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Bariatric dentistry is the branch of dental medicine focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing US and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy, it is necessary that proper accommodations are made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. The aim of the present case report was to bring awareness and start professional discussions on the importance of dental practitioners in the community and dental academic programs working together to assure access for primary oral health for bariatric patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Research on the health and economic costs due to insufficient sleep remains scant in developing countries. In this study we aimed to estimate the years of life lost (YLLs) due to short sleep and quantify its economic burden in China. METHODS: We estimated both individual and aggregate YLLs due to short sleep (ie, ≤6 hours) among Chinese adults aged 20 years or older by sex and five-year age groups in 2010, 2014, and 2018. YLL estimates were derived from 1) the prevalence of short sleep using three survey waves of the China Family Panel Studies, 2) relative mortality risks from meta-analyses, and 3) life tables in China. YLL was the difference between the estimated life expectancy of an individual in the short sleep category vs in the recommended sleep category. We estimated the economic cost using the human capital approach. RESULTS: The sample sizes of the three survey waves were 31 393, 31 207, and 28 618. Younger age groups and men had more YLLs due to short sleep compared to their counterparts. For individuals aged 20-24, men had an average YLL of nearly 0.95, in contrast to the approximate 0.75 in women across the observed years of 2010, 2014, and 2018. The trend in individual YLLs remained consistent over these years. In aggregate, China experienced a rise from 66.75 million YLLs in 2010 to 95.29 million YLLs in 2014, and to 115.05 million YLLs in 2018. Compared to 2010 (USD 191.83 billion), the associated economic cost in 2014 increased to USD 422.24 billion, and the cost in 2018 more than tripled (USD 628.15 billion). The percentage of cost to Chinese gross domestic product in corresponding years was 3.23, 4.09, and 4.62%. CONCLUSIONS: Insufficient sleep is associated with substantial YLLs in China, potentially impacting the populations overall life expectancy. The escalating economic toll attributed to short sleep underscores the urgent need for public health interventions to improve sleep health at the population level.

At some point, every working person will face the decision about whether to retire, and the resulting decision emerges about when to do it. It can always be undone, and a return to work in some form can ensue, but the decision tree must be negotiated in some manner whether once or multiple times. Financial professionals obviously have a significant role in the financial capacity of their clients to do so. All have probably also encountered their clients' attitudes, quandaries, questions, issues, eligibility, and challenges about both the decision and the capacity in some form or another. Aside from finances and related issues, others such as health, age, personal and spousal life expectancy, family care responsibilities, socioeconomic conditions, anxiety, and innumerable others may go into the process. For some, all of these are negotiated quickly and successfully. Others may require additional resources and understanding on the part of the financial professional. Understanding some of the personal and demographic dynamics can assist in making the decision process more successful for both. [ABSTRACT FROM AUTHOR]

I analyze the inter vivo transfers and bequest decisions of 700,000 individuals during a period when the decision maker receives negative news regarding their life expectancy. The event that initiates the news is a health outcome. Expected mortality increases both the likelihood of transferring wealth to the next generation and the amount transferred. The size of the inter vivo transfer and bequest are positively related to the wealth of the parent and the severity of the diagnosis, regardless of diagnosis-specific demand for informal care. Using a structural life cycle model, I estimate the bequest parameters that are consistent with the causal effect estimates. Authors have furnished an Internet Appendix , which is available on the Oxford University Press Web site next to the link to the final published paper online. [ABSTRACT FROM AUTHOR]

We estimate the efficiency of health spending in 145 middle and high-income and the potential gains from improving efficiency for a range of health system outputs using Robust Data Envelopment Analysis for 2010–2014 and 2015–2019 and examine associations with health system characteristics. Focusing on Latin American and Caribbean countries, we find large variability in efficiency and overall substantial potential gains in the later period, despite improvements over time. Our results suggest that, for example, improving spending efficiency could increase life expectancy at birth by 3.5 years (4.6%), or slightly more than the 3.4-year improvement in average life expectancy in the region between 2000 and 2015. Similarly, improved efficiency could reduce neonatal mortality by 6.7 per 1,000 live births (62%), increase service coverage by 6 percentage points (8.7%), and reduce the rich-poor gap in birth attendance by 10 percentage points (12.6%). We find that governance quality is positively associated with efficiency. Overall, the findings indicate an urgent need to improve efficiency in the region and substantial scope for realizing the potential gains of such improvements. [ABSTRACT FROM AUTHOR]

Background: Current cardiovascular prevention strategies are based on studies that seldom include valvular heart disease (VHD). The role of modifiable lifestyle factors on VHD progression and life expectancy among the elderly with different socioeconomic statuses (SES) remains unknown. Methods: This cohort study included 164,775 UK Biobank participants aged 60 years and older. Lifestyle was determined using a five-factor scoring system covering smoking status, obesity, physical activity, diet, and sleep patterns. Based on this score, participants were then classified into "poor," "moderate," or "ideal" lifestyle groups. SES was classified as high or low based on the Townsend Deprivation Index. The association of lifestyle with major VHD progression was evaluated using a multistate mode. The life table method was employed to determine life expectancy with VHD and without VHD. Results: The UK Biobank documented 5132 incident VHD cases with a mean follow-up of 12.3 years and 1418 deaths following VHD with a mean follow-up of 6.0 years. Compared to those with a poor lifestyle, women and men followed an ideal lifestyle had lower hazard ratios for incident VHD (0.66 with 95% CI, 0.59–0.73 for women and 0.77 with 95% CI, 0.71–0.83 for men) and for post-VHD mortality (0.58 for women, 95% CI 0.46–0.74 and 0.62 for men, 95% CI 0.54–0.73). When lifestyle and SES were combined, the lower risk of incident VHD and mortality were observed among participants with an ideal lifestyle and high SES compared to participants with an unhealthy lifestyle and low SES. There was no significant interaction between lifestyle and SES in their correlation with the incidence and subsequent mortality of VHD. Among low SES populations, 60-year-old women and men with VHD who followed ideal lifestyles lived 4.2 years (95% CI, 3.8–4.7) and 5.1 years (95% CI, 4.5–5.6) longer, respectively, compared to those with poor lifestyles. In contrast, the life expectancy gain for those without VHD was 4.4 years (95% CI, 4.0–4.8) for women and 5.3 years (95% CI, 4.8–5.7) for men when adhering to an ideal lifestyle versus a poor one. Conclusions: Adopting a healthier lifestyle can significantly slow down the progression from free of VHD to incident VHD and further to death and increase life expectancy for both individuals with and without VHD within diverse socioeconomic elderly populations. [ABSTRACT FROM AUTHOR]

