBM.</sec><sec><title>METHODS</title>We searched PubMed/MEDLINE, Embase, and Cochrane CENTRAL for controlled trials of steroids in TBM. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for mortality, neurological complications, functional recovery, and adverse events.</sec><sec><title>RESULTS</title>Fourteen trials with 2,028 patients were included. Steroids reduced mortality in adults (RR = 0.83; 95% CI: 0.72-0.95) but not in children (RR = 0.68; 95% CI: 0.36-1.29). No significant benefit was seen for neurological complications (RR = 1.03; 95% CI: 0.74-1.44) or functional recovery (RR = 1.16; 95% CI: 0.86-1.57). Results were consistent across steroid types, doses, and routes.</sec><sec><title>CONCLUSION</title>Adjunctive steroids reduce mortality in adult TBM but not in children, nor do they improve neurological or functional outcomes.</sec>.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are a major cause of morbidity, hospitalization, and short-term mortality in older adults. Growing evidence suggests that aging-related immune remodeling and immune-inflammatory vulnerability (IMV) substantially contribute to biological heterogeneity, susceptibility, and adverse outcomes in this population. However, clinically applicable tools that quantitatively capture this multidimensional biological vulnerability remain limited. This study aimed to develop and externally validate an Immune-Inflammatory Vulnerability Index, hereafter referred to as IAS, conceptualized as a biologically informed index of IMV, to support immune phenotype stratification and short-term risk assessment in older adults hospitalized with AECOPD. In this prospective observational cohort study, 219 patients aged ≥ 60 years hospitalized for AECOPD were enrolled in the derivation cohort, and 136 independent patients from an external center were included for validation. Immune phenotyping was performed within 48h of admission, including PD-1⁺CD4⁺ T cells, CD28⁻CD8⁺ T cells, and serum interleukin-6 (IL-6). IAS was constructed using biologically prespecified immune biomarkers with LASSO-based coefficient weighting, using infection-related versus non-infection-related AECOPD as a supervised biological contrast to enhance immune phenotype differentiation rather than as a direct predictive endpoint. Primary objectives were to evaluate IAS for immune phenotype stratification and to assess its associations with predefined short-term clinical outcomes, specifically 30-day readmission and 90-day all-cause mortality. IAS demonstrated strong immune phenotype stratification performance for distinguishing infection-related from non-infection-related AECOPD, with an area under the curve (AUC) of 0.842 (95% CI: 0.771-0.901) in the derivation cohort and 0.826 (95% CI: 0.754-0.885) in the external validation cohort. For prediction of 90-day all-cause mortality, IAS achieved an AUC of 0.824 (95% CI: 0.750-0.890). Higher IAS was independently associated with increased 30-day readmission, prolonged hospitalization, and elevated 90-day mortality risk after adjustment for age, disease severity, and established clinical risk scores (adjusted HR = 3.42, 95% CI: 2.01-5.82). Sensitivity analyses showed that IAS outperformed IL-6 alone and retained discriminatory capacity even after exclusion of IL-6, supporting its broader immune-inflammatory relevance beyond acute inflammatory burden. Longitudinal analyses demonstrated partial remission-associated declines in IAS, consistent with state-responsive biological vulnerability rather than a fixed immune-aging trait. IAS is a biologically informed, geriatric-oriented index of IMV that integrates aging-related immune remodeling with dynamic inflammatory responses in older adults with AECOPD. Rather than serving as a definitive measure of fixed immune-aging burden or as a dedicated infection classification tool, IAS provides a quantitative framework for biologically relevant immune-inflammatory vulnerability stratification and short-term prognostic assessment. Further prospective multicenter studies are warranted to refine clinical applicability, evaluate implementation feasibility, and improve translational potential before routine clinical adoption can be recommended.

Sleep disturbances are common in older adults and may be associated with frailty, malnutrition, sarcopenia, and adverse outcomes. This study aimed to evaluate the relationship between sleep quality and comprehensive geriatric assessment parameters and to investigate whether poor sleep quality is independently associated with 12-month mortality. This retrospective observational study included 1058 adults aged ≥ 65 years who underwent a comprehensive geriatric assessment. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Participants were categorized as having good or poor sleep quality. Demographic characteristics, comorbidities, geriatric syndromes, and assessment parameters were compared between groups. Correlations between PSQI and geriatric measures were analyzed using Spearman's correlation. Kaplan-Meier analysis and multivariable Cox regression were used to assess 12-month mortality. Of the 1058 participants, 641 (60.6%) had good sleep quality and 417 (39.4%) had poor sleep quality. Poor sleep quality was associated with older age, female sex, higher mortality, greater frailty and sarcopenia risk, polypharmacy, worse nutritional status, lower handgrip strength, poorer physical performance, and higher frequencies of dementia, depression, and falls (all p < 0.05). PSQI correlated significantly with all geriatric assessment parameters (all p < 0.01). In multivariable Cox regression, higher PSQI remained independently associated with increased 12-month mortality (hazard ratio = 1.222, 95% confidence interval 1.113-1.341; p < 0.001). Poor sleep quality is associated with multidimensional geriatric vulnerability and is independently associated with 12-month mortality in older adults.

Severe burns lead to intense and prolonged systemic inflammation and high rates of organ failure and major complications such as acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and mortality. Although corticosteroids have shown benefits in various critical care settings, no adequately powered randomized controlled trial has yet evaluated their effect in burn patients. The DEXA-BURN trial aims to assess whether early administration of dexamethasone reduces the incidence of major complications (moderate-to-severe ARDS or stage 2-3 AKI) and all-cause mortality in adults with severe burns. DEXA-BURN is a multicenter, randomized, placebo-controlled, double-blind trial conducted in 10 French intensive care units. Adult patients with ≥ 20% total body surface area (TBSA) burns, admitted within 24h of injury and requiring mechanical ventilation, will be randomized (1:1) to receive either dexamethasone (0.2mg/kg/day IV for 5days) or placebo. Two endpoints are pre-specified and evaluated using a hierarchical testing strategy: (1) major complications within 28days (moderate-to-severe ARDS or AKI KDIGO stages ≥ 2); and, if statistically significant, (2) all-cause mortality at day 90. Secondary endpoints include nosocomial infections, ventilator-free days, intensive care unit /hospital stay, CRP trajectory, and steroid-related adverse events. A total of 478 patients will be enrolled. Analyses will follow the intention-to-treat and modified intention-to-treat principle. This trial will provide high-quality evidence on the effectiveness and safety of corticosteroid therapy in the acute management of severely burned patients. Findings may inform future guidelines and improve critical care practices for this understudied population with a high risk of mortality. EudraCT: 2024-517708-12-00; ClinicalTrials.gov: NCT06968559. Registered on April 22, 2025.