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Correction: Prevalence and psychological correlates of borderline personality traits among medical students in Egypt: a multicenter cross-sectional study
No full textSuicide mortality in Bangladesh: a comparative analysis of the incidence of suicide in 2002 and 2015 from Bangladesh Health and Injury surveys
No full textAbstract Background Suicide ranks as the 17th highest cause of death worldwide, making it an ongoing public health concern. To comprehend Bangladesh’s current mental health situation, it is essential to compare the country’s suicide death rates across time. The current study compares the changes in the suicide mortality rates in Bangladesh over 13 years from 2002 to 2015. This is a cross-sectional independent-sample design comparison using two distinct nationally representative datasets. Methods In Bangladesh, two community-based nationally representative surveys, namely the Bangladesh Health and Injury Survey (BHIS), were conducted in 2003 and 2016. Both surveys adopted a similar approach. To get the intended sample, a multistage cluster sampling approach was applied in both surveys, while considering the probability-proportional-to-size technique. The population’s causes of morbidity and mortality data were collected using a three-year recall period and compared with suicide occurring in 2002 and 2015 using a pretested, semi-structured questionnaire. The cause of death was determined by the verbal autopsy procedure. Result The suicide rates in 2002 were 6.2 per 100,000 population (95% CI: 4.7–8.1); whereas in 2015, it was 7.7 per 100,000 population (95% CI: 5.1–11.6). A major shift in suicide trends among the age group was observed between 2002 and 2015. Results showed that those aged 60 years and above had the highest suicide rates in 2002 (rate: 13 per 100,000; 95% CI: 2.6–23.4) and in 2015, adolescents had the highest suicide rates (rate: 22.9 per 100,000; 95% CI: 13.6–38.7). Moreover, in 2015, females had a higher suicide rate compared to males, but in 2002, both sexes showed similar death rates. In both years, the death tolls were higher in the rural areas than in the urban areas. Conclusion The suicide rates have been increasing over the past decade, which is alarming for the nation. Extensive research is needed now to explore the factors affecting the increasing suicide rates among adolescents and females
Knee muscle strength as a mediator of sex differences in incident knee osteoarthritis
No full textAbstract Background Females have a higher risk of incident knee osteoarthritis (KOA) than males, particularly in the lateral compartment; however, the underlying mechanisms remain unclear. We investigated whether knee flexor and extensor strength mediate the association between sex and lateral radiographic and symptomatic KOA risk. Methods This cohort study utilized data from the Osteoarthritis Initiative, a longitudinal prospective study of participants aged 45–79 years. We included knees without radiographic or symptomatic KOA at baseline. Knee extensor and flexor strength were measured isometrically using a validated device (Good Strength Chair) and normalized to body mass index. Mediation analyses were performed using marginal structural models to assess the contribution of knee flexor and extensor strength to the relationship between sex and the risk of lateral radiographic and symptomatic KOA, adjusting for age, race, knee injury history, physical activity, knee alignment, cartilage volume, and hormone therapy. Results A total of 5,126 eligible knees from 3,056 participants without radiographic KOA and 6,773 from 3,720 participants without symptomatic KOA were identified at baseline. Among 5,126 knees without radiographic KOA, the 8-year risks of lateral radiographic KOA were 5.9% in females and 3.4% in males, with an odds ratio (OR) of 1.72 (95% confidence interval [CI]: 1.28 to 2.31). The indirect effects of female sex on lateral radiographic KOA via flexors and extensor strength were OR = 1.14 (95% CI: 1.04 to 1.26) and 1.16 (95% CI: 1.05 to 1.27), respectively. The direct effects (not mediated through flexor/extensor strength) were OR = 1.48 (95% CI: 1.01 to 1.95) and 1.46 (95% CI: 1.01 to 1.92). Knee flexor and extensor strength mediated 31.1% and 33.9% of the total effect of sex on lateral radiographic KOA risk, respectively. Similar results were also observed for incident lateral symptomatic KOA. Conclusion The lateral radiographic and symptomatic KOA risk is higher in females than males, partly mediated by lower flexor and extensor strength. These findings suggest that enhancing knee flexor and extensor strength in females may help reduce their risk of developing lateral radiographic and symptomatic KOA
TiRank prioritizes phenotypic niches in tumor microenvironment for clinical biomarker discovery