Background: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019. Methods: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time. Results: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region. Conclusion: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region. [ABSTRACT FROM AUTHOR]

The macroeconomic dimensions of health production function in Greece were studied, by linking doctors’ number, per capita health expenditures, population percentage living in material deprivation conditions, pollutant emissions and alcohol consumption with health indicators. Articles were searched, by recording data from databases (Hellenic-European Statistical Service, Organisation for Economic Co-operation and Development [OECD]) and medical personnel number, per capita health expenditures, population segment living in poverty, pollutant emissions (expressed as CO2/capita) and alcohol use variation were correlated with changes in infant mortality, healthy life years and life expectancy. By above methodology, strong negative correlation of doctors’ number with infant mortality (0.90% approximately) (1960–2015) and significantly positive corresponding in life expectancy change (0.94% approximately) (2000–2015) were captured. The strong negative association of per capita health expenditure on infant mortality (84% for years 2000–2015 and 96% for years 1989–2011), 90% negative correlation of people living in material deprivation conditions with healthy life years were highlighted (2008–2015), as well as negative correlation (about 95%) of environmental pollution, expressed as per capita CO2 emitted amount, with life expectancy change (2007–2015) and the 95% approximate connection of alcohol consumption with life expectancy (2005–2014). The studied cases and correlation with longitudinal health indicators’ modification document macroeconomic dimensions of health production function and measures to mitigate negative consequences/enhance beneficial effects on life quality are proposed. [ABSTRACT FROM AUTHOR]

The article examines the state of prostate cancer (PCa) screening in Canada. Topics include the high incidence of PCa in Canadian men and the benefits and risks associated with prostate-specific antigen (PSA) screening; the financial barriers and inequities in screening access, such as Black and Indigenous men, are disproportionately affected; and the need for more context-specific research to address these disparities and improve screening practices.

Successful management of type 1 diabetes (T1D) requires not only optimal glycemic outcomes, but also a holistic approach that encompasses all aspects of life and recommendations to address needs. Current goals include optimal glycemic values, quality of life and life expectancy similar to peers, prevention of long-term complications, prevention of severe hypoglycemia as far as possible and facilitation of glucose management. The International Society for Pediatric and Adolescent Diabetes (ISPAD) has been updating its guidelines for diabetes care every four years since 1995, covering more and more topics. For optimal metabolic outcomes, diabetes teams need to follow these current recommendations, adapt them to their clinical practice and provide guidance to people with T1D and their families. In this review, in the light of ISPAD 2018-2022 guidelines and clinical experiences, "10 Key Recommendations", emphasizing the importance of teamwork and the use of technology, current T1D treatment is described for practical applications. [ABSTRACT FROM AUTHOR]

For those affected, infertility is linked to impaired overall health and reduced life expectancy. In particular, infertile individuals bear an increased risk for cardiovascular disease (CVD) and different types of cancer, partially due to lifestyle differences and to genetic alterations that cause both infertility and an increased cancer risk. Genetic variants causing an increased CVD risk are more commonly found in infertile individuals, but their link to infertility remains unclear. Offspring of infertile couples, conceived via medically assisted reproduction, are as likely as their parents to exhibit or develop adiposity, hormonal alterations such as insulin resistance, and infertility. The effects on health of subsequent generations are completely unclear. [ABSTRACT FROM AUTHOR]

The article discusses the need to urgently resolve diverse population and older adult exclusion in clinical trials and research to improve drug evaluation in these groups as of 2024. Topics covered include the consequences of exclusion in trials, the barrier of institutional structures to inclusivity, and the process of trial recruitment and compensation for these people. Also noted are recommendations made for this effort and their implementation.

Background: The landscape of systemic therapies for metastatic hormone‐sensitive (mHSPC) and castration resistant prostate cancer (mCRPC) extensively improved within the last decades resulting in a significantly prolonged overall survival. However, subgroup analyses of phase III trials suggest potentially different overall survival outcomes for older adults. Methods: We relied on our institutional metastatic prostate cancer database to identify mHSPC and subsequently mCRPC patients. Older adults were stratified according to age groups 70–74 versus ≥75–79 versus ≥80 years at metastatic occurrence. Subsequently, uni‐ and multivariable time to mCRPC and overall survival analyses were performed. Results: Of 494 older adults, 217 (44%) were 70–74 versus 180 (36%) 75–79 versus 97 (20%) ≥80 years old. Rates of local prostate cancer treatment differed significantly between all three groups (p < 0.01). Regarding mHSPC treatment, androgen receptor signaling inhibitors (ARSI) were administered in 30–39% of patients and docetaxel with 9% in age group 70–74 years and 6% and 3% in age groups 75–79 years and ≥80 years. Regarding mCRPC treatment, significant differences between treatment proportions were observed (p < 0.01). Most common treatment was ARSI for all three groups. Conversely, chemotherapy was more frequently administered in patients aged 70–74 (16%), relative to 4% and 3% in 75‐79 year and ≥80 year aged patients. In univariable and multivariable time to mCRPC analyses, overall survival in mHSPC and OS in mCRPC analyses, no significant differences between all three age groups were observed (all p ≥ 0.3). Conclusions: Treatment patterns differ significantly between older adults with metastatic prostate cancer. However, these differences may not result in differences of overall life expectancy. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the link between severe mental illness and suboptimal physical health • To enhance your knowledge of the complex and multifaceted causes of diagnostic overshadowing • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). People with severe mental illness (SMI) often have suboptimal physical health and associated outcomes. An important issue for mental health nurses to be aware of is diagnostic overshadowing, which occurs when healthcare professionals misattribute a person’s physical health symptoms to their existing mental illness. This misattribution increases the likelihood of delays in treatment, potentially giving rise to complications that further negatively influence health outcomes. While the causes of diagnostic overshadowing are complex and multifaceted, mental health nurses need to ensure that their practice is not a contributing factor, which requires ongoing self-reflection on their knowledge, skills and attitudes. This article defines diagnostic overshadowing, proposes potential explanations for why it may occur and offers practical strategies to prevent it. Raising awareness of diagnostic overshadowing could help to improve physical health outcomes for people with SMI. [ABSTRACT FROM AUTHOR]

