Incidence and clinical manifestations of sudden death in young adults: a two-decade, nationwide, retrospective, cross-sectional study.

Effects of doxycycline post-exposure prophylaxis on bacterial sexually transmitted infections and antiretroviral therapy adherence among adolescents and young adults living with HIV.

Drawing on 964 field observations from typical community parks in Changsha, this study utilizes the System for Observing Play and Recreation in Communities (SOPARC) alongside Kernel Density Estimation (KDE) to quantitatively dissect the intrinsic associations between older adults’ outdoor activity patterns and micro-spatial characteristics. The findings reveal a pronounced demographic differentiation in spatial utilization. Specifically, female-dominated collective activities, such as square dancing, exhibit a profound reliance on central plazas with unobstructed sightlines to cultivate a sense of social security. Conversely, male users demonstrate a distinct preference for static social interactions, including playing chess or cards, within semi-enclosed and shaded spaces beneath a tree canopy. Beyond gender distinctions, age-related spatial anchoring is also evident. Intergenerational caregiving activities among the younger old cohort (aged 55 to 74) are exclusively concentrated around children’s playgrounds, whereas older old individuals and those with impaired mobility rely heavily on densely distributed micro-scale resting amenities. Driven by these empirical insights, this research contends that age-friendly park design must transcend generic accessibility standards, advocating instead for a “categorized spatial provision” strategy. By meticulously balancing open exhibition plazas, semi-private shaded units, and composite caregiving zones within a single park ecosystem, this approach can effectively accommodate the multifaceted health and social requirements of various older adult subgroups.

Background Oxidative stress is central to type 2 diabetes mellitus (T2DM) and Parkinson’s disease (PD). However, the utility of biomarkers for lipid peroxidation (F2-isoprostanes) and DNA damage (8-OHdG) in the comorbidity of PD and T2DM remains unclear. Methods We conducted a systematic review and meta-analysis of 54 unique studies of human subjects aged ≥ 50 years (n = 7,521: 3,522 with T2DM, 722 with PD, and 3,277 controls), measuring biomarkers in serum, plasma, or leukocytes. Mixed-effects models quantified standardized differences (Hedges’ g) across subgroups. Results In T2DM, F2-isoprostanes (g = 1.60, 95% CI: 0.95–2.25) and 8-OHdG (g = 2.64, 95% CI: 2.13–3.14) were markedly elevated (p < 0.001). Stronger effects were observed in younger cohorts and serum/plasma samples, with complications like nephropathy exhibiting extreme oxidative stress (g = 5.24). In PD, 8-OHdG was moderately elevated (g = 0.78, 95% CI: 0.18–1.39; p = 0.011), particularly in randomized controlled trials and plasma samples, whereas F2-isoprostanes were not significantly elevated (g = 0.47, 95% CI: −0.43–1.38). High heterogeneity in T2DM (I2 > 90%) reflected methodological variability. Conclusion Distinct profiles – both markers elevated in T2DM but only 8-OHdG in PD – underscore 8-OHdG’s potential in PD-T2DM comorbidity. Future research should focus on standardized assays, multi-compartmental or multi-modal sampling, and longitudinal studies to clarify mechanisms and therapeutic targets.

Palliative and end of life care in older major trauma - A point prevalence evaluation in England, Wales and Scotland.

South Korea faces escalating climate change threats that increase the risk of large-scale outages of long duration. However, efforts to expand the grid are often limited by low consumer acceptance of higher tariffs. This study employs a nationally representative contingent valuation survey of 1000 households to quantify residential consumers’ willingness to pay (WTP) for grid expansion to avoid a hypothetical 24 h nationwide blackout caused by extreme weather. The findings reveal an average monthly WTP of KRW 2226 (USD 1.54), equivalent to about KRW 0.60 trillion (USD 0.4 billion) annually—approximately 12% of planned grid investment needs. Among the socioeconomic variables, the negative coefficient on generation suggests younger cohorts exhibit higher WTP, consistent with—though not conclusive evidence of—their expectation of greater exposure to future climate risks. Similarly, the presence of children is positively associated with WTP, indicating family protection motives that encompass both immediate household needs and intergenerational considerations related to the distribution of climate-related burdens. These findings provide policy-relevant insights for designing equitable and acceptable tariff schemes that support critical investments to strengthen sustainable grid resilience amidst escalating climate risks.

Abstract Growing concerns about synthetic inputs have increased interest in organic food, yet consumer preferences may differ across demographics and may be evolving with the emergence of alternative sustainable production methods, such as regenerative agriculture. Using a Best–Worst Scaling approach, this study examines U.S. rice consumers’ preferences for production attributes. Random Parameter Logit results show food safety and price as influential factors, while the marketing channel ranks lowest. Latent Class Analysis identifies four segments: conventional, pragmatic, sustainability-conscious, and low-engagement, revealing substantial heterogeneity. Low-engagement consumers indicate insignificant preference for most attributes. Sustainability-conscious consumers (younger, educated, and higher income) prefer organic and regenerative attributes, while conventional consumers (older) focus on price and domestic origin. Pragmatic consumers (younger and educated), though skeptical of organic claims, show modest interest in regenerative attributes, suggesting potential heterogeneity in how sustainability-related claims are evaluated within younger cohorts.

Universal tumor testing is increasingly recommended for Lynch syndrome (LS). However, data involving younger Japanese patients are still limited. This study aimed to prospectively evaluate the prevalence and clinicopathologic profile of DNA mismatch repair (MMR)-deficient (dMMR) endometrial cancers (EC) in patients aged under 50years, and characterize immunohistochemical (IHC) loss patterns and genetic testing results. Patients with EC aged under 50years who consented to study participation were prospectively enrolled at a single Japanese institution. Diagnostic specimens underwent MMR IHC (MLH1, MSH2, MSH6, and PMS2). Clinicopathologic variables were compared between proficient MMR (pMMR) and dMMR. Among 111 patients, 26 (23.4%) had dMMR. Grades differed when dichotomized as G1 versus G2-G3 (p < 0.01). FIGO stage distribution also varied between groups (p = 0.035). Among dMMR tumors, IHC patterns were loss of MLH1/PMS2 (n = 12), loss of MSH2/MSH6 (n = 8), and isolated loss of MSH6 (n = 6). Of the 12 (46.2%) patients with dMMR who underwent germline testing, 9 had LS (MLH1/PMS2 loss: 3/5; MSH2/MSH6 loss: 4/4; MSH6 isolated loss: 2/3). The overall dMMR prevalence in this young cohort was comparable to that in all-age series from multiple regions. This represents a minimum prevalence of LS in the overall study cohort, as germline testing was performed only in a subset of patients with dMMR tumors. In this prospective Japanese cohort, approximately one in four patients with EC had dMMR, with clinicopathologic features skewing toward a higher grade. Notably, many dMMR tumors were grade 2-3, suggesting that a substantial proportion of patients may fall outside the conventional criteria for fertility-sparing treatment.

ABSTRACTBackgroundOlder patients have been under‐represented in clinical trials of atrial fibrillation (AF) ablation. The safety of pulsed field ablation (PFA) in this cohort is not known.MethodsWe conducted an observational study of consecutive patients undergoing PFA with a pentaspline catheter (Farapulse, Boston Scientific) for AF at a tertiary centre comparing procedural and clinical outcomes in patients aged ≥ 75 years (older cohort) versus < 75 years (younger cohort). Baseline demographics, procedural characteristics, complications, and clinical outcomes were collected. Arrhythmia recurrence was defined as AF, atrial flutter, or atrial tachycardia > 30 s at any follow‐up.Results564 consecutive patients underwent de novo PFA for AF between 2022 and 2025; 65 patients were aged ≥ 75 years (11.5%) (median age 77 years; younger cohort median age 62 years). The older cohort had a higher incidence of hypertension, vascular disease, lower eGFR, and lower body mass index (p < 0.01 for all). There was no difference in lesion set or procedural time. There was no difference in overall major procedural complications (1.5%–1.6%; p = 0.97); however, older patients had more major vascular complications (3.1% vs. 0.2%; p = 0.003), pulmonary oedema (3.1% vs. 0.4%; p = 0.02), and transient renal impairment when assessed (p = 0.007). At median follow‐up 6.3–7.0 months, there was no difference in freedom from arrhythmia recurrence between the older and younger cohorts (69.8% and 73.2%; p = 0.66).ConclusionPulsed field ablation for AF can be performed in older patients with acceptable procedural safety and clinical outcomes. Clinical trials are needed to further determine the safety and efficacy of PFA in older patients.

