Preventive Interventions Research Articles

The risk information and skin-cancer education for undergraduate prevention (RISE-UP) study: Protocol for a trial of personalized sun protection interventions for skin cancer prevention among undergraduate students

BackgroundAddressing the increasing incidence of skin cancer among young adults is a priority. The objective of the Risk Information and Skin-cancer Education for Undergraduate Prevention (RISE-UP) study is to identify personalized intervention components to prevent sunburn, a clinically significant outcome highly associated with skin cancer, in college students. MethodsGuided by the Elaboration Likelihood Model, the study will use Multiphase Optimization Strategy (MOST) methodology to test three intervention components (ultraviolet photography, MC1R genetic testing, and action planning) each with two levels (yes v. no) in a full-factorial experiment to evaluate unique and combined effects of these components to improve outcomes over the longer-term, with seasonally timed follow-up. At-risk University of Utah students (N = 528) will be recruited. Eligibility criteria include self-reported sunburn or tanning in the past year, or not utilizing recommended sun protection. After baseline assessment, participants will be randomized to intervention group, stratified by sex. Assessments will be completed at (1) Baseline; (2) Intervention; (3) 1 month after intervention; (4) 4 months after intervention (the end of the first summer); and (5) 15 months after intervention (the end of the second summer). The primary outcome will be participants' self-reported number of sunburns. Secondary outcomes will include self-reported sun protection and tanning behaviors and, in a randomly selected subgroup, an objective measure of ultraviolet radiation (UVR) exposure. ConclusionThe RISE-UP study will determine the efficacy of different combinations of personalized skin cancer preventative interventions for young adults and determine the optimal combination of intervention components to prevent skin cancer.Clinical Trial Registration:NCT05634252

The role for ω-3 polyunsaturated and short chain fatty acids in hypertension: an updated view on the interaction with gut microbiota

As of 2024, arterial hypertension is still considered the leading modifiable cardiovascular risk factor and, due to high rates of undertreatment and poor blood pressure control, the major contributor to human morbidity and mortality. Development of new treatment options and better interventions in lifestyle correction have become a priority of experimental and clinical research. In the last decades, dietary supplementation of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) and generation of gut microbiota-derived short chain fatty acids (SCFAs) have surged as potential and promising interventions for hypertension and cardiovascular prevention. ω-3 PUFAs are considered “essential” fatty acids that can be obtained only from dietary sources. Although previous intervention trials were not consistent in reporting a significant benefit of ω-3 PUFAs, the recent REDUCE-IT trial has provided robust evidence in support of their role in cardiovascular prevention. Recent studies have also identified the intestinal microbiota as a potential player in the pathophysiology and progression of hypertension. Although this might occur through many pathways, generation of SCFAs that is highly dependent on dietary fiber intake is primarily involved, providing an additional target for the development of novel therapeutic strategies. For these reasons, some scientific societies currently recommend dietary supplementation of ω-3 PUFAs and fiber-containing foods in patients with hypertension. In this narrative review, we summarize the results of studies that examined the effects of ω-3 PUFAs and SCFAs on blood pressure, highlighting the mechanisms of action on the vascular system and their possible impact on hypertension, hypertension-related organ damage and, ultimately, cardiovascular outcomes.

Risk of postpartum depression in women with allergic disorders: A nationwide cohort study involving 1,017,507 women

BackgroundAllergic symptoms and depression are prevalent ailments in childbearing age women. This study assessed the risk of maternal postpartum depression (PPD) associated with prenatal allergic disorders. MethodsFrom 1,017,507 eligible women of 20–49 years old with singleton live births and 20-week or more gestational age in the birth registry of Taiwan, from 2011 to 2020, we identified cohorts with and without allergic disorders matched by propensity score in the size of 457,826. Cumulative incident PPDs in one year after births were assessed from insurance claims data. Odds ratios (OR) of PPD were measured by each allergic type and multiple types, comparing with the controls. ResultsWith an overall cumulative PPD incidence 1.25-fold higher in the allergic cohort than in the controls (0.69 % versus 0.55 %), the rate was the highest in women with asthma: 0.94 % with an adjusted OR of 1.71 (95 % CI = 1.49–1.95), followed by those with allergic rhinitis, allergic conjunctivitis and atopic dermatitis. The rate increased from 0.65 % for those with one allergic disorder to 1.06 % for those with 4 or 5 disorders, and the corresponding adjusted OR increased from 1.17 (95 % CI = 1.10–1.24) to 1.92 (95 % CI = 1.36–2.69). LimitationThe claims data lack detailed information on socio-demographic status, lifestyle, laboratory result, physical activity, and family medical history. ConclusionsWomen with prenatal allergic disorder(s) are at an increased risk of PPD in addition to the impact of pregnancy. Prompt and efficient intervention for PPD prevention is needed for women with allergic disorders, particularly for those with asthma and multiple disorders.