Background: Unsafe sex is recognized as an important risk factor for cervical cancer (CC). Understanding the global disease burden of CC attributable to unsafe sex can assist policymakers in allocating healthcare resources. Methods: Data were obtained from the 2019 global burden of disease database (GBD). We examined global, regional, and national levels of CC mortality, disability‐adjusted life years (DALYs), and age‐standardized rates (ASRs) caused by unsafe sex. ASRs were evaluated using estimated annual percentage changes (EAPCs). Results: Attributable to unsafe sex, there were 280,479 CC‐related deaths in 2019 and 8,955,013 CC‐related DALYs. In the period 1990–2019, the global ASRs of CC due to unsafe sex decreased around the world; for age‐standardized mortality rate (ASMR) and age‐standardized DALY rate (ASDR), the EAPCs were −0.93 and −0.95. The highest ASMRs and ASDRs were found in central sub‐Saharan Africa and the lowest in Australasia. Conclusion: In the past few decades, the ASMR and ASDR of CC caused by unsafe sexual practices have decreased over time, with significant variations observed among different countries and regions. Increased focus is needed on spreading awareness about sexual health and promoting CC prevention and screening, particularly in low‐ and middle‐income nations. [ABSTRACT FROM AUTHOR]

Objective: Health inequalities are universal, but their magnitude and determinants vary according to geographic areas, and understanding variations is essential to designing and implementing preventive and corrective policies. Our objective was to evaluate health inequalities in the Maresme region (Catalonia, Spain) and the relationship with socioeconomic indicators. Design: Cross‐sectional ecological study (2017). Site: Maresme region. Participants: Population assigned to any of the Maresme's 21 basic health areas (BHAs). Measures: Sociodemographic, socioeconomic, health, and health resource use indicators published by the Catalan Health Service's Information and Knowledge Unit. Results: Differences observed between BHAs were 49% in mortality, 266% in diabetes incidence, 348% in stroke incidence, and 89% in hospitalizations. In the most compared to the least disadvantaged BHAs, socioeconomic deprivation, as measured by the socioeconomic index (SEI), was 4.6 times greater and the percentage population with low educational attainment (EA) was 3.7 times higher. Greater deprivation was associated with greater prevalence of diabetes, chronic obstructive pulmonary disease, and high blood pressure, and greater incidence of diabetes, ischemic heart disease, and cancer. Likewise, a greater percentage population with low EA was associated with higher premature mortality and avoidable hospitalizations. Conclusion: Great variation exists in socioeconomic, health, and health resource use between the different Maresme BHAs. Socioeconomic deprivation is strongly correlated with the prevalence and incidence of certain chronic diseases, and low EA is correlated with premature mortality and avoidable hospitalizations. Our findings point to the urgency of taking health inequalities into account in designing and implementing healthcare strategies, programs, and policies. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess the current status and spatial distribution differences of elderly care service resources supply and demand in China. Methods: Semi‐structured qualitative interviews were utilized to gather participants' insights into the current demands for elderly care services, the status of resource allocation, and related indicators. The entropy weight method was employed to determine indicator weights, yielding objective demand and allocation indices for elderly care service resources. Kernel density estimation was used to illustrate the distribution characteristics of the demand and allocation indices. The coupling coordination degree model was applied to measure the coupling coordination level of China's elderly care service resource supply and demand system in 2020. Results: The demand index ranks highest in Beijing (0.3291), Shanghai (0.2941), and Tianjin (0.2563), while the lowest are found in Tibet (0.1673), Guangxi (0.1727), and Guizhou (0.1737). Kernel density estimation shows that the demand index is concentrated in the range of 0.1800 to 0.2000. The top three regions for allocation index are Shanghai (184.0007), Qinghai (129.8177), and Beijing (109.5941), with the lowest in Liaoning (34.8558), Hainan (35.3168), and Yunnan (36.6366). Kernel density estimation indicates that the allocation index is concentrated in the range of 25–75. Calculations of coupling coordination degree show that Shanghai has high coordination quality (0.9368), Beijing has good coordination (0.8392), while Hainan and Yunnan experience severe imbalances (0.1990, 0.1831). Conclusions: There is a significant lack of coordination between the demand for elderly care services and the allocation of resources in Hainan and Yunnan provinces in China. Most provinces, with the exception of Beijing and Shanghai, exhibit some degree of misalignment. The Chinese government should address the varying needs of the elderly population in different regions, pay timely attention to regional disparities, enhance regional cooperation, and dynamically allocate elderly care resources in a rational manner. [ABSTRACT FROM AUTHOR]

This article utilizes the Panel Study of Income Dynamics to demonstrate how disadvantages in healthy life expectancies accumulated across generations create disparate kin structures among African American families in the United States. The analysis quantifies the overlap in parents' healthy years with their adult children's healthy life expectancies and examines how much the overlap coincides with the adult children's childrearing years. Non-Hispanic Black adults experienced parental illness and death sooner than non-Hispanic White adults, and their parents' poor health coincided longer with their own health declines. Non-Hispanic White adults, on the other hand, enjoyed more years in good health with two healthy parents. The intergenerational accumulation of unequal healthy life expectancies directly translated into unequal kin structures for the subsequent third generation. Race inequities in the intergenerational kin structure and health were greater among women than among men, and non-Hispanic Black women spent the most years raising children in poor health with unhealthy or deceased parents. Disparities in the intergenerational tempos of fertility, mortality, and morbidity are building profound structural racial inequities within a fundamental social institution—the family. [ABSTRACT FROM AUTHOR]

