This study aims to examine trends in injury-related mortality among children and adolescents aged 0-19 years in a central urban district of Shanghai from 1993 to 2024, as well as its epidemiological characteristics.

This study is a retrospective study. From 1993 to 2024, data were obtained from the Shanghai Cause-of-Death Surveillance System. Death records with injury as the underlying cause that were categorized under the International Statistical Classification of Diseases and Related Health Problems (ICD) codes V01-Y89 (external causes of injury and poisoning) were gathered.

For children and adolescents aged from 0 to 19, the standardized injury-related mortality rate was 5.21 per 100,000, and 8.87% of all-cause mortality. The top two causes of injury-related mortality were suicide (1.15 per 100,000) and traffic injuries (1.02 per 100,000). Leading causes of injury-related mortality varied by age group: traffic injuries were the primary cause of injury-related death in the 5-9 age group; accidental poisoning and suicide were most common for the 10-14 age group, traffic injuries and suicide were the most prevalent causes in the 15-19 age group. The crude mortality rate of the 0-4 year old age group has shown a fluctuating low-level trend since 2003. The peak of accidental falls and drowning deaths in the 0-4 age group occurred in 2003. In the 5-19 years group, road traffic injuries exhibited intermittent peaks, while suicide showed a persistent upward trend. From 1993 to 2004, accidental poisoning and traffic injuries were the primary causes, while suicide and traffic injuries ranked first and second between 2005 and 2014. From 2015 to 2024, suicide surpassed traffic injuries as the primary cause of death. During the study period, the overall standardized injury-related mortality among children and adolescents aged 0-19 years in Huangpu District showed fluctuations (APC = -0.875, p = 0.420). However, significant declining trends were observed for traffic injuries, drowning, accidental falls, and accidental poisoning (p < 0.05).

Different types of injuries exhibit gender and age differences, suggesting the need for targeted interventions according to the developmental trends and characteristics of children and adolescents.

Non-communicable diseases are a growing public health challenge, shaped not only by biological predispositions but also by geo-demographic, socioeconomic, psychological, and lifestyle factors. A comprehensive understanding of these determinants is essential for developing targeted public health strategies. This study aimed to examine the multifactorial determinants of individual health status by analyzing geo-demographic, socio-economic, behavioral, psychological, and lifestyle variables.

Data were collected from 4,010 participants (age: 37.2 ± 15.4 years; 59.5% female) across 10 Mediterranean and neighboring countries using the multinational MEDIET4ALL e-survey. Health status was categorized as healthy, at-risk, or with diseases. Multinomial logistic regression, Quade's Rank ANCOVA and series of multiple regression models were conducted.

Collectively, around 25% of respondents declared to be at-risk of or with known disease. BMI emerged as the strongest negative predictor of health status (β = -0.145), with both obesity and underweight significantly increasing the odds of being at risk (OR = 1.8 and 5.2, respectively) and having diseases (OR = 2.2 and 11.9, respectively). Other significant negative predictors included psychological distress (notably anxiety, β = -0.091), insomnia (β = -0.084), alcohol consumption (β = -0.053), and prolonged sitting time (β = -0.037). Conversely, life satisfaction was the strongest significant protective factor (β = 0.066), followed by higher education, better sleep quality, and adherence to the Mediterranean Diet and lifestyle (β = 0.034 to 0.050). Socio-economic disparities, including employment status (β = -0.045) and living environment (β = -0.031), also significantly influenced health outcomes with rural environment and employed individual showing lower odd ratios of being at-risk and/or having diseases (p < 0.001). Furthermore, individuals residing in Mediterranean regions, females, married or cohabiting individuals, and non-smokers exhibited significantly lower odds of being at-risk or having diseases (p < 0.05). While gender remained a significant predictor in the final refined comprehensive regression model (β = -0.049), marital status lost significance, suggesting that its protective effect may be mediated by psychological well-being and health-related behaviors.

These findings highlight the complex interplay of lifestyle, mental health, and socio-environmental factors in determining health outcomes, while emphasizing the urgent need for multi-level public health interventions, including policies promoting physical activity, healthy eating, mental well-being, and equitable healthcare access. Future research should employ longitudinal designs to establish causal relationships and guides preventive strategies.

Dual primary malignancies, including colorectal (CRC) and gastric cancers (GC), are complicated cases due to the complexity of managing patients.

