BMC Medicine最新文献

{"title":"Sex and gender considerations in randomized controlled trials in critical care nephrology: a meta-epidemiologic study.","authors":"Nuttha Lumlertgul, Anyarin Wannakittirat, Janice Y Kung, Nattachai Srisawat, David Collister, Emily J See, Neesh Pannu, Ravindra L Mehta, Danielle E Soranno, Marlies Ostermann, Sean M Bagshaw","doi":"10.1186/s12916-025-04202-y","DOIUrl":"10.1186/s12916-025-04202-y","url":null,"abstract":"<p><strong>Background: </strong>How sex and gender are considered in randomized controlled trials (RCTs) in critical care nephrology is unclear. We aimed to perform a meta-epidemiologic study to describe the representation, sex and gender reporting, and sex- and gender-based analyses (SGBA) in high-impact RCTs in critical care nephrology.</p><p><strong>Methods: </strong>We searched the Web of Science Core Collection for critical care nephrology papers from 2000 to 2024. We included trials published in high-impact journals in general medicine, pediatrics, critical care, and nephrology. The main outcome was the proportion of female/woman participants enrolled and the association with trial characteristics, findings, and women authorship. We estimated the participation-to-prevalence ratio (PPR) to evaluate the representativeness of females within identified RCTs and selected case-mix and disease populations. Sex and gender reporting and SGBA were investigated.</p><p><strong>Results: </strong>A total of 117 RCTs, including 106,057 participants, were included. Sex (54.7%), gender (26.5%), both (2.6%), or none (16.2%) terminology were used for reporting. Male/female (82.1%), men/women (11.1%), both (4.3%), boys/girls (0.9%) and none (1.7%) were used as descriptors. Of the 115 RCTs with available sex/gender data, the median proportion of female/women participants was 35.4% (interquartile range (IQR) 31.2%-40.8%). Pediatric age group and process of care as an intervention were independently associated with the proportion of female/women participants. The median PPR was 0.89 (IQR 0.8-1.06), except in major surgery, for which PPR was 0.67 (IQR 0.29-0.73). Twelve (10.9%) and 49 (41.9%) studies used sex and/or gender as inclusion and exclusion criteria, respectively; 5 (4.3%) studies used sex/gender-stratified randomization; and 35 (29.9%) studies performed SGBA. RCTs with pregnancy, lactation, or women of childbearing age as exclusion criteria had a lower enrollment of female/women participants than RCTs that did not (33.6% vs. 36.8%, P = 0.04). Exclusion criteria of pregnancy, lactation, or childbearing age were considered strongly justified, potentially justified, and poorly justified in 36.1%, 14.9%, and 48.9%, respectively. There were no changes in the representation of females/women and SGBA across identified RCTs over the search range.</p><p><strong>Conclusions: </strong>Females/women are less frequently represented in critical care nephrology RCTs. Significant gaps exist in sex- and gender-specific eligibility criteria, reporting, and analysis.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"386"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Objective sleep quality in diverse older adults: a cross-sectional study on the importance of race and ethnicity and sex.","authors":"Clémence Cavaillès, Katie L Stone, Yue Leng, Carrie Peltz, Kristine Yaffe","doi":"10.1186/s12916-025-04204-w","DOIUrl":"10.1186/s12916-025-04204-w","url":null,"abstract":"<p><strong>Background: </strong>Research on sleep disparities across different sociodemographic groups is limited and often yields inconsistent findings. We aimed to examine differences in objective sleep measures by race and ethnicity, sex, and age within a diverse cohort of community-dwelling older adults.</p><p><strong>Methods: </strong>We analyzed cross-sectional data from 838 participants aged ≥ 50 years in the Dormir Study (2020-2024). Sleep metrics, including sleep duration, sleep efficiency, wake after sleep onset (WASO), and sleep fragmentation index (SFI), were derived from a minimum of four nights of wrist actigraphy (mean = 6.1 ± 0.7 nights). Race and ethnicity (Black; Mexican American (MA); Non-Hispanic White (NHW)), sex, and age (< 65; ≥ 65 years) were self-reported. We compared sleep metrics across sociodemographic groups and assessed their multivariable associations using linear, logistic, and multinomial regression models.</p><p><strong>Results: </strong>We studied 190 (22.7%) Black, 282 (33.6%) MA, and 366 (43.7%) NHW Dormir participants, with a mean age of 66.7 ± 8.4 years, and 64.8% women. Compared to NHW participants, Black and MA participants had shorter mean sleep duration (Black: 7.1 ± 1.2 h; MA: 7.1 ± 1.1 h; NHW: 7.5 ± 1.1 h; p < 0.0001), lower median sleep efficiency (Black: 87.2%; MA: 87.8%; NHW: 90.6%; p < 0.0001), longer median WASO (Black: 61.2 min; MA: 56.7 min; NHW: 44.4 min; p < 0.0001), and higher mean SFI (Black: 32.0 ± 11.0%; MA: 27.3 ± 9.7%; NHW: 24.0 ± 9.0%; p < 0.0001). Compared to men, women had longer mean sleep duration (women: 7.4 ± 1.1 h; men: 7.1 ± 1.2 h; p = 0.0004) and lower mean SFI (women: 25.9 ± 8.8%; men: 28.9 ± 12.1%; p = 0.0001). Older participants had longer mean sleep duration (old: 7.4 ± 1.1 h; young: 7.1 ± 1.1 h; p < 0.0001), higher median sleep efficiency (old: 89.8%; young: 87.7%; p < 0.0001), shorter median WASO (old: 48.5 min; young: 56.8 min; p < 0.0001), and lower mean SFI (old: 26.1 ± 10.2%; young: 28.1 ± 10.2%; p = 0.007). After adjusting for socioeconomic and behavioral factors, comorbidities, and sleep medications, findings were consistent except for age group comparisons in which differences were no longer significant.</p><p><strong>Conclusions: </strong>Our findings demonstrate significant variations in objective sleep measures across sociodemographic groups, with non-White participants and men experiencing poorer sleep quality. These disparities may contribute to health inequalities, emphasizing the need for targeted interventions to support at-risk populations.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"391"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multisensory BCI promotes motor recovery via high-order network-mediated interhemispheric integration in chronic stroke.","authors":"Rongrong Lu, Zhen Pang, Tianhao Gao, Zhijie He, Yiqian Hu, Jie Zhuang, Qin Zhang, Zