Fear of progression (FoP) is a significant psychosocial burden for children with cancer and their parents, influencing their quality of life (HRQoL) and emotional adjustment. In this pilot randomised controlled trial (RCT) we present results on feasibility and preliminary efficacy of the family-based therapeutic intervention "Kinder-Progredienzangst" (KIPA), targeting FoP in pediatric oncology.

N = 29 families with a child undergoing acute cancer treatment or follow-up care completed the program, with participation open to parents alone or to parents and children; ultimately, n = 6 children participated. Eligibility criteria included moderate or high FoP in at least one family member. Families were randomised to either an intervention group or a waitlist-control group receiving treatment as usual. KIPA consists of psychoeducation, anxiety confrontation, and resource activation. Participants completed questionnaires for FoP, anxiety, depression, HRQoL, and posttraumatic stress symptoms (PTSS) at different time points. Participation and retention rates were calculated, and we used Mann-Whitney U tests for between-group comparisons, Friedman and Wilcoxon tests for within-group comparisons and Hedges g for effect sizes.

Feasibility results showed a participation rate of 23%, with higher participation in acute treatment (51%) compared to follow-up care (15%). Retention rates were 71% overall, with significant variability between settings. Efficacy analyses revealed significant differences in parental FoP between study conditions with high effect size (W = 65.5, p=.023, g=-0.855). Improvements were also noted in PTSS (W = 33, p<.001, g=-1.365), anxiety (W = 59, p=.017, g=-0.906) and mental (W = 217, p<.001, g = 1.619) and physical (W = 180, p=.042, g = 0.834) HRQoL. The pre-post analysis showed a significant reduction in parental FoP in both settings, and the follow-up data indicates sustainability. Effects on children's FoP were not significant.

The study showed mixed feasibility-particularly regarding child participation, follow-up enrolment and drop-out during acute treatment-highlighting the need for optimisation before larger trials. Nevertheless, the data provide initial indications that KIPA may benefit parents of children with cancer across both acute and follow-up care settings, a group highly affected by FoP. Given the methodological limitations, the efficacy results should be viewed as preliminary. To demonstrate KIPA's effectiveness, especially in children, large multicentre trials using reliable RCT designs suitable for acute care settings are needed.

The trial was retrospectively registered at the German Trial Registry (TRN: DRKS00024106, 04.05.2022).

Hyperuricemia has been widely associated with cardiovascular health, but its relationship with incident valvular heart disease (VHD) remains uncertain. This study investigated the association between hyperuricemia and VHD, and further explored the role of weight management within this context.

Participants from the UK Biobank cohort were categorized into three groups based on serum uric acid (SUA) level: normal (< 6.0 mg/dL), high (6.0-8.9 mg/dL), and very high (≥ 9.0 mg/dL). The risk of VHD associated with SUA level was assessed in the overall population and across subgroups with differing metabolic profiles. To examine the impact of obesity on VHD development, the relative risk of VHD was analyzed based on body mass index and waist circumference.

Among 462,705 participants, 340,793 (73.7%) had normal SUA levels, 118,861 (25.7%) had high levels, and 3,051 (0.7%) had very high levels. Over an average follow-up period of 12.3 years, the adjusted risk of VHD was significantly higher in individuals with very high SUA, followed by those with high and normal SUA (2.31 vs. 1.25 vs. reference, respectively). Stratifying VHD risk by metabolic disorders revealed a dose-response relationship between SUA level and VHD risk. The impact of obesity on VHD development was notable among individuals with SUA below 9.0 mg/dL, but less pronounced in those with SUA exceeding 9.0 mg/dL.

This finding suggests a significant association between hyperuricemia and VHD, highlighting the potential relevance of elevated SUA levels in VHD risk stratification.

Studies conducted among university students show non-compliance with the recommendations for healthy physical activity, while the factors that hinder or facilitate its practice remain insufficiently understood. The aim of this study is to examine barriers, motivations, and the degree of compliance with physical activity among medical students, comparing University of Seville, Spain (US) and Paris-Saclay University, France (UP-S) samples.

