Reduction In Mortality Research Articles

Reproductive Justice & Women’s Human Rights

This paper argues that women must have as much sovereignty over their own bodies, and decisions effecting their health and well-being as men have over theirs. Conditions for reproductive justice are foundational for women’s human rights. Reproductive justice includes access to abortion, and to pre- and post-natal care, decisions regarding the spacing of pregnancies and whether or not to have children, reductions in infant and maternal mortality, and appropriate conditions for the successful and healthful care and raising of children. From this point of view reproductive justice and women’s human rights are intertwined with the abolition of colonialism, neo-colonialism, racism, poverty, and war, and a recognition of women’s full humanity.

Potential effects of beta-blockers in HFpEF.

Heart failure with preserved ejection fraction (HFpEF) poses a significant challenge in contemporary medicine, characterized by poor quality of life, high healthcare costs, and increased mortality. Despite advancements in medical research, treatment strategies for HFpEF remain elusive, with unclear guidance on the use of beta-blockers. While sympathetic overstimulation is common in HFpEF, beta-blockers, though potentially beneficial in reducing sympathetic activity, may exacerbate chronotropic incompetence and decrease exercise tolerance. Additionally, their impact on outcomes in HFpEF patients with concurrent atrial fibrillation is uncertain. Some studies suggest the potential benefits of beta-blockers on diastolic function, yet evidence on clinical endpoints remains inconclusive. Recent research indicates a potential reduction in all-cause mortality with beta-blocker use in HFpEF, although their effect on combined mortality or HF hospitalizations is less clear. Moreover, beta-blocker efficacy may vary depending on ejection fraction subgroups, with more favorable outcomes observed in HFmrEF compared to HFpEF. Current literature underscores the need for large-scale randomized clinical trials to clarify the role of beta-blockers in HFpEF management. Given the limitations of existing evidence, future research is essential to inform updated treatment guidelines and therapeutic protocols tailored to the contemporary clinical landscape.

Toxic epidermal necrolysis: management strategies in burns units.

The most common severe exfoliative condition is toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, for which patients may sometimes require admission to hospital burns units. This study analyses the experience of the authors and results in this condition at the Cruces University Hospital in Bilbao, Spain. Over the last 22 years, the authors carried out a retrospective analytical observational study of TEN cases at the hospital and analysed risk factors including age, associated comorbidities, percentage of body surface area affected, positive bacterial culture, and treatment strategies used to assess their potential influence on prognosis. The results indicated an association between mortality and age (ρ (rho)=0.60, 95% CI [0.29, 0.79], p<0,001), ocular (ρ=0.58, 95% CI [0.28, 0.78], p<0.001), oropharyngeal (ρ=0.64, 95% CI [0.36, 0.81], p<0.001), genitourinary (ρ=0.58 CI [0.28, 0.78], p<0.001) respiratory mucosa involvement (ρ=0.53, 95 % CI [0.28, 0.78], p<0.001) and bacteraemia (ρ=0.44, 95% CI [0.17, 0.64], p=0.020). Bacteraemia also showed a higher incidence in elderly patients (ρ=0.4, 95% CI [0.03, 0.67], p=0.033) and in those with a higher Score for Toxic Epidermal Necrolysis at admission (ρ=0.51, CI [0.17, 0.74], p=0.006). A reduction in mortality was found in patients who received systemic treatment; cyclosporine, etanercept or a combination of both (ρ=-0.44, Cl [-0.70, -0.09], p=0.018). TEN is a rare but serious exfoliative condition. Traditionally, management of denuded skin was seen as the main prognostic factor; yet, systemic damage, especially to the respiratory mucosa, significantly increases mortality risk. While life support is crucial and recovery is possible, preventing long-term sequelae relies on effective care protocols. Current treatments may offer benefits, though their efficacy remains unclear. Clinicians in burns units should develop standardised protocols and collaborate on long-term studies to enhance patient care.

