Comparison of Tdap vaccine immunogenicity between pregnant and non-pregnant active duty service members.

Patients with multiple sclerosis (MS) require increasing health care support, particularly in the last year of life. Despite the benefits of palliative care in addressing symptom burden and improving quality of life, its integration into MS care remains inconsistent. This study aimed to characterize health care utilization and palliative care access among people with MS in the last years of life and to identify key factors associated with hospital death and receipt of palliative care. A retrospective cohort study was conducted using linked health administrative databases in Ontario, Canada. The cohort consisted of all decedents aged 18 years or older who died in Ontario between April 2016 and March 2020, and we compared health care utilization in decedents with MS to the rest of the cohort. The identification of MS cases was based on a validated algorithm. Demographics, health care utilization, palliative care involvement, and medical interventions were analyzed. Predictors of palliative care receipt and hospital deaths were evaluated using multivariable logistic regression models. MS decedents (n = 1,975; mean age 68 years; 66.4% female) were younger and had fewer comorbidities than non-MS decedents (n = 500,904; mean age 77). High percentage of MS decedents had outpatient neurology visits in the last 5 years of life (49.4%) but a steep decline closer to death (2.7% in the last month). Palliative care use was similar (58.0% vs 56.9%) but occurred earlier in MS (61.9% vs 59.6% in the last 5 years). Multivariable regression showed that rural residence was associated with increased odds of hospital death (odds ratio [OR] 1.81, 95% CI 1.21-2.70) and lower odds of receiving palliative care (OR 0.74, 95% CI 0.55-0.99), while receiving palliative care within the last 5 years of life reduced the odds of hospital death (OR 0.47, 95% CI 0.37-0.60). Higher comorbidity and increased outpatient visits to urology were associated with a greater odd of receiving palliative care (OR 3.64, 95% CI 2.50-5.29 and OR 1.47, 95% CI 1.20-1.80). Although palliative care receipt was comparable between MS and non-MS decedents, rural disparities and high hospital deaths persist. Earlier palliative integration, particularly through neuropalliative care, could improve quality of life and reduce hospitalizations.

IV thrombolysis (IVT) is contraindicated in patients with acute ischemic stroke (AIS) while on dabigatran or other oral anticoagulant (OAC) treatment. Idarucizumab completely reverses the effect of dabigatran within minutes, without increasing the risk of thromboembolism. Limited data exist on IVT treatment after dabigatran reversal with idarucizumab. We aimed to investigate the safety and outcomes of IVT after dabigatran reversal in patients with AIS. This is an observational study based on the Safe Implementation of Treatment in Stroke (SITS) International Stroke Thrombolysis Registry. Hospitals treating patients with AIS contributed data. The main outcome was safety as measured by any parenchymal hematoma (PH), symptomatic intracerebral hemorrhage (SICH) per SITS, and death within 3 months. The secondary outcome was functional independence defined as modified Rankin Scale scores of 0-2 at 3 months. Propensity score matching (PSM) was used to compare patients treated with dabigatran reversal to patients without prior OAC in primary analysis and for secondary analysis between patients treated with dabigatran reversal with idarucizumab to patients on dabigatran without reversal treatment. Among 258,589 IVT treated patients with AIS, 510 were on dabigatran and 156 received dabigatran reversal. Dabigatran reversal patients were older (75 vs 69 years, p < 0.01), had similar median baseline NIH Stroke Scale (9 vs 10, p = 0.47), and longer onset to IVT time (185 vs 150 minutes, p < 0.01) compared with patients without prior OAC treatment (n = 191,648). After PSM analysis where good balance was achieved, patients treated with dabigatran reversal before IVT had similar results in all outcomes as compared with patients treated with IVT without prior OAC (any PH: 3 vs 9%, p = 0.10; SICH: 1 vs 1%, p = 1.00; death: 25 vs 19%, p = 0.33, functional independence: 51 vs 52%, p = 0.95). Secondary analysis showed similar results for all outcomes before and after PSM. In our observational study with patients with AIS, IVT treatment after dabigatran reversal was safe and had similar outcomes to IVT treatment without previous OAC. Furthermore, comparison between dabigatran reversal vs no reversal also indicates that IVT is safe for patients on dabigatran without idarucizumab reversal, which is currently being investigated in clinical trials. This study provides Class III evidence that IVT after idarucizumab reversal in patients with AIS who took dabigatran within 48 hours of onset of symptoms is safe and comparable with those of patients with AIS not on prior oral anticoagulation.