Background: Primary care providers (PCPs) are often the first point of contact for discussing lung cancer screening (LCS) with patients. While guidelines recommend against screening people with limited life expectancy (LLE) who are less likely to benefit, these patients are regularly referred for LCS. Objective: We sought to understand barriers PCPs face to incorporating life expectancy into LCS decision-making for patients who otherwise meet eligibility criteria, and how a hypothetical point-of-care tool could support patient selection. Design: Qualitative study based on semi-structured telephone interviews. Participants: Thirty-one PCPs who refer patients for LCS, from six Veterans Health Administration facilities. Approach: We thematically analyzed interviews to understand how PCPs incorporated life expectancy into LCS decision-making and PCPs' receptivity to a point-of-care tool to support patient selection. Final themes were organized according to the Cabana et al. framework Why Don't Physicians Follow Clinical Practice Guidelines, capturing the influence of clinician knowledge, attitudes, and behavior on LCS appropriateness determinations. Key Results: PCP referrals to LCS for patients with LLE were influenced by limited knowledge of the life expectancy threshold at which patients are less likely to benefit from LCS, discomfort estimating life expectancy, fear of missing cancer at the point of early detection, and prioritization of factors such as quality of life, patient values, clinician-patient relationship, and family support. PCPs were receptive to a decision support tool to inform and communicate LCS appropriateness decisions if easy to use and integrated into clinical workflows. Conclusions: Our study suggests knowledge gaps and attitudes may drive decisions to offer screening despite LLE, a behavior counter to guideline recommendations. Integrating a LCS decision support tool that incorporates life expectancy within the electronic medical record and existing clinical workflows may be one acceptable solution to improve guideline concordance and increase confidence in selecting high benefit patients for LCS. [ABSTRACT FROM AUTHOR]

This study aimed to assess the burden of early-onset gastrointestinal (GI) cancers in China over three decades. A comprehensive analysis was performed using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Data on early-onset GI cancers in 2020 and from 1990 to 2019 were extracted from GLOBOCAN 2020 database and GBD 2019, respectively. The average annual percent change (AAPC) was calculated to analyze the temporal trends using the Joinpoint Regression Program. The Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2030. In China, there were 185,980 incident cases and 119,116 deaths of early-onset GI cancer in 2020, with the highest incidence and mortality observed in liver cancer (new cases: 71,662; deaths: 62,412). The spectrum of early-onset GI cancers in China has transitioned over the last 30 years. The age-standardized rates of incidence, mortality, and disability-adjusted life years for colorectal and pancreatic cancers exhibited rapid increases (AAPC >0, P ≤ 0.001). The fastest-growing incidence rate was found in colorectal cancer (AAPC: 3.06, P < 0.001). Despite the decreases in liver, gastric, and esophageal cancers, these trends have been reversed or flattened in recent years. High body mass index was found to be the fastest-growing risk factor for early-onset GI cancers (estimated annual percentage change: 2.75–4.19, P < 0.05). Projection analyses showed an increasing trend in age-standardized incidence rates for almost all early-onset GI cancers during 2020–2030. The transitioning pattern of early-onset GI cancers in China emphasizes the urgency of addressing this public health challenge. [ABSTRACT FROM AUTHOR]

Background: Evidence on type 2 diabetes onset age and duration on mortality risk has been limited by short follow‐up, inadequate control for confounding, missing repeated measurements, and inability to cover the full range of onset age, duration, and major causes of death. Moreover, scarce data dissect how type 2 diabetes onset age and duration shape life expectancy. Methods: We evaluate prospectively these topics based on 270,075 eligible participants in the Nurses' Health Studies and Health Professionals Follow‐up Study, leveraging repeated measurements throughout up to 40 years of follow‐up. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results: In fully adjusted analyses, incident early onset type 2 diabetes (diagnosed <40 years of age) was associated with significantly higher mortality from all‐causes (HR, 95% CI was 3.16, 2.64–3.79; vs. individuals without type 2 diabetes), cardiovascular disease (6.56, 4.27–10.1), respiratory disease (3.43, 1.38–8.51), neurodegenerative disease (5.13, 2.09–12.6), and kidney disease (8.55, 1.98–36.9). The relative risk elevations declined dramatically with each higher decade of age at diagnosis for deaths from most of these causes, though the absolute risk difference increased continuously. A substantially higher cumulative incidence of mortality and a greater loss in life expectancy were associated with younger age at type 2 diabetes diagnosis. Longer disease duration was associated with generally higher relative and absolute risk of mortality. Conclusion: Early onset of type 2 diabetes and longer disease duration are associated with substantially increased risk of all‐cause and cause‐specific mortality and greater loss in life expectancy. [ABSTRACT FROM AUTHOR]

Canine mammary tumours (CMT) have histological, clinicopathological and molecular resemblances to human breast cancer (HBC), positioning them as viable models for studying the human disease. CMT initiation and progression occur spontaneously in immune‐competent animals, which challenge the suggested limitations of genetically modified mice, also enabling the evaluation of immunotherapies in canine patients. Dogs have shorter life expectancy compared to humans, and cancer advances more rapidly in this species. This makes it possible to perform studies about the clinical efficacy of new therapeutic modalities in a much shorter time than in human patients. The identification of biomarkers for tumour subtypes, progression and treatment response paves the way for the development of novel therapeutic and diagnostic approaches. This review addresses the similarities between CMT and HBC and the molecular signatures identified in CMT samples that have been explored to date. We proposed a detailed molecular exploration of the CMT stroma using state‐of‐the‐art methods in transcriptomics and proteomics. Using CMT as an analog for HBC not only helps to understand the complexities of the disease, but also to advance comparative oncology to the next level to prove the claim of dogs as a valid translational model. [ABSTRACT FROM AUTHOR]

The life expectancy of people with multiple sclerosis (MS) has increased, yet we have noted that development of a typical Alzheimer disease dementia syndrome is uncommon. We hypothesized that Alzheimer disease pathology is uncommon in MS patients. In 100 MS patients, the rate of amyloid‐β plasma biomarker positivity was approximately half the rate in 300 non‐MS controls matched on age, sex, apolipoprotein E proteotype, and cognitive status. Interestingly, most MS patients who did have amyloid‐β pathology had features atypical for MS at diagnosis. These results support that MS is associated with reduced Alzheimer disease risk, and suggest new avenues of research. ANN NEUROL 2024;96:453–459 [ABSTRACT FROM AUTHOR]

We aimed to calculate disability-adjusted life expectancy (DALE) for Korean older adults based on their sex, educational attainment, and residential region across their cognitive status. We included 3,854 participants (aged 65–91 years) from the Korean Longitudinal Study of Aging's seventh survey data. The participant's cognitive function status (normal, moderately impaired, or severely impaired) was determined based on cognitive examination and physical function independence, which was used to calculate their DALE. Females with normal cognition had higher DALE (7.60 years, Standard Deviation (SD) = 3.88) than males (6.76, SD = 3.40); however, both sexes had comparable DALE for cognitive impairment. In contrast, the DALE values increased with higher educational achievements. Regarding residential areas, the DALE value for participants with normal cognition and moderate impairment was the highest among urban dwellers, while DALE for participants with severely impaired cognitive function was highest among rural dwellers; however, there were no statistically significant differences based on residential conditions. Our findings suggest that demographic characteristics should be considered when developing health policies and treatment strategies to meet the needs of the aging population in Korea. [ABSTRACT FROM AUTHOR]

