Improvements in cardiovascular disease (CVD) mortality have plateaued in the US and have increased among adults with fewer years of education, a pattern not seen in peer countries. Differences in health system performance managing CVD risk factors may be important in this disparity.

To compare cardiovascular disease risk factor prevalence and management in the US, England, and South Korea over time and by education strata.

This secondary analysis of a serial cross-sectional study used nationally representative data from adults 50 years or older from 3 countries during years ranging from 1998 to 2020. Data were analyzed from May 2025 to April 2026.

For each risk factor (cholesterol, blood pressure, and diabetes), the share at risk, the care cascade, and the share with uncontrolled risk were measured.

This study assessed data from 120 678 adults (mean [SD] age, 63.5 [9.9] years; No. [weighted %], 54 167 [46%] male and 66 511 [54%] female). For each risk factor, the US (n = 27 327) had higher shares at risk than England (n = 41 986) or South Korea (n = 51 365). For example, England had a smaller proportion at risk: 52% in period 4 (mean [SE], 11.1 [1.6] percentage points [pp] lower than in the US). Cholesterol risk in South Korea increased from 46% in 2005 to 2008 to 51% in 2015 to 2020 (P for trend < .001), with levels ultimately similar to England but 12.1 (1.1) pp below the US. US patients at risk were more likely to be aware, treated, and have controlled risk using medications, resulting in more similar uncontrolled risk across countries. Because of higher control of condition risks in the US, the rates of uncontrolled cholesterol risk in the US and England were both 29% (mean [SE] difference, <0.1 [1.5] pp), and the rate uncontrolled in South Korea was 2.2 (1.0) pp higher than the US despite higher at-risk rates. South Korea achieved rapid gains in treatment and control, especially hypertension (6% controlled in 1998-2001 to 42% in 2005-2008, P for trend < .001) and cholesterol (6% controlled in 2005-2008 to 31% in 2015-2020, P for trend < .001). Across countries, risk was higher among adults without a college degree, but control rates among those at risk were similar by education strata. Diabetes risk increased substantially over time (15% to 22% in the US, 9% to 10% in England, and 13% to 19% in South Korea, P for trend < .001), whereas cholesterol and hypertension risk remained stable or decreased.

In this repeated cross-sectional study of adults aged 50 years and older in the US, England, and South Korea, despite higher baseline risk, the US health system achieved comparable or better performance than England and South Korea in managing CVD risk factors. Differences in risk factor treatment did not explain disparities by country or education strata, suggesting that upstream risk accumulation, rather than care delivery, may be associated with increasing disparities in CVD risk.

Traditional Chinese medicine (TCM) has been increasingly applied in treating diabetic pruritus. Objectives: To conduct a systematic review and meta-analysis evaluating the efficacy and safety of TCM or integrated TCM-Western therapy for diabetic pruritus. This systematic review and meta-analysis was registered with registration number: INPLASY202570074. Major Chinese and international databases (China National Knowledge Infrastructure, PubMed, Web of Science and ScienceDirect) were searched between their inception and December 2024. Eligible randomised controlled trials (RCTs) investigating TCM or integrated TCM-Western therapies for diabetic pruritus were included. Two independent researchers performed literature screening, data extraction and quality assessment according to predefined inclusion and exclusion criteria. Outcome indicators included clinical efficacy rate, pruritus severity (Visual Analogue Scale [VAS] score) and incidence of adverse reactions. Meta-analyses were conducted using RevMan 5.4, Stata 16.0 or R 4.x. A total of 13 RCTs were included, with 557 participants in both the control group and the experimental group. Meta-analysis showed that TCM or integrated TCM-Western therapies significantly improved clinical efficacy compared with control groups (risk ratio [RR]=1.30, 95% CI:1.17-1.45, p<0.001). Most studies favoured TCM or integrated therapy in reducing VAS scores. Pooled estimate (mean difference=-1.09, 95% CI: -2.20-0.03, p=0.06) did not reach statistical significance due to high heterogeneity (I²=92.8%), indicating substantial variability among studies. Despite the heterogeneity, the existing evidence suggests that TCM or integrated TCM-Western therapies have potential -clinical advantages in treating diabetic pruritus, including improved efficacy and lower incidence of adverse reactions.

Food insecurity (FIS), limited or uncertain access to adequate, nutritious food, is frequently cited as associated with various chronic health conditions. With the goal of determining how these data might influence public policy and/or clinical practice, this narrative review synthesizes methodological insights from prior systematic reviews and more recent studies to critically examine the associations between FIS and the conditions of depression, anxiety, hypertension, diabetes, and dyslipidemia.

