Western Countries Research Articles (Page 1)

In Western countries, the standard perioperative treatment for resectable locally advanced esophagogastric junction adenocarcinoma (EGJ-AC) is 5-fluorouracil, oxaliplatin, and docetaxel (FLOT) therapy based on the results of the FLOT4 and ESOPEC trials. On the other hand, there was little evidence based on optimal perioperative treatment for resectable locally advanced EGJ-AC in Japan. Our previous report showed that neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy demonstrated modest efficacy for resectable locally advanced EGJ-AC. Therefore, we compared neoadjuvant DCF to FLOT therapy in terms of efficacy and safety in this study. We retrospectively analyzed the data of patients who received DCF or FLOT therapy for resectable EGJ-AC between 2015 and 2024 in our hospital. We assessed the R0 resection rate, histopathological response, disease-free survival (DFS), overall survival, and adverse events. Thirty-two patients in the DCF therapy group and 20 patients in the FLOT therapy group were analyzed. The patients' characteristics in the DCF group and FLOT group were as follows: median age, 63/59years; ECOG PS 0, 66%/85%, respectively. The pCR rate was numerically higher in the FLOT group (20%) compared with the DCF group (3%) (p = 0.07). Similarly, the 1-year DFS rate was higher in the FLOT group (93%) than in the DCF group (68%) (p = 0.02), although this difference did not remain statistically significant after adjustment for baseline factors. Febrile neutropenia was significantly lower in the FLOT group (0%) than in the DCF group (12.5%). Neoadjuvant FLOT therapy is well-tolerated and has comparable short-term efficacy to DCF therapy.

ABSTRACT Academia is profoundly influenced by faculty hiring networks, which serve as critical conduits for knowledge dissemination and the formation of collaborative research initiatives. While extensive research in various disciplines has revealed the institutional hierarchies inherent in these networks, their impacts within GIScience remain underexplored. To fill this gap, this study analyzes the placement patterns of 946 GIScience faculty worldwide by mapping the connections between PhD-granting institutions and current faculty affiliations. Our dataset, which is compiled from volunteer-contributed information, is the most comprehensive collection available in this field. While there may be some limitations in its representativeness, its scope and depth provide a unique and valuable perspective on the global placement patterns of GIScience faculty. Our analysis reveals several influential programs in placing GIScience faculty, with hiring concentrated in the western countries. We examined the diversity index to assess the representation of regions and institutions within the global GIScience faculty network. We observe significant internal retention at both the continental and country levels, and a high level of non-self-hired ratio at the institutional level. Over time, research themes have also evolved, with growing research clusters emphasis on spatial data analytics, cartography and geovisualization, geocomputation, and environmental sciences, etc. These results illuminate the influence of hiring practices on global knowledge dissemination and contribute to promoting academic equity within GIScience and Geography.

Extractive ideologies have led to a condition of climate change that threatens all life as we know it. Many congregations in the Western world mostly feel the faint warning of climate change. By contrast, Native peoples recognise climate change as fulfilment of an Elder’s warning that the weather is “growing old” — our climate grows strangely warm. This paper argues that indigenous practices of mutuality and reciprocity between human and non-human beings is a kind of strategically aligned storytelling. Native storytellers, like Peter John-Xadalt’eyh, “braid” together vulnerable communities, including non-human, for a sustainable ecology, forming empathy and knowledge between different tribes, human and nonhuman. In the context of this journal, this article explores how his testimony informs thinking in homiletics on topics of place, interdependency, the beautiful and the grotesque, and the problem of hope. As a piece of a larger project, I close the paper with some thoughts about how we, as teachers, might equip our students to “see the sound” of the sermon.

Gallstone disease is common in the Western world, and approximately 15,000 cholecystectomies and 9000 endoscopic retrograde cholangiopancreatographies (ERCPs) are performed each year in Sweden. While being safe, the high frequency of these procedures has a significant cumulative impact on health in the community, exceeding those of many complex procedures for malignant conditions. Compliance with established guidelines for gallstone disease management varies and the strength of supporting evidence remains inconsistent. The Swedish National Register for Gallstone Surgery and ERCP (GallRiks) was launched in May 2005 to monitor outcomes nationwide, to enhance quality of care, and to facilitate population-based research. Continuous feedback to participating units has contributed to improvement in patient care. Since its introduction, laparoscopic procedures have become more prevalent than open cholecystectomies, antibiotic prophylaxis is used more selectively, and the proportion of procedures performed on a day-case basis has increased: all of this despite unchanged healthcare resources. Register-based studies have highlighted the benefits of intraoperative cholangiography, the advantages of centralizing care to high-volume surgeons, endoscopists and units, as well as the impact of surgeon gender on outcomes. Now in its 20th year, GallRiks remains a cornerstone of quality assurance in Swedish gallstone surgery. Research based on register data continues to improve gallstone disease management and shape clinical guidelines and healthcare practice.

This review article seeks to analyze the main contributions of historical research and, to a lesser extent, sociology and anthropology, over the last twenty years in three distinct but closely interwoven domains: the history of eugenics, the history of heredity, and the history of the biological notion of race. After clarifying the relations between these too-often conflated subjects, the article compares the evolution of their respective fields of research, distinguishing between the development of previously addressed themes and the exploration of new perspectives. It considers historiographical reflections on eugenicist policies of forced sterilization, on the close relations established between eugenics and natalism in certain countries such as France, and on the genealogy of the category of race and mechanisms for objectifying racial diversity. The profound renewal of the three domains of research over the period is analyzed via two complementary perspectives: the significant broadening of their geographical horizons and the reproblematization of their scientific objects. Though the focus of earlier work on the European and North-American experience may have suggested that biopolitics, eugenics, and “scientific racism” were the prerogative of Western countries, the recent increase in studies of Latin America, Asia, and, to a lesser extent, the Middle East and Africa, has definitively discredited this reductive vision. In parallel, a better awareness of gender perspectives, the exploration of historical continuities between eugenics and medical genetics, and the reevaluation of the role of biomedicine in debates on human heredity and the notion of race have profoundly renewed the three fields of research studied here.

Mental health services in the developed Western world have known a significant change in paradigm in favor of recovery. However, the transformation has not followed at the same pace in the developing Arab countries. Introducing recovery-oriented approaches in mental health care systems in Arab countries needs the provision of a valid, reliable, economic, and culturally tailored recovery measure that can be easily applied among people with mental illness. This study proposes to contribute to the field by translating and validating the Recovery Assessment scale (RAS-8) in the Arabic language. The Arabic translated version of the RAS-8 was administered to 177 persons with schizophrenia receiving treatment, who were recruited from a long-stay hospital in Lebanon. Findings from the confirmatory factor analysis indicate that the bidimensional factor structure of the Arabic version of the RAS-8 revealed adequate goodness-of-fit values. A Cronbach's α coefficient of .68 was observed, indicating adequate internal consistency reliability. Concurrent validity was supported by showing that RAS-8 scores correlated significantly and negatively with symptom severity, and correlated positively with functioning levels. Finally, cross-sex invariance was established at the scalar, metric, and configural levels. The present study makes available a simple, valid, and reliable translated version of the RAS-8 in the Arabic language to measure personal recovery as experienced and self-rated by patients with schizophrenia in an Arabic-speaking Lebanese population. Hopefully, the Arabic version of the RAS-8 will serve as a useful measure of recovery for both mental health professionals and researchers working in the Arabic language and context. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Live streaming platforms have become an important part of the digital entertainment economy, forming close connections with users through interactive functions and diversified monetization tools. However, the unique multi-account transaction chains, virtual gifts, and distributed reward mechanisms of live streaming platforms significantly increase the complexity of financial risk management, creating new compliance and regulatory challenges. This paper systematically reviews the potential types of financial risks associated with live streaming platforms, evaluates the applicability of existing detection methods, and compares regulatory models across different jurisdictions. The study finds that the real-time and micro-transaction characteristics of live streaming make the application of traditional anti-money laundering (AML) frameworks subject to delays and insufficient coverage. Taking China and Western countries as examples, China has implemented stricter measures in real-name authentication and platform responsibility systems, while Western jurisdictions mainly rely on financial institutions risk assessments and reporting mechanisms. This paper proposes an integrated risk management framework that combines behavioral analysis, network analysis, and cross-platform regulatory collaboration to enhance the monitoring of complex transaction structures. At the same time, it recommends that regulators adopt adaptive regulatory strategies to cope with the rapidly evolving compliance challenges in live streaming environments.

