As populations age and hypertension prevalence rises, the burden of hypertension-attributable chronic kidney disease (CKD) keeps aggregating and varies across regions. A systematic assessment of how disease burden and care quality change over time becomes a prerequisite for sound prevention and control policies.

To describe temporal changes and geographical distributions of hypertension-attributable CKD's burden and quality of care across countries, regions, and globally from 1990 to 2021.

Data were obtained from the Global Burden of Disease Study 2021. Temporal trends in disease burden and Quality of Care Index (QCI) were analyzed using the estimated annual percentage change (EAPC). Spearman correlation analysis and cross-national inequality analysis were conducted to explore QCI health inequality related to the Socio-demographic Index (SDI).

From 1990 to 2021, global age-standardized incidence and mortality rates of hypertension-attributable CKD increased by 22.30% and 29.21%, respectively. Age-standardized disability-adjusted life-years rate (ASDR) reached 128.41 per 100,000, up 19.15% over 31 years, whereas the QCI declined. Men had higher ASDR and QCI than women. SDI was negatively correlated with ASDR and positively correlated with QCI. Global health inequalities persisted: low-SDI regions (e.g., sub-Saharan Africa) faced heavier burdens and poorer care quality, whereas high-SDI regions such as Eastern Europe and High-income Asia Pacific displayed lower ASDR and higher QCI, indicating better disease management.

Global burden of hypertension-attributable CKD continues to rise while care quality declines, with low-SDI countries facing the greatest challenges. Enhanced hypertension prevention, improved CKD management, equitable resource allocation, and global health equity initiatives, with a focus on improving global quality of care, are needed.

To explore the feasibility of a novel multimodal executive function intervention in school-aged children with complex congenital heart disease (cCHD).

Single-centre, single-blinded, randomised-controlled 8-week multimodal personalised executive function intervention (E-Fit) study. Outcomes were measured throughout the intervention, post-intervention (T1) and at 4-month follow-up (T2).

Tertiary care centre between May 2022 and May 2024.

Children 10 to 12 years (M=11.0, SD=0.9) with cCHD without a genetic diagnosis with infant open-heart surgery and reported difficulties (T-scores ≥60) on any of the summary scales of the parent- or teacher-reported Behavior Rating Inventory for Executive Function (BRIEF).

Children with cCHD were randomly assigned to one of two groups: the intervention or the control group. The 8-week intervention was multimodal including three modalities: (1) computerised executive function (EF) training 3×20 min/week with CogniFit; (2) a weekly, remote standardised 1:1 individual EF strategy coaching; (3) analogue games played at convenience. The control group completed activity logs.

Acceptability: Acceptance and Feasibility Scale (AFS) and coach-rated engagement during coaching sessions. Demand: Number of completed computerised training, strategy coaching and analogue game sessions.

E-Fit Fidelity Measurement System, assessing adherence to core components. Practicality: Retention rate. Integration: AFS integration items. Exploratory efficacy: BRIEF, neuropsychological EF testing and psychosocial variables at baseline, post-intervention (8 weeks) and at 4-month follow-up.

We recruited 42 participants (N_female=20). Acceptability: The intervention was acceptable, with moderate observed engagement. Demand: median number of computerised training sessions completed was 16 of 24 sessions (67%, (IQR; 6 to 19)), all children attended all scheduled coaching sessions, analogue games were played in total a median of 9 times (IQR 4 to 14).

Coaching sessions could be implemented by the coaches as intended. Practicality: Overall retention rate was 90%. Integration: E-Fit was well integrable into the home setting. Exploratory efficacy favoured the intervention group with improvements in the parent-rated Behavioral Regulation Index of the BRIEF (adjusted Hedge's (g_A1) = -0.408 to -0.903) and in social responsiveness (g_A1 = -0.427 to -0.521) at T1 and at T2.

E-Fit is a feasible intervention suggesting EF and social responsiveness improvements in children with cCHD. Motivational strategies to improve adherence to computerised training should be refined before a full-scale efficacy trial.

NCT05198583.

To identify whether patients with arrhythmia, heart failure or ischaemic heart disease presenting with anxiety symptoms measured by the Hospital Anxiety and Depression Scale (HADS) have identifiable anxiety according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID) and, if so, which type of anxiety disorder based on the SCID.

Initial screening data from the Heart and Mind randomised clinical trial.