A multicriteria analysis of meat and milk alternatives from nutritional, health, environmental, and cost perspectives

Reducing meat and dairy intake has been identified as a necessary strategy for mitigating the high environmental impacts food systems are currently having on climate change, biodiversity loss associated with land-use changes, and freshwater use. Having a choice of dedicated meat and milk replacements available to consumers can help in the transition toward more plant-based diets, but concerns about nutritional and health impacts and high costs can impede uptake. Here, we conduct a multicriteria assessment of 24 meat and milk alternatives that integrates nutritional, health, environmental, and cost analyses with a focus on high-income countries. Unprocessed plant-based foods such as peas, soybeans, and beans performed best in our assessment across all domains. In comparison, processed plant-based products such as veggie burgers, traditional meat replacements such as tempeh, and plant milks were associated with less climate benefits and greater costs than unprocessed foods but still offered substantial environmental, health, and nutritional benefits compared to animal products. Our findings suggest that a range of food products exist that when replacing meat and dairy in current diets would have multiple benefits, including reductions in nutritional imbalances, dietary risks and mortality, environmental resource use and pollution, and when choosing unprocessed foods over processed ones also diet costs. The findings provide support for public policies and business initiatives aimed at increasing their uptake.

Long-Term Cardiovascular Disease Outcomes Following Bariatric Surgery

IntroductionThe long-term cardiovascular benefits of bariatric surgery remain unclear. We aimed to analyze the association between bariatric surgery and cardiovascular disease outcomes. MethodsThe Maryland Health Services Cost Review Commission database (2015-2022) was queried for patients aged 15 to 84 y with obesity. Bariatric surgery patients were matched with nonsurgical patients using propensity score matching. Primary outcomes included all-cause mortality, new-onset heart failure (HF), myocardial infarction (MI), and ischemic stroke. A subgroup analysis of outcomes based on age, sex, diabetes, and smoking status was performed. ResultsA total of 222,700 patients met the inclusion criteria. 104,855 (47.09%) bariatric and 117,845 (52.90%) nonsurgical patients were analyzed. Bariatric surgery was associated with reduced risk of all-cause mortality 12.1 versus 15.7 per 1000 person-years (hazard ratio [HR] = 0.77, 95% confidence interval [CI] = 0.73-0.79, P < 0.001), HF (HR = 0.63, 95% CI = 0.69-0.67, P < 0.001), MI (HR = 0.69, 95% CI = 0.63-0.74, P < 0.001), and stroke (HR = 0.75, 95% CI = 0.69-0.80, P < 0.001). The association between bariatric surgery in the obese population and the improvement in cardiovascular outcomes was significantly pronounced in the pre-existing diabetes mellitus (DM) group compared to the non-DM group in terms of all-cause mortality, HF, and MI (adjusted HR = 0.59, 0.62, 0.59 respectively, P < 0.05). Bariatric surgery was also associated with a statistically significant reduction in all-cause mortality, MI, and stroke in smokers compared to nonsmokers (adjusted HR = 0.61, 0.59, 0.59 respectively, P < 0.05). ConclusionsOur study demonstrates a statistically significant association between bariatric surgery and improvement in long-term cardiovascular outcomes and reduction in all-cause mortality in the obese population following bariatric surgery.

Global, regional, and national burden of HIV/AIDS, 1990-2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021.