Schizophrenia ranks among the top ten causes of disability worldwide. The provision of healthcare services requires estimates on the epidemiology of schizophrenia, but recent data for Germany are lacking. Based on a large German health claims database (GePaRD), we identified persons aged 0-64 years with treated schizophrenia, i.e., persons having at least one inpatient/outpatient ICD-10 diagnosis (F20) with at least one prescription for a schizophrenia-recommended antipsychotic in the same calendar year. For each year from 2012 (eligible persons: 9,589,084) to 2021 (eligible persons: 12,450,531), we calculated the standardized incidence proportion (SIP) and the prevalence of schizophrenia. Analyses were stratified by sex, age, and population density in the region of residence. The SIP of treated schizophrenia remained stable from 2012 to 2017 (46.0-46.5/100,000) and subsequently declined to 41.3/100,000 in 2021, with higher SIP in men (45.3/100,000) than in women (37.1/100,000). In 2021, the SIP was comparable in urban, rural, and sparsely populated rural districts (36.3-38.5/100,000) and higher in large urban cities (48.3/100,000). SIP estimates among children and adolescents (aged 0-17 years) varied between 3.5/100,000 and 4.1/100,000 over the study period. The standardized prevalence of schizophrenia declined from 366.1/100,000 in 2012 to 334.0/100,000 in 2021. Similar to other Western countries, there has been a decline in the incidence and prevalence of schizophrenia in Germany over the last few years. The higher incidence in males and those living in large urban areas highlights the health care needs of these populations.

ABSTRACT This article assesses contributions of NATO members to the alliance from the start of Russia’s war against Ukraine in 2022 to 2024/early 2025 and the correlation of these contributions with first geographic proximity to Russia and/or Ukraine and second the presence of right-wing populists in government. There was a strong correlation between proximity to Russia (and to some extent Ukraine) and a high contribution to NATO: those states bordering Russia (Finland, Poland, and the Baltic states) were amongst the highest contributors to NATO; virtually all the countries which made high or medium contributions to NATO were northern or eastern European states. The large majority of low contributors to NATO were southern or western European states which are relatively distant from Russia. The impact of right-wing populism was mixed, with populist leaders/governments in Hungary, Slovakia, and Türkiye deviating from the NATO consensus, Italy sticking to that consensus but being a low contributor, and Poland being a high contributor. The second Trump administration will be a major test of the impact of right-wing populism on NATO. A new NATO burden-sharing divide appears to be emerging between higher contributing eastern and northern European members and lower contributing western and southern European members.