Phenotypes of patients with lupus-associated pulmonary hypertension in the Chinese Han population: a cluster analysis.

Pulmonary hypertension (PH) is a severe complication of systemic lupus erythematosus (SLE). This study investigated the clinical features of patients with SLE-PH in China based on disease manifestations and organ involvement to define precise treatment of SLE and early prevention of complications. In total, 205 SLE-PH patients were included in this study. A cluster analysis was applied according to six clinical and serological variables to define different subgroups of patients. The survival rates of SLE-PH patients and risk factors that influenced prognosis were also compared and a clinical prediction model was developed for the diagnosis of associated lupus nephritis (LN). Patients were clustered in five groups. Patients in cluster 1 had severe renal damage (all patients had LN and had the highest creatinine and urea nitrogen and the lowest eGFR levels). Patients in cluster 2 had mild renal damage (more than half of the patients had associated LN and 87.5% had increased urinary protein levels but presented a lower degree of renal damage than those in the first group. Patients in cluster 3 had low-grade proteinuria (all patients had 24h urinary protein < 0.5g). Patients in cluster 4 had hematuria or urinary tubular damage (26% of patients had associated LN, but none of the patients had proteinuria. In cluster 5, patients barely had any major organ involvement. The clinical prediction model for a diagnosis of SLE-PH-LN was anti-dsDNA antibodies > 364.64IU/mL and neutrophil-to-leukocyte ratio (NLR) > 5.55. Our findings provide evidence indicating that SLE-PH presents varying clinical phenotypes and the treatment varies accordingly, suggesting the need for individualized treatment. Key Points • Clustered grouping of patients with SLE-PH is associated with renal injury. • This may be because PH and LN share a common pathogenesis. • The clinical prediction model for a diagnosis of SLE-PH-LN was anti-dsDNA antibodies >364.64 IU/mL and NLR >5.55.

Prevalence of diarrhoea and treatment-seeking practices among children

Estimating the proportion of children with diarrhoea and those who are taken in as inpatients or outpatients is important for policy planning, resource allocation, and to evaluate the effectiveness of diarrhoea prevention and control interventions. We aimed to estimate the proportion of children <2 years of age with diarrhoea, explore their treatment-seeking practices, and identify factors associated with both diarrhoea and treatment seeking. We designed a longitudinal study based on a sample of children <2 years of age in the Birhan field site from September 2018 to September 2019. The study site collected data on child mortality and morbidity and treatment-seeking practice for those with a history of illness every three months. Mothers/caregivers were asked about signs or symptoms of illnesses for a two-week period prior to each study visit. We estimated the proportion of children <2 years of age with diarrhoea and treatment-seeking practices for each of the four rounds of data collection and identified associated factors through bivariable and multivariable logistic regression. We enrolled 4678 children <2 years of age. The proportion of children with diarrhoea was the highest from 11 September 2018 to 9 December 2018 (4.47%; 95% confidence interval (CI) = 3.70-5.35) and the lowest from 10 December 2018 to 9 March 2019 (2.48%; 95% CI = 1.90-3.19). Children from households with chlorinated drinking water had a 50% (adjusted odds ratio (aOR) = 0.50; 95% CI = 0.28-0.88) lower odds of developing diarrhoea compared to those who did not. Among 339 children with diarrhoea, 275 (81.12%; 95% CI = 76.54-85.15) were taken to health facilities for treatment. Female children had lower odds of being taken to health facilities for treatment (aOR = 0.37; 95% CI = 0.17-0.80) compared to males. While the proportion of children with diarrhoea in our study was lower than that observed in prior research conducted in Ethiopia, treatment-seeking practices were higher. Female children and children from the poorest families had lower odds of treatment. We recommend more studies to explore gender-based and socioeconomic differences affecting treatment-seeking practices.

Neighborhood Ecologies, Cases, and Deaths during the Beginning of the COVID-19 Pandemic: Lessons for Current and Future Epidemics?