As set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV in 204 countries and territories and forecast HIV incidence, prevalence, and mortality up to 2050 to allow countries to plan for a sustained response with an increasing number of people living with HIV globally. We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 analytical framework to compute age-sex-specific HIV mortality, incidence, and prevalence estimates for 204 countries and territories (1990-2021). We aimed to analyse all available data sources, including data on the provision of HIV programmes reported to UNAIDS, published literature on mortality among people on antiretroviral therapy (ART) identified by a systematic review, household surveys, sentinel surveillance antenatal care clinic data, vital registration data, and country-level case report data. We calibrated a mechanistic simulation of HIV infection and natural history to available data to estimate HIV burden from 1990 to 2021 and generated forecasts to 2050 through projection of all simulation inputs into the future. Historical outcomes (1990-2021) were simulated at the 1000-draw level to support propagation of uncertainty and reporting of uncertainty intervals (UIs). Our approach to forecasting utilised the transmission rate as the basis for projection, along with new rate-of-change projections of ART coverage. Additionally, we introduced two new metrics to our reporting: prevalence of unsuppressed viraemia (PUV), which represents the proportion of the population without a suppressed level of HIV (viral load <1000 copies per mL), and period lifetime probability of HIV acquisition, which quantifies the hypothetical probability of acquiring HIV for a synthetic cohort, a simulated population that is aged from birth to death through the set of age-specific incidence rates of a given time period. Global new HIV infections decreased by 21·9% (95% UI 13·1-28·8) between 2010 and 2021, from 2·11 million (2·02-2·25) in 2010 to 1·65 million (1·48-1·82) in 2021. HIV-related deaths decreased by 39·7% (33·7-44·5), from 1·19 million (1·07-1·37) in 2010 to 718 000 (669 000-785 000) in 2021. The largest declines in both HIV incidence and mortality were in sub-Saharan Africa and south Asia. However, super-regions including central Europe, eastern Europe, and central Asia, and north Africa and the Middle East experienced increasing HIV incidence and mortality rates. The number of people living with HIV reached 40·0 million (38·0-42·4) in 2021, an increase from 29·5 million (28·1-31·0) in 2010. The lifetime probability of HIV acquisition remains highest in the sub-Saharan Africa super-region, where it declined from its 1995 peak of 21·8% (20·1-24·2) to 8·7% (7·5-10·7) in 2021. Four of the seven GBD super-regions had a lifetime probability of less than 1% in 2021. In 2021, sub-Saharan Africa had the highest PUV of 999·9 (857·4-1154·2) per 100 000 population, but this was a 64·5% (58·8-69·4) reduction in PUV from 2003 to 2021. In the same period, PUV increased in central Europe, eastern Europe, and central Asia by 116·1% (8·0-218·2). Our forecasts predict a continued global decline in HIV incidence and mortality, with the number of people living with HIV peaking at 44·4 million (40·7-49·8) by 2039, followed by a gradual decrease. In 2025, we projected 1·43 million (1·29-1·59) new HIV infections and 615 000 (567 000-680 000) HIV-related deaths, suggesting that the interim 2025 targets for reducing these figures are unlikely to be achieved. Furthermore, our forecasted results indicate that few countries will meet the 2030 target for reducing HIV incidence and HIV-related deaths by 90% from 2010 levels. Our forecasts indicate that continuation of current levels of HIV control are not likely to attain ambitious incidence and mortality reduction targets by 2030, and more than 40 million people globally will continue to require lifelong ART for decades into the future. The global community will need to show sustained and substantive efforts to make the progress needed to reach and sustain the end of AIDS as a public threat. The Bill & Melinda Gates Foundation and the National Institute of Allergy and Infectious Diseases.

Bioactive peptides inhibit feeding activity in the grey garden slug, Deroceras reticulatum.

The grey garden slug (Deroceras reticulatum) is considered the most damaging slug pest in global agriculture. Control methods primarily rely on chemical pesticides, which pose environmental risks and potential hazards to human health. There is a need for sustainable management alternatives such as biologically-based slug control options. However, the efficacy of nonchemical measures for controlling pest slug populations remains limited, particularly in the context of variable outdoor conditions. Neuropeptides and their corresponding receptors have been proposed as promising biological targets for the development of new pest management strategies. A total of 23 bioactive peptides belonging to the PRX family, previously identified from the grey garden slug, D. reticulatum, were injected into or fed to this species. The detrimental effects of these peptides, including a reduction in body weight and an inhibition of feeding activity, were evaluated in feeding choice tests with D. reticulatum. Furthermore, the bioactive peptide formulated with a lipid particle demonstrated a feeding deterrent effect. One of the myomodulin (MM) peptides, APPLPRY, demonstrated a significant reduction in feeding activity, resulting in a reduction in slug weight or mortality in just 30 min. The results represent the first evidence of a bioactive peptide having detrimental effects on D. reticulatum including causing feeding deterrent for this slug pest. The in vivo results provide insights into the potential development of active ingredients for managing slugs in the field. © 2024 Society of Chemical Industry.