Background: Previous studies from Western countries have reported associations between environmental temperature and pulmonary embolism (PE), with increased risk in colder seasons. However, large-scale studies have not yet been conducted in East Asia. Research Questions: We hypothesized a U-shaped association between temperature and PE incidence, with temperature sensitivity varying across clinical subgroups, assuming that cold temperatures might also increase PE risk in Japan. Methods: We analyzed data from the Japanese Registry Of All cardiac and vascular Diseases (JROAD)-DPC inpatient database (2012–2021), covering nearly all acute-care hospitalizations in Japan (~6 million/year). A total of 63,354 emergency admissions for acute PE were identified. Mean age was 69 ± 16 years; 42% male, 17% with cancer, 13% with diabetes, 16% with dyslipidemia, and 30% with hypertension. Weather data (mean/max/min temperature, humidity, pressure, sunshine, wind) were obtained from the Japan Meteorological Agency and linked to admission dates by region. Univariable and multivariable logistic regression were used to evaluate associations between PE risk and meteorological factors. Subgroup analyses were conducted for season, temperature shocks (≥5°C change in 24h), extreme days (≥30°C or ≤0°C), and cancer or shock status. PE incidence per 10 million population was calculated using prefectural population data, and cubic spline models were used to visualize the temperature–PE relationship. Results: Lower mean temperature (OR 1.02 per 1°C decrease; 95% CI 1.01–1.03), cold shock (OR 1.05; 95% CI 1.02–1.08), and hot shock (OR 1.04; 95% CI 1.01–1.07) were associated with increased PE risk. In winter, lower temperatures increased PE risk (min temp OR 1.009; p<0.001); in spring, higher temperatures were linked to increased risk (min temp OR 1.025; p<0.001). Hot days (OR 1.13; 95% CI 1.05–1.22) and cold days (OR 0.87; 95% CI 0.81–0.94) were also significantly associated with PE. Spline analysis confirmed a U-shaped association, with lowest risk at ~20°C. Patients without cancer or shock were more temperature-sensitive, while those with cancer or shock had persistently high PE incidence year-round. Conclusion: This nationwide study in Japan identified a U-shaped association between temperature and PE incidence. Patients without cancer or shock showed clear weather sensitivity, whereas those with cancer had elevated year-round risk.

BackgroundCompulsive sexual behavior disorder (CSBD) involves persistent, repetitive sexual behaviors that continue despite efforts to stop, leading to significant distress or impairment in personal, family, social, educational, and occupational functioning. Most compulsive sexual behavior (CSB) research focuses on Western countries, leaving its characteristics in Japan largely unexplored. Although treatment-seeking behavior for CSB is documented in Western contexts, there is a need to understand this behavior in Japan to improve mental health services.AimsThis cross-sectional study aimed to clarify association between CSB, sociodemographic factors, maximum sexual behavior duration, life satisfaction, negative consequences, psychological co-morbidities, and treatment-seeking behaviors in Japan.MethodsParticipants were recruited from a national probability-based sample of adults aged 18-59 in Japan using a web-based questionnaire, with proportional representation of sex assigned at birth, age groups, and residential areas. A total of 1094 respondents (43.69% heterosexual cisgender men, Mage = 39.9 ± 11.6) were included.OutcomesParticipants completed the Compulsive Sexual Behavior Disorder Scale-19 (mean score = 24.35 ± 9.27), reporting sexual behavior frequency, time spent on sexual behaviors, life satisfaction, negative consequences related to sexual behaviors, treatment-seeking behaviors, and comorbid conditions such as depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and Adult Attention-deficit Hyperactivity Disorder (ADHD) (Adult Attention-deficit Hyperactivity Disorder Self-Report Scale).ResultsIndividuals at high risk of CSBD (n = 28; 2.56%), based on the CSBD-19 cut-off score, were more likely to be cisgender heterosexual men than women (chi-squared test). Compared to low-risk individuals, those at high risk spent more maximum duration on pornography and masturbation, lower life satisfaction in health and intimate relationships, experienced negative consequences in various life domains (eg, sleep, social activities, work, family life, finances, and physical health), and exhibited symptoms of depression, anxiety, and ADHD. Three individuals at high risk of CSBD reported seeking treatment.Clinical ImplicationsIndividuals at high risk of CSBD experience negative consequences and psychological co-morbidities, making it critical to investigate contributing factors to provide effective treatment for CSB in Japan.Strengths and LimitationsThis study contributes to limited research on CSB in non-Western cultures using a nationally probability-based sample in Japan. The measures lacked detail, so future studies should include more specific questions to evaluate treatment-seeking and other conditions. The small sample size limits the generalizability of the findings when comparing high- and low-risk CSBD groups.ConclusionThis study identified characteristics of individuals at high risk of CSBD in Japan, highlighting the need to develop a support system specific to CSB to ensure effective treatment.