Association Between Alcohol Consumption, Cognitive Abilities, and Neuropathologic Changes: A Population-Based Autopsy Study.

Data on time trends in cluster headache epidemiology are sparse. The aim of this study was to report trends in prevalence and incidence of cluster headache in Norway over a 14-year period. We conducted a registry-based study using linked data from the Norwegian Registry for Primary Health Care, the Norwegian Control and Payment of Health Reimbursements Database, the Norwegian Patient Registry, the Norwegian Prescribed Drug Registry, and Statistics Norway from 2009 to 2022. Data included diagnostic codes, prescriptions, and education. Adults (age ≥18 years) were included. Cluster headache prevalence was defined as ≥2 contacts (clinical consults or prescriptions) for cluster headache in a 365-day period. Age-standardized trends in prevalence and incidence by sex and year, and interactions between education and year, were analyzed with negative binomial regression. We estimated prevalence rate ratio (PRR) and incidence rate ratio per calendar year with 95% CIs. The number of patients with cluster headache increased from 1,029 in 2009 (median age 44 years; 39.7% women) to 1,833 patients in 2022 (median age 47 years; 50.1% women). The annual age-standardized prevalence rate increased from 27.0 to 42.5 per 100,000 in the same period. Women had a 3-fold higher annual increase of 6% (PRR 1.06, 95% CI 1.05-1.07) compared with 2% (PRR 1.02, 95% CI 1.02-1.03) in men. The prevalence rate was higher in women than in men by 2022 (43.4 vs 41.7 per 100,000). The annual prevalence of chronic cluster headache and refractory chronic cluster headache varied between 6%-7% and 1%-2% of all cluster headache cases, respectively. The annual age-standardized incidence rate of cluster headache increased in women, from 10.1 to 14.6 per 100,000 from 2012 to 2022 and decreased in men, from 13.5 to 11.0 per 100,000. Incidence and prevalence rates were higher among individuals with lower education. Prevalence increased over 14 years, possibly reflecting improved diagnostic practices and awareness. These findings challenge previous reports of cluster headache predominantly affecting men, illustrating distinct shifts and trends in disease epidemiology. A limitation was the lack of clinical validation of cluster headache diagnostic codes in primary health care.

Spinal muscular atrophy (SMA) causes progressive muscle weakness. Respiratory muscle weakness results in progressive lung function decline, scoliosis, and chest wall deformities that predispose to respiratory failure. The efficacy of survival motor neuron protein-augmenting therapies on motor function in patients with SMA has been reported extensively, but how respiratory function changes under treatment remains underexplored. The aim of this study was to evaluate longitudinal changes in lung function and respiratory muscle strength during nusinersen treatment. We conducted a national retrospective observational cohort study at the University Medical Center Utrecht. We included children and adults with SMA types 1, 2, and 3a, who symptomatically started treatment with nusinersen between May 2017 and July 2025 as part of the Dutch reimbursement arrangements. We retrieved all available data on lung function and respiratory muscle strength collected during routine care. We analyzed the differences in the annual rates of change of lung function and respiratory muscle strength before and after nusinersen treatment initiation, using linear mixed-effects models. We included 120 patients (60 female individuals, 50%), of whom 78 were children (median age 7.3 years, range 0.7, 17.7) and 42 adults (median age 34.4 years, range 18.1, 76.1) at nusinersen initiation. In children, we observed a slower decline in lung function and a higher expiratory muscle strength after starting nusinersen. The absolute mean slope differences were 4.1% (95% CI 2.2-6.0) for forced vital capacity, 3.8% (95% CI 1.4-6.2) for forced expiratory volume in 1 second (FEV1), 4.2% (95% CI 0.3-8.0) for peak expiratory flow, and 5.1% (95% CI 0.7-7.6) for maximal expiratory pressure after initiation of nusinersen. In adults, we only observed a change in FEV1 after starting nusinersen. At treatment initiation, 30 patients required ventilatory support. None were able to discontinue ventilation, and 6 patients started noninvasive ventilation during treatment. This large retrospective cohort study found slower deterioration of lung function in symptomatic children during nusinersen treatment and improvements in respiratory muscle strength. In adult patients treated with nusinersen, we only observed a change in FEV1. This study provides Class IV evidence that nusinersen slows deterioration of lung function and improves respiratory muscle strength in symptomatic children with SMA.