Background and Hypothesis Few microsimulation models have been developed for chronic psychotic disorders, severe and disabling mental disorders associated with poor medical and psychiatric outcomes, and high costs of care. The objective of this work was to develop a microsimulation model for individuals with chronic psychotic disorders and to use the model to examine the impact of a smoking cessation initiative on patient outcomes. Study Design Using health records and survey data from Ontario, Canada, the PSY-SIM model was developed to simulate health and cost outcomes of individuals with chronic psychotic disorders. The model was then used to examine the impact of the Smoking Treatment for Ontario Patients (STOP) program from Ontario on the development of chronic conditions, life expectancy, quality of life, and lifetime health care costs. Study Results Individuals with chronic psychotic disorders had a lifetime risk of 63% for congestive heart failure and roughly 50% for respiratory disease, cancer and diabetes, and a life expectancy of 76 years. The model suggests the STOP program can reduce morbidity and lead to survival and quality of life gains with modest increases in health care costs. At a long-term quit rate of 4.4%, the incremental cost-effectiveness ratio of the STOP program was $41,936/QALY compared with status quo. Conclusions Smoking cessation initiatives among individuals with chronic psychotic disorders can be cost-effective. These findings will be relevant for decision-makers and clinicians looking to improving health outcomes among this patient population. [ABSTRACT FROM AUTHOR]

We construct an overlapping generations model in which the government chooses the tax rate that determines publicly provided education and healthcare. Education increases human capital accumulation, and healthcare improves life expectancy. Each policy is financed by taxes. Two sectors of government, the public education and public healthcare sectors, uncooperatively determine the tax rates for education and healthcare that maximize the GDP per capita and an adult's welfare. Our main findings are as follows. First, the optimal tax rates for both branches of government based on per capita GDP maximization are uniquely determined. Second, in the case based on welfare maximization, there are multiple equilibria that can be ranked. The conclusion relies on the strategic complementary relationship between public education and healthcare, and the result is consistent with empirical data. [ABSTRACT FROM AUTHOR]

Automatic Adjustment Mechanisms (AAMs) are legal instruments that help social security systems respond to demographic and economic changes. In Brazil, the Social Security Factor (SSF) was introduced in the late 1990s as an AAM to link retirement benefits to life expectancy at the retirement age, hoping to promote contributory justice and discourage early retirement. Recent research has highlighted the limitations of right-censored life tables, such as those used in Brazil. It has recommended using the gamma-Gompertz-Makeham ( Γ G M ) model to estimate adult and old-age mortality. This study investigated the impact of right-censoring on the SSF by comparing the official SSF and other social security metrics with a counterfactual scenario computed based on fitted Γ G M models. The results indicate that from 2004 to 2012, official life tables may have negatively impacted retirees’ income, particularly for those who delayed their retirement. Furthermore, the Γ G M fitted models’ life expectancies had more stable paths over time, which could have helped with long-term planning. Our findings are significant for policymakers as they highlight the importance of using appropriate mortality metrics in AAMs to ensure accurate retirement benefit payments. They also underscore the need to consider the potential impacts of seemingly innocuous hypotheses on public action outcomes. Overall, this study provides valuable insights for policymakers looking to enhance the effectiveness and fairness of social security systems. [ABSTRACT FROM AUTHOR]

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Recently, there is a new stream of mortality forecasting research using the vector autoregressive model with different sparse model specifications. They have been shown to be able to overcome some of the limitations of the more traditional factor models such as the Lee–Carter model. In this paper, we propose a more generalized systematic vector autoregressive framework for modeling and forecasting mortality. Under this framework, we progressively increase the sophistication of the diagonal parameters in the autoregressive matrix and formulate a range of model structures in a systematic fashion. They offer much flexibility for capturing the mortality patterns of different populations. The resulting models produce age coherent forecasts, and their parameters are reasonably interpretable for modelers, demographers, and industry practitioners. Using the mortality data of Australia, Japan, New Zealand, and Taiwan, we demonstrate that the proposed approach generates appropriate forecasts of mortality rates and life expectancies and produces very good performance in the fitting and out‐of‐sample analysis. [ABSTRACT FROM AUTHOR]

Recently, health-related issues have been attributed to some environmental factors and practices in Sub-Saharan Africa (SSA). These factors have further increased the high mortality rate despite increased spending on health. This study investigates the impact of environmental degradation and renewable energy consumption on the health outcomes of the population in the region. The study used a panel of 45 SSA countries from 2000 to 2019 and employed the generalized method of moments (GMM) and pooled mean group (PMG) regression analysis system. The findings reveal that increased environmental degradation in the form of CO2 emissions exposes people to health hazards, thus reducing their life expectancy. Renewable energy consumption, on the other hand, is a major contributor to the increase in life expectancy. The study recommends adopting the appropriate energy mix to reduce the consumption of non-renewable energy. [ABSTRACT FROM AUTHOR]

A complete understanding of the interplay between environmental regulations and fiscal decentralization for the realization of health outcomes is crucial for policy formulation and decision-making. The aim of the study is to investigate both policy variables' separate and combined impacts using data on four BRICS economies from 2000 to 2020. The study has employed the novel method of moments quantile regression to quantify the effect. The findings of the study show (i) a significant impact of regulations on health outcomes in higher quantiles. Environmental regulations have a strong positive impact on all three-health proxies, that is, health expenditures, life expectancy, and the number of infant deaths. Total revenue and expenditure decentralization affect health outcomes positively, while tax revenue decentralization negatively impacts them, with the effect being stronger in the lower quantiles; (ii) the combined impact of decentralization and environmental regulations turned out to be negative and significant in our study; and (iii) all variables have unidirectional causality. However, with tax revenue decentralization, health expenditures, life expectancy, and infant deaths have bidirectional causality. This finding has a strong policy implication for the policymakers. Although both policies positively impact health indicators, their interaction leads to deteriorating health outcomes. From a policy point of view, it is suggested to strike a balance between regulations and fiscal decentralization to realize the full potential of this policy mix to get better health outcomes. This study adds to previous research by incorporating the interconnected impact of environmental regulations and fiscal decentralization on health outcomes in BRICS economies. [ABSTRACT FROM AUTHOR]