SUMMARYCoagulase-negative staphylococci (CoNS) are a group of bacteria commonly found on human skin and mucous membranes. Traditionally regarded as low-virulence microorganisms, they have gained recognition as significant pathogens in healthcare-associated infections, particularly among immunocompromised individuals and patients with indwelling medical devices. In diabetic foot infections (DFIs), CoNS can play a substantial role, particularly following previous antibiotic treatments or in the presence of indwelling devices. DFIs are usually polymicrobial, involving a mixture of aerobic and anaerobic bacteria. Although Staphylococcus aureus is recognized as the major pathogen, especially in Western countries, CoNS are increasingly emerging as significant pathogens in DFIs, including osteomyelitis. Their presence may complicate treatment by increasing the microbial burden and harboring antibiotic resistance mechanisms. The treatment of DFIs involving CoNS often requires a combination of antibiotics targeting both gram-positive and gram-negative bacteria, selected according to the severity of the infection and results of antibiotic susceptibility testing. This review aims to highlight the growing importance of CoNS in DFIs, discussing their pathogenic mechanisms, clinical implications, and the necessity for healthcare providers to consider their involvement in order to ensure effective treatment and successful patient outcomes. This narrative review aims to underscore the growing clinical relevance of CoNS in DFIs by exploring their pathogenic mechanisms, diagnostic challenges, and therapeutic implications. It emphasizes the need for clinicians to recognize CoNS as potential pathogens rather than mere contaminants and highlights the ongoing difficulty in distinguishing true infection from colonization. This distinction is critical for accurate diagnosis, appropriate antimicrobial stewardship, and the development of improved treatment strategies.

Multiple Myeloma (MM) is the second most frequent hematologic malignancy in adults in the Western world. The bone marrow microenvironment plays a critical role in MM progression by supporting malignant plasma cell (PC) survival, immune evasion, and proliferation. Among immune checkpoints, TIGIT has recently emerged as a relevant immunoregulatory molecule, capable of dampening cytotoxic responses and enhancing immune suppression. We investigated the expression of TIGIT in the bone marrow of newly diagnosed MM patients and its correlation with disease characteristics and microenvironmental features.We enrolled 25 consecutive patients with newly diagnosed MM. Bone marrow samples were collected for cytomorphology, cytogenetics (FISH), and immunohistochemistry using the Cytomatrix system. TIGIT expression was analyzed in bone marrow-infiltrating immune cells. Histological evaluation and confocal microscopy assessed immune cell localization, neutrophil extracellular trap (NET) formation, and proinflammatory cytokine expression. Clinical parameters, staging (ISS, R-ISS, R2-ISS), cytogenetic risk, and laboratory values were correlated with TIGIT status.TIGIT was expressed in 86% (19/22) of evaluable samples. TIGIT-positive patients had a significantly higher frequency of advanced R-ISS stages (p = 0.01), high-risk cytogenetics (100%), and elevated LDH (> 220 mU/ml, 100% TIGIT+). Among patients with PC% >60% or FLC ratio > 100, 92% were TIGIT+. Morphological differences were evident between groups: TIGIT-negative PCs were larger and altered, while TIGIT-positive PCs showed polarized nuclei and proximity to neutrophils. TIGIT-positive samples displayed increased neutrophils undergoing NETosis, as confirmed by neutrophil elastase and Ly6b co-expression (p = 0.0067). Elevated IL-6 (p = 0.0003) and IL-8 (p = 0.004) in TIGIT-positive samples suggest a proinflammatory microenvironment promoting neutrophil recruitment and NETosis.TIGIT expression in the bone marrow of MM patients is associated with more aggressive disease features and an inflammatory microenvironment enriched with NET-forming neutrophils. These findings support TIGIT as a potential biomarker of disease severity and a therapeutic target in MM.

