With a gradually aging global population, more and more older persons are receiving care in long-term care institutions during the final stages of their lives. A variety of factors, including the process of aging, dependence on assistance, and psychological problems, are known to undermine the self-perceived sense of dignity of older persons living in long-term care institutions. The purpose of this study was to examine the factors that influence dignity and the incidence of low self-perceived dignity among older persons living in long-term care institutions. This cross-sectional descriptive study was conducted from April to December 2022 on a sample of 188 older persons living in seven long-term care institutions in southern Taiwan. A structured questionnaire, including a demographic characteristics datasheet, Barthel Index, Patient Dignity Inventory-Mandarin version, and Patient Health Questionnaire-9, was used to collect data. The independent samples t test, one-way analysis of variance (ANOVA), and Pearson's correlation coefficient were used to examine the correlation between demographic variables and dignity, while binary logistic regression was used to analyze the probability of low dignity. Dignity was found to relate significantly with marital status (t = 2.49, p = .014), number of children (r = -.19, p = .008), educational level (t = -2.42, p = .016), chronic condition (r = .25, p = .001), ability to perform activities of daily living (r = -.36, p < .001), dependency level (F = 9.85, p < .001), mobility level (t = 2.84, p = .005), indwelling catheter status (t = -3.29, p = .001), and depression level (r = .47, p < .001). The results of binary logistic regression analysis showed factors including having fewer children (OR = 0.652, p < .001) or no children (OR = 0.101, p = .007), a higher education level (OR = 3.441, p = .001), or lower activities of daily living (OR = 0.976, p = .001) as well as suffering from depression (OR = 6.025, p = .047) or being unable to walk (OR = 0.448, p = .045) to be significantly associated with self-perceived low dignity. The findings indicate that older persons living in long-term care institutions with fewer or no children, a higher level of education, and/or lower activities of daily living, as well as those unable to walk and/or suffering from depression, face a relatively greater risk of suffering from low dignity. In light of this, professional caregivers working in long-term care institutions should place greater emphasis on providing dignified care to older persons.

The rising global older population increases the incidence of atrial fibrillation (AF), a major cause of stroke and heart failure, necessitating access to effective treatment. Catheter ablation (CA) has evolved into a primary treatment option, driven by significant advancements in device innovation, but is not available in all facilities. According to public data from Japan (the Vital Statistics survey of Japanese events in 2022, the Japanese government Survey of Household Economy, the Survey on the Impact of the Diagnosis Procedure Combination System, and publicly available data from the Japan Heart Rhythm Society), a severe regional disparity exists in access to CA due to the uneven distribution of arrhythmia specialists. Ablation procedures per 10,000 population across the 47 prefectures averaged 6.67 (95% CI: 6.19-7.12), with a range of 3.02-9.24. This access gap is the "paradox of technological innovation", associated with inequitable treatment outcomes, higher AF-related hospitalization, and poorer quality of life in underserved prefectures. Structural threats, including a shrinking cardiologist workforce and new work constraints (Restrictions under the Work Style Reform-related Laws by the Japanese Government), risk worsening this disparity. Addressing this requires a paradigm shift toward equitable dissemination of CA. The future of arrhythmia care rests not only on pursuing cutting-edge technology but also on formulating evidence-based, policy-oriented action plans to fulfill the professional and societal responsibility of eliminating treatment inequity.

SUMMARY This clinical reflection explores the evolving landscape of teaching and training in old age psychiatry, highlighting recent reforms such as the 2022 UK curriculum revision, which emphasises person-centred, interdisciplinary and digitally enhanced care. It examines national and international initiatives addressing health inequalities, integration of artificial intelligence, and co-produced education. The article underscores the need for adaptable, inclusive and forward-thinking training to meet the complex mental health needs of an ageing global population.