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected Black and Latinx communities. Ecologic analyses have shown that counties with a higher percentage of Latinx and Black people have worse COVID-19 outcome rates. Few ecologic analyses have been published at the neighborhood (census tract) level. We sought to determine whether certain sociodemographic neighborhood ecologies were associated with COVID-19 case and death rates in metropolitan Atlanta, Georgia. We used census data and principal-component analysis to identify unique neighborhood ecologies. We then estimated correlation coefficients to determine whether the neighborhood profiles produced by a principal-component analysis were correlated with COVID-19 case and death rates. We conducted geographically weighted regression models to assess how correlation coefficients varied spatially for neighborhood ecologies and COVID-19 outcomes. We identified two unique neighborhood profiles: (1) high percentage of residents, Hispanic ethnicity, without a high school diploma, without health insurance, living in crowded households, and lower percentage older than 65 years; and (2) high percentage of residents, Black race, living in poverty, unemployed, and households receiving Supplemental Nutrition Assistance Program benefits. Profile 1 was associated with COVID-19 case rate (Pearson r = 0.462, P < 0.001) and profile 2 was associated with COVID-19 death rate (Spearman r = 0.279, P < 0.001). Correlations between neighborhood profiles and COVID-19 outcomes varied spatially. Neighborhoods were differentially at risk of COVID-19 cases or deaths depending on their sociodemographic ecology at the beginning of the COVID-19 pandemic. Prevention methods and interventions may need to consider different social determinants of health when addressing potential cases and deaths during future emergent epidemics.

Estudio descriptivo de conducta suicida en adolescentes hospitalizados en la Unidad de Psiquiatría de un hospital de Madrid durante 2023.

The suicidal behavior among adolescents has shown a significant increase in the last decade, according to a study by the ANAR Foundation. Subsequently, there is a highlighted increase of 128% in the post-COVID-19 period. This study aims to analyze the reasons for admission and sociodemographic characteristics of adolescents hospitalized in 2023. An observational descriptive study was conducted at the Puerta de Hierro University Hospital. Out of the 229 recorded admissions, 78.6% were females and 21.4% males, with a mean age of 15.07 years. Suicidal ideation and suicide attempts were the main reasons for admission, with drug overdose being the most common method. The main diagnoses at discharge were mixed emotions and behavior disorder onset in childhood and adolescence, and adaptive disorder. The majority had a history of mental health problems. These findings reinforce the importance of prevention and early intervention programs to address suicide as an urgent public health issue.

Risk Factor Analysis and Predictive Model Development for Problematic Internet Gaming Disorder Occurrence

&amp;lt;div&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim &amp;lt;/strong&amp;gt;To examine several aspects, such as sociodemographic, psychological, personality, and parenting characteristics, that may contribute to the occurrence of PIGD in Yogyakarta, Indonesia. Additionally, the study intends to create a model that can accurately predict people who are at high risk of developing PIGD.&amp;lt;span class=&amp;quot;apple-converted-space&amp;quot;&amp;gt;&amp;amp;nbsp;&amp;lt;/span&amp;gt;&amp;lt;/p&amp;gt; &amp;lt;/div&amp;gt; &amp;lt;div&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Methods. &amp;lt;/strong&amp;gt;A cross-sectional study was conducted on 350 participants aged 15-25 years in Yogyakarta. The data was gathered through the use of a questionnaire that consisted of demographic measures: the Internet Gaming Disorder Scale&amp;amp;mdash;Short Form (IGDS9-SF), the Depression Anxiety Stress Scale (DASS-21), the Big Five Inventory (BFI), and the Parenting Style Questionnaire. Multiple logistic regression was utilized for data analysis in order to identify relevant risk factors and construct a risk prediction model.&amp;lt;/p&amp;gt; &amp;lt;/div&amp;gt; &amp;lt;div&amp;gt; &amp;lt;p&amp;gt;&amp;lt;span class=&amp;quot;apple-converted-space&amp;quot;&amp;gt;&amp;lt;strong&amp;gt;Results. &amp;lt;/strong&amp;gt;&amp;lt;/span&amp;gt;The study revealed that certain sociodemographic characteristics (male and student), psychological factors (depression, anxiety, and stress), personality traits (high neuroticism, low conscientiousness), and authoritarian parenting style were all significant predictors of the occurrence of PIGD. These characteristics led to the creation of the risk prediction model, which demonstrated strong performance with an area under the curve (AUC) of 0.85 (95% CI 0.80-0.90).&amp;lt;/p&amp;gt; &amp;lt;/div&amp;gt; &amp;lt;div&amp;gt; &amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Conclusion. &amp;lt;/strong&amp;gt;Multifaceted issue and variety of risk factors influence PIGD. This study&amp;#039;s risk prediction model can effectively identify individuals at a heightened risk of developing PIGD. This allows for early and targeted preventative and treatment interventions to be implemented.&amp;lt;/p&amp;gt; &amp;lt;/div&amp;gt;