Background: Chronic Kidney Disease (CKD) and Ischemic Heart Disease (IHD)-related mortality is a significant burden among US adults. This study investigates trends in CKD and IHD-related mortality in adults aged 25 and older focusing on overall, geographic, and racial/ethnic disparities from 1999 to 2020. Methods: A retrospective analysis was conducted using death certificate data from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region. Results: CKD and IHD-related mortality accounted for 552171 deaths among US adults aged 25+. Most deaths occurred at a medical facility (45.30%) and the patient’s home (19.90%). The overall AAMR decreased from 13.1 in 1999 to 10.8 in 2020, with an AAPC of -1.1378 (95 % CI: -4.1816 to 2.0028, p = 0.473276). It is worth noting from 2015 to 2020 the APC has been 6.1116 (95 % CI: 2.1479 to 10.2291, p = 0.005627) suggesting an acute rise. Racial/ethnic disparities showed the highest AAMRs in Blacks (19), followed by American Indians (15.7), Hispanics (12), Whites (10.6), and Asians (9.9). Over the years, racial stratification showed a decrease in mortality among all races. The most significant decrease was in Asians (AAPC: -4.0767, p = 0.000034) and Hispanics (AAPC: -3.8230, p = 0.000122). Geographically, AAMRs ranged from 5.6 in Nevada to 18.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 12.4) followed by the West (AAMR: 11.4). Over the years, the mortality has been decreasing in all the regions with the most significant decline being in the Northeastern (AAPC of -2.3167, p = 0.000741) followed by the Western states (AAPC of -1.8062, p = 0.046572). Nonmetropolitan areas exhibited higher AAMRs (12.2) than metropolitan areas (11.4). Overall trends (1999 to 2020) show a decline in mortality for both metro and non-metro however from 2015 to 2020 the mortality has increased in both areas with a sharper increase in the non-metropolitan areas (APC: 7.2592, p = 0.001435) than in the metropolitan areas (APC: 5.9817, p = 0.008059). Conclusion: We believe better cardiorenal interventions are required to combat this acute rise of the IHD burden in CKD patients with a special focus on the Black and American Indian populations, the Midwest, and non-metropolitan areas.