Depression is a prevalent mental health disorder affecting approximately 4% of the global population. Pharmacological management commonly involves the use of serotonin–norepinephrine reuptake inhibitors (SNRIs), including venlafaxine, duloxetine, desvenlafaxine, milnacipran, and levomilnacipran. Although these agents are effective in alleviating depressive symptoms, their prolonged use raises concerns regarding long-term safety. Clinical guidelines recommend antidepressant (AD) therapy for at least six months following symptom remission after the first episode of major depression; however, in practice, treatment duration often extends for years. Extended exposure to SNRIs has been associated with both common short-term adverse effects—such as weight gain, appetite changes, and sexual dysfunction—and less understood long-term outcomes, including metabolic, cardiovascular, and skeletal complications. The objective of this study is to systematically evaluate existing literature on the long-term side effects of SNRI therapy in patients diagnosed with depression. By synthesizing current evidence, this review aims to enhance understanding of the risk profile associated with chronic SNRI use and inform safer clinical practices.

Sub-Saharan Africa (SSA) continues to bear a disproportionate global disease burden while also facing significant disparities in research productivity and impact. As such, strengthening the research capacity in SSA is an urgent priority, necessitating a multifaceted assessment of the current landscape, the role of international collaboration and the alignment of research efforts with health needs. In this study, we conducted a macro-level bibliometric analysis to assess research capacity, thematic alignment and structural autonomy in SSA. We found that SSA accounted for approximately 15% of the global population and 21% of the global disease burden, yet it received only 2.7% of global citations in 2021. Despite increasing the research output over time, academic impact and leadership remain limited. Higher international collaboration rates were positively associated with a higher research impact, but also with a markedly greater proportion of publications without SSA researchers in key authorship positions, indicating persistent structural dependency. Researcher autonomy in SSA was substantially lower than in other regions, though slight improvements were observed during the COVID-19 period. Meanwhile, the Burden-Adjusted Research Intensity analysis showed a disproportionate concentration of research on HIV/AIDS, tuberculosis and malaria. This focus was sustained-and even intensified-in SSA during the pandemic, while many other high-burden diseases, including neglected tropical diseases, remained severely under-researched. In conclusion, this study provides quantitative evidence of persistent academic dependency and misaligned research priorities in SSA, with our analyses revealing how structural inequities in international collaborations and externally driven research agendas limit local research leadership and potentially hinder effective responses to regional health needs. Achieving a more just global research ecosystem demands active decolonisation efforts centred on empowering Global South ownership, including genuinely equitable partnerships, the reform of funding mechanisms to prioritise locally led research, and sustained investment in developing local research and leadership capacity.

Functional constipation affects up to 15% of the global population, significantly affecting the quality of life and imposing substantial clinical and economic burdens. Colonic transit time (CTT) studies have emerged as a pivotal diagnostic tool for distinguishing various types of functional constipation (i.e., slow transit constipation, normal transit constipation, and ano-rectal dyssynergia), thereby guiding personalized treatment strategies and enabling precise monitoring of therapeutic response. CTT studies using radiopaque markers (ROM) have been the most widely used technique by researchers worldwide. Despite its affordability and high diagnostic yield, the ROM CTT study remains grossly underutilized in routine clinical practice largely due to a pervasive lack of awareness among physicians regarding its methodological nuances and clinical advantages. This narrative review systematically examined the multifaceted role of ROM CTT studies in clinical practice. It underscored how ethnic, dietary, and lifestyle factors profoundly influence colonic motility, thereby necessitating the development of population-specific diagnostic protocols. The review also highlighted the significant variability in imaging methodologies, such as differences in radiographic timing and patient positioning (supine vs erect), which further complicate the interpretation and reliability of CTT assessments. By drawing on a wide spectrum of research, this review advocated for enhanced physician education and the implementation of standardized, evidence-based protocols. Such initiatives are critical to optimizing the diagnostic accuracy and clinical utility of ROM CTT studies, ultimately leading to more effective management of refractory constipation and improved patient outcomes.

Obesity is a major public health challenge affecting an ever-increasing proportion of the global population. It is associated with numerous comorbidities. Progressive expansion and remodeling of adipose tissue may lead to depot specific changes in adipose tissue biology and energy partitioning. Such changes likely precede the development of obesity-related complications. To facilitate a deeper understanding of adipose tissue biology, a comprehensive quantitative proteomic dataset is presented at the peptide and protein level. Data-independent acquisition LC-MS/MS data were acquired from matched subcutaneous and omental adipose tissues from metabolically healthy individuals with no comorbidities and covering a wide range of body mass indexes. Adipose tissue samples were collected during elective surgeries and immediately processed for histology or frozen until proteomic analysis. Internal and external quality control systems ensured high quality data. All data presented are available via ProteomeXchange. This dataset will allow new insights into biological changes that evolve with increasing adiposity captured before the onset of comorbidities. Matched sampling across fat depots provides an opportunity to uncover depot-specific physiological signatures.

With the global population projected to continue to increase, the necessity for food security (i.e., a region’s ability to reliably provide food to its residents) becomes ever-present. Aquaculture is currently one of the most prevalent methods for propagating aquatic species, though aquaponics (i.e., combining aquaculture and hydroponics to artificially propagate aquatic species and plants) is often considered a more sustainable food production method in comparison. Though aquaponics is promising both environmentally and socially, the general aquaponics business model is failing to generate proper revenue in many instances. The addition of value-added and value-recovered processes is one option for producers to increase the value of their final products without major capital investment. A paper survey was deployed for this study for both aquaculture and aquaponics operations, given the current prevalence of aquaculture and infancy of aquaponics in the United States. The survey aims to understand the basic parameters of their operation while also gauging interest in the addition of value-added and value-recovered products for their operations. Less than half of the respondents were interested in value-added and value-recovered products for several different reasons. The survey also provides useful information related to operation, prior experiences, and potential future directions for aquaponics in the United States, though investigation into consumer preferences is required for optimized success of the aquaponics industry.

Almost 10% of the global population suffers from chronic kidney disease (CKD). The inexistence of a therapeutic to restore renal function motivates the scientific community to search for new treatments. The 5/6 nephrectomy (Nx) rat model is widely used to mimic human CKD, but the impact of strain-specific responses on disease progression remains unclear. Here, we aimed to compare CKD development in Wistar, Lewis, and Fischer rats submitted to the Nx model. In summary, even submitted to the same surgical procedure, the three studied rat strains presented distinct patterns of CKD progression: Wistar rats exhibited faster and sustained renal function loss, with exuberant hypertension, proteinuria, and renal inflammation, being considered as excellent models to study rapidly progressive human nephropathy. Lewis animals, in turn, presented mild low-progressive CKD, which make this rat strain especially useful to simulate intermediate degrees of human CKD and to develop long-term tests. Finally, Fischer rats submitted to Nx did not even develop hypertension, proteinuria, or glomerular damage within 30 days. Moreover, compared to Wistar rats, both Lewis and Fischer animals have a relatively higher basal number of nephrons and a lower number of whole blood leukocytes, which may have contributed to the renoprotection exhibited by these rat strains.

Allergic rhinitis (AR) affects 10-40% of the world's population, and modern high-salt diets (HSD) may influence immune function. Currently, the influence and mechanism of a HSD on AR remain poorly understood. The study aims to investigate the role of a HSD in AR through the P38/MAPK-NFAT5-SGK1 signaling pathway. The serum IgE levels, 24-hour urinary sodium excretion, and AR symptom scores in patients were detected. To evaluate the immune responses and potential pathway, ovalbumin-induced AR mice were exposed to a HSD. Cellular gene silencing technology was employed to identify key regulators of the NFAT5 pathway. In AR patients, urinary sodium excretion was positively correlated with IgE levels and symptom scores. In the mouse model, a HSD altered the gut microbiota and upregulated NFAT5 expression, leading to nasal mucosal barrier disruption and inflammation exacerbation. Gene-silencing experiments confirmed the critical role of the P38/MAPK-NFAT5-SGK1 pathway in mediating both allergic responses and epithelial damage. Notably, switching from a HSD to a normal diet partially reversed clinical symptoms in mice, but the immune memory remained difficult to reset. In conclusion, this work provides the strong evidence of salt-immune axis in AR through osmotic sensing pathways, advancing mechanistic understanding and clinical management approaches.