Early recognition of patients with rapidly progressive dementia (RPD) attributed to autoimmune encephalitis (AE) is important because rapid initiation of immunotherapy improves outcomes. However, ancillary testing is often time-consuming because of the broad differential diagnosis, highlighting the need for accurate patient selection based on early clinical features. We aim to determine the frequency of AE subtypes in patients with RPD (AE-RPD) and characterize presenting subphenotypes (i.e., symptoms in addition to dementia) compared with other diagnoses. This prospective multicenter observational cohort study was conducted from December 2019 to December 2024 across centers in the Netherlands and included adult patients with RPD, defined as dementia beginning within 1 year of symptom onset. Clinical features and ancillary testing data were collected and reviewed by 3 neurologists. Serum and CSF were evaluated for neuronal/glial autoantibodies. A total of 147 patients were included (46% female; median age 67 years, range 36-86). AE-RPD was the largest diagnostic category (58/147; 39%) and most common treatment-responsive cause of RPD (58/95; 61%). Neurodegenerative diseases (20/147; 14%) and Creutzfeldt-Jakob disease (CJD, 17/147; 12%) accounted for the largest nonresponsive causes of RPD. RPD accompanied by seizures at first presentation was more frequent in AE-RPD compared with other diagnoses (20/58; 34% vs 9/89; 10%; p < 0.001), with anti-LG1 (11/20; 55%) encephalitis representing the most frequent underlying subtype. Seizures manifested as subtle focal events in 9 of 20 patients with AE-RPD (42%), complicating early clinical identification. Movement disorders were observed at presentation in similar proportions of patients with AE-RPD (17%) and CJD (35%; p = 0.11) but were more likely to emerge within 3 months of symptom onset in patients with RPD-AE (80% vs 25%; p = 0.004). In patients with AE-RPD without seizures, autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy was the most common subtype (8/31; 26%), mostly presenting with prominent psychotic features or movement disorders (both 4/8; 50%). In this study, AE was the most common treatment-responsive cause of RPD. Anti-leucine-rich, glioma-inactivated 1 encephalitis and autoimmune GFAP astrocytopathy were the predominant subtypes in AE-RPD.

Adults older than age 55 years have the highest incidence rate and are the fastest-growing population among people with epilepsy. The aim of this study was to characterize the etiologies of new-onset seizures in older adults and to examine how seizure etiology varies across demographic groups. We used data from 7 US epilepsy centers from 2021 to 2025 and compared findings with those of previous population-based studies, providing an updated view and highlighting opportunities for prevention and improved risk stratification. We retrospectively reviewed medical charts of 2,052 patients aged ≥55 years at the time of a first seizure, who were evaluated at 7 epilepsy centers between 2021 and 2025. We categorized seizures by etiology as follows: ischemic stroke, hemorrhagic stroke, tumor, neurodegeneration, provoked seizures, traumatic brain injury, and unknown. We examined differences in etiology by demographic strata (age, sex, race, and primary language) using chi-square tests, Kruskal-Wallis tests, analysis of variance, and Cuzick tests. The most frequent seizure etiologies among older adults were unknown (29.9%), ischemic stroke (15.4%), and provoked seizures (14.9%). Neurodegenerative disease was the etiology for 5.3% of cases overall but increased in prevalence with age, accounting for 18.5% among patients aged 85-89 years. Seizure etiologies also differed by sex and race. Men more commonly had seizures caused by cerebrovascular disease and traumatic brain injury, while women more commonly had seizures due to neurodegenerative disease. Black patients had higher proportions of ischemic stroke and neurodegenerative disease, while unexplained epilepsy was more common among White patients. The causes of late-onset seizures vary based on age, sex, and race. Nearly one-third of cases of epilepsy in older adults remain unexplained despite advances in imaging techniques, underscoring the need for further research on the mechanisms and health implications of late-onset unexplained epilepsy. Improved prevention of cerebrovascular disease and optimized management of provoked seizures may reduce the growing burden of epilepsy in older adults.