Abstract We contribute to the literature on the overlap of social trust and regulation. The literature on trust and regulation uses cross-country samples. We analyze the United States from 1972 to 2018 using time series data. Examining a single country allows us to focus on trends, which literature on social trust and regulation has not done. The literature suggests that market exchange facilitates and discovers trust amongst trading parties. When trust breaks down, so does the economy. Buchanan argues that if moral order exists, communities can interact and flourish with trust. However, if the moral order breaks down, it creates moral anarchy. Environments devoid of social trust may substitute regulation to facilitate exchange. Low social trust may necessitate high regulation. Thus, in highly regulated economies, exchange occurs not by social trust but by regulation. Regulation removes the social feedback loop that leads to generalized social trust. Thus, high regulation erodes social trust over time. A negative correlation between social trust and regulation exists, but an issue of simultaneity remains. We examine whether a lower social trust is to blame for the proliferation of regulations in the U.S. or if the increase in regulation contributes to declining social trust. Consistent with the literature, we find a negative correlation between trust and regulation, with increases in regulation leading to future decreases in social trust, for the cohort of individuals under the age of 42. This exposes a vicious cycle between regulation and trust for the younger cohort. However, for the full sample, increases in social trust growth rates are associated with a small increase in regulation growth.

Political economy shared its enlightened cradle with French salon culture. The professionalisation of careers and the scientisation of theories then claimed economists for other social spaces: universities, academies and journals. Only a Tuscan salonnière of the second half of the 19th century, Emilia Toscanelli Peruzzi, still used the network centered on her salon to spread the theories of John Stuart Mill and Adam Smith. Although liberalism faded from Italian politics, the salon left a young cohort of proteges in positions of responsibility and power, as members of Parliament or professors of political economy.

The population of adults experiencing homelessness in the US is aging, with 20% now 55 years or older. Individuals who are unhoused, but especially those who are older, experience substantial morbidity and mortality and incur the high costs of acute health care. To assess the health outcomes and cost of providing stable housing to older adults experiencing homelessness in the US. This was an economic evaluation using a model-based cost-effectiveness analysis of adults experiencing homelessness in 2025 in the US. Two simulated cohorts of 1000 adults were used to compare those aged 55 years and older to those aged 18 to 54 years. Provision of stable housing, with no requirement to enter treatment for opioid use disorder. Overdoses and deaths during a 5-year period, lifetime per person discounted quality-adjusted life-years (QALYs) and costs, and incremental cost-effectiveness ratios compared to the status quo (no housing provision). The analysis assessed and compared 2 simulated cohorts of 1000 unhoused adults each: an older cohort of those aged 55 years and older (mean [SD] age, 62.6 [7.5] years; 321 females [32.1%], 679 males [67.9%]) and a younger cohort of those aged 18 to 54 years (mean [SD] age, 39.2 [9.5] years; 319 females [31.9%], 679 males [67.9%]). Among the older cohort, under the status quo, 218 (95% CI, 209-229) deaths occurred over 5 years, with 5.64 (95% CI, 5.11-6.20) lifetime QALYs and $308 598 (95% CI, $299 000-$318 000) in costs per person. With the stable housing intervention, 184 (95% CI, 176-194) deaths occurred over 5 years, with 7.52 (95% CI, 6.82-8.26) lifetime QALYs and $460 673 (95% CI, $438 000-$485 000) in costs per person. The intervention cost $80 700 (95% CI, $67 900-$96 100) per QALY gained. Among the younger cohort, under the status quo, 72 (95% CI, 60-90) deaths occurred over 5 years, with 9.60 (95% CI, 8.65-10.67) lifetime QALYs and $391 976 (95% CI, $367 000-$415 000) in costs per person. With the stable housing intervention, 62 (95% CI, 50-78) deaths occurred over 5 years, with 12.13 (95% CI, 10.94-13.37) lifetime QALYs and $530 492 (95% CI, $496 000-$564 000) in costs per person. The intervention cost $54 800 (95% CI, $44 200-$68 500) per QALY gained. In sensitivity analyses, the housing intervention for older adults experiencing homelessness consistently cost less than $100 000 per QALY gained. In this economic evaluation, investing in stable housing for adults of any age who were experiencing homelessness saved lives, improved health outcomes, and was cost-effective. As the homeless population continues to age, meeting the housing and care needs of older adults in vulnerable conditions is an increasingly urgent national priority. These findings strengthen the evidence demonstrating that permanent supportive housing for older adults experiencing homelessness is a health intervention with strong humanitarian, clinical, and economic justification.