Patients with arrhythmia, heart failure or ischaemic heart disease were screened using HADS, and patients with a HADS-anxiety (HADS-A) score≥8 were invited to participate. Participants were interviewed by trained cardiac nurses using the SCID to determine whether they met the criteria for anxiety and, if so, the type of anxiety disorder.

Of the 7816 patients who completed the HADS questionnaire, 1803 (23%) had a HADS-A score≥8. Among these, 398 (22%) agreed to the SCID interview, and 336 (84%) met the diagnostic criteria for an anxiety disorder. The mean age was 61 years, with 40% being female. The mean HADS-A score was 11.3 (SD=2.7). The most common types of anxiety were generalised anxiety disorder (61%), panic disorder (23%) and specific phobia (8%).

The majority of individuals identified by the instrument also met the diagnostic criteria for an anxiety disorder. Generalised anxiety disorder and panic disorder were the most prevalent subtypes. Anxiety was common across the cardiac population, underscoring the need for routine assessment and targeted intervention in clinical practice.

NCT04582734.

To review the literature reporting patient preferences for ambulatory heart rhythm monitoring (AHRM) and what factors affect experience and engagement.

The prevalence of arrhythmia continues to rise and contributes significantly to outpatient care burden. There is limited understanding of patient experience and compliance with monitoring. As innovative technologies are developed and healthcare strategies move towards surveillance and prevention, understanding this is key.

A scoping review was conducted using guidance from the Joanna Briggs Institute and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The review included studies of adults under investigation or surveillance for arrhythmia with a range of devices (Holter monitor, patch device, event recorder, mobile cardiac telemetry, external and implantable loop recorders, wearables and other implantable cardiac devices) in ambulatory care settings worldwide. The final search was conducted on 3 January 2026 across Medline (PubMed), Embase (Ovid), Web of Science (Clarivate Analytics), Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), PsycINFO (Ovid) and Google Scholar. Quantitative, qualitative, mixed methods, multiple methods and any type of review articles were included.

54 studies were eligible for inclusion from the initial search that identified 1320 articles. Two overarching themes emerged from the quantitative and qualitative data: patient factors and device factors affecting experience and engagement. Patient factors included clinical and demographic factors, education and expectations, experience and preferences and impact on daily life and healthcare. Device factors could be common to several devices, for example, skin irritation or device specific, for example, the nature of activation.

Patient and device factors influence preferences for and experience and engagement with AHRM. While existing literature is incomplete and heterogeneous, it identifies key considerations that should be integrated into the development and testing of novel approaches for arrhythmia surveillance in healthcare contexts.

https://doi.org/10.17605/OSF.IO/6K3W8 (Open Science Framework).

To enhance venous thromboembolism (VTE) prevention and management in county-level hospitals, we developed a VTE quality control platform leveraging clinical databases and Clinician Workstations. The platform is characterised by simplified construction, cost-effectiveness and a user-friendly interface enabling precise real-time monitoring of VTE prevention measures in hospitalised patients. Comparative analysis of pre-implementation and post implementation data revealed significant improvements in key metrics: VTE bleeding risk assessment rate (1.33% vs 7.43%, p<0.001), basic prevention compliance (20.87% vs 50.38%, p<0.001), mechanical prevention utilisation (24.60% vs 27.37%, p=0.002) and appropriate prevention rate (11.67% vs 53.11%, p<0.001). The platform effectively optimised VTE prevention practices, demonstrating ease of deployment, affordability and operational efficiency-making it a scalable and practical solution for county-level hospitals in China.

ObjectiveThis study was undertaken to systematically examine the effects of robot-assisted, task-oriented training on upper limb function and activities of daily living in patients with stroke.MethodsA systematic search was conducted across PubMed, EMBASE, SCOPUS, CINAHL, and Ovid LWW databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, including literature published from 2014 to 2025. Eligible studies were randomized controlled trials that compared an experimental group receiving robot-assisted task-oriented training with a control group undergoing conventional treatment or alternative interventions and evaluated upper limb function and activities of daily living outcomes. The Physiotherapy Evidence Database scale was used to assess the methodological quality of the literature. This systematic review was registered with the Open Science Framework (DOI: 10.17605/OSF.IO/4DT6G).ResultsTen studies were included in the analysis. Robot-assisted interventions consistently improved upper extremity motor function, particularly when implemented as an adjunct to conventional therapy or integrated with advanced technologies such as functional electrical stimulation. However, activities of daily living-related improvements varied across studies, and functional improvements were confirmed in only three studies. The effectiveness of robotic intervention depended on the intervention modality, stroke phase, and technological integration.ConclusionsRobot-assisted task-oriented training can effectively improve upper limb function in patients with stroke, and in some cases, combining it with conventional therapy may produce synergistic effects. Nevertheless, evidence regarding improvements in activities of daily living and long-term maintenance effects remains limited. Further high-quality randomized trials focusing on optimizing specific clinical dimensions and facilitating the transfer of motor recovery to activities of daily living are required.

