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Global, regional, and national burden of breast cancer among females, 1990-2023, with forecasts to 2050:a systematic analysis for the Global Burden of Disease Study 2023
No full textBACKGROUND: Breast cancer is a leading cause of mortality and morbidity among females worldwide. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we provided an updated comprehensive assessment of the epidemiological trends, disease burden, and risk factors associated with breast cancer globally, regionally, and nationally from 1990 to 2023.METHODS: Breast cancer incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) were estimated by age and sex for 204 countries and territories from 1990 to 2023. Mortality estimates were generated using GBD Cause of Death Ensemble models, leveraging data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Mortality-to-incidence ratios were calculated to derive both mortality and incidence estimates. Prevalence was calculated by combining incidence and modelled survival estimates. YLLs were established by multiplying age-specific deaths with the GBD standard life expectancy at the age of death. YLDs were estimated by applying disability weights to prevalence estimates. The sum of YLLs and YLDs equalled the number of DALYs. Breast cancer burden attributable to seven risk factors was examined through the comparative risk assessment framework. The GBD forecasting framework was used to forecast breast cancer incidence and mortality from 2024 to 2050. Age-standardised rates were calculated for each metric using the GBD 2023 world standard population.FINDINGS: In 2023, there were an estimated 2·30 million (95% uncertainty interval [UI] 2·01 to 2·61) breast cancer incident cases, 764 000 deaths (672 000 to 854 000), and 24·1 million (21·3 to 27·5) DALYs among females globally. In the World Bank low-income group, where a low age-standardised incidence rate (ASIR) was estimated (44·2 per 100 000 person-years [31·2 to 58·4]), the age-standardised mortality rate (ASMR) was the highest (24·1 per 100 000 [16·8 to 31·9]). The highest ASIR was in the high-income group (75·7 per 100 000 [67·1 to 84·0]), and the lowest ASMR was in the upper-middle-income group (11·2 per 100 000 [10·2 to 12·3]). Between 1990 and 2023, the ASIR in the low-income group increased by 147·2% (38·1 to 271·7), compared with a 1·2% (-11·5 to 17·2) change in the high-income group. The ASMR decreased in the high-income group, changing by -29·9% (-33·6 to -25·9), but increased by 99·3% (12·5 to 202·9) in the low-income group. The increase in age-standardised DALY rates followed that of ASMRs. Risk factors such as dietary risks, tobacco use, and high fasting plasma glucose contributed to 28·3% (16·6 to 38·9) of breast cancer DALYs in 2023. The risk factors with a decrease in attributable DALYs between 1990 and 2023 were high alcohol use and tobacco. By 2050, the global incident cases of breast cancer among females were forecast to reach 3·56 million (2·29 to 4·83), with 1·37 million (0·841 to 2·02) deaths.INTERPRETATION: The stable incidence and declining mortality rates of female breast cancer in high-income nations reflect success in screening, diagnosis, and treatment. In contrast, the concurrent rise in incidence and mortality in other regions signals health system deficits. Without effective interventions, many countries will fall short of the WHO Global Breast Cancer Initiative's ambitious target of achieving an annual reduction of 2·5% in age-standardised mortality rates by 2040. The mounting breast cancer burden, disproportionately affecting some of the world's most vulnerable populations, will further exacerbate health inequalities across the globe without decisive immediate action.FUNDING: Gates Foundation, St Jude Children's Research Hospital.</p
Synthesis and evaluation of 14β-acyl substituted 17-cyclopropylmethyl-7,8-dihydromorphinone derivatives:mixed partial agonists at mu opioid and nociception/orphanin FQ peptide receptors
Full text linkOpioids remain the standard of care for management of severe pain, but adverse effects limit their use, particularly for the treatment of chronic pain. Compounds that have dual partial agonist activity at mu opioid (MOP) and nociceptin opioid peptide (NOP) receptors have been shown, in non-human primates, to display excellent analgesic activity with greatly reduced adverse effect profile. In this study we looked to increase the range of MOP/NOP dual acting compounds and, in particular, provide ligands with a greater diversity of MOP:NOP profiles. Reduction of the C6 carbonyl in the naltrexone scaffold to methylene resulted in a balanced MOP:NOP receptor profile in this series, in particular increasing potency at the NOP receptor. Ultimately, this will allow us to determine the optimal profiles for a range of therapeutic indications including pain and drug use disorders.</p
“You can’t just say you need to breastfeed” - identifying barriers and solutions to appropriate infant feeding in emergencies
Full text linkThe 2017 Operational Guidance for Infant and Young Child Feeding in Emergencies and other international policies aim to enhance infant and young child feeding during emergencies (IYCF-E). However, in practice these guidelines continue to be poorly implemented. This article investigates the underlying reasons that hinder their effective implementation. Semi-structured interviews with humanitarian professionals and a literature review lead us to identify three main barriers to effective IYCF-E: Structural, socio-economic and cultural factors; the prevalence and use of infant formula; and shortcomings in humanitarian practice and IYCF emergency preparedness. Based on these findings we argue that in order to ensure appropriate implementation of infant and young child feeding policies during emergencies, IYCF needs to be prioritised and localised in non-emergency settings and within humanitarian practice. Our novel recommendations for localised infant feeding support, emergency preparedness and response are likely to improve health outcomes for mothers and children both before and during emergencies