This cross-sectional empirical study included 223 undergraduate medical students (M = 22.30 years, SD = 2.259), from US and UP-S, 68.8% were women. In the selected classroom and in their respective languages, participants completed the instruments: International Physical Activity Questionnaire (IPAQ); habitual distances travelled; Self-Report of Barriers to Physical Exercise Practice (ABPEF); Goal Content for Exercise Questionnaire (GCEQ). The non-parametric Mann-Whitney U test was used, with significance set at p < 0.05, and correlational analyses were conducted using Kendall's tau-b (Tb) statistic in SPSS version 25.0.

UP-S students reported higher barriers than US students across all ABPEF factors, with significant differences in Total score (U = 4.616,5; p = 0.001), Fatigue/Laziness (p < 0.001), and Environment/Facilities (p = 0.002). US students showed significantly higher motivation in the Social Recognition factor of the GCEQ (p = 0.018). According to the IPAQ classification of three physical activity levels, US students were classified in the high physical activity level, whereas UP-S students were classified in the low and moderate levels (p < 0.001). The University/Country variable was associated with the distance from home to leisure facilities (p = 0.008), with the Total, Fatigue/Laziness, and Environment/Facilities (p = 0.002) barrier scores, and also with the Social Recognition motivational scale (p = 0.018).

The differences identified in our results highlight the need to consider the environmental context in studies on the physical activity of professionals directly involved in public health. US and UP-S medical students perceive Lack of time, primarily due to the high academic demands, as the main barrier to physical activity. Universities and European Higher Education Area policies should make greater efforts to provide physical and curricular environments that facilitate and motivate physical activity practice, within medical degree programs, a population that is key to the prevention of non-communicable diseases, in line with "Healthy Doctor - Healthy Patient", and the 3rd Sustainable Development Goal.

To determine the optimal timing for initiating liraglutide in patients with persistent obesity (BMI ≥ 28 kg/m² in China) six months after metabolic and bariatric surgery, a key gap in postoperative weight management.

In this prospective study, 100 patients were allocated to receive liraglutide (3.0 mg/day) starting at 6 (LG-6), 9 (LG-9), or 12 (LG-12) months post-surgery, or standard care without liraglutide (n = 25 each). The primary endpoint was percent total weight loss (%TWL) at 18 months. Secondary outcomes included changes in body composition and remission of obesity-related comorbidities.

All three liraglutide groups showed greater %TWL (LG-6 16.3 ± 5.7%, LG-9 13.7 ± 5.3%, LG-12 12.6 ± 6.0%) compared with controls (5.3 ± 5.2%; P < 0.05). Higher proportions of patients in liraglutide groups achieved BMI < 28 kg/m² (LG-6 40%, LG-9 52%, LG-12 36%) and ≥ 15% TWL (64%, 32%, 28%) versus controls (16%, 4%; P < 0.05). The LG-6 group showed the highest proportion reaching ≥ 20% TWL (24% vs. 0% in controls; P < 0.05). Reductions in fat mass and alanine transaminase, preservation of muscle mass, and remission of metabolic dysfunction-associated steatotic liver disease and hyperuricaemia were observed in association with liraglutide treatment.

Early liraglutide initiation, particularly at six months post-surgery, was linked to greater weight loss and more favourable metabolic profiles compared with standard care. These findings suggest that timely pharmacotherapy may be associated with improved long-term weight management outcomes, though causality remains to be established.

Dental caries remains one of the most prevalent noncommunicable diseases worldwide despite decades of clinical and behavioural interventions. Persistently high prevalence suggests that current approaches are better organised for ongoing disease management than for preventing new disease occurrence. This commentary examines whether an elimination framework could provide a more coherent and outcome-oriented direction for oral health policy and practice.

We apply the Dahlem Framework to assess whether dental caries meets established criteria for disease eradication. We then position caries within the classical continuum of control, elimination, and eradication, drawing on current evidence on caries aetiology, fluoride exposure, dietary environments, primary care integration, surveillance, and the social and commercial determinants of oral health.