No full textAbstract Background Tumor microenvironment (TME) plays a crucial role in cancer progression, metastasis, and treatment response. Recent advances in single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics (ST) have provided valuable insights into the cellular diversity and spatial organization of the TME. However, prioritizing clinically relevant cellular subpopulations in spatial contexts using high-dimensional and sparse data remains a challenge. Methods We introduce TiRank, a novel framework designed to prioritize clinically relevant spatial niches. TiRank incorporates a relative expression ordering (REO)-transformation module to mitigate systematic biases across modalities and utilizes a multitask transfer learning framework to align scRNA-seq, ST, and bulk transcriptomes into a unified embedding space. We benchmarked TiRank using multiple public datasets and pan-cancer clinical cohorts, demonstrating its capability to identify phenotypic cell subpopulations and spatial niches. Results By integrating scRNA-seq, ST, and bulk transcriptomics with clinical phenotypes, TiRank demonstrates high accuracy in identifying drug-sensitive cells and clinically relevant spatial niches across various cancer types. As a case study, we applied TiRank to gastric cancer (GC) to prioritize spatial niches associated with patient outcomes. In our clinical cohort, TiRank successfully revealed a distinct spatial niche at the tumor boundary, characterized by an enrichment of cancer-associated fibroblasts (CAFs). This niche was associated with the efficacy of different treatment regimens. To validate this finding, we further performed multiplex protein imaging on an independent cohort to confirm the spatial distribution of the CAFs-enriched barrier. Moreover, this barrier, termed Fibro-Bar, was strongly correlated with treatment response to neo-adjuvant chemoimmunotherapy. To improve accessibility, we developed TiRank as an open-source tool with an interactive graphical user interface for both researchers and clinicians. Conclusions TiRank offers a phenotype-guided, cross-modal strategy to prioritize clinically relevant spatial niches by coupling an REO-based representation with transfer learning from bulk clinical cohorts. This design enables clinically supervised niche prioritization without requiring large, matched single-cell or spatial clinical cohorts, advancing biomarker discovery and supporting precision oncology
Refining the PTV margin determination for VMAT SBRT lung treatment through moving target dose model to account for respiratory motion uncertainty
No full textAbstract Objective Adding a Planning Target Volume (PTV) margin remains a straightforward and effective strategy to ensure adequate target coverage under various uncertainties. Appropriately reduced margins can minimize treatment-related toxicity without compromising tumor control. However, respiratory motion introduces complex interactions with Internal Target Volume (ITV) management, making conventional PTV recipes less reliable. This study aims to refine the definition of PTV margin for lung stereotactic body radiotherapy (SBRT) using a moving target dose (MTD) model to account for respiratory motion uncertainty under free breathing, and to compare it with alternative margin calculation methods. Methods Data from 31 patients with non-small-cell lung cancer (15 in the upper lobe, 16 in the lower lobe) were retrospectively analyzed. All patients underwent Four-Dimensional (4D) CT simulation and tumor motion tracking during treatment, represented by three-dimensional coordinates extracted from log files generated by Synchrony Respiratory Tracking System, which were used to characterize displacement along the superior-inferior (S–I), anterior-posterior (A–P), and left-right (L–R) axis. The MTD model is proposed to assess the accumulative dose of the moving target considering both motion and dose fall-off outside of the PTV from VMAT treatment, then margins were calculated to ensure Gross Tumor Volume (GTV) receives a minimum of 95% of the prescribed dose during treatment, stratified both by anatomical direction and tumor location. Results While the results of different methods exhibit a consistent pattern across pathological locations and different directions, they show significant discrepancies in magnitude. The smallest result is derived from the MTD model, whereas the spatial-temporal (ST) and adjusted van Herk models yield slightly larger result than the others. As calculated using the MTD model, for the upper-lobe group, the margins were 3.10 mm (S–I), 0.98 mm (A–P), and 0.41 mm (L–R), whereas for the lower-lobe group, the corresponding margins were 5.28 mm (S–I), 1.00 mm (A–P), and 0.80 mm (L–R), respectively. Compared with MTD model, upper-lobe margins from ST model was larger by 1.47 mm (S–I), 0.84 mm (L–R), and 1.31 mm (A–P), whereas lower-lobe margin increased by 2.00 mm (S–I), 1.12 mm (L–R), and 1.49 mm (A–P). Notably, the margins would generally increase with prolonged treatment time, majorly caused by respiratory baseline drift effects and short-term error fluctuations. Conclusion Our study provided a method of incorporating dosimetric factors into PTV definition for lung SBRT to account for respiratory motion-induced uncertainties. Margins derived solely from spatial-temporal analysis are relatively conservative, whereas the MTD model provides a margin definition relevant to the accumulated dose by the target, potentially balancing GTV cumulative dose coverage with reduced normal tissue exposure. For clinical robustness, future calculation should incorporate device/therapist-specific uncertainties via variance summation to refine margin recipe. Clinical trial number Not applicable