ABSTRACT Drawing on Mannheim, we examine how the ebbs and flows of student mobilization have shaped distinct political generations in Chile. We identify four generations forged through key moments of student activism and wider episodes of collective mobilization: the Dictatorship, Democracy, Penguin, and Frontlines generations. We use longitudinal data from the ELSOC study (2016–2023) to trace attitudinal and behavioral patterns of political engagement across cohorts. The findings show that the Penguin and Frontlines generations, socialized during 2006 and 2011–2019 protest cycles, exhibit higher protest levels and electoral participation, especially during the 2019 social uprising and the 2020 plebiscite. They also show stronger digital activism and progressive attitudes, particularly among women. However, generational effects are not static: while early mobilization fosters engagement, demobilization and political fatigue emerge over time, after the 2019 social uprising. Moreover, younger cohorts show declining student movement identification, suggesting a shift in political referents. Our findings indicate that protest waves can shape enduring political dispositions, but these may change as individuals and their political contexts evolve. Generational identities are thus dynamic, contingent on formative experiences and subsequent developments. Understanding these dynamics is crucial, as the endurance of political generations can shape the long-term durability of student movement outcomes.

Breast cancer is the most diagnosed cancer among Australian women. Recently, incidence rates have risen but mortality rates have decreased. The extent to which these changes are the result of cumulative risk factor effects (age-effects), events affecting all women at specific points in time (period effects), or changes in generational risk factors (cohort effects) is unclear. This study investigates whether observed trends in breast cancer incidence and mortality are associated with age, period, or cohort effects. Annual Australian breast cancer incidence (1982-2020) and mortality data (1907-2022) were obtained from the Australian Institute of Health and Welfare. Age-Period-Cohort (APC) modelling with a drift in cohort function was used to estimate adjusted age, period and cohort effects. Age effects showed higher incidence and mortality rates with increasing age, peaking at 75-84 years. Cohort effects showed progressively increasing risk among women born after the 1940s, with higher incidence among younger cohorts. Incidence peaks corresponded with introduction of population-based mammography screening, and also changes in population level risk factors. Period effects (adjusting for cohort effects) were modest, demonstrating reductions in incidence over time, while mortality peaked in the 1990s before declining after 2000. Increasing age-related breast cancer incidence and mortality reinforce the importance of early prevention. Incidence has shifted due to cohort and period effects with younger generations showing the highest increases in incidence, suggesting generational shifts in breast cancer risk, likely attributable to mammography screening and increased prevalence of modifiable risk factors.

Long-Term Outcomes of Type B Aortic Dissections in Younger (<55 years) Patients.

Per- and polyfluoroalkyl substances (PFAS) and menstrual cycle characteristics in midlife women: The Study of Women's Health Across the Nation.