Dental caries does not meet the criteria for eradication. It has no single causal agent, no interruptible transmission cycle, no immunising intervention, and no global surveillance architecture capable of detecting incidence. Eradication is therefore conceptually impossible. Elimination, however, defined as the stable disappearance of dental caries as a public health problem within a defined population, is biologically plausible and operationally achievable. An elimination frame shifts expectations from managing recurrence to preventing occurrence and reframes caries as a system outcome rather than solely an individual behavioural or clinical problem.

Caries elimination is not the promise of biological absence, but a realistic and measurable population health objective. Adopting an elimination framework could strengthen policy coherence, surveillance, implementation research, professional education, and accountability, while reorienting oral health systems toward prevention, equity, and sustained population-level impact.

Atrial fibrillation (AF) increases the risk of stroke and heart failure, yet accurate quantification of AF burden in daily life remains difficult. Although smartwatch photoplethysmography (PPG) supports continuous monitoring, complex rhythms and signal noise can impair burden estimation. We developed an AI-enhanced dual-modal framework that combines continuous watch-based PPG (W-PPG) with intermittent single-lead watch-based ECG (W-ECG). A hybrid convolutional neural network-long short-term memory model uses high-fidelity W-ECG segments as dynamic anchors to correct long-term W-PPG classifications. In this prospective validation study, 1,054 patients with AF undergoing catheter ablation (mean age, 62.1 years) were evaluated against patch-based ECG as the reference standard. After ECG-based correction, the system achieved 98.60% sensitivity and 99.27% specificity. The mean absolute percentage error of AF burden decreased by 23.4%, from 1.11% to 0.85%, while the Pearson correlation remained 0.9988. This dual-modal approach offers a scalable and clinically practical solution for long-term AF monitoring, improving burden estimation beyond PPG-only devices without requiring continuous multi-lead ECG. It may support personalized AF management and large-scale cardiovascular screening in real-world settings. (NCT06552468).

Kidney stone disease (KSD) is a global health burden. Premature menopause (PM) may increase the likelihood of KSD, but the influence of hormone therapy (HT) and genetic predisposition is unclear. We examined the association between PM and KSD in two large cohorts and evaluated potential modification by HT and polygenic risk scores (PRS).

We conducted cross-sectional analyses in 7,112 women from the National Health and Nutrition Examination Survey and 189,900 women from UK Biobank (UKB), with PM defined as menopause before age 40 years. Logistic regression estimated odds ratios (ORs) for prevalent KSD, and Cox models estimated hazard ratios (HRs) for incident KSD over a mean follow-up of ∼15 years in UKB. Sensitivity analyses and PRS stratification were performed to assess robustness and potential effect modification. Statistical analyses were conducted using R software.

In National Health and Nutrition Examination Survey (N = 7,112), KSD prevalence was higher in women with PM compared with women without PM (13.4% vs. 8.4%), with logistic regression showing 50% higher odds (OR: 1.54, 95% CI: 1.11-2.13). In the UKB baseline analysis (N = 189,900), PM was associated with higher odds of KSD (OR: 1.55, 95% CI: 1.32-1.83). In the prospective cohort (N = 188,282), women with PM had a 29%-55% higher hazard of incident KSD (HR: 1.29-1.55). Cumulative hazard curves showed early divergence (P < 0.001). PRS analyses demonstrated increasing hazards of KSD with higher genetic predisposition (HR: 1.22-1.80). HT use partially attenuated, but did not eliminate, the elevated association.

PM was consistently associated with KSD across two large cohorts. This association remained robust across multiple analytical approaches. Genetic predisposition was associated with higher hazards of KSD, whereas HT did not meaningfully modify these associations. These findings suggest a clinically relevant link that warrants further investigation in prospective and mechanistic studies.

To estimate the associations between gestational weight gain and maternal immediate perinatal and postpartum outcomes by pooling data from low and middle income countries.

Individual participant data meta-analyses.

PubMed, Embase, Web of Science, and Cochrane Library, based on three searches (Search 1: all prospective studies published from January 2000 to May 2021; Search 2: randomized controlled trials of balanced energy and protein supplementation published until June 2021; Search 3: randomized controlled trials of anti-infectious agents published until August 2021).