Fluid shifts are main drivers for microgravity simulation-induced immune-physiological changes: findings from the VIVALDI studies
No full textAbstract Microgravity strongly affects human physiology during spaceflight. Biological sex has not yet been sufficiently considered as a variable for spaceflight deconditioning. The VivalDI studies investigated physiological systems affected by 5-days dry immersion (DI) in females and males, with a focus on immune changes in this report. In both sexes proportions of peripheral granulocytes and NK cells were elevated during DI and T-cell numbers were reduced. Leukocyte activation and cytokine levels were moderately affected. Females showed a higher Torque-Teno-virus shedding at the end of DI. Noradrenaline concentrations increased during the study with sex-specific patterns. Hemodynamics suggest that immunological changes were caused by DI-induced fluid shifts. Moreover, male study participants’ patterns were compared to a historical data set from a 5-days head-down-tilt bed rest (HDT-BR) study. Changes in leukocyte proportions and body fluid indicators were stronger in DI versus HDT-BR. These analyses indicate that fluid shifts primarily drive intervention-related immune-physiological differences, independent of biological sex. ClinicalTrials.gov, TRN: NCT05043974 and NCT05493176
Hepatitis B knowledge among nursing students at Jiblah University for medical and health sciences
No full textAbstract Background Hepatitis B virus is a blood borne disease that poses a significant public health problem and is classified as an occupational hazard for healthcare workers, including nursing students. Healthcare workers are four times more likely to contract HBV than the general population. Therefore, a thorough understanding of HBV is crucial for nursing students. This study aimed to assess the level of knowledge about HBV infection among nursing students at Jiblah University of Medical and Health Sciences. Methods A descriptive cross-sectional study was conducted. This study included all 94 students enrolled in the Faculty of Nursing. A standardized, pre-tested questionnaire consisting of three sections was used: students’ sociodemographic data, their knowledge of hepatitis B virus infection, and their knowledge of hepatitis B treatment and prevention. The collected data were analyzed using SPSS version 26. The chi-squared test value was set at 0.05. A p-value less than 0.05 is considered statistically significant. Results The results showed that the mean age of the participants was 22.15 ± 2.32 years, and that 57.47% were female. Overall, 73% of students had a good knowledge of hepatitis B virus. Forty-six students (48.9%) in the study group were vaccinated against HBV. A lack of knowledge was found regarding HBV transmission methods. Students’ knowledge of HBV infection was associated with gender and year of study. Conclusions The study indicated that students had a good knowledge of hepatitis B virus infection. There were statistically significant correlations between students’ knowledge of hepatitis B virus infection and their gender and year of study
Assessing the effectiveness of health checkup services in reducing depressive symptoms in older adults with chronic diseases: a community-based pre-post observational study
No full textAbstract Background More research is needed to fully understand the efficacy and applicability of technology-enhanced interventions for addressing both chronic disease management and mental health concerns simultaneously across diverse populations and healthcare settings. Therefore, this study aimed to evaluate the effectiveness of health checkup services provided by the community-based smart home healthcare project in reducing depressive symptoms among older adults with chronic diseases in Siheung-si, South Korea. Methods The study population comprised older adults with chronic diseases residing in a single residential complex. The intervention used Internet of Things health measurement devices located at the Eungye Community Care Center. Results A total of 93 older adults participated in the study. Participation in health checkup services was significantly associated with a decrease in depressive symptoms (β=-0.74, standard error = 0.16, p < 0.001). Social support was found to partially mediate this relationship (indirect effect estimate=-0.21, p < 0.001). Conclusions Engaging in community-based health checkup services may not only directly reduce depressive symptoms but also indirectly mitigate their impact by enhancing social support. This study highlights the potential of integrated, technology-enhanced community health services in addressing both physical and mental health needs of older adults with chronic conditions. However, further research with extended study periods is needed to fully assess the long-term effectiveness of these services and their applicability in diverse settings
