Global health & medicine最新文献

Tuberculosis is reported as highly prevalent among slum dwellers and unhoused individuals worldwide. We conducted a study to estimate the prevalence of tuberculosis among slum dwellers and unhoused individuals in Ho Chi Minh City, Vietnam, and identified risk factors. An interview and chest X-ray screening of 367 slum dwellers and 32 unhoused individuals was conducted with sputum GeneXpert for X-ray-positive participants. The prevalence of bacteriologically confirmed tuberculosis was 1,504 per 100,000 population (1,362 among slum dwellers and 3,125 among unhoused individuals), and that of interview and chest X-ray positive status was 4,511 per 100,000 population (4,087 among slum dwellers and 9,375 among unhoused individuals). The above data represent 5.4- and 4.1-fold higher prevalence, respectively, compared to the general adult population of Vietnam based on point estimates. Interview and chest X-ray positive status was significantly associated with being 60 years or older (adjusted odds ratio = 5.039, p = 0.005) and having a monthly income below the median (adjusted odds ratio = 4.305, p = 0.037). The estimated high tuberculosis prevalences among the participants call for the need for systematic screening for tuberculosis disease among these populations.

Liver resection (LR) and liver transplantation (LT) are the two principal curative options for early-stage hepatocellular carcinoma (HCC), but the optimal choice for individual patients remains uncertain. Recent meta-analyses suggest that LT confers superior long-term survival compared with LR, particularly when tumor burden meets transplant criteria and donor availability is sufficient. Although LT requires lifelong immunosuppressive therapy, patient-reported quality of life appears comparable between LT and LR. Overall, current evidence indicates that LT may offer improved survival without compromising quality of life in appropriately selected patients.

[This corrects the article on p. 28 in vol. 7, PMID: 40026853.].

Sleep is crucial to maintaining physiological stability and exhibits a bidirectional relationship with metabolic health. This study used random sampling to investigate sleep status and factors influencing it among 585 community-dwelling elderly diabetics (age ≥ 60 years) in Shanghai (April-August 2025). Data were collected through a self-designed general questionnaire, the Athens Insomnia Scale (AIS), and clinical biochemical tests. Univariate analysis and binary logistic regression were used to identify influencing factors. Results indicated a median AIS score of 4.0 (3.0, 6.0), with 26.84% of patients (157/585) experiencing sleep problems. Univariate analysis revealed significant correlations between sleep quality and sex, level of education, glycated hemoglobin (HbA1c), fasting blood glucose (FBG), urine leukocytes, urine specific gravity, hypertension, the number of comorbidities, and diabetic peripheral neuropathy (p < 0.05 for all). Binary logistic regression analysis identified that being female (OR = 1.778, 95% CI: 1.115-2.836, p = 0.016), having a college degree or above (OR = 2.820, 95% CI: 1.305-6.092, p = 0.008), elevated glycated hemoglobin (OR = 1.460, 95% CI: 1.221-1.745, p < 0.001), elevated fasting blood glucose (OR = 1.490, 95% CI: 1.327-1.673, p < 0.001), and diabetic peripheral neuropathy (OR = 1.713, 95% CI: 1.046-2.804, p = 0.032) were independent risk factors for sleep disorders. Implementing individualized, multidimensional management for these high-risk populations is crucial to enhancing the overall effectiveness of diabetes prevention and control.

Recent literature has demonstrated the link between lifestyle behavior factors and cognitive function, yet most evidence comes from Western populations. This study examined the associations between multiple healthy lifestyle factors and cognitive function among community-dwelling older adults in Shanghai, China. This cross-sectional study included 942 residents aged ≥ 60 years in Pudong District, Shanghai, China, who participated in China's national free physical examination program from July to September 2024. Cognitive function and cognitive impairment status were assessed by Mini-Mental State Examination (MMSE). Five healthy lifestyle factors were considered: never smoking, healthy body mass index, regular physical activity, light-to-moderate alcohol drinking and optimal night sleep duration. A composite healthy lifestyle score (0-5) was calculated. Results showed that regular physical activity and optimal night sleep duration were positively correlated with a MMSE score [β = 0.21 (95% confidence interval (CI): 0.09-0.34), p = 0.001; β = 0.15 (95% CI: 0.03-0.27), p = 0.016, respectively], and were significantly associated with lower odds of cognitive impairment [odds ratio (OR) = 0.69 (95% CI: 0.47-0.98); OR = 0.66 (95% CI: 0.45-0.95), respectively]. Compared with participants with ≤ 1 healthy lifestyle factor, the β (95% CI) of MMSE score for participants with 3, and 4-5 healthy lifestyle factors were 0.26 (0.08-0.44) and 0.25 (0.04-0.47), respectively; and the OR and 95% CI for participants with 3 healthy lifestyle factors were 0.59 (0.34-0.98). Adherence to multiple healthy lifestyle behaviors, particularly regular physical activity and adequate night sleep, was associated with better cognitive function among elders in Shanghai.