Subjective cognitive decline (SCD) is a well-recognized risk state for developing mild cognitive impairment (MCI) and dementia. Optimal risk stratification for early interventions and clinical trial selection remains challenging. This study evaluates progression risk across multimodal biomarker profiles in SCD. We conducted a longitudinal observational study including participants from the BioFINDER-1 and BioFINDER-2 cohorts with a baseline diagnosis of SCD, at least 1 follow-up visit, and available information on dementia progression. Baseline predictors included cognitive performance, APOE4 status, plasma phosphorylated tau (p-tau) 217, "AD-signature" cortical thickness, hippocampal volume, and white matter hyperintensities (WMHs) measured by the Fazekas scale. Missing data were handled using multiple imputation. Predictors were evaluated individually and then combined in progressively complex Cox regression models to predict progression to all-cause dementia, Alzheimer disease (AD) dementia, and MCI (BioFINDER-2 only). Model performance was assessed using the Harrell C-index, and Akaike information criterion was used for comparing model fit. A total of 469 participants with SCD (mean age 69.1 ± 7.1 years, 51.4% female) were included in the main sample. Eighty-four individuals progressed to dementia over 4.0 ± 2.1 years (66.7% AD dementia). Progressors were older and more frequently APOE4 carriers and showed worse baseline cognition, higher plasma p-tau217, and greater atrophy and WMH burden. Plasma p-tau217 was the strongest individual predictor for AD dementia (C-index = 0.86 ± 0.012), but multivariable models outperformed single-biomarker models. The best model for all-cause dementia included all variables and achieved a C-index of 0.89 ± 0.003. For AD dementia, a more parsimonious model combining plasma p-tau217, cognitive scores, and APOE4 status showed excellent predictive ability (C-index = 0.91 ± 0.009), with only marginal improvement when MRI markers were added. Among 249 individuals from BioFINDER-2, 84 progressed to MCI within 2.3 ± 1.2 years. For MCI prediction, model performance was generally lower and similar between the plasma model and the model including all variables (C-index = 0.83 ± 0.009). A clinically feasible multimodal approach combining cognitive assessment, plasma p-tau217, and APOE4 status accurately predicts AD dementia risk in individuals with SCD. Adding MRI measures of brain atrophy and WMHs further improves prediction for all-cause dementia. These findings underscore the clinical value of plasma p-tau217 in refining risk assessment in SCD and support its potential implementation in memory clinic settings alongside other widely available biomarkers.

ABSTRACT Currently, a variety of land surface temperature (LST) products generated from thermal infrared bands have been already accumulated. Compared to the thermal infrared band, the mid-infrared band exhibits higher transmittance and greater robustness under humid atmospheric conditions, offering potential for further improving LST retrieval accuracy. However, the mid-infrared band presents larger variability in emissivity and higher estimation difficulty, limiting the effectiveness of LST retrieval using mid-infrared remote sensing data sources. This study proposed a MODIS night-time mid-infrared LST retrieval algorithm that integrates reflectance spectral characteristics to estimate emissivity. A few-shot machine learning model was established to build the correlation between MODIS optical band reflectance and mid-infrared band emissivity within a simulated dataset accounting for mixed spectral components, then applied to real observational data. Validation results from SURFRAD ground stations indicate an overall RMSE of 2.5521 K for this new algorithm, with values of 2.5558 K under dry atmospheric conditions and 2.5021 K under humid atmospheric conditions. The new algorithm can accurately retrieve night-time LST without significant error increasing as atmospheric water vapor content rises. Future work will further study on fields including eliminating daytime solar radiance effects, conducting multi-surface-type validation, and reducing dependence on external parameters.

Prior studies examining associations between Epstein Barr Virus (EBV)-positive infectious mononucleosis (IM) and risk of multiple sclerosis (MS) frequently lacked laboratory confirmation of EBV-positive IM or relied on billing codes to identify MS. We assessed whether laboratory-confirmed EBV-positive IM was associated with an increased risk of developing verified cases of MS. We conducted a population-based retrospective cohort study using medical records from the Rochester Epidemiology Project. We identified individuals with serologic evidence of EBV infection and an associated IM diagnosis (EBV-positive IM; exposed cohort) between 1998 and 2022. Age- (± 1 year) and sex-matched individuals without evidence of IM (3:1 match) comprised the unexposed cohort. Incident MS cases were verified through blinded expert chart review. Multivariate Cox proportional hazard models were used to assess associations between EBV-positive IM and risk of MS. 4,721 persons had EBV-positive IM (exposed cohort: 55% female, 70% <20 years). The referent cohort included 14,163 persons without EBV-positive IM (55% female, 70% <20 years). During follow-up (median, 6 years for exposed; 8 years for referents), MS developed in 8 individuals with EBV-positive IM (0.17%) and 10 referents (0.07%). EBV-positive IM was associated with a >3-fold increased risk of MS (adjusted Hazard Ratio: 3.14, 95% Confidence Interval: 1.18-8.34). EBV-positive IM was associated with a substantially higher risk of MS. Findings are consistent with prior studies and underscore the importance of preventive strategies targeting EBV to reduce the long-term burden of MS.