Influence of caffeic acid and Bacillus coagulans supplementation on growth, digestive enzymes, immune response, and antioxidant gene expression in common carp (Cyprinus carpio) and its resistance to Aeromonas hydrophila infection

Present study aimed to investigate the efficacy of dietary supplementation with caffeic acid and Bacillus coagulans on growth performance, digestive enzymes, and immunity of common carp (Cyprinus carpio), and also fish resistance against Aeromonas hydrophila. Fish (21.0 ± 0.5 g) divided into four groups: control group (CD, commercial basal diet), caffeic acid (CA, 5 g/kg feed), B. coagulans (BC, 2×107 CFU/g feed), and CA+BC (5 g/kg + 2×107 CFU/g feed) for 8 weeks, followed by a 14-day challenge with A. hydrophila. A significant enhancement was obtained in growth performance of all treated groups compared to CD (P < 0.05). Also, feed conversion ratio was significantly reduced in treated fish compared to CD group (P < 0.05). Fish of BC and CA+BC groups revealed an increase in activity of amylase, lipase, protease, trypsin, and chymotrypsin in the intestinal tissue. In addition, amylase, lipase, protease, and trypsin in CA group exhibited a higher activity than CD (P < 0.05). A lower decrease in aspartate aminotransferase and a higher increase in alkaline phosphatas were observed in BC and CA+BC groups than CD group (P < 0.05). Values of total protein, total immunoglobulin, lysozyme activity, and alternative complement pathway (ACH50) were higher in sera of BC and CA+BC groups than CD (P < 0.05). Additionally, expression of genes related to lysozyme, IL-1β, IL-8, TNF-α, superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) in liver tissues of treatment groups were upregulated better than CD (P < 0.05). Furthermore, a significant reduction in mortality was observed in treatment groups compared to CD under the A. hydrophila challenge. These results exhibited that including a combination of caffeic acid and B. coagulans as functional dietary supplements in diet favors common carp health status and growth and, thus, can be recommended in the fish diet.

The application of analytical hierarchy process to assess adaptation strategies for flood and landslides risks: A case study of a multi-risk area community

The increasing frequency of flood-related emergencies has heightened discussions on climate adaptation and risk management. Despite investments in infrastructure, early warning systems, urban planning improvements, and awareness initiatives, sustained attention and action are essential. The efficacy of preventive measures relies heavily on local community decisions and their cooperation with authorities, impacting the entire risk management cycle. This study investigates the factors influencing flood and landslide adaptation strategies and their perception by citizens in vulnerable areas, aiming to identify key variables that shape citizen behaviour for effective planning and management of adaptation actions. Focusing on Ischia Island, Italy, a multi-risk area, the study applied the Analytic Hierarchy Process (AHP) in focus groups to achieve three objectives: i) Highlight the critical role of citizen perceptions in forming adaptation strategies, emphasizing the need for cohesive efforts among policymakers, experts, and communities to enhance resilience. ii) Examine residents' views on flood and landslide risks to understand local concerns and vulnerabilities. iii) Use multi-criteria analysis to evaluate the importance of factors shaping adaptation strategies, providing a systematic framework for decision-making in disaster risk management. Findings reveal an optimism bias in respondents' perceptions of their home security despite recognizing the area's vulnerability and mistrust in authorities. Environmental and social factors are deemed most important, with environmental strategies focused on harm reduction and local environment enhancement, and social strategies emphasizing information dissemination and mortality reduction. This research offers valuable insights into community perceptions and factors influencing adaptation strategies for flood and landslide risks.

Efficacy and safety of novel anticoagulant therapies in patients with chronic kidney disease-asystematic review and meta-analysis.

Chronic Kidney Disease (CKD) significantly increases the risk of cardiovascular diseases, including atrial fibrillation, which usually requires anticoagulant therapy. The effectiveness and safety of direct oral anticoagulants compared to vitamin K antagonists in patients with CKD remain insufficiently studied, particularly in the more advanced stages. This systematic review, registered in PROSPERO (CRD42023410192), adhered to PRISMA guidelines and included randomized clinical trials and cohort studies comparing direct oral anticoagulants and vitamin K antagonists in CKD patients. Major databases were searched, and studies were selected based on strict inclusion criteria. A meta-analysis was performed using random-effects models. Twenty-three studies with a total of 465,673 CKD patients were included. Direct oral anticoagulants showed a significant reduction in major bleeding events compared to vitamin K antagonists (Relative Risk [RR] = 0.62, 95% Confidence Interval: 0.49-0.79, p < 0.01) and a non-significant trend toward reducing thromboembolic events (RR = 0.69, 95% Confidence Interval: 0.43-1.14, p = 0.11). Furthermore, direct oral anticoagulants were associated with a significant reduction in all-cause mortality (RR = 0.63, 95% Confidence Interval: 0.43-0.91, p = 0.02). Direct oral anticoagulants may offer a safe alternative to vitamin K antagonists in CKD patients, particularly in terms of reducing bleeding risks and potentially improving survival. However, their role in preventing thromboembolic events remains uncertain, highlighting the need for further research, especially in patients with advanced CKD and kidneyfailure.