Introduction: Extreme heat events pose increasing risks for cardiovascular mortality. This study examined trends in cardiovascular deaths associated with heat-related illness in the United States from 1999 to 2020. Hypothesis: We hypothesized that cardiovascular mortality associated with heat-related illness increased from 1999 to 2020, with significant disparities across age, sex, race, region, and urbanization, reflecting disproportionate climate vulnerability among at-risk populations. Methods: Mortality data from CDC WONDER (1999–2020) were analyzed. Death listings for both cardiovascular disease (I00–I99) and heat-related illness (T67, R53, R55) were included. We used the 2000 U.S. standard population to generate age-adjusted mortality rates (AAMRs) per 100,000. Joinpoint regression calculated the annual and average annual percentage change (APC and AAPC). Stratified analyses were conducted by race/ethnicity, age, sex, region, and urban/rural status. A significance level of p < 0.05 was used. Results: From 1999–2020, 121,600 heatwave-related cardiovascular deaths occurred. AAMR rose from 1.76 to 2.27. In 1999, the South had the highest AAMR (2.02), Northeast the lowest (1.29); in 2020, the Midwest was highest (2.59), Northeast remained lowest (1.45). Black individuals had the highest AAMR in both 1999 (2.50) and 2020 (2.43), Asians the lowest (1.05; 1.43). Rural mortality exceeded urban in both years (2.00 vs 1.71 in 1999; 2.34 vs 2.24 in 2020). Males had higher AAMRs than females (1.87 vs 1.63 in 1999; 2.44 vs 2.06 in 2020). The West showed the largest increase (AAPC: 2.42%; 95% CI: 0.29–4.61); the South had the smallest, nonsignificant change (AAPC: 0.23%; 95% CI: –0.51–0.97). American Indians showed the largest decline (AAPC: –4.81%; 95% CI: –7.94–1.58), Whites the greatest rise (AAPC: 1.25%; 95% CI: 0.10–2.41). Urban areas had a higher AAPC (1.26%) than rural (0.71%). Males showed a significant increase (AAPC: 1.31%; 95% CI: 0.39–2.23), females nonsignificant (AAPC: 1.05%; 95% CI: –0.73–2.87). Age 35–44 had the lowest mortality (0.11 in 1999; 0.06 in 2020) and declined (AAPC: –3.75%; 95% CI: –4.70–2.78); 85+ had the highest (38.20 and 48.99). The largest increase was in age 55–64 (AAPC: 2.14%; 95% CI: 1.50–2.78); smallest in 45–54 (AAPC: 0.33%; 95% CI: –0.59–1.26). Conclusion: Cardiovascular deaths linked to heatwaves rose over two decades, affecting older adults, men, and Western states most, while American Indians and younger adults showed improvement.

Background: Chronic kidney disease (CKD) significantly amplifies the risk and complexity of heart failure (HF), yet national and state-level trends of HF burden attributable to CKD remain poorly characterized. With rising CKD prevalence and widening health disparities, a comprehensive assessment of geographic and temporal patterns is essential to inform targeted prevention and policy efforts in the U.S. Methods: We analyzed the burden of HF attributable to CKD in the United States from 1990 to 2021 using the Global Burden of Disease Study 2021 framework. Prevalence and years lived with disability (YLDs) were estimated by applying standardized case definitions and disability weights. Age-standardized prevalence rates and annualized percentage changes (APC) were calculated at national, state, and regional levels. Subnational comparisons and age-sex stratified analyses were performed to identify demographic and geographic trends. Results: Between 1990 and 2021, the total number of prevalent HF cases due to CKD rose from 26,681 (95% UI: 20,454–34,584) to 145,197 (106,346–197,734), reflecting a 444% increase. Similarly, YLDs increased from 3,425 (2,128–5,141) to 18,320 (11,119–28,692), marking a 435% rise. Subnationally, all states reported increases in prevalence, with the highest APC in Nevada (8.11%), Arizona (6.98%), Alaska (6.66%), and Texas (6.57%). Slower growth was observed in Rhode Island (4.37%) and the District of Columbia (3.48%). Regionally, the Western U.S. exhibited the highest APC at 6.40%, followed by the South (5.32%), Midwest (5.25%), and Northeast (5.05%). In 2021, the highest age-specific prevalence rate was noted among adults aged 55+ years at 128.12 (89.79–181.33) per 100,000, compared to 9.43 (6.35–13.74) in <20 years and 6.02 (4.30–8.19) in 20–54 years. By gender, the APC in age-standardized prevalence was slightly higher in males (3.57%) than in females (3.47%). Conclusion: In 2021, the United States contributed 7.49% of the global prevalence of HF attributable to CKD. Western and Southern states, as well as older adults, experienced disproportionately higher increases. These findings highlight the urgent need for regionally tailored interventions and integrated cardiovascular–renal care strategies to mitigate the growing disease burden.