Prospective studies (randomised controlled trials or observational cohort studies) with measured maternal weight during pregnancy and data available on maternal height, based in populations from low and middle income countries with no underlying conditions.

The analyses included 156 300 women from 61 studies and 23 countries, with most participants based in South Asia (n=78 454, 50.2%) and sub-Saharan Africa (n=36 327, 23.2%). Compared with women with adequate (90-125%) gestational weight gain, women with excessive (>125%) gestational weight gain had a higher risk of caesarean delivery (risk ratio 1.10, 95% confidence interval 1.06 to 1.13, τ²=0.000) and emergency caesarean delivery (risk ratio 1.22, 1.03 to 1.43, τ²=0.000). Women with moderately (70% to <90%) or severely inadequate (<70%) versus adequate gestational weight gain had lower risks for caesarean delivery (risk ratio in women with moderately inadequate gestational weight gain 0.88, 95% confidence interval 0.84 to 0.92, τ²=0.004; risk ratio in women with severely inadequate gestational weight gain 0.82, 0.77 to 0.88, τ²=0.010) and emergency caesarean delivery (risk ratio in moderately inadequate gestational weight gain 0.82, 0.71 to 0.95, τ²=0.004; risk ratio in severely inadequate gestational weight gain 0.73, 0.56 to 0.96, τ²=0.103). Excessive versus adequate gestational weight gain was associated with higher postpartum weight retained at any time point (mean difference 2.00 kg, 95% confidence interval 1.49 to 2.50, τ²=1.317), whereas moderately and severely inadequate gestational weight gain were associated with lower retained weight compared with adequate gestational weight gain. Similar trends were found for postpartum body mass index. Severely inadequate gestational weight gain was associated with lower systolic and diastolic blood pressure at any time point post partum than adequate gestational weight gain. No associations were observed for other outcomes including postpartum depressive symptoms or breastfeeding. Evidence indicating an interaction between gestational weight gain and body mass index before pregnancy was found when examining the risk of caesarean delivery and postpartum weight retention, body mass index, and systolic blood pressure as outcomes.

These findings support the association between suboptimal gestational weight gain and adverse maternal outcomes in the immediate perinatal and postpartum periods. Further research examining the consequences of suboptimal gestational weight gain in low and middle income countries would be valuable to inform potential strategies to improve long term maternal health.

PROSPERO CRD42023432836.

Higher mean arterial pressure (MAP) is commonly pursued in septic shock, yet randomized trials have failed to demonstrate a survival benefit-and patients achieving higher MAP often exhibit paradoxically greater mortality. We hypothesized this reflects impaired vascular responsiveness requiring greater vasopressor support, quantifiable by the MAP-to-norepinephrine-equivalent dose ratio (MAP/NEQ).

We conducted a retrospective cohort study using two independent critical care databases (MIMIC‑IV and eICU). Adult patients with septic shock receiving vasopressors within 24 h of ICU admission were included. The primary exposure was the 24-h time-weighted average MAP (65-80 mmHg vs. ≥ 80 mmHg); the key secondary exposure was MAP/NEQ. The primary outcome was 28-day mortality. Cox regression, restricted cubic splines, and mediation analysis were performed.

A total of 7433 patients were included (MIMIC‑IV: n = 4944; eICU: n = 2489). Despite being younger with fewer comorbidities, patients with MAP ≥ 80 mmHg had higher 28-day mortality (MIMIC-IV: 19.5% vs. 12.6%; eICU: 20.5% vs. 11.0%; both P < 0.001). After adjustment for MAP/NEQ, the association between high MAP and mortality became non-significant, while MAP/NEQ remained independently and inversely associated with mortality in both cohorts (AUC 0.81 and 0.72). Mediation analyses revealed a suppression effect (- 33% and - 26%), indicating higher MAP coexisted with impaired vascular responsiveness. Subgroup and sensitivity analyses were consistent.

Higher achieved MAP was not independently associated with 28-day mortality after accounting for vascular responsiveness. MAP/NEQ may serve as a clinically accessible tool for early risk stratification and identification of a vasoplegic phenotype in septic shock, though prospective validation is needed before clinical application.