Exploring the global impact of obesity and diet on dementia burden: the role of national policies and sex differences.

Obesity is a significant modifiable risk factor for dementia. This study aims to quantify the global impact of obesity on dementia burden and examine how national strategies for managing overweight/obesity and dietary factors influence dementia prevalence and mortality, with a focus on sex-specific differences. We used data from the Global Burden of Disease (GBD) and World Health Organization (WHO) to evaluate the association between obesity age-standardized prevalence rate (ASPR) and dementia age-standardized mortality rate (ASMR) and ASPR across 161 countries. A two-step multivariate analysis adjusted for socioeconomic and lifestyle factors was performed. Temporal trends in dementia were analyzed based on the presence of national obesity management strategies and varying dietary scores. A 1% increase in national obesity prevalence was associated with a 0.36% increase in dementia mortality (OR: 1.0036; 95% CI: 1.0028-1.0045) in males and 0.12% in females (OR: 1.0012; 95% CI: 1.0007-1.0018). A 1% increase in national obesity ASPR was associated with an increase in ASPR of dementia by 0.26% for males (OR: 1.0026, 95% CI: 1.0024-1.0028) and 0.05% for females (OR: 1.0005, 95% CI: 1.0004-1.0006). Males exhibited a higher susceptibility to obesity-related dementia. Countries with national obesity management strategies showed a significantly greater reduction in dementia mortality, particularly among females (P = 0.025). Higher dietary scores were associated with a more significant decrease in dementia prevalence across both sexes. Rising obesity prevalence is linked to increased dementia burden globally, with males being more vulnerable to this relationship. National management of overweight/obesity and healthier dietary habits may help mitigate the dementia burden, emphasizing the need for integrated public health interventions.

Procalcitonin-guided antibiotic treatment in patients with cancer: a patient-level meta-analysis from randomized controlled trials

BackgroundUse of serum procalcitonin (PCT), an inflammatory biomarker for bacterial infections, has shown promising results for early stopping antibiotic treatment among patients with respiratory infections and sepsis. There is need for additional data regarding effectiveness and safety of this concept among patients with cancer.MethodsIndividual data of patients with a documented diagnosis of cancer and proven or suspected respiratory infection and/or sepsis were extracted from previous trials where adult patients were randomized to receive antibiotic treatment based on a PCT protocol or usual care (control group). The primary efficacy and safety endpoints were antibiotic exposure and 28-day all-cause mortality.ResultsThis individual-patient data meta-analysis included 777 patients with a diagnosis of cancer from 15 randomized-controlled trials. Regarding efficacy, there was a 18% reduction in antibiotic exposure in patients randomized to PCT-guided care compared to usual care ([days] 8.2 ± 6.6 vs. 9.8 ± 7.3; adjusted difference, − 1.77 [95% CI, − 2.74 to − 0.80]; p < 0.001). Regarding safety, there were 72 deaths in 379 patients in the PCT-guided group (19.0%) compared to 91 deaths in 398 participants in the usual care group (22.9%) resulting in an adjusted OR of 0.78 (95% CI, 0.60 to 1.02). A subgroup analysis showed a significant reduction in mortality in patients younger than 70 years (adjusted OR, 0.58 [95% CI, 0.40 to 0.86]).ConclusionResult of this individual patient meta-analysis from 15 previous trials suggests that among patients with cancer and suspected or proven respiratory infection or sepsis, use of PCT to guide antibiotic treatment decisions results in reduced antibiotic exposure with a possible reduction in mortality, particularly among younger patients.