Despite the known benefits of physical activity and diet modifications for hypertension control, adults in rural South African settings still have high levels of uncontrolled hypertension. This paper outlines an intervention that targets adjusting routine physical activity and diet practices for hypertension control in adults from rural South Africa (HYPHEN). The intervention involved a structured group education, individualised physical activity education, and individualised dietary education. We aimed to evaluate the feasibility, acceptability, and fidelity of HYPHEN for adults aged 40 years and older living with hypertension in rural South Africa. Feasibility was measured by assessing recruitment and retention rates. Acceptability was assessed through interviews after the intervention using pre-determined themes of perceived expectations, benefits, motivation, and barriers concerning the intervention. Fidelity was evaluated by intervention adherence, dosage, quality, and participant responsiveness. Participants were also asked to rate their overall satisfaction on a Likert scale out of 10. Our study demonstrated high level of feasibility, acceptability, and fidelity. Thirty participants were successfully recruited (100% of target), 28 (93%) participants were retained, and 28 (93%) provided complete data. Qualitative data demonstrated high acceptability, with participants reporting that the intervention met expectations, provided benefits, motivated continued engagement, and involved few barriers. Intervention fidelity was high with all three components carried out as planned, minor dosage adjustment, high delivery quality, and 100% participant engagement. The average rating on the Likert scale was 8.6/10 (SD = 2.55). HYPHEN is a feasible and acceptable intervention for hypertension control. Trial registration: Pan African Clinical Trial Registry (pactr.samrc.ac.za) PACTR202306662753321. Retrospectively registered on 29 June 2023.

Intracerebral hemorrhage (ICH) carries a substantial risk of early death and is frequently linked to unfavorable clinical outcomes, yet early prognostication remains challenging. The hemoglobin glycation index (HGI), which quantifies the discrepancy between measured glycosylated hemoglobin A1c(HbA1c) and the level expected based on fasting plasma glucose (FPG), has shown prognostic relevance in various clinical settings. Our objective was to investigate whether the HGI serves as a predictor of short-term mortality among individuals with ICH.

We performed a retrospective analysis utilizing data from the critical care database. We identified 1,318 adult ICH patients with available HbA1c and FPG data. HGI was defined as the difference between the observed HbA1c level and the HbA1c value predicted on the basis of admission FPG. Patients were stratified into HGI tertiles. The main outcome was 30-day all-cause mortality (90-day mortality served as a secondary endpoint). The relationship between HGI and mortality was examined using Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic spline analyses. Subgroup analyses were also performed.

Mortality was significantly greater among individuals in the lowest HGI tertile than among those in the highest tertile (30.18% vs 17.24% at 30-day mortality, p < 0.001; 33.64% vs 22.07% at 90-day mortality, p < 0.001). Multivariable Cox regression showed that higher HGI was an independent predictor of reduced mortality risk. The adjusted hazard ratio(HR) for 30-day mortality was 0.84 (95% CI 0.75-0.93), for 90-day mortality was 0.86(95% CI: 0.79-0.95) in fully adjusted models. Restricted cubic spline (RCS) analysis demonstrated an L-shaped association, with inflection points identified at HGI values of 0.692 for 30-day mortality and 0.472 for 90-day mortality, respectively. Below these thresholds, each one-unit increase in HGI corresponded to a 47.7% reduction in 30-day mortality risk and a 40.4% reduction in 90-day mortality risk, respectively. The association between HGI and mortality was consistent across most subgroups, with a significant interaction by diabetes status (p for interaction < 0.05), indicating the predictive value of HGI was more pronounced in patients with diabetes.

An L-shaped association exists between HGI and short-term mortality in ICH patients, with low HGI indicating substantially higher risk and holds potential as a novel prognostic indicator for facilitating early risk stratification in patients with acute ICH.