Brain White Matter Microstructure in Middle and Older Aged Adults With Bipolar Disorder: A 2-Site Study.

Cortical activity during supported and unsupported choice-stepping reaction time tasks in young and older people: a functional near-infrared spectroscopy study.

To determine which patient, physician, physician-group, and geographic factors influence the likelihood of health care visits to family physicians (FPs) outside of patients' enrolling physician groups. Cross-sectional analysis using administrative health data. A multilevel logistic regression model was used to determine the probability of outside use based on a set of observable factors at the patient and physician-group levels, accounting for the variation attributable to the patient, physician, physician-group, and geographic levels. Ontario. Patients enrolled in family health organizations (FHOs) during the study period from April 1, 2018, to March 31, 2019. Outside use, defined as an encounter with an FP outside of the patient's enrolling physician group who submitted an Ontario Health Insurance Plan fee code in the FHO core primary care services. Patient-level factors explained 83.7% of the variation in outside use probability. Physician- and physician-group-level variations each explained less than 2% of outside use probability, while 14.2% was explained at the physician-group geographic level. Patient-level factors associated with outside use included age (oldest versus [vs] youngest cohort, odds ratio [OR]=0.44, 95% confidence interval [CI] 0.42 to 0.45); female sex (OR=1.21, 95% CI 1.19 to 1.23); expected relative health care costs (highest vs lowest complexity score quintile, OR=3.65, 95% CI 3.53 to 3.79); distance from enrolled physician group (longest vs shortest travel time, OR=2.10, 95% CI 2.01 to 2.19); and FP to population need ratio (highest vs lowest quintile, OR=1.71, 95% CI 1.62 to 1.80). Statistically significant physician-group-level variables (P<.05) included Rurality Index for Ontario scores, group size, years of existence, proportion of female physicians, average age, and number of weekend and holiday days worked per patient. Physician- or physician-group-level policy options for effectively reducing outside use may include increasing group size to more than 5 and increasing weekend and holiday days worked per patient and after-hours care. However, because outside use is primarily explained by variations at the patient level, other innovative policy options may need to be implemented to improve care continuity.

Weight, eating behaviours and mental health have a complex interrelationship that is not fully understood. This study aimed to investigate the relationships between weight, eating behaviours and mental health over 12 months among socio-demographically diverse young adults (18-35 years) from the UK and Australia. Longitudinal analysis of data from the YOUTH cohort study was conducted. Three timepoints of data were used (baseline, 6 months, 12 months), collected between 2021-2023 using online surveys hosted via the Prolific platform. The dataset includes 507, 371 and 336 participants at the respective timepoints. Random-intercept cross-lagged panel models (RI-CLPM) were used to explore the relationships between eating behaviours (addictive, disordered and emotional eating) and mental health (stress, depression, anxiety, quality of life) with weight (kilograms) over the three timepoints. Significant relationships were found between weight at baseline with Eating Disorder Examination Questionnaire (EDEQ) global score at 6 months (β = 0.028, p = 0.005, 95% CI = 0.009, 0.048); Positive-Negative Emotional Eating Scale (PNEES)-positive score at 6 months (β = -0.217, p = 0.011, 95% CI = -0.386, -0.053); and EDEQ shape concern score at 6 months (β = 0.040, p < 0.001, 95% CI = 0.019, 0.060) and 12 months (β = 0.034, SE = 0.010, p = 0.001, 95% CI = 0.014, 0.056). The relationships between EDEQ shape concern at baseline and weight at 12 months (β = 1.845, p = 0.005, 95% CI = -0.017, 2.927), and weight at baseline with quality of life at 12 months (β = -0.393, p = 0.034, 95% CI = -0.737, 0.031) were significant based on p value only. No other results were statistically significant for the other explanatory variables with weight. Longitudinal relationships were identified for higher weight with higher disordered eating, less eating in response to positive emotions and lower quality of life in this young adult cohort. Future research should include more longitudinal analyses of these relationships. Findings also support the need for screening of disordered eating and mental ill-health in young adults within weight management services.