Outcomes of Device Extraction in Patients with Chronic Kidney Disease on Renal Replacement Therapy and Cardiac Implantable Electronic Device Infections

BackgroundPatients with chronic kidney disease (CKD) on renal replacement therapy (RRT) are at high risk for cardiovascular implantable electronic device (CIED) infections. Although device extraction is standard management, it is often avoided in these patients due to high procedural risks. ObjectivesEvaluate the outcomes of CIED extraction in CKD on RRT patients with device infection. MethodsThis study utilized data from the TriNetX research network. The International Classification of Diseases-10th Revision-Clinical Modification coding system was used to identify patients. Adults with a history of CKD on RRT and CIED infection were included. Patients with renal transplantation and prosthetic heart valves were excluded. Patients were stratified by device extraction. The primary outcome was mortality at one year. ResultsA total of 530 patients were identified, of whom 30% (n=159) underwent device extraction. Following propensity score matching (PSM), 302 patients remained, with 151 in each group. Kaplan-Meier survival analysis demonstrated a significant one-year survival benefit for patients in the device extraction group (59.2%) compared to the no-extraction group (48.8%, p=0.043, HR 0.696, 95% CI 0.489-0.991). Freedom from complications such as pericardial effusion was similar between groups. Sensitivity analysis using Cox proportional hazards, adjusted for baseline confounders, confirmed the survival benefit of extraction, with a reduced mortality risk (HR 0.581, 95% CI 0.382-0.883, p=0.011)." ConclusionIn CKD on RRT patients with CIED infection, device extraction is associated with a reduction in all-cause mortality at one year. However, the rate of device extraction is low in this group.

Early onset metastatic colorectal cancer patients as a distinctive clinical and molecular phenomenon.

Despite a reduction of both incidence and mortality from CRC, recent studies have shown an increase in the incidence of early-onset CRC (EO-CRC). Data on this setting are limited. The aim of our study was to evaluate the clinical and molecular profiles of metastatic EO-CRC patients in order to identify differences compared to a late-onset CRC (LO-CRC) control group. We retrospectively collected data from 1272 metastatic colorectal cancers from 5 different Italian Institutions. The main objective was to the evaluate clinical outcome for EO-CRC patients in comparison to patients included in the control group. In the overall population, mOS was 34,7 in EO-CRC pts vs 43,0 months (mo) (p < 0,0001). In the RAS/BRAF mutated subgroup mOS in EO-CRC pts was 30,3 vs 34,0 mo (p = 0,0156). In RAS/BRAF wild-type EO-CRC mOS was 43,0 vs 50,0 mo (p = 0,0290). mPFS was 11,0 in EO-CRC pts vs 14,0 mo (p < 0,0001). Findings indicate a general worse prognosis for patients with early-onset colorectal cancer compared to late-onset patients. Interestingly this seems to occur regardless of the molecular status. These observations might have a considerable impact on clinical practice and research.

Beta-Blockers and Mortality Reduction in Heart Failure: A Systematic Review of Randomized Controlled Trials

Background: Heart failure is a leading cause of morbidity and mortality. This systematic review evaluates beta blockers' effects on all-cause mortality, cardiovascular mortality, and hospital admissions in heart failure, synthesizing data from over 50 randomized controlled trials. Methods: Using PRISMA principles, the data regarding the effect of beta blockers on heart failure mortality and hospitalizations were synthesized. Extensive database searches (PubMed, Embase, Cochrane Library, and Web of Science) and manual reference checks were used to identify randomized controlled studies that compared beta blockers with placebo or conventional treatment in adults. The quality of data extraction process was evaluated according to the Cochrane Risk of Bias tool following the guidelines. Heterogeneity was assessed (I2), sensitivity analyses guaranteed robustness, and random-effects meta-analyses quantified results. Transparency was guaranteed via PROSPERO registration. Results: Beta-blockers were linked to a 29% decrease in cardiovascular mortality (OR 0.71, 95% CI 0.64–0.79, p&lt; 0.05) and a 33% decrease in all cause mortality (OR 0.67, 95% CI 0.59–0.76, p &lt; 0.05) when compared to alternative therapies. Additionally, beta-blocker-treated patients saw a 37% decrease in hospital admissions (OR 0.63, 95% CI: 0.56–0.71, p &lt; 0.05). The class impact of beta blockers in heart failure treatment is supported by these advantages which were constant across subgroups and beta blocker types. Conclusion: This systematic review corroborates the well-established benefit of beta blockers in lowering mortality and hospitalizations in heart failure patients, particularly with HFrEF. The findings support the use of beta blockers as a cornerstone of heart failure therapy and there is a need for further research to optimize the use of beta blockers in combination with other emerging therapies.