Developing an explanatory model of alcohol misuse among South Sudanese refugees in northern Uganda: A qualitative study

BackgroundAlcohol misuse is a significant health problem among forcibly displaced populations including male South Sudanese refugees in northern Uganda, yet interventions are sorely lacking. Developing an explanatory model of alcohol misuse in this population is the first step to designing appropriate and effective interventions. The aim of the current study was to examine alcohol misuse in this setting and to conceptualize an explanatory model of alcohol misuse. MethodA total of 57 interviews were conducted with male refugees (18+ years) with alcohol misuse (n=17), their family members (n=15), community and religious leaders (n=15), and mental health and psychosocial support providers (n=10) in Rhino Camp settlement in northern Uganda. A thematic analysis approach was used to inductively analyze the data. ResultsAlcohol misuse was identified as a significant psychosocial problem among men in this setting. The adversity (e.g. trauma, loss, poverty), psychological distress (e.g. demoralization), perpetuators (e.g. ease of availability of alcohol, family conflict), and consequences of alcohol use (e.g. interpartner violence, exacerbated poverty) were identified. An explanatory model emerged from the data showing a reinforcing relationship in which adversity causes psychological distress, which leads to increased alcohol use via a number of personal, interpersonal, community and societal perpetuators, and over time increased alcohol use amplifies psychological distress which further increases alcohol misuse. ConclusionsGiven the need to address alcohol misuse in this population, this explanatory model of alcohol misuse can be used to inform prevention and treatment interventions for alcohol misuse. These interventions should endeavor to address the identified determinants of alcohol misuse while being cognizant of the social and cultural considerations specific to males in this population.

Climate crisis and mental health.

Climate change has negative effects on mental health as shown by the World health organization (Who). Heatwaves can exacerbate some mental conditions such as schizophrenia and psychosis, both in the elderly and children as well as in young adults, and increase mortality for neurological and psychiatric diseases. Subjects facing climate events such as heavy rains and flooding may suffer from a psychological problem in the short, medium and long-term. Studies from the international and Italian context show that air pollution exposure may affect common mental problems such as depression and anxiety. Taking into account the growing trend in climate extremes, there is the need to deepen the knowledge on this topic to support the implementation of prevention and mitigation interventions.

Trends in new hepatitis C virus infections among repeat blood donors - Georgia, 2017-2023.

Blood donor cohorts are an underappreciated resource for surveillance and public health programming for infectious diseases. The incidence of hepatitis C virus (HCV) infection was evaluated in repeat blood donors in Georgia. Using data from the national hepatitis C screening registry, we calculated overall hepatitis C incidence for 2017-2023 and annual incidence during 2017-2022 among adults who donated blood at least twice and had a nonreactive HCV antibody (anti-HCV) test result upon first screening and a subsequent anti-HCV test conducted in any location. Rates of anti-HCV seroconversion and current infection were calculated by year, sex, age group, and location of last HCV screening and expressed per 100,000 person-years (PY). Of 101,443 blood donors with ≥2 anti-HCV results,775 (0.8%) seroconverted to anti-HCV reactive, of whom 403 (52.0%) had current infection. Incidence of anti-HCV seroconversion decreased from 408 per 100,000 PY in 2017 to 218 per 100,000 PY in 2022 and incidence of infection decreased from 172 per 100,000 PY in 2017 to 118 per 100,000 PY in 2022. Males, persons aged 18-39 years, and people last tested for HCV in prisons had the highest incidence rates for anti-HCV seroconversion and HCV infection, while persons last screened in blood banks and during antenatal care had the lowest. Despite the observed decline, incidence of HCV infection among repeat blood donors remains high in specific subgroups. Hepatitis C prevention, screening and treatment interventions need to particularly focus on incarcerated populations and young adults in Georgia.