Climate change risk assessment studies focus on identifying and analyzing different risks considering several climate change scenarios and on evaluating the cost‐effectiveness of different adaptation measures. However, risk acceptability is often not reflected on in the context of climate change risk studies. Noting that the different climate change scenarios depict drastically contrasting images of the future in terms of population growth, economic development, and changes to life expectancy, this article uses risk acceptance criteria that are based on socioeconomic considerations to highlight the need for nonuniform risk acceptability across climate change scenarios. For this purpose, the optimum implied cost of averting a fatality derived based on the life quality index concept and the value of a quality‐adjusted life year derived based on the time principle of acceptable life risk are assessed in three different climate change scenarios for Sweden. Additionally, an illustrative example that assesses the acceptable probability of failure of a steel rod under axial tension in the different climate change scenarios is presented. It is shown that risk acceptance criteria can vary considerably across the different climate change scenarios (e.g., more than 190% variation in the acceptable probability of failure for Sweden in the considered example). This article demonstrates that the ability of societies to afford risk‐reducing measures may vary considerably across the different climate change scenarios. Hence, it can be concluded that (1) in the context of climate change risk assessments, risk acceptance criteria need to be developed to account for the different climate change scenarios, and (2) these criteria may vary considerably across the different climate change scenarios. Finally, relevant challenges and research needs are also provided. [ABSTRACT FROM AUTHOR]

Introduction: Air pollution is a major health risk factor. Ports might be an understudied source of air pollution. Methods: We conducted a spatial health impact assessment (HIA) of port-sourced air pollution for Barcelona for 2017 at the neighbourhood level. Total NO2 and PM10 and port-sourced NO2, PM10 and PM2.5 concentrations were available through the ADMS-Urban model. Population data, mortality and morbidity data, and risk estimates were obtained. We followed standard HIA methodologies and calculated relative risks and impact fractions for 1.35 million adults living in 73 neighbourhoods. Results: The city-wide mean total NO2 and PM10 concentrations were 37.88 μg/m3 (range: 19.61–52.17 μg/m3) and 21.68 μg/m3 (range: 17.33–26.69 μg/m3), respectively, of which 7% (range: 2–36%) and 1% (range: 0–7%) were port-sourced, respectively. The mean port-sourced PM2.5 concentration was 0.19 μg/m3 (range: 0.06–1.38 μg/m3). We estimated that 1,123 (PI: 0–3,060) and 1,230 (95% CI: 0–2,566) premature deaths were attributable to total NO2 and PM10, respectively, of which 8.1% (91; PI: 0–264) and 1.1% (13; 95% CI 0–29) were attributable to port-sourced NO2 and PM10, respectively. 20 (95% CI: 15–26) premature deaths were attributable to port-sourced PM2.5. Additionally, a considerable morbidity burden and losses in life expectancy were attributable to port-sourced air pollution. Neighbourhoods closest to the port in the south-east were most adversely affected, gradually decreasing towards the north-west. Conclusions: The port is an understudied air pollution source in Barcelona with strong health impacts. Cities need local insight into health risk factors, their sources, attributable burdens and distributions for defining targeted policies. [ABSTRACT FROM AUTHOR]

Previous studies on the relationship between working time and health generally find that longer working hours are detrimental for health outcomes. An unexplored issue in prior research is how other social structures, such as income inequality, can influence the working time/health relationship. Integrating arguments on the health consequences of income inequality and working time, this study considers how income inequality moderates the relationship between working hours and average life expectancy. It is proposed that the effect of working hours on life expectancy is greater in places that have higher levels of income inequality due to the increased precarity, stress and anxiety associated with longer work hours. Examining data from all 50 US states from 2005 to 2018, results from two‐way fixed‐effect models suggest that states with longer average working hours tend to exhibit lower average life expectancy net of other important economic and demographic controls. The models also reveal that the effect of working time on life expectancy is larger in states with higher levels of income inequality. These findings suggest that there are complex linkages between working time and inequality that negatively impact population health. [ABSTRACT FROM AUTHOR]

Cancer is considered a risk factor for COVID-19 mortality, yet several countries have reported that deaths with a primary code of cancer remained within historic levels during the COVID-19 pandemic. Here, we further elucidate the relationship between cancer mortality and COVID-19 on a population level in the US. We compared pandemic-related mortality patterns from underlying and multiple cause (MC) death data for six types of cancer, diabetes, and Alzheimer’s. Any pandemic-related changes in coding practices should be eliminated by study of MC data. Nationally in 2020, MC cancer mortality rose by only 3% over a pre-pandemic baseline, corresponding to ~13,600 excess deaths. Mortality elevation was measurably higher for less deadly cancers (breast, colorectal, and hematological, 2–7%) than cancers with a poor survival rate (lung and pancreatic, 0–1%). In comparison, there was substantial elevation in MC deaths from diabetes (37%) and Alzheimer’s (19%). To understand these differences, we simulated the expected excess mortality for each condition using COVID-19 attack rates, life expectancy, population size, and mean age of individuals living with each condition. We find that the observed mortality differences are primarily explained by differences in life expectancy, with the risk of death from deadly cancers outcompeting the risk of death from COVID-19. [ABSTRACT FROM AUTHOR]

Summary Background Aims Methods Results Conclusions The WHO has set a goal to decrease viral hepatitis‐related fatalities by 65% by 2030.To locate and retrieve to care all individuals diagnosed with hepatitis B, D or C, and investigate why they were not linked to appropriate medical management.We conducted a retrospective‐prospective search for patients with hepatitis B, D or C virus (HBV, HDV and HCV) infection in the central laboratory database of the Barcelona northern health area (catchment population, 450,000). We reviewed records and contacted candidates for retrieval who were offered a specialist medical visit.We reviewed records of 3731 patients with viral hepatitis (January 2019–December 2022): 1763 HBsAg+, 69 anti‐HDV+ and 1899 HCV‐RNA+. Among these, 644 (37%) HBV, 20 (29%) HDV and 1116 (56%) HCV patients were not currently linked to care. The proportion of patients receiving appropriate care was higher in HBV and HDV (p < 0.0001), and a higher percentage of unlinked hepatitis C patients had low life expectancy/comorbidities (39%; p < 0.0001). After implementing the linkage strategy, 254 HBV, 16 HDV and 54 HCV patients were successfully reintegrated into care. Among 1780 patients requiring linkage, 638 (35.8%) had moved to another health area or were missing essential contact data.Among patients with viral hepatitis who required appropriate specialist care and were eligible for contact, 64% with HBV, 100% with HDV and 27% with HCV were successfully reintegrated into care. Overall, 324 (47.2%) eligible patients were linked to care, indicating the success of this strategy. [ABSTRACT FROM AUTHOR]