Conjoint effect of post-discharge physical exercise and co-managed care on health outcomes of older patients with hip fracture in China: A post-hoc factorial analysis

ObjectivesThe study aimed to explore the effects of post-discharge physical exercise combined with co-managed care on health the outcomes of older patients with hip fracture. MethodsBased on a completed non-randomised controlled trial which evaluated a co-managed care of patients aged 65 years and above with hip fracture, provided by orthopedists and geriatricians within an acute setting, a retrospective post-hoc factorial analysis was further conducted. The analysis observed the health outcomes of older patients with post-discharge physical exercise combined with co-managed care within hospitals compared to those had either post-discharge physical exercise or co-managed care. The collected data included demographics, clinical characteristics, and follow-up information about post-discharge physical exercises and health outcomes at one-month, four-month, and one-year after admission. The health outcomes comprised the cumulative mortality, complications, ambulatory ability (Fracture Mobility Score), and quality of life (the five-level EuroQol five-dimensional questionnaire) at each follow-up visit. ResultsPatients who having the conjoint interventions benefited more reduction of one-year mortality (RR 0.59, 95 %CI: 0.38, 0.80) but no reduction of complications (RR 0.70, 95 %CI: 0.43, 1.14) than each single intervention. Ambulance ability (at one-year follow-up) and quality of life (at four-month follow-up) of patients who having the conjoint interventions were observed a significant improvement against each single intervention. ConclusionThe conjoint intervention with co-managed care and post-discharge physical exercise might contribute more to the quality improvement of hip fracture care in a long run.

Machine learning evaluation of intensified conditioning on haematopoietic stem cell transplantation in adult acute lymphoblastic leukemia patients

BackgroundThe advantage of intensified myeloablative conditioning (MAC) over standard MAC has not been determined in haematopoietic stem cell transplantation (HSCT) for adult acute lymphoblastic leukemia (ALL) patients.MethodsTo evaluate heterogeneous effects of intensified MAC among individuals, we analyzed the registry database of adult ALL patients between 2000 and 2021. After propensity score matching, we applied a machine-learning Bayesian causal forest algorithm to develop a prediction model of individualized treatment effect (ITE) of intensified MAC on reduction in overall mortality at 1 year after HSCT.ResultsAmong 2440 propensity score-matched patients, our model shows heterogeneity in the association between intensified MAC and 1-year overall mortality. Individuals in the high-benefit group (n = 1220), defined as those with ITEs greater than the median, are more likely to be younger, male, and to have higher refined Disease Risk Index (rDRI), T-cell phenotype, and grafts from related donors than those in the low-benefit group (n = 1220). The high-benefit approach (applying intensified MAC to individuals in the high-benefit group) shows the largest reduction in overall mortality at 1 year (risk difference [95% confidence interval], +5.94 percentage points [0.88 to 10.51], p = 0.011). In contrast, the high-risk approach (targeting patients with high or very high rDRI) does not achieve statistical significance (risk difference [95% confidence interval], +3.85 percentage points [−1.11 to 7.90], p = 0.063).ConclusionsThese findings suggest that the high-benefit approach, targeting patients expected to benefit from intensified MAC, has the capacity to maximize HSCT effectiveness using intensified MAC.

Impact of iron-folic acid supplementation on maternal and neonatal outcomes: A systematic review & meta-analysis.