The socioeconomic dimension of forest therapy: A contribution to human well-being and sustainable forest management

Forests provide a variety of ecosystem services that contribute in various ways to human well-being. In times of land-use pressures, urbanisation, and nature degradation, the societal demand for forest-based therapeutic uses is increasing. Although nature-related therapies and the beneficial effects of nature on health and well-being are an old concept in cultures such as Asia and, more recently, Europe, forest therapy offers are increasingly taking hold in the forest recreation landscape. This Commentary paper identifies recent forest therapy offers and research in Asia and Europe that focus on the therapeutic effects of forests and examine their underlying rationales, practices, and status. In particular, we elaborate the socioeconomic potential of forest therapy to contribute to human health and sustainable forest management. Based on a scoping review on forest therapy offers and research, we found that countries such as Japan and South Korea are ahead of European countries in the professionalization of forest therapy offers and respective studies. While the number of studies that demonstrate the positive health benefits of forests are increasing, there is a lack of understanding the link with forest management approaches and forest and health policies. A lack of socioeconomic evaluation hinders its successful integration into policy frameworks, and prevents its use as an alternative forestry product or preventive medical treatment. For forest therapy to become part of the forestry portfolio and a medical alternative, we recommend:•Interdisciplinary research approaches and new actor alliances that link societal demands for forest therapy with insights from forest management and medical health research,•Transdisciplinary research and multi-actor approaches to link insights from forest and medical research with practitioners’ skills for forest management, service design, and communication,•To identify trade-offs and conflict potentials with forest therapy, for example in relation to timber production or questions of insurance in case of injuries by falling branches etc., that allow to develop integrated and sustainable solutions,•Policy backup and economic support for forest managers and owners to compensate for their efforts to manage their forests for therapeutic purposes•Recognition of forest therapy as an explicit part of the forestry portfolio and an alternative medical offer for clinical treatments.

The Impact of Methamphetamine on Liver Injury in Iraqi Male Addicts

Methamphetamine (METH) is a powerful stimulant that affects neurochemical processes controlling heart rate, appetite, blood pressure, body temperature, and wakefulness, making it highly susceptible to abuse. Liver enzymes such as ALT, AST, ALP, and GGT are crucial for liver function. Albumin, a protein synthesized by healthy liver cells, serves as an indicator of chronic liver disease. Additionally, hepatocytes produce bile acids, which are essential for the secretion of bile salts into the bile canaliculi. Disruption in this secretion results in the accumulation of bile salts in the canaliculi, leading to intrahepatic cholestasis. METH-induced liver toxicity involves disruptions in hepatic metabolism, oxidative stress, and increased body temperature, affecting cellular processes such as cell division and the cell cycle and potentially accelerating liver cell apoptosis. The study explores the link between liver toxicity and hepatocyte damage in Iraqi males suffering from addiction. This is a case-control study, conducted at Ibn-Rushed Psychiatric Hospital in Baghdad from July 2023 to February 2024, involved 196 males, with addiction durations exceeding 24 months with varying degrees of methamphetamine (METH) addiction. The study included 187 healthy male controls with no history of drug addiction. Participants were aged 18 to 40 years. Diagnosis was confirmed using a drug test screening card administered by a specialist. The study included liver function tests (ALT, AST, ALP, and GGT), total bilirubin, and albumin concentration assessments. Significant differences were observed between the addicts and controls, particularly a marked decrease in serum albumin concentration in the addicted males. The ROC curve classification model at various thresholds demonstrated that liver enzymes, especially ALT, ALP, and GGT, exhibited increased sensitivity to METH addiction. A histopathological examination was conducted on a deceased 38-year-old male who had a six-year history of chronic amphetamine addiction to confirm liver injury and the resulting elevation of liver enzymes. The findings of this study indicate that METH greatly affects liver function, suggested to the importance of following a preventative measures and effective treatment approaches for monitoring METH addiction progress.