Japan, at the forefront of a super-aged society where individuals age 65 and older constitute 29.3% of the total population, faces an urgent need for early detection of and intervention in reversible geriatric syndromes known as frailty to prevent older adults from becoming dependent on long-term care. One notable innovation is the frailty detection service e-Frail Navi, which began operational in 2023 following pilot testing since 2020. This service analyzes household electricity consumption patterns using AI, sending alerts to municipal welfare departments when unusual behavioral patterns are detected, enabling early intervention through professional home visits. A groundbreaking community-based integrated care model leveraging digital technology, 29 municipalities have adopted it as of June 2025. However, several challenges remain regarding the use of such technology, including issues with the accuracy of frailty assessment, ethical and legal concerns, and the potential barriers to use posed by disparities in digital literacy and economic circumstances.

Breast augmentation may compromise the accuracy of breast cancer screening and mammography in particular. The aim of this study was to assess its impact on screening practices and the need for diagnostic follow-up. Data from 1,596 women undergoing comprehensive health checkups in 2024 were retrospectively analyzed. Among 912 women screened for breast cancer, 853 underwent both a mammography and ultrasound, while 54 underwent ultrasound only. Additional evaluation was required in 41/853 (4.8%) of the combined screening group compared to 1/54 (1.9%) of the ultrasound-only group. Breast augmentation was identified in 13/912 (1.43%) using extended detection, and 13/912 (1.43%) in the dedicated field. These findings highlight the limitations of mammography in augmented breasts. Breast augmentation influences screening choices and may hinder cancer detection. Alternative modalities, such as diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) MRI or low-compression 3D mammography, should be considered to improve detection accuracy and patient outcomes.

The global landscape of influenza is becoming increasingly complex. In the Northern Hemisphere, seasonal influenza activity is exhibiting a pattern of "early onset, high intensity". At the same time, highly pathogenic avian influenza (HPAI) continues to circulate widely among wild birds and poultry, with a growing tendency to spillover into mammals, including dairy cattle, thereby substantially increasing the zoonotic risk. This convergence exposes the limitations of control systems that manage human and animal influenza separately. Given the ongoing cross-species adaptive evolution of influenza viruses at the human-animal-environment interface, global strategies need to pivot toward a fully integrated One Health paradigm as the organizing principle for preparedness and response. By synthesizing surveillance data and research capacity across human, animal, and environmental health sectors, the international community can build a more resilient defense network that both reduces the current disease burden and helps pre-empt the emergence of novel pandemic strains arising from viral reassortment.

In March 2021, the Japanese TNM Classification for Cancer of the Biliary Tract (JCCB) was revised. This study aimed to validate the 7th edition of JCCB based on long-term outcomes after resection for distal cholangiocarcinoma (DCC). We retrospectively reviewed 107 patients with resected DCC without distant metastasis between 2007 and 2019. Survival curves according to TNM factors were compared between the 6th and 7th editions. The 5-year overall survival (OS) and recurrence-free survival rate (RFS) were 43.4% and 35.5%, respectively. Significant differences in OS were observed between T categories in the 7th edition (T1 vs. T2, p = 0.049; T2 vs. T3, p = 0.027), but not in the 6th. The N classification also showed better prognostic discrimination in both editions, with more refined stratification in the 7th. Stage grouping in the 6th edition failed to show significant OS differences, while the 7th edition demonstrated clear stratification (e.g., Stage I vs. IIA, p = 0.0274; StageⅡA vs. StageⅡB, p = 0.0043; StageⅡB vs. StageⅢA, p = 0.0108). These findings indicate that the revised T and N classifications in the 7th edition more accurately reflect postoperative prognosis for resected DCC. Overall, our results support the clinical validity and improved prognostic utility of the 7th edition compared with the 6th edition.

In Japan, the approved maximum daily dose of cefepime (4 g) is lower than international standards (6 g), potentially compromising efficacy against Pseudomonas aeruginosa (P. aeruginosa) infections. Using Monte Carlo simulations with a population pharmacokinetic model for Japanese patients, we determined optimal dosing regimens across renal function levels. The target was 60% fT > MIC (percentage of time free drug concentration exceeds minimum inhibitory concentration), with ≥ 90% probability of target attainment for minimum inhibitory concentration (MIC) up to 8 mg/L. Lower doses sufficed for impaired renal function, while higher doses with prolonged infusion (2 g q8 (3 h)) were needed for creatinine clearance (CCr) 101-130 mL/min. For augmented renal clearance (CCr > 130 mL/ min), continuous infusion (2 g loading dose followed by 4 g continuous infusion) achieved optimal attainment below neurotoxicity thresholds. Current approved dosing in Japan may be insufficient; adjustments including prolonged or continuous infusions are crucial for optimizing therapy.