Bowen in Italy
No full textElizabeth Bowen's letters, novels, and short stories all attest to her love of Italy, a country that she visited often and one where she experienced excitement, love, grief, sorrow, and occasionally boredom. In ‘Pictures and Conversations’, Bowen explores the importance of the location in her fiction: ‘the locale of the happening [which] always colours the happening, and often, to a degree, shapes it’ (PC 37). Italy provided the ‘locale’ for many significant events in her own life: the breaking off of an engagement or the shared experiences of a country providing solace when she and her lover, Charles Ritchie, were apart; when facing both the potential and actual loss of her family home, Bowen’s Court, or when mourning the deaths of Humphry House, her former lover, and her husband, Alan Cameron. This chappter draws on Bowen’s experiences in Italy, placing her writing – in letters, essays, selected early short stories, novels, and her ‘travelogue’, A Time in Rome – within their biographical, bibliographical, and geographical contexts
Prophetic dance: divergent practices in the Christian church and effects on participant and congregational wellbeing
No full textA variety of manifestations of ‘prophetic dance’ exists in expressions of Christianity, from eclectic forms within professional dance companies to amateur offerings in worship services. Although scholarly writings talk about the notion of praise/worship dance and its benefits and characteristics, few examine the impact of prophetic dance on wellbeing. Examining different perspectives through a combination of auto-ethnographic research, interviews and selected case studies from Church and para Church dance practices, and arising from a holistic view of humankind, rather than the contrasting dualist nature embedded in some Christian theology (Korak 2012), my research reveals a wide-ranging impact on the wellbeing of participants and viewers. The definition of prophetic dance or movement relates to different interpretations through varied means. These include storytelling, choreography and spontaneous dance which expresses abstract concepts such as joy or hope, bringing physical, emotional or spiritual healing and ‘release’
Psychological capital and perceived environmental uncertainty: influence on growth aspiration and quality of life of nascent entrepreneurs
Full text linkPurpose: This paper investigates the influence of Psychological Capital (PsyCap) on the Growth Aspiration (GAsp) and Quality of Life (QoL) of nascent entrepreneurs. We expand existing research by testing a conceptual model that examines how PsyCap shapes GAsp and the realisation of these aspirations through QoL, within the context of Perceived Environmental Uncertainty (PEU) and its three dimensions. Design/methodology/approach: We used multiple regression analysis on data from 264 active nascent entrepreneurs. Findings: Results show PsyCap is significantly and positively linked to QoL. PEU also demonstrates a significant positive association with both GAsp and QoL. Of the three PEU dimensions, operational uncertainty’s effect on GAsp is positively moderated by PsyCap. Perceived uncertainty appears to encourage nascent entrepreneurship. As a personal resource, PsyCap helps entrepreneurs overcome self-limitations and adapt to environmental change. These findings deepen understanding of the personal and contextual factors shaping nascent entrepreneurs’ aspirations. Originality: This study advances the entrepreneurial behaviour literature by drawing on Conservation of Resources (COR) theory to explain the significance of PEU and PsyCap for entrepreneurial aspirations in the context of transition economies
Modified star excursion balance test performance in individuals with chronic ankle instability:a participant-level analysis
Full text linkIntroduction: For 1 in 5 individuals, an initial ankle sprain results in chronic ankle instability (CAI). Research is inconclusive as to whether individuals with CAI display decreased stability performance. This study conducted a participant-level analysis to determine normative values for modified Star Excursion Balance Test (mSEBT) performance in a CAI population. Design: Participant-level analysis. Methods: Ten datasets of mSEBT data were combined and participants categorised into one of three groups: individuals with CAI, Copers and Healthy participants. Maximal reach distances were analysed in the anterior (ANT), posterolateral (PL), posteromedial (PM) and composite (COMP) directions. The CAI and Healthy groups were sub-categorised into 4 groups depending on the stance position and whether the average or best scores were reported. Results: The final pooled data consisted of 429 participants (202 CAI; 181 Healthy; 46 Coper). The 4 CAI sub-groups recorded a mean reach of 66.53%–76.42% (ANT), 54.67%–87.16% (PM), 44.55%–83.01% (PL) and 55.25%–82.19% (COMP). Smaller reach distances were reported in Group 1's ANT, PL and COMP reaches and Group 2's ANT reach (p < 0.05) compared to the Healthy group. Copers exceeded CAI and Healthy reaches for all reaches. Reach distances in the ANT direction were generally the smallest for the CAI group and ANT and PL directions for the Healthy and Coper groups. Conclusion: Reduced mSEBT reach was performed in specific directions for specific sub-groups only for the CAI population compared to both Healthy and Coper. The normative data can inform clinical practice and aid decision-making regarding dynamic balance for assessment and rehabilitation purposes.</p