Integrating Digital Tools Optimizes Scale Management

_ This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 218700, “Integrating Digital Tools to Optimize Scale Management: Case Studies,” by Hugh M. Bourne, SPE, Shaun Hosein, and Garry Keilty, BP, et al. The paper has not been peer reviewed. _ The complete paper describes the suite of cloud-based digital-twin tools developed by the operator that provides online, real-time calculation of scale risk and barrier health on a well-by-well basis. The paper presents field case studies in which the suite of tools, integrated into a dashboard, have been implemented. Introduction Several case histories are shared in the complete paper, highlighting the challenges of updating evolving scale risk and monitoring the health of deployed barriers, which drove the decision to create the digital tools to further optimize scale management. Case Study 1 A mature asset with subsea wells had been operated for many years without any history of scaling. The wells were operated under pressure depletion with no water-injection support, but lift gas injection was initiated approximately 10 years ago to maintain production. When a decision was made to increase production from one of the wells by further opening the choke, the potential effect of this change on scale risk was not immediately assessed. Further opening the choke reduced the wellhead pressure by approximately 30 bar, and the well flowed faster, increasing wellhead temperature by as much as approximately 10°C. After an initial increase in production, a decline was observed. A light intervention vessel encountered a hard restriction below the wellhead. When solids were recovered to surface, the tool became stuck in the well and the intervention was stopped while a rig was mobilized to recover the stuck tool. In the intervening period, the recovered solids were analyzed, confirming that the restriction was calcium carbonate scale. Scale predictions were updated with the new operating conditions, confirming that the higher wellhead temperature, coupled with the lower wellhead pressure in the presence of lift gas, had pushed the fluids into a calcite scaling regime. The scale restriction was remediated using acid washing and a preventative scale squeeze treatment. The intervention, in total, cost the operation more than $50 million. Since the scaling event, wells have been routinely squeezed to protect production at a typical cost of around $5 million per well per treatment. Case Study 2 A subsea field is being developed as a tieback to a mature facility. Production from the new tieback has the potential to deposit halite in the wells and flowline at various stages of field life. A multistage wash-water-injection strategy has been proposed to allow a standard tree design. Additional wash water will be injected at the wellhead to protect the flowline from halite deposition as the fluids cool and to ensure that the produced-water chloride concentration is sufficiently reduced. This will create produced water with an almost 1:1 mix of formation water and wash water. Further wash-water injection is planned at the slug catcher. However, the host facility has produced water-handling limitations that restrict the amount of water it can process. Optimizing the amount of additional wash water while managing the halite-deposition risk, ensuring effective corrosion inhibition, and meeting export specification will be essential to minimize deferrals, thereby maximizing production.

Community prevention and standardized clinical treatment jointly improve cancer outcome: Real-world evidence from an esophageal cancer patient cohort study

Extensive efforts have been put into reducing the heavy burden of esophageal squamous cell carcinoma (ESCC) in China. However, the joint impact of prevention and treatment on the long-term overall survival (OS) of ESCC patients remains largely unknown. We consecutively recruited 13,255 ESCC patients from two Chinese centers: the Northern center, located in a high-risk area with abundant screening programs; and the Southern center, situated in a non-high-risk area with improved clinical practices. Inter-center comparison, longitudinal intra-center comparison, and a simulation analysis were conducted to investigate the influence of tumor downstaging and high-quality clinical treatment on OS. During a follow-up period of 12.52 years, the Northern center exhibited higher median survival than the Southern center (6.22 vs. 3.15 years; HRadjusted = 0.73, 95% CI: 0.69–0.77). Mediation analysis demonstrated that its OS advantage was largely (77.7%) attributed to earlier TNM stage (stage 0–II: 51.3% vs. 24.6%). In temporal analyses, patient survival in the Southern center gradually improved (median survival during 2015–2018 vs. 2009–2014: 3.58 vs. 2.93 years; HRadjusted = 0.86, 95% CI: 0.79–0.94), coinciding with the progress of treatment-related indices (completeness of TNM staging in discharge diagnosis [from 53.7% to 99.6%], adoption of minimally invasive esophagectomy [from 0.0% to 51.1%] and right thoracic esophagectomy [from 12.4% to 86.4%], etc.). Simulation analysis further demonstrated that integrating both downstaging and high-quality treatment would lead to the best survival. Tumor downstaging and high-quality clinical treatment have a joint impact on ESCC patient survival. Establishing a comprehensive strategy that integrates cancer prevention with optimal clinical treatment is crucial for alleviating the ESCC burden.

Antifungal Activity of Citrus Essential Oil in Controlling Sour Rot in Tahiti Acid Lime Fruits.