Objectives Patients and Methods Results Conclusion To compare the clinical, economic, and health utility outcomes associated with alternative cystoscopic surveillance regimens for high‐risk non‐muscle‐invasive bladder cancer (HRNMIBC).We performed real‐world clinical data‐driven microsimulations of a hypothetical cohort of 100 000 patients diagnosed with HRNMIBC at age 70 years. The cohort was simulated to undergo alternative surveillance regimens recommended by five guidelines, and two hypothetical regimens—surveillance intensity escalation and de‐escalation—which had a surveillance intensity moderately higher and lower, respectively, than the guideline‐recommended regimens. We evaluated the 10‐year cumulative incidence of muscle‐invasive bladder cancer (MIBC), cancer‐specific survival (CSS), overall survival (OS), and cost‐effectiveness from a United States healthcare payer perspective.The guideline‐recommended surveillance regimens led to an estimated 10‐year cumulative incidence of MIBC ranging from 11.0% to 11.6%, CSS 95.0% to 95.2%, and OS 69.7% to 69.8%. Surveillance intensity escalation resulted in a 10‐year cumulative incidence of MIBC of 10.5% (95% confidence interval [CI] 10.3–10.7%), CSS of 95.4% (95% CI 95.2–95.5%), and OS of 69.9% (95% CI 69.6–70.1%), vs 11.9% (95% CI 11.7–12.1%), 94.9% (95% CI 94.8–95.1%), and 69.6% (95% CI 69.3–69.9%), respectively, from surveillance intensity de‐escalation. By increasing surveillance intensity, the number‐needed‐to‐treat to prevent one additional MIBC progression over 10 years was ≥80, and ≥257 to avoid one additional cancer‐related mortality. Compared to surveillance intensity de‐escalation, higher‐intensity regimens incurred an incremental cost of ≥$336 000 per incremental quality‐adjusted life year gained, which well exceeded conventional willingness‐to‐pay thresholds, ≥$686 000 per additional MIBC progression prevented, and ≥$2.2 million per additional cancer‐related mortality avoided.In microsimulations testing a wide range of cystoscopic surveillance intensity for patients newly diagnosed with HRNMIBC, moderate surveillance de‐escalation appears associated with an insignificant change in 10‐year OS and furthermore is cost‐effective vs higher‐intensity surveillance regimens. These results suggest that moderate surveillance de‐escalation can reduce costs of care without compromising life expectancy for many patients. [ABSTRACT FROM AUTHOR]

Background: Spontaneous rupture of hepatocellular carcinoma (rHCC) poses a life-threatening complication with a mortality rate of 25–75%. Treatment aims at achieving hemostasis and includes options such as trans-arterial embolization, perihepatic packing, and hepatic resection. The optimal treatment remains a subject of debate. Our retrospective review evaluates these treatments and investigates imaging's role in prognosis for rHCC patients. Purpose: We aimed to compare survival outcomes among rHCC patients who received transarterial embolization (TAE), surgery (perihepatic packing, hepatectomy), or best supportive care (BSC), while also identifying predictive imaging factors in these patients. Materials and methods: All patients diagnosed with rHCC and admitted to Maharaj Nakorn Chiangmai Hospital between January 2012 and December 2021 were included. We reviewed clinical features, imaging results, treatment modalities, and outcomes. In order to balance pretreatment confounders, inverse probability treatment weighting (IPTW) was employed. Flexible parametric survival regression was utilized to compare survival outcomes and identify imaging factors predicting the survival of rHCC patients. Hazard ratios (HR) and the difference in restricted mean survival time (RMST) were reported. Result: Among the 186 rHCC patients included, we observed 90-day and 1-year mortality rates of 64% and 84%, respectively. Both the TAE and surgery groups exhibited significantly lower 1-year mortality rates compared to BSC. The HR were 0.56 (95% CI 0.33–0.96) for TAE and 0.52 (95% CI 0.28–0.95) for surgery compared to BSC. Both the TAE and surgery also significantly extended the 1-yeaar life expectancy post-initial treatment when compared to BSC, with an RMST difference of + 55.40 days (95% CI 30.18–80.63) for TAE vs. BSC and + 68.43 days (95% CI 38.77–98.09) for surgery vs. BSC. The presence of active contrast extravasation and bleeding in both lobes were independent prognostic factors for 1-year survival. Conclusions: TAE and surgical treatments provide comparable survival benefits for rHCC patients, extending survival time by approximately 2 months compared to best supportive care. We strongly recommend active management for all rHCC patients whenever possible. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion The increasing life expectancy of individuals with Down syndrome has led to a growing awareness of mid‐ and late‐life conditions.Based on the Disease Analyser database (IQVIA), this retrospective cohort study compared adults ≥18 years of age with Down syndrome (ICD‐10: Q90) in general practices in Germany with a propensity score‐matched cohort without Down syndrome. The outcome was the first diagnosis of a fracture within 5 years of the index date. The cumulative incidence of fractures over a 5‐year period was presented using Kaplan–Meier curves. Univariable Cox regression analyses by age group and sex were performed to assess the association between Down syndrome and fractures.A total of 2547 individuals with Down syndrome and 12 735 individuals without Down syndrome were included in the study. A significantly higher cumulative fracture incidence within 5 years was observed in the age group 51–60 years (9.3% Down syndrome vs. 4.8% without Down syndrome, P = 0.003) as well as in the age group >60 years (20.3% Down syndrome vs. 8.6% without Down syndrome, P < 0.001) compared with the cohort without Down syndrome. Regression analysis showed a significant association between Down syndrome and fracture risk in women with Down syndrome aged 51–60 years (hazard ratio [HR] = 1.60; 95% confidence interval [CI]: 1.13–2.26), and in those aged 51–60 years (HR = 2.08; 95% CI: 1.27–3.41) and >60 years (HR = 2.98; 95% CI: 1.87–4.73)), but not in men. When comparing fractures in individuals with and without Down syndrome, shoulder and arm fractures were most common in the Down syndrome cohort.The results of our study indicate a positive association between individuals with Down syndrome and subsequent fractures in women and those aged >50 years. Prevention of falls appears to be particularly important in these populations. However, future studies should clarify the extent to which socio‐economic factors, such as housing, play a role in this context. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of an adnexal mass might be a sign of ovarian cancer, with an overall poor prognosis. This study aimed to explore women's experiences and perceptions of facing ovarian surgery due to an adnexal mass, and expectations on life after surgery. Methods: Individual in-depth interviews with 15 women facing ovarian surgery due to an adnexal mass. Interviews were analysed using qualitative content analysis. Results: An overarching theme, From symptoms to surgery–a pathway through uncertainty and hope, was identified. The theme was made up of three categories; I. The road to diagnosis, II. Striving for information and guidance, and III. Balancing emotions of hope and fear. The period between discovering the adnexal mass and surgery was often described as chaotic and difficult to manage. However, the diagnostic procedures were mostly described as timely and efficient, and participants felt safe and cared for. Person-centred care was considered crucial when being in this vulnerable situation, and the nurse navigator was described as a key person to approach for any queries. While participants expressed overall satisfaction with the information provided by health professionals, some reported a lack of information regarding the surgery's potential impact on hormonal production and sexuality. Restrictions during the COVID-19 pandemic forced participants to attend healthcare visits alone, and some wished that health professionals had taken more responsibility for informing their relatives. Many participants focused on the positive aspects of the information gained about the adnexal mass, and that the entire situation gave perspective of what was important in life. Conclusions: Waiting for surgery on a possibly malignant adnexal mass can be very stressful, however person-centred care and the guidance of a nurse navigator can make the process more manageable. To improve women's experience, health professionals may involve relatives more often and make sure to inform of potential hormonal loss and sexuality after ovarian surgery. [ABSTRACT FROM AUTHOR]