Comparing three approaches to modelling the effects of temperature and rainfall on malaria incidence in different climatic regions
No full textAbstract Background Malaria transmission is primarily limited to tropical regions where environmental conditions are conducive for the survival of Plasmodium parasites and Anopheles mosquitoes. Adequate rainfall provides breeding sites, while suitable temperatures facilitate vector mosquito life-cycles and parasite development. Evaluating the efficacy of vector control interventions is crucial to determine their effectiveness in reducing malaria transmission. The aim of this study was to explore how these factors affect transmission dynamics at varying levels of vector control efficacy. Methods We developed a vector-host compartmental mathematical model to compare three published approaches to incorporating weather influences on malaria transmission. The first approach examines mosquito biting behaviour and mortality rates in larval and adult stages. The second focuses on temper- ature effects on mosquito life-cycle characteristics throughout the aquatic and adult stages. The third considers how temperature and rainfall influence adult mosquito behaviour, environmental carrying capacity, and survival during the aquatic stages. Model simulations were conducted at different annual vector con- trol coverage levels, to identify variations in transmission patterns and seasonal variability in daily and annual incidence across three climate regions. Results The first approach indicates sustained seasonal transmission, with lower cases per 1,000 in tropical regions compared to semi-arid and sub-tropical regions, even with enhanced vector control reducing cases. The second approach projects extended seasonal peaks in malaria transmission in tropical and semi- arid regions, driven by prolonged warm periods, while sub-tropical regions show lower incidence due to cooler temperatures limiting mosquito survival. In con- trast, the third approach projects multiple irregular peaks, with transmission ceasing in winter across all regions. Conclusions Simulations indicate that climatic events like heatwaves or flood- ing, can trigger mosquito population surges and malaria outbreaks, even in areas previously free of malaria, despite strong vector control efforts. However, the results demonstrate that sustained and effective vector control, particularly in regions with moderate temperatures, can substantially reduce malaria inci- dence. Effective malaria control requires incorporating weather predictions into intervention plans, and enhancing current vector control strategies with supple- mentary measures like larval source management. Accurate timing and targeting of these interventions, based on transmission season projections, are crucial for maintaining robust control as weather conditions evolve and to prepare for future challenges
Trends in alcohol, smoking, and drug use in cross-sectional samples of young people in Australia, 2015-24
No full textAbstract Background This study aims to examine trends in alcohol, smoking (including e-cigarettes), and other drug use, including trends in specific drug types, among young people aged 15–29 years in Australia between 2015 and 2024. Methods Annual online cross-sectional surveys were conducted in convenience samples of young people in Australia between 2015 and 2024, with a total of 9988 participants. Logistic regression analyses were used to determine associations between year of survey and alcohol, smoking, and other drug use. Results There was a decrease by year in the odds of reporting lifetime use of alcohol, past year use of alcohol, having had their first alcoholic drink while underage, and drinking more than 4 standard drinks on a typical day. Tobacco smoking decreased with year, but e-cigarette use increased. The drugs with the greatest increasing odds by year of reporting past month use were non-prescribed pharmaceutical stimulants and benzodiazepines. The drugs with odds indicating the greatest decrease in reporting by year were speed, crystal methamphetamine, and ecstasy. Conclusions Alcohol use largely trended downwards in our study, e-cigarette use trended up, and other drug use trends showed an increase in non-prescribed pharmaceutical drug use. Ongoing monitoring of the trends can inform public health policies and interventions
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