Sour rot, caused by Geotrichum citri-aurantii, is a significant post-harvest disease in citrus, resulting in economic losses due to the lack of effective fungicides. This study investigates the antifungal activity of citrus essential oils in controlling sour rot in Tahiti acid lime fruits. Essential oils were extracted via hydrodistillation with chemical composition analyzed by CG-MS and tested in vitro and in vivo. In vitro assays evaluated mycelial growth inhibition at 2 to 32 µL mL-1 concentrations. In vivo trials involved preventive and curative treatments on artificially inoculated fruits stored at 25 °C ± 2, and the results showed that Pera IAC sweet orange oil, at 32 µL mL-1, reduced disease severity by 96% in curative treatments. In contrast, Late IAC 585 willowleaf mandarin oil demonstrated moderate inhibition (44%) at the highest concentration in vitro. The oils did not affect key fruit quality parameters such as juice yield and total soluble solids. These findings suggest that citrus essential oils could be natural alternatives to synthetic fungicides for post-harvest sour rot management, combining effectiveness with maintaining fruit quality.

Is rheumatoid arthritis always preceded by a symptomatic at-risk phase of arthralgia?

ObjectivesSecondary prevention of rheumatoid arthritis (RA) is generally considered potentially impactful because the entire RA population is believed to experience a symptomatic ‘pre-RA’ phase. We wondered whether this dogma is...

Cost-effectiveness of falls prevention strategies for older adults: protocol for a living systematic review

IntroductionOne-third of adults aged 65+ fall annually. Injuries from falls can be devastating for individuals and account for 1.5% of annual healthcare spending. With the growing ageing population, falls place...

Associations and mediating factors between adverse childhood experiences and substance use behaviours in early adulthood: A population-based longitudinal study

BackgroundResearch has demonstrated positive associations between adverse childhood experiences (ACEs) and substance use behaviours in young adults. However, many of these are based on cross-sectional data. The pathway between ACEs and substance misuse among emerging adults is also not fully understood and few studies have investigated potential mediating factors. MethodsWe analysed data from the Child Cohort of the Growing Up in Ireland study, a nationally representative longitudinal sample of children recruited at 9 years of age (n = 4,729). Logistic regression was used to examine individual and cumulative ACE exposure relationships with substance use at age 20 years. Mediation analyses were used to assess whether parental and peer relationships and school engagement mediate ACE history associations with substance use behaviours. ResultsACE exposure relationships with current cannabis use, other illicit drug use and problematic drug use were observed. In particular, young adults who had experienced 2 ACEs or 3 + ACEs had an approximate two-fold (OR=1.80, 95 % CI: 1.29, 2.51) and approximate three-fold (OR=2.94, 95 % CI: 2.06, 4.19) increased odds of problematic drug use, respectively, when compared to participants who had experienced no ACEs during the study period. Mediation analyses suggested that parent and peer attachment and liking school partially mediate relationships between ACEs and substance use behaviours. ConclusionsChildren who have experienced ACEs are at higher risk of future substance use and problematic drug use. In supporting these children, identified mediators such as interpersonal relationships and school engagement may help guide selection of prevention interventions.

Evaluating the Impact and Cultural Relevance of LifeKeepers Gatekeeper Training Across Three Training Modalities.

Background: While Gatekeeper Training (GKT) is an accepted component of suicide prevention strategies, there is little evidence about its effectiveness with Indigenous populations and online. Aims: This study examined the effects of LifeKeepers, a novel GKT, comprising three modalities: General, e-learning, and a culturally tailored Māori (New Zealand Indigenous) training. Methods: A total of 5,981 participants completed measures of declarative knowledge, perceived knowledge, and self-efficacy pre- and post-training. Participants rated satisfaction with LifeKeepers, its safety considerations and cultural acceptability post-training. Results: There were statistically significant improvements across all outcome measures (declarative knowledge 1.3 [95% CI 1.3-1.4], perceived knowledge 10.9 [95% CI 10.7-11.1], and self-efficacy 2.5 [95% CI 2.5-2.6]), including across all modalities. More than 90% of participants rated satisfaction, cultural acceptability, and safety considerations highly. Limitations: Without a control group, changes may not be solely due to engagement in LifeKeepers. Conclusions: This study offers preliminary evidence of the immediate effectiveness of LifeKeepers, across its in-person, Indigenous Māori, and e-learning modalities. It addresses a critical literature gap by exploring participants' safety perspectives and strongly supports LifeKeepers as a primary suicide prevention intervention in New Zealand, especially for Indigenous Māori communities. Comparable outcomes for e-learning participants indicate wider accessibility, bolstering suicide prevention efforts.