Background: This study investigates trends in acute MI-related mortality in adults aged 65 and older with CKD, focusing on overall, geographic, and racial disparities from 1999 to 2020. Methods: A retrospective analysis was conducted using death certificate data from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region. Results: Acute MI in older (65+) patients with CKD accounted for 98349 deaths in the US. Most deaths occurred at a medical facility (57.30%). The overall AAMR for acute MI in older CKD patients decreased from 14.4 in 1999 to 8.5 in 2020, with an AAPC of -3.0286 (95 % CI: -4.2853 to -1.7555, p = 0.000083). Overall, the burden is higher in males (AAMR: 14.9) than in females (AAMR: 7.9) . Over the years mortality declined in both males (AAPC: -2.9094, 95% CI: -4.0724 to -1.7323, p = 0.000053) and females (AAPC: -3.2648, 95% CI: -4.5673 to -1.9445, p = 0.000054). Racial/ethnic disparities showed the highest AAMRs in Blacks (20.8), followed by American Indians (15.4), Hispanics (13.3), Asians (12.1), and Whites (9.3). Over the years, racial stratification showed a decrease in mortality in all races. The most significant decrease was in Blacks (AAPC: -5.5259, p < 0.000001) and Asians (AAPC: -5.3397, p < 0.000001). Geographically, AAMRs ranged from 4.1 in Nevada to 17.3 in North Dakota, with the highest mortality observed in the West (AAMR: 11.1) followed by the Midwest (AAMR: 10.9) . The mortality has been decreasing in all the regions with the most significant decline being in the Northeast (AAPC of -3.3588, p = 0.000031). Nonmetropolitan areas had higher AAMRs (11.8) than metropolitan areas (10.5). Overall trends show a decline in mortality for nonmetropolitan (AAPC of -1.5479, p = 0.028573) and metropolitan areas (AAPC of -3.3185, p = 0.000024). Conclusion: The overall mortality burden from acute MI in patients above 65 with CKD has declined over the years. Males have a much higher burden than females with a decline in both sexes over the years. Racial stratification shows a higher burden on Blacks and American Indians and a decline in all races over the years. The Western states bear a significantly higher burden. Non-metropolitan areas have a higher burden. We believe these trends and disparities should be addressed via targeted policymaking.

Abstract Church disaffiliation by millennials is a common phenomenon in Western countries, including the Netherlands, where conservative Reformed churches have been affected by it. Parents have a major influence on their children’s religious socialisation; however, little is known about how church leavers experience this influence. We examined millennials’ experiences of their parents’ parenting style concerning religion. Most of the parents in question adopted a combination of authoritative or permissive parenting style and authoritarian style regarding religious socialisation. They also exhibited ambiguity by emphasising the cognitive aspect of believing. As a result, their children experienced believing in God as having to comply with rules and obligations. This does not fit with millennials’ views of life and core values of autonomy and authenticity. The findings suggest that, for parents, it is more important to focus on the process than on the desired outcome; it is also important to transmit faith by doing, by showing, and talking about what it does to you as a parent.

Abstract In recent years, international scientific collaboration has become increasingly entangled with geopolitical tensions, especially between China and Western countries. While institutional and policy-level analyses have offered important insights, relatively little is known about how these global dynamics are experienced and navigated by individual researchers within China. Drawing on the analytical lens of institutional complexity and in-depth interviews with scholars in China engaged in international research, this study examines how researchers navigate the often conflicting expectations of national political agendas, organizational performance metrics, and global academic norms. The findings reveal five cross-cutting themes: the growing salience of national imperatives, intensifying organizational pressures, sustained commitment to global scientific values, pragmatic navigation of international collaborations, and perceived misrecognition and emotional tensions. By highlighting the micro-level strategies and adaptation, this study contributes to a deeper understanding of researcher agency under competing institutional logics in a rapidly evolving academic landscape.

This study utilized the literature method and the logical analysis method, which propose the problems in the development of National Fitness Program (NFP) research in China. Meanwhile, a quantitative analysis and discussion were conducted on the current research. It is found that the current research lacks comparative studies of countries with different cultural backgrounds and does not delve deeply enough into regional research. Finally, prospects for the future research of NFP are presented, including discussions on the legacy impact of major events and comparative studies with Western countries.