Numerous studies, including meta-analyses, have found that individuals screening positive for FIS are also significantly more likely to screen positive for depression or anxiety using validated tools for establishing these conditions. In contrast, the associations between FIS and cardiometabolic conditions such as hypertension, diabetes and dyslipidemia have been inconsistent, with rigorous meta-analyses failing to demonstrate strong associations of FIS with these conditions. These variations in findings reflect the use of self-reported disease diagnosis in contrast to measurement of blood pressure or disease biomarkers to indicate disease presence/activity; regional/geographic differences in the populations studied; and potential confounding by other conditions. While there is consistent evidence for associations of depression and anxiety with FIS, the associations between FIS and cardiometabolic diseases are complex and much less clear. In furthering our understanding of these associations and their implications for policy and clinical care, future studies should (i) emphasize measurable indicators of disease presence/activity over self-reports of disease; (ii) give greater attention to regional and population heterogeneity to better contextualize the data; (iii) more consistently account for key covariates in cross-sectional and longitudinal studies; and (iv) assess respondents' overall health-related worry or somatic symptom burden, when self-reports are used as indicators of disease.

The aim of this study was to evaluate serum chromium (Cr), magnesium (Mg), and nickel (Ni) levels in periodontitis and type 2 diabetes mellitus (T2DM) and to examine the relationship of these elements with periodontal clinical parameters and glycemic control.

A total of 74 individuals were included in this cross-sectional study and participants were divided into four groups: periodontally and systemically healthy control group (n = 18), periodontitis group (n = 19), controlled T2DM+periodontitis group (n = 18), and uncontrolled T2DM+periodontitis group (n = 19). Clinical periodontal parameters, plaque index (PI), gingival index (GI), bleeding on probing index (BOP), probing pocket depth (PPD), and clinical attachment level (CAL), were recorded in all patients. Serum HbA1c, Cr, Mg, and Ni levels were measured using atomic absorption spectrometry.

Serum Cr levels were significantly lower in the periodontitis group compared to the control group. Serum Cr and Mg levels were significantly lower in both the controlled and uncontrolled T2DM+ periodontitis groups compared to the healthy control group. Significant correlations were found between serum Cr and Mg levels and periodontal clinical parameters and HbA1c. Serum Ni levels did not differ between groups but showed significant correlations with periodontal parameters and HbA1c.

The decrease in serum Cr and Mg levels in individuals with periodontitis associated with T2DM suggests that metabolic and inflammatory load may affect mineral homeostasis. Serum Ni levels did not differ significantly between the groups.

The combination of periodontitis and uncontrolled T2DM may exert a synergistic effect on mineral homeostasis. Future longitudinal or interventional studies should assess whether monitoring chromium and nickel adds clinical value in understanding periodontal-systemic interactions and periodontal treatment response.

Retrospectively registered at ClinicalTrials.gov (Identifier: NCT07327086.; First submitted: 2025-12-24).

We evaluated the outcomes of immediate in situ urethroplasty performed at the time of artificial urinary sphincter explantation for urethral erosion and explored the factors associated with postoperative wound dehiscence.

We retrospectively reviewed patients who underwent artificial urinary sphincter explantation for endoscopically confirmed urethral cuff erosion at a single tertiary referral center between January 2008 and September 2025. Partial erosions were managed using primary repair, whereas circumferential defects were treated using excision and primary anastomosis. The primary outcome was the postoperative urethral stricture-free rate. Secondary outcomes included postoperative wound dehiscence and secondary artificial urinary sphincter implantation. Exploratory subgroup analyses were performed to compare the patients with and without postoperative wound dehiscence.

Sixteen patients were included in the study. The median patient age was 76 years, and the median follow-up duration was 14 months. Six patients (37.5%) had prior pelvic radiation therapy and seven (43.8%) had diabetes mellitus. Postoperative urethral stricture occurred in one patient (6.3%), yielding a stricture-free rate of 93.8%. Postoperative wound dehiscence occurred in seven patients (43.8%). All wounds were limited to the subcutaneous tissue and were managed with secondary closure under local anesthesia (Clavien-Dindo grade IIIa). Secondary artificial urinary sphincter implantation was performed in seven patients (43.8%), with two patients requiring repeat explantation due to recurrent infection.

Immediate in situ urethroplasty at the time of artificial urinary sphincter explantation was associated with a low observed urethral stricture rate in this selected cohort, although interpretation is limited by the small sample size and absence of a comparator group.