This case report presents a 62-year-old male patient with rectal and gastric adenocarcinomas. Initially, rectal adenocarcinoma after a complaint of hematochezia was diagnosed by prognostic modalities. The patient received total neoadjuvant therapy with FOLFOX chemotherapy and chemoradiotherapy. After surgery, a complete pathological response was obtained. A few months later, gastric adenocarcinoma with persistent heartburn was detected through esophagogastroduodenoscopy (EGD). total neoadjuvant therapy with FOLFOX chemotherapy and chemoradiotherapy followed by total gastrectomy were prescribed. After gastrectomy, a complete pathological response was obtained.

This case of synchronous CRC and GC, diagnosed 5 months apart, underscores the pivotal role of early detection and multidisciplinary management in achieving favorable outcomes. Complete pathologic responses in both malignancies following tailored TNT with FOLFOX and FLOT regimens, combined with surgical interventions, highlight the efficacy of personalized treatment strategies, even in resource-constrained settings. Continued research is essential to optimize diagnostic protocols, refine therapeutic approaches, and improve access to genetic testing for synchronous and metachronous malignancies, promoting equitable cancer care globally.

Background: The changes in the role of hospitals in the future require planning for the changes in the structure of hospitals. This study aimed to explore the state of public hospitals in Iran by 2032.

Materials and Methods: The participants were 20 hospital management and healthcare experts selected using purposive sampling. Structural interaction analysis and MICMAC software were used for data processing.

Results: The findings indicated the growing budgetary constraints in the health sector due to the increasing economic and health burden of non-communicable diseases and emerging diseases caused by environmental changes, the structure of the purchase of drugs, consumables, and medical equipment, the share of the health sector in the national public budget, providing access to capital/loans for the development of hospital activities by the government, the cost-effectiveness ratio of each service, the overcharged tariff set for hospital services, and public health insurance and a shift from employer-based insurance coverage to government-oriented insurance coverage are the key drivers affecting the state of public hospitals in Iran.

Conclusion: The identified factors play a vital role in the state of public hospitals in Iran. This can be useful for policymakers and hospital managers to recognize the future developments of hospitals and healthcare centers.

Diabetic foot ulcer (DFU) is a serious complication of diabetes that is associated with an increased risk of amputation and morbidity. Early identification and management are essential to prevent DFU and its complications. This study aimed to determine the prevalence and associated factors of DFU among diabetic patients attending primary healthcare centers (PHC) in Bahrain.

A cross-sectional study was conducted across all PHCs in Bahrain between July and September 2025 using a cluster sampling technique. Adults with diabetes attending diabetes clinics were included. Data on demographics, comorbidities, clinical examination, laboratory values, and treatment were collected using a standardized form. Wagner's classification was used to grade the severity of DFUs after clinical assessment.

A total of 601 patients were included, with a median age of 61 years; most were males (56.6%), Bahraini (85.4%), and had type 2 diabetes (96.7%). Dyslipidemia (77.5%), hypertension (66.7%), and ischemic heart disease (10.1%) were the most common comorbidities. DFU was noted in 5.3% (n=32) of the participants; 15 had superficial ulcers, 10 had deep ulcers, and seven had amputated limbs/toes. In multivariable logistic regression, insulin use (OR 2.555, p = 0.042), ischemic heart disease (OR 3.752, p = 0.016), and skin changes (OR 8.166, p < 0.001) were independently associated with DFUs.

DFU is relatively uncommon among diabetic patients attending PHCs in Bahrain. Ischemic heart disease, foot skin changes, insulin use, and low hemoglobin were associated factors of DFU risk. Routine screening for these high-risk clinical features should be performed by physicians and nurses caring for patients with diabetes to reduce morbidity and prevent severe outcomes.

To define the role of post-mastectomy radiotherapy (PMRT) in triple-negative breast cancer (TNBC), employing lymph node ratio (LNR, ratio of positive over excised lymph nodes) to offer personalized treatment strategies for this aggressively behaving cancer type.

The study included a total of 6474 women diagnosed with T1-4 N1-3 M0 TNBC from 2010 to 2017 using the SEER database, all of whom underwent mastectomy. Breast cancer-specific survival (BCSS) was defined as the time from diagnosis until death attributable to the breast cancer. Overall survival (OS) was defined as the time from diagnosis until death from any cause. A 1:1 propensity score matching (PSM) method was utilized to balance the baseline characteristics between the PMRT and non-PMRT groups. Kaplan-Meier analysis, together with the log-rank test, was applied to estimate survival outcomes.