Proteus mirabilis, a Gram-negative bacterium renowned for its distinctive swarming motility, is a major causative agent of catheter-associated urinary tract infections (CAUTIs) and nosocomial complications. While advances in sequencing technologies have generated extensive genomic data, critical gaps persist in understanding the global population structure and evolutionary drivers of antimicrobial resistance in this pathogen. To address this knowledge gap, we performed a phylogenomic analysis of 1,142 P. mirabilis genomes spanning 34 countries and 16 ecological niches. Our investigation identified a dominant multidrug-resistant lineage (Cluster-1) carrying significantly elevated antimicrobial resistance gene burdens, including high-prevalence carbapenemase genes blaKPC-2 and blaIMP-27. Bayesian evolutionary dating traced the most recent common ancestor of Cluster-1 to approximately 1910, with subsequent expansion linked to acquisition of the autotransporter gene agn43 within the PmGRI1 genomic island. Notably, Cluster-1 diversified into two clinically significant subclades: a China-associated branch carrying blaKPC-2 and a USA-associated branch harboring blaIMP-27. Functional characterization revealed that agn43 deletion caused significant attenuation in biofilm formation, heat stress tolerance, and swarming motility. Our findings delineate the emergence of a globally disseminated P. mirabilis clone, highlighting the synergistic role of antimicrobial resistance and agn43-mediated adaptive traits in its epidemiological success.

Introduction As global populations age at unprecedented rates, nations worldwide confront the challenge of developing effective end-of-life (EoL) care systems. While advance directives (ADs) represent a cornerstone of patient-centered dying, their adoption varies dramatically across jurisdictions. This study introduces a novel dual-dimensional analytical framework—“Resilience from Scale” and “Resilience from Structure”—to explain cross-national variations in EoL care policy effectiveness among China, South Korea, the United States, and the United Kingdom. Methods Using a comparative, secondary-data-based design, we apply a Most Similar Systems Design to the East Asian cases and comparative institutional analysis to the Western cases. We employ semi-quantitative, ordinal coding of “Scale” and “Structure” indicators to assess how resource capacity and institutional configurations align with divergent policy outcomes. Results The comparative evidence suggests that higher structural resilience—operationalized through national legislation, insurance integration, and state capacity/legitimacy—tends to be more consistently aligned with higher AD implementation than cultural explanations or resource availability alone. South Korea’s post-2018 shift following the Life-Sustaining Treatment Decision Act provides a salient within-case contrast, supporting the comparative plausibility that institutional design can coincide with substantial changes in advance care planning uptake even where cultural constraints are often assumed to be strong. Conclusion These findings challenge culturally deterministic interpretations in EoL policy research and propose a “Structural Adaptation Model” as a heuristic for jurisdictions seeking to develop effective advance care planning systems.

Given global population aging and the absence of aging-reversal therapies, elucidating the aging-related cancer risk association and developing cancer prevention strategies are imperative. This population-based cohort study analyzed data from the UK Biobank. Aging was assessed through four validated markers, including Klemera-Doubal method (KDM), PhenoAge, leukocyte telomere length (TL) and chronological age. Over a median follow-up of 13.5 years, significant associations between all aging measures and elevated overall cancer risk were observed. False discovery rate (FDR)-corrected analyses revealed a significant association in a biological aging group for seven site-specific cancers, including esophageal, colorectal, pancreatic, skin, kidney, urinary tract cancers, and lymphoma, as evaluated by the four aging markers. A significant interaction (FDR-corrected p < 0.05) between Life's Essential 8 (LE8) and PhenoAge was observed for lung cancer risk. Furthermore, joint analyses revealed that elevated LE8 scores modify this risk for overall cancer among individuals with biological aging, with consistent risk reductions observed for esophageal, gastric, breast, and uterine cancers across all aging markers. These findings suggest that a higher LE8 score is associated with lower cancer risk in the context of biological aging.

The global population of individuals suffering from hypertension is estimated to surpass 1.28 billion. Uncontrolled hypertension makes contributions to the development of cardiovascular and cerebrovascular diseases. Emerging evidence indicates a significant correlation between hypertension and gut microbiota. As an intestinal regulator, which could confer health benefits to the host in adequate amounts, probiotics may become a novel approach to regulating blood pressure without side effects. Therefore, we overview the antihypertensive effects and the potential mechanisms of probiotics supplement on hypertension.