Background: Patients with diabetes mellitus and nonobstructive coronary artery disease (NOCAD) may remain at increased cardiovascular risk despite the absence of flow-limiting stenosis. Quantitative coronary CT angiography (CCTA) enables comprehensive assessment of anatomical, functional, and inflammatory imaging biomarkers beyond luminal stenosis. This study aimed to evaluate the prognostic value of an automated multiparametric CCTA-derived imaging framework for risk stratification in patients with NOCAD, with exploratory assessment in those with diabetes mellitus. Methods: This retrospective single-center study included 485 patients with NOCAD who underwent CCTA between January 2020 and December 2021. Automated CCTA analysis was performed to quantify plaque burden, high-risk plaque features, CT-derived fractional flow reserve (CT-FFR), and perivascular fat attenuation index. The primary endpoint was major adverse cardiovascular events (MACE) during follow-up. Prognostic associations were assessed using Kaplan-Meier analysis, Cox regression, and hierarchical models. Results: During a median follow-up of approximately three years, MACE occurred in 56 patients. Patients with diabetes had a higher event rate than those without diabetes. Increased plaque burden, high-risk plaque features, elevated perivascular fat attenuation index, and reduced CT-FFR were associated with adverse outcomes. The fully integrated model combining anatomical, functional, and inflammatory CCTA-derived biomarkers improved risk stratification compared with plaque-based assessment alone. Conclusions: Automated multiparametric CCTA phenotyping may provide complementary prognostic information for risk stratification in patients with NOCAD. The diabetes-specific findings should be considered exploratory and require validation in larger prospective cohorts.

This paper aims to analyse available scientific sources related to adjacent segment disease after the surgical stabilisation of lumbar spine. To be specific, to the incidence, risk factors, gender and age of patients, correlation between the length of the instrumentation and ASD development, and the effects of suboptimal sagittal spine stability.

A systematic review was elaborated in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guideline. A literature search in PubMed database was conducted in January 2025. The papers included in the systematic review were published between 2004 and 2023.

The search brought about 1,014 results, of which 59 studies were shortlisted based on their title and abstract. Those 59 articles were subsequently thoroughly examined and unsuitable papers were excluded. Yet another study meeting our criteria was identified through the analysis of cited references. A total of 17 papers that satisfied the predetermined criteria were selected. The number of patients included in the cohorts ranged from 117 to 3,799. The subjects were followed up for the period of at least 12 months up to 10 years postoperatively, the mean follow-up period reached 5.44 years. At the time of initial surgery, the age of the followed-up patients was 18 to 74 years, with a mean age of 56.67 years. The ASD incidence ranged from 0.74% to 30.3%. As concerns surgical therapy, 2.62%-27.4% of patients underwent surgery for adjacent segment disease. The most commonly referred to factor contributing to ASD development was the adjacent segment degeneration visible already preoperatively as well as iatrogenic damage to adjacent facets, high BMI, length of the fixation, sagittal balance, rheumatoid arthritis, or age. Osteoporosis, smoking, or diabetes mellitus, on the other hand, were not confirmed as risk factors.

Currently, there is a large body of studies on ASD published over several decades. This fact further reinforces its high clinical significance and long-term interest of academia in spine surgery.

ASD is a common postoperative complication in instrumented lumbar and lumbosacral fusions. The most commonly cited risk factors were preoperative adjacent segment degeneration, followed by iatrogenic alterations on unfixed intervertebral joints, sagittal imbalance, and higher BMI of the patient. Some authors also refer to advanced age as a factor contributing to earlier development of adjacent segment degeneration. Different conclusions are stated with respect to the fixation length, with more frequent reference to higher incidence of ASD in longer-segment fixation. The outcomes of other studies, however, reveal that the frequency of ASD development is independent of the number of fixed segments. Moreover, in one case, protective effects of long-segment fixations were proven by the authors. No correlation between gender, smoking, diabetes mellitus or osteoporosis with adjacent segment disease development was confirmed. Although the incidence of ASD can be reduced by correct indication and surgical technique, we shall continue to encounter this condition in clinical practice.

Abnormal serum potassium levels are a common issue in patients with heart failure with reduced ejection fraction (HFrEF), limiting the use of prognostically beneficial therapies. The primary aim of this study was to characterise the HFrEF population according to baseline potassium levels and to assess their impact on medium- to long-term prognosis.

A retrospective study was conducted on a cohort of consecutive patients with HFrEF recruited at our centre. Patients were classified according to baseline serum potassium levels into: Group 1 (<3.5 mEq/L), Group 2 (3.5-5.0 mEq/L), and Group 3 (>5.0 mEq/L). Prognostic impact was assessed in terms of HF readmissions, HF mortality and all-cause mortality.