After PSM, the PMRT group displayed better OS (HR_OS = 0.898, 95% CI = 0.819-0.984, p = 0.021). Subgroup analyses indicated that PMRT improved BCSS outcomes in the high-LNR group (HR_BCSS = 0.762, 95% CI = 0.636-0.913; p = 0.003) rather than low- (HR_BCSS = 1.125, 95% CI = 0.938-1.348; p = 0.203) or intermediate-LNR groups (HR_BCSS = 0.925, 95% CI = 0.778-1.099; p = 0.374). Compared with the non-PMRT group, patients receiving PMRT had better OS in the intermediate-LNR (HR_OS = 0.834, 95% CI = 0.715-0.972, p = 0.021) and high-LNR groups (HR_OS = 0.757, 95% CI = 0.643-0.893, p = 0.001), whereas the difference was not significant in the low-LNR group (HR_OS = 1.044, 95% CI = 0.889-1.226, p = 0.599).

PMRT substantially improves the survival outcomes for individuals who fall into the intermediate to high-risk groups as determined by LNR, an essential prognostic factor. This helps in developing personalized PMRT treatment strategies for TNBC patients, thereby enabling precision medicine approaches.

Tuberculosis (TB) remains a major global health threat, particularly in low- and middle-income countries, with TB infection (TBI) serving as the primary source of TB disease. While HIV infection has long been recognised as a major risk factor for TB progression, the rise of Non-Communicable Diseases (NCDs), which may exert immunosuppressive effects, further compounded by their treatment, contributes to increased TB susceptibility. This scoping review synthesises evidence from systematic reviews on medical and behavioural risk factors for TBI progression to TB disease, for both asymptomatic and symptomatic disease.

A preliminary literature search was conducted on 11 January 2025, in PUBMED using the keywords "tuberculosis," "asymptomatic or subclinical tuberculosis" "risk factors," and "systematic review" followed by targeted reviews on the identified medical and behavioural risk factors for TB infection progression to TB disease.

A total of 25 systematic reviews were included. Medical risk factors for progression from TB infection to TB disease included diabetes mellitus (DM), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), undernutrition (including iron and vitamin D deficiency), cancer-particularly haematological malignancies-and immunosuppressive therapies (TNF-α inhibitors and glucocorticoids). Iron and vitamin D deficiency, particularly severe deficiency, is linked to increased TB risk, especially among people living with HIV. Behavioural risk factors, including tobacco, drug, and alcohol use, were also highlighted. Geographic variations in TB prevalence, diagnostic practices, and healthcare systems contributed to differences in risk estimates across reviews. No systematic reviews were identified that examined risk factors for asymptomatic TB.

The convergence of TB with NCDs, compounded by immunosuppressive therapies, poses a public health challenge in high TB burden settings. Effective TB prevention requires targeted screening, along with enhanced management of these NCDs. Nutritional support, particularly screening and treatment of anaemia and vitamin D deficiency, may benefit individuals with TBI, comorbid NCDs, and HIV. A multidisciplinary approach, integrating behavioural interventions and tailored prevention strategies, is essential to achieving WHO's End TB targets. Addressing the evidence gap on risk factors for asymptomatic TB is also critical to improve early detection and interrupt transmission.

Physical inactivity and excess nutritional intake have contributed to a global pandemic of metabolic and non-communicable diseases, resulting in unhealthy fat accumulation, metabolic dysregulation, and a high burden of chronic conditions such as type 2 diabetes, cardiovascular disease, and obesity [...].

Neurodegenerative diseases such as Alzheimer's and Parkinson's disease are characterized by progressive neuronal loss, oxidative stress, and limited treatment options. While vitamin D₃ has demonstrated neuroprotective potential, we hypothesize that its co-administration with vitamin A may enhance therapeutic effects via synergistic interactions between their nuclear receptors (the vitamin D Receptor (VDR) and Retinoid X Receptor (RXR)). The interaction leads to the formation of a heterodimer, which regulates genes involved in neuronal survival, inflammation, and oxidative balance. A comprehensive literature review was conducted to evaluate the mechanisms underlying Vitamin D₃'s neuroprotection and Vitamin A's modulatory role through RXR activation, focusing on studies exploring the VDR-RXR heterodimer in Alzheimer's and Parkinson's disease models. Evidence indicates that vitamin D₃ mitigates neurodegeneration by upregulating neuroprotective genes, reducing oxidative stress, and modulating calcium homeostasis, with these effects amplified by RXR activation. The VDR-RXR heterodimer interaction appears critical for enhancing transcriptional activity, promoting neuronal resilience, while potentially slowing neurodegeneration progression. We propose that combined vitamin D₃ and vitamin A supplementation could offer a promising therapeutic strategy by synergistically optimizing VDR-RXR signaling, thereby improving neuroprotection. This hypothesis requires validation through an integrated approach that includes molecular, cellular, behavioral, and translational neuroimaging methods to investigate neuroprotective effects associated with VDR-RXR co-activation.