Isolated distal deep vein thrombosis (IDDVT) is common, yet tools for predicting poor recanalization remain limited. We aimed to develop and compare machine learning models for predicting poor recanalization in patients with IDDVT and to identify the most informative predictors.

A total of 1600 patients with IDDVT were retrospectively enrolled. The dataset was randomly divided into a development set (n = 1280) and an independent test set (n = 320) using stratified sampling. Six predictive models were developed and compared: logistic regression (LR), support vector machine (SVM), random forest (RF), multilayer perceptron (MLP), extreme gradient boosting (XGBoost), and a Voting Ensemble. Model training and hyperparameter tuning were performed in the development set using five-fold stratified cross-validation, and optimal classification thresholds were determined using the Youden index. Model performance was evaluated by discrimination, calibration, and classification metrics, with 95% confidence intervals estimated by bootstrap resampling (10,000 iterations). SHAP analysis was applied to interpret the final model.

In the independent test set, all models showed acceptable to strong discrimination, with AUC values ranging from 0.808 to 0.908. XGBoost achieved the best overall performance, with an optimal threshold of 0.183, an AUC of 0.908 (95% CI, 0.855-0.952), a Brier score of 0.077 (95% CI, 0.058-0.096), an accuracy of 0.900 (95% CI, 0.866-0.931), a precision of 0.650 (95% CI, 0.529-0.767), a recall of 0.803 (95% CI, 0.686-0.906), an F1-score of 0.717 (95% CI, 0.615-0.806), and a specificity of 0.918 (95% CI, 0.884-0.950). The calibration intercept and slope of the XGBoost model were 0.149 (95% CI, -0.192 to 0.454) and 1.410 (95% CI, 1.098-1.809), respectively, indicating acceptable overall calibration. SHAP analysis identified D-dimer rate, provoking-factor-related variables, anticoagulant use, and age group as the most influential predictors.

Among six candidate models, XGBoost showed the best overall performance for predicting poor recanalization in patients with IDDVT. This study establishes an interpretable machine learning-based prediction framework focused specifically on poor recanalization in IDDVT and highlights the contribution of dynamic laboratory information, particularly D-dimer rate. The model may support early risk stratification and individualized follow-up planning, but external validation is required before routine clinical implementation.

Takotsubo Syndrome (TS) is a cardiac condition that mimics myocardial infarction (MI). Long-term readmission data remain limited. Previous studies in other conditions suggest that socioeconomic factors, such as low income and unemployment, may influence readmission rates, but this has not been explored in TS. This study aims to investigate the risk factors of one-year readmissions in TS patients and the impact of socioeconomic factors, comparing results with matched individuals from the general population and those with MI. Methods A nationwide cohort study was conducted using national registers. Patients discharged alive from Danish hospitals with an incident TS diagnosis between 2008 and 2018 were identified through the Danish National Patient Registry. Each TS patient was matched with four individuals from the general population and patients with MI by sex and age. In the analyses of one-year readmission of TS, we included socioeconomic factors such as cohabitation, labor market attachment, education, family income psychological distress, and comorbidities. Results A total of 1022 individuals with TS were identified, with a median age of 70 years (IQR 61-77), and 89% were women. Compared to the general population, TS patients had higher rates of cardiovascular comorbidities, respiratory diseases, and psychotropic medication use, but fewer cardiac conditions except for heart failure in the MI population. TS patients were more likely to receive incapacity pensions, have basic education, and belong to the lowest income percentile compared to the general population. In the first year, (36%) of TS patients were readmitted, compared to 4% in the general population and 44% in the MI group. The most common causes of readmission in the TS cohort were cardiac (27%), 'other' conditions (22%), and respiratory (20%).Readmission rates were higher among TS patients in vulnerable socioeconomic groups compared to the general population: 37% vs 6% for those in the lowest income percentile, 42% vs 6 % for those with basic education, and 37% vs 4% for those on incapacity pension, but overall lower compared to the MI population. Most readmissions occurred within the first two months. The two lowest income quintiles, vocational/high school and below and living alone all predicted readmission. The lowest income had a Hazard Ratio of 1.64 and 95% confidence intervals of 1.01-2.69. Conclusion Although TS patients exhibit a disadvantaged socioeconomic profile and a substantial comorbidity burden, our analyses suggest that socioeconomic factors are associated with readmission risk, with part of this association potentially mediated through comorbidity burden. These findings indicate that, even in healthcare systems with free access such as Denmark's, socioeconomic inequalities may remain relevant for readmission risk in TS patients.