A total of 409 patients were analysed. The median age was 69 years [IQR 59-77], with a predominance of male patients (74.1%). There were 26 patients (6.36%) with hypokalaemia, 365 (89.24%) with normokalaemia, and 18 (4.4%) with hyperkalaemia. Group 1 showed a higher prevalence of diabetes mellitus (69.2% vs. 47.4% vs. 33.4%; p = 0.043) and a greater proportion of patients with ≥2 previous admissions for HF (25% vs. 10.5% vs. 0%; p = 0.008). No differences were observed regarding echocardiographic parameters, markers of congestion, or HFrEF treatment. After a median follow-up of 60 months, no significant differences were found between groups in rates of HF readmissions, HF mortality and all-cause mortality.

Patients with hypokalaemia exhibited a higher prevalence of diabetes mellitus and previous HF admissions. In our population, no differences were observed between groups in the use of prognostically beneficial therapies or in outcomes in terms of HF rehospitalisations and mortality.

Background: Given the paucity of evidence on diabetes and associated risk factors among Pasifika communities in Australia, this analysis aimed to estimate the prevalence of diabetes and associated risk factors in this population. Methods: A whole-of-community-based cross-sectional analysis was conducted using baseline health screening data from adults aged ≥18 years in the Pasifika Preventing Diabetes Programme, a stepped-wedge randomised controlled trial evaluating the effectiveness of a "through the church" behaviour change intervention on diabetes prevention and management in Pasifika communities in Greater Sydney. HbA1c, random blood glucose, blood pressure, and anthropometric measurements were collected alongside sociodemographic, health behaviour, diabetes knowledge, and quality-of-life questionnaire data. Diabetes was defined by HbA1c ≥ 6.5% or self-reported diagnosis. Multivariable binary logistic regression was conducted to identify significant factors associated with the odds of having diabetes. Results: Among 1161 participants, 33.9% (95% CI: 31.1-36.7) had diabetes, of whom 34.3% were previously undiagnosed. Only 2.5% met fruit and vegetable guidelines; 34.3% met minimum physical activity recommendations, 95.8% were obese/overweight, and 68.0% had high blood pressure. The adjusted odds ratio (AOR) of having diabetes increased with family history of diabetes (AOR, 2.23; 95% CI: 1.56-3.20), high blood pressure (AOR, 1.65; 95% CI: 1.15-2.38), and older age (AOR, 1.06; 95% CI: 1.05-1.07). A high level of physical activity was associated with a 41% lower odds of diabetes compared to a low level of physical activity (AOR, 0.59; 95% CI: 0.38-0.94). Conclusions: This study demonstrates a high burden of diabetes among Pasifika adults in Australia, including a substantial proportion of previously undiagnosed cases. Older age, family history of diabetes, and high blood pressure were associated with higher odds of diabetes, while high physical activity was associated with lower odds. These findings highlight the need for culturally safe, community-based approaches to strengthen diabetes screening, early diagnosis, and integrated prevention strategies in this underserved high-risk population.

Background: Chronic kidney disease (CKD) is a major public health problem, primarily affecting patients with diabetes mellitus and/or hypertension. Early detection is critical to delay progression to renal replacement therapy. Therefore, this study aims to evaluate the implementation of a digital module for CKD detection in at-risk patients within the Peruvian Social Health Insurance system (EsSalud) during 2024. Materials and Methods: Data were collected through the Renal Health Module (MOSARE), a digital tool integrated into EsSalud's electronic health record for monitoring patients at risk of CKD. Key indicators were assessed using the RE-AIM framework: reach, effectiveness, adoption, implementation, and maintenance. Quantitative analyses evaluated patient identification, screening, and diagnosis, while qualitative analyses of technical documents identified barriers, facilitators, and stakeholder perceptions. Results: In 2024, MOSARE was implemented in a population of 1,667,856 insured individuals with CKD-related risk conditions, predominantly women (55.7%) and adults aged >55 years (88.3%). Nationwide, 93,266 patients were screened (5.59% reach), with 34.3% diagnosed with CKD. Screening coverage showed substantial geographic variability (0.35-29.59%). A total of 32,004 CKD cases were identified, with 84.2% in early stages (1-3A). Adoption reached 66.8% of level I and II healthcare facilities, with variability across networks. Regarding maintenance, 65% of trained facilities sustained active use. Implementation gaps were associated with interoperability issues, resource limitations, and training variability. Conclusions: MOSARE proved to be a feasible and operationally sensitive tool for CKD screening and risk identification, improving integration of renal care. However, addressing technical, training, and resource barriers is essential to ensure sustainability and scalability.