Prevalence and risk factors for malnutrition based on the Global Leadership Initiative on Malnutrition (GLIM) criteria in patients with inflammatory bowel disease: a population-based study.

Cardiovascular diseases (CVD) are a leading cause of death and disability worldwide. Self-risk assessment of these diseases can be a cornerstone of primary prevention programs. This study was designed to investigate the validity of CVD risk assessment based on self-measured data. The present study is a population-based descriptive-analytic study in people 30years and over. A sample of 475 individuals was randomly selected from a general population on the coverage of a comprehensive health center. Data were collected first through an application (self-assessment) and then through standardized measurements by trained personnel. Data analysis was based on paired t-test, ICC, and sensitivity and specificity indices. The results of the study showed an overestimation of height and systolic blood pressure and an underestimation of weight, BMI, waist circumference and diastolic blood pressure. However, the findings showed that Self-measurement anthropometric measures had excellent reliability (ICC > 0.90). Self-assessment tools demonstrated good agreement for CVD risk (ICC = 0.79), with high sensitivity (78-89%) and increasing specificity (76-96%) at higher risk thresholds. Self-assessment evaluations of 10-year cardiovascular disease risk demonstrate strong validity and reliability. As a result, utilizing Self-assessment data can serve as a practical and suitable method for the early detection of at-risk individuals. The online version contains supplementary material available at 10.1007/s40200-025-01830-2.

Cervical cancer in foreign-born women living in Italy: A systematic review of population-based studies.

Squamous cell carcinoma of the parotid gland: A population-based registry study of primary versus metastatic disease.

RefLaTEA: a robust visualization and analysis framework leveraging background data for enhanced insight.

Public sunscreen dispensers and sun-protective behaviours: an observational study in Toronto, Canada.

Physiologic effects of THRIVE versus facemask preoxygenation in obese patients undergoing bariatric surgery: A pilot observational electrical impedance tomography study.

Analysing outbreak signals, 2013-2024: The amsterdam UMC centre for Tropical Medicine and Travel Medicine Epi Alert programme - an observational study.

To investigate the causal relationships among osteoarthritis (OA), sepsis, and potential mediators, which include immune cell phenotypes, metabolic, and inflammation. Firstly, the observational study extracted data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The exposure was OA and the control group was patients without any diagnosis of OA. The outcome was a diagnosis of sepsis in the ICU. Secondly, we analyzed summary data from genome-wide association studies on OA, 731 immune cell phenotypes, 1400 plasma metabolites, 91 inflammation factors, and sepsis (diagnosis and 28-day survival), with GWAS datasets including up to ∼30 million SNPs for OA phenotypes and ∼12 million SNPs for sepsis-related outcomes. Bidirectional Mendelian Randomization (MR) analysis was conducted to explore the causal links between OA and sepsis. In observational study, the MIMIC-IV study did not observe a significant association between any OA and sepsis (Odds Ratio (OR) = 1.04, 95% CI: 0.87-1.24). Similarly, lower limb OA showed no correlation with sepsis (OR = 1.21, 95% CI: 0.82-1.77). However, a causal effect of hip osteoarthritis on the risk of developing sepsis was identified (OR: 1.09, 95% CI: 1.01-1.18, P = 0.024). Additionally, we found that sphingomyelin levels and X-24585 levels act as mediators in the causal relationship between hip OA and sepsis, with mediation proportions of 12.4% and 14.2%, respectively. No association between OA and sepsis diagnosis was observed in this cross-sectional study, possibly due to confounding. However, with the MR analysis in GWAS data, hip OA emerged as a potential risk factor for sepsis, with metabolic factor likely acting as mediator. Further mechanisms remain unclear.