Background & Aims: Iron-folic acid (IFA) supplementation is widely recommended as both a preventive and therapeutic measure for pregnant women. Despite its widespread use, there is limited research exploring adherence to IFA supplementation during pregnancy and its impact on maternal and neonatal outcomes. This study aims to assess the effectiveness of IFA supplementation in improving pregnancy and neonatal outcomes. Methods: A comprehensive search on PubMed, Google Scholar, EMbase and Trip databases was conducted for relevant studies published up to May 31, 2024. Outcomes measured were preterm birth (PTB), low birth weight (LBW), neonatal mortality, perinatal mortality, small for gestational age (SGA) and stillbirth. Pooled risk ratios (RRs) with 95% confidence intervals (CIs), sensitivity analysis, publication bias, trial sequential analysis and quality assessment of the included studies were performed. Results: Eleven studies involving a total of 42,458 pregnant women who received IFA supplementation and 16,351 women who received folic acid (FA) alone or Control (no supplementation) were included. A significant reduction in overall neonatal mortality (RR = 0.73, 95% CI: 0.61-0.87) as well as in subgroup analyses (IFA vs. control and IFA vs. FA) was observed. However, a decrease in incidence of LBW was noted only in IFA vs. control group (RR = 0.79, 95% CI: 0.69-0.90). No significant association was found for overall LBW (RR = 0.48, 95% CI: 0.08-2.76), PTB (RR = 0.56, 95% CI: 0.09-3.50), perinatal mortality (RR = 0.85, 95% CI: 0.69-1.04), SGA (RR = 0.98, 95% CI: 0.86-1.12) and stillbirth (RR = 0.75, 95% CI: 0.48-1.16) when comparing to IFA vs. control and IFA vs. FA group. Conclusions: Our findings provide strong evidence supporting the effectiveness of IFA supplementation in reducing neonatal mortality and LBW among pregnant women, highlighting its importance in prenatal care.

Cardiac Rehabilitation After Open Heart Surgery: A Narrative Systematic Review.

Postoperative cardiac rehabilitation (CR) programs are increasingly recommended by clinicians, but only a minority of patients who have undergone open heart surgery participate in such programs. Participation rates in postoperative CR, if anything, appear to be declining. This systematic review examines the effectiveness of post-operative CR and reveals possible participation barriers. A search of two scholarly databases for primary research papers published in the last decade examining the impact of post-operative CR was conducted and the resultant papers reviewed. The 21 resulting studies revealed physiological functioning improvement and a reduction in mortality and readmission rates, while highlighting an enhancement in mental status. Some of the studies recognized the need for nutritional support and suggested that age, gender, access to CR centers, and socioeconomic variables impact participation in CR. Post-operative CR participation rates continue to decline despite increasing evidence of the value of the approach.

Assessing the multidimensional impact of community-based cattle feedlot programs in the Eastern Cape, South Africa

Traditional cattle farming in the region faces numerous challenges, including limited market access, inadequate nutrition, and poor herd management, which hinder productivity and the livelihoods of farmers. This research explores whether structured feedlot programs can address these issues by enhancing agricultural productivity and improving farmer livelihoods. The study utilized quantitative data from 250 respondents and regression models to compare changes before and after participation in the feedlot programs. The findings reveal significant improvements in herd dynamics, with average herd size increasing by 40% and calving rates rising from 60 to 80%. Mortality and morbidity rates decreased by 50 and 47%, respectively. Regression analysis showed a positive impact on herd size (β = 20.00, p &amp;lt; 0.001) and a notable reduction in mortality (β = −0.30, p = 0.050). Animal performance also improved, with average daily gain (ADG) increasing by 60% and feed conversion ratio (FCR) improving by 25%. Health status was enhanced, indicated by a 50% reduction in disease incidence and an 80% increase in vaccination coverage. Regression results supported these improvements, showing significant positive effects of feedlot participation on ADG (β = 0.50, p &amp;lt; 0.001) and health status (β = −0.10, p &amp;lt; 0.005). Socio-economic benefits were also substantial, with household income increasing by 67% and new employment opportunities emerging. Food security improved significantly, with 85% of households reporting better access to food, and the average sales price per cattle increased by 50%. Regression analysis indicated strong positive impacts on household income (β = 1,500, p &amp;lt; 0.001) and food security (β = 300, p = 0.010). Factors influencing farmer participation in the feedlot programs included perceived benefits (β = 0.80, p &amp;lt; 0.001), access to training (β = 0.50, p &amp;lt; 0.005), and market access (β = 0.70, p &amp;lt; 0.001), while the cost of participation negatively affected involvement (β = −0.002, p = 0.050). Overall, the study demonstrates that community-based cattle feedlot programs significantly enhance herd dynamics, animal performance, and socio-economic conditions for farmers in the Eastern Cape Province, offering a viable strategy for improving rural livelihoods and agricultural productivity.