Despite evidence documenting high prevalence of type 2 diabetes among several Indigenous populations, a comprehensive systematic review of type 2 diabetes among global Indigenous Peoples has not been recently conducted. Our aim was to report region-, time-, age- and sex-specific type 2 diabetes prevalence among Indigenous adult populations globally. MEDLINE, Embase and CINAHL were searched for English-language studies published between 1 January 1980 and 3 March 2023. Studies reporting type 2 diabetes prevalence and/or cases of diabetes among global Indigenous adult populations aged 18 years and older were included. Type 2 diabetes prevalence data were extracted for the overall Indigenous population, sex, age group and year. Summaries of extracted data were tabulated, and are presented using comprehensive tables and figures. A modified Newcastle-Ottawa quality assessment scale reflective of Indigenous-specific criteria was applied to assess paper quality. The search identified 2332 studies, of which 202 met the inclusion criteria. The included studies represented at least 187 Indigenous populations from 37 countries, although the exact number of populations is approximate, as some studies did not name specific Nations/Tribes/Groups for populations from different geographic regions. Diabetes prevalence ranged from 0 to 40%, with a mean of 73% of Indigenous populations reporting type 2 diabetes prevalence above the estimated global prevalences for every decade between 1980 and 2020. Prevalence increased over time and with age for many populations, with the highest reported prevalence (50.5%) in the 45-54 year age group. Type 2 diabetes prevalence was notably high among Indigenous women, with 73% of studies reporting higher prevalence for Indigenous women than for Indigenous men. Potential limitations include publication bias, which may have led to fewer studies being included in this review. Type 2 diabetes prevalence among Indigenous adult populations was markedly higher than the global averages in every decade from 1980 to 2020, with a mean of 73% of populations reporting higher prevalence. These findings underscore the persistent and disproportionate burden of diabetes experienced by many Indigenous communities over several decades. Future work should aim to generate representative data on type 2 diabetes prevalence across global Indigenous populations, investigate factors that contribute to alarmingly high and notably low diabetes prevalence, and support Indigenous-led, culturally safe, Indigenous population-specific health practices to prevent and manage type 2 diabetes and achieve equitable outcomes. There was no funding source for this study. PROSPERO registration no. CRD42021258623.

Effects of varying the human-edible fraction of concentrates offered on dairy cow performance and nutrient utilization.

Young adult life courses in the Global South: A comparative framework and research agenda.

Patient Access to Opioids for Pain Management in SEA with a Focus on Timor-Leste: A Scoping Review.

Toxoplasma gondii is an obligate intracellular parasite that infects more than a third of the world's population. This parasitic protozoan can be replaced in different parts of the female and male reproductive system. Toxoplasmosis has caused changes in the function of sperm, testes, epididymis and prostate, in experimental models. Human studies have investigated the frequency of anti-T. gondii antibodies mostly in the female population, and there is little information about the relationship between this infection and sperm factors and testosterone. This cross-sectional study involved 197 male volunteers who referred to the Fertility and Infertility Research Centre of Hamadan, Hamadan, Iran, from April to December 2023. Sera and semen were collected. ELISA test was performed to detect IgG and IgM antibodies in sera. Semen analysis was carried out based on WHO guidelines. The frequency for anti-T. gondii IgG antibody was detected 48% (95 out of 197). Three percent of participants had anti-T. gondii IgM. The highest level of T. gondii IgG antibodies was observed in the age range of 36 to 40 (p < 0.001). The participants with defects in spermatozoids including abnormal morphology and non-progressive sperms had higher percentage of antibodies against T. gondii (49.1%). Testosterone on average showed normal diversity 540ng/dl. Fifty-one-point five percent, 48.5%, 52% and 100% of rural, self-employed, smokers and pet-(cat) keeper participants were positive for toxoplasmosis respectively. Although no significant relationship was observed between any other factors except age and toxoplasmosis, it seems that the high frequency of anti-T.gondii IgG in this group of men who have infertility problems confirmed the parasite as not a main factor but a side factor with the production of pro-inflammatory substances as wells as cytokines which can lead to infertility and dysfunction of sperms.

Critical assessment of geriatric oncology guidelines based on the AGREE II tool.