AbstractWith the increase in the education level of women, their level of representation in the professional professions and their presence in business life has increased. It has been inevitable that this situation would affect the socio-economic structure of societies and the health indicators of employed women. The aim of this study is to examine the effect of women’s employment indicators on women’s health indicators using the panel data analysis method. Two different econometric models were developed in the study. Model-1 predicts that a possible 1% increase in the female unemployment rate would result in a 0.06% decrease in the fertility rate. Model-2 estimates that a possible 1% increase in the female unemployment rate would lead to a 0.04% decrease in female-specific average life expectancy. Also, it is predicted that a possible increase of 1% in the total labor force participation rate of women can provide an increase of 0.04% in the average life expectancy of women. The results of the study indicate that the presence of women in the workforce directly impacts women’s health indicators, particularly socio-economic indicators. Thus, there is a need to develop employment policies based on women’s health in the employability of women. [ABSTRACT FROM AUTHOR]

Disparities in life expectancy between Black and White Americans increased substantially during the COVID-19 pandemic. During the same period, the US experienced the largest increase in homicide on record. Yet, little research has examined the contribution of homicide to Black-White disparities in longevity in recent years. Using mortality data and population estimates, we conduct a comprehensive decomposition of the drivers of Black-White inequality in life expectancy and lifespan variability between 2019 and 2021 among men. We find that homicide is one of the principal reasons why lifespans have become shorter for Black men than White men in recent years. In 2020 and 2021, homicide was the leading contributor to inequality in both life expectancy and lifespan variability between Black and White men, accounting for far more of the racial gap in longevity and variability than deaths from COVID-19. Addressing homicides should be at the forefront of any public health discussion aimed at promoting racial health equity. [ABSTRACT FROM AUTHOR]

An unprecedented extension of life expectancy observed during the past century drastically increased the number of patients diagnosed with Parkinson's diseases (PD) worldwide. Estimated costs of PD alone reached $52 billion per year, making effective neuroprotective treatments an urgent and unmet need. Current treatments of both AD and PD focus on mitigating the symptoms associated with these pathologies and are not neuroprotective. In this review, we discuss the most advanced therapeutic strategies that can be used to treat PD. We also critically review the shift of the therapeutic paradigm from a small molecule-based inhibition of protein aggregation to the utilization of natural degradation pathways and immune cells that are capable of degrading toxic amyloid deposits in the brain of PD patients. [ABSTRACT FROM AUTHOR]

This study presents a comprehensive analysis of global, regional, and national trends in the burden of hearing loss (HL) among children and adolescents from 1990 to 2019, using data from the Global Burden of Disease study. Over this period, there was a general decline in HL prevalence and years lived with disability (YLDs) globally, with average annual percentage changes (AAPCs) of −0.03% (95% uncertainty interval [UI], −0.04% to −0.01%; p = 0.001) and −0.23% (95% UI, −0.25% to −0.20%; p < 0.001). Males exhibited higher rates of HL prevalence and YLDs than females. Mild and moderate HL were the most common categories across all age groups, but the highest proportion of YLDs was associated with profound HL [22.23% (95% UI, 8.63%−57.53%)]. Among females aged 15−19 years, the prevalence and YLD rates for moderate HL rose, with AAPCs of 0.14% (95% UI, 0.06%−0.22%; p = 0.001) and 0.13% (95% UI, 0.08%−0.18%; p < 0.001). This increase is primarily attributed to age-related and other HL (such as environmental, lifestyle factors, and occupational noise exposure) and otitis media, highlighting the need for targeted research and interventions for this demographic. Southeast Asia and Western Sub-Saharan Africa bore the heaviest HL burden, while High-income North America showed lower HL prevalence and YLD rates but a slight increasing trend in recent years, with AAPCs of 0.13% (95% UI, 0.1%−0.16%; p < 0.001) and 0.08% (95% UI, 0.04% to 0.12%; p < 0.001). Additionally, the analysis revealed a significant negative correlation between sociodemographic index (SDI) and both HL prevalence (r = −0.74; p < 0.001) and YLD (r = −0.76; p < 0.001) rates. However, the changes in HL trends were not significantly correlated with SDI, suggesting that factors beyond economic development, such as policies and cultural practices, also affect HL. Despite the overall optimistic trend, this study emphasizes the continued need to focus on specific high-risk groups and regions to further reduce the HL burden and enhance the quality of life for affected children and adolescents. [ABSTRACT FROM AUTHOR]