Assessing the impact of automated devices for enhancing health and reducing medication errors in older adults with long-term health conditions (ADHERE):a study protocol for a randomised controlled trial in Bedfordshire, Luton and Milton Keynes, UK
Full text linkINTRODUCTION: Medication non-adherence in older adults with long-term conditions contributes to significant morbidity, mortality and healthcare costs. While adherence support tools exist, many interventions fail to reach those most at risk. Automated medication dispensers (AMDs) show promise in improving adherence and health outcomes, but their integration into routine community pharmacy practice remains underexplored. This study aims to assess the effectiveness of an AMD intervention with SMS reminders in enhancing medication adherence among older adults and to evaluate how this technology can be integrated into community pharmacy workflows.METHODS AND ANALYSIS: This randomised controlled trial involves 144 participants recruited from eight community pharmacies who will be randomised to receive either the AMD intervention or usual care. Primary outcomes include medication adherence, measured through pharmacy records and self-report at baseline, 3 and 6 months. Secondary outcomes include Morisky Medication Adherence Scale, health-related quality of life (SF-12), and healthcare resource use. A nested mixed methods process evaluation will explore uptake, acceptability and implementation.ETHICS AND DISSEMINATION: The study protocol has been approved by the University of Bedfordshire Institute for Health Research Ethics Committee (IHREC1039), the NHS and the local authority Research Governance and Research Ethics Committee (NHS REC reference: 25/EE/0026). The findings will be disseminated via a final report, peer-reviewed journal publications and presentations at relevant conferences.TRIAL REGISTRATION NUMBER: ISRCTN18849739.</p
Within session reliability of center of pressure measures to assess lower limb postural control under alternative auditory conditions
Full text linkBACKGROUND: Postural control is maintained through sensory information from visual, audio-vestibular and somatosensory inputs. When one of these senses are challenged, individuals shift their reliance more heavily onto other inputs to maintain postural control. Manipulation of vision to progress and regress lower limb rehabilitation has been researched extensively however, there is limited research on the effects of audio stimuli on postural control. In order to assess how audio stimuli can be manipulated for postural control and rehabilitation purposes, a reliable method must be identified.RESEARCH QUESTION: When testing postural control under alternative auditory conditions, is there an acceptable level of reliability for lower limb center of pressure measures?METHODS: Thirteen healthy participants completed three 30 s single leg balance (SLB) trials in five auditory conditions (no sound, white noise, audio book, ear to ear and non-ear to ear) on a force plate in random order. Intraclass correlation (ICC) and coefficient of variation (CV) with 95 % confidence intervals were used to assess the reliability of the center of pressure (COP) anterior-posterior (AP), medial-lateral (ML) and total sway path (TSP) outcome measures.RESULTS: The CV for each COP sway path measure remained under 10 %, ranging from 3.44 % to 7.28 %. Based on the ICC, reliability was excellent for all sway path COP outcome measures (ICC= 0.705-0.950), except no sound and white noise conditions in the AP direction which show low reliability scores (ICC= 0.39 0.42).SIGNIFICANCE: Three 30 s SLB trials were sufficient to ensure excellent within session reliability of COP TSP, in ML and some AP directions during alternative auditory conditions.</p
Evidence-based practice attributes among specialist nurses in acute care:a cross-sectional study
Full text linkBACKGROUND AND AIMS: Evidence-based practice (EBP) is central to high-quality acute care, yet evidence on how specialist nurses engage with EBP remains limited. This study aimed to examine EBP beliefs, organisational culture, and self-reported implementation among specialist nurses working in acute care, and to assess associations with professional characteristics, including specialist certification and academic qualifications.DESIGN: A descriptive cross-sectional study.METHODS: Data were collected between June and November 2023. Participants were specialist nurses employed in acute care roles, including critical care, emergency and urgent care, specialist medical and surgical units, and advanced practice positions. Validated instruments were used to measure EBP beliefs, organisational culture, and implementation. Analyses included descriptive statistics, group comparisons, and multivariable regression models.RESULTS: A total of 510 specialist nurses were included. Overall, nurses reported strong beliefs in EBP, moderately positive perceptions of organisational culture, and variable levels of implementation. Specialist certification was consistently associated with higher EBP implementation (standardised β = 0.24, 95% CI 0.15-0.33) and more positive organisational culture perceptions (β = 0.19, 95% CI 0.07-0.31), independent of experience and academic qualification. A clear pattern across clinical areas was observed, with higher EBP engagement reported in adult critical care and advanced practice roles, and lower organisational culture scores in emergency care settings.CONCLUSION: Among specialist nurses working in acute care, positive beliefs about EBP are widespread, but implementation varies and is associated with specialist certification and organisational context rather than years of experience or academic attainment. These findings highlight the importance of certification pathways and supportive organisational environments in strengthening EBP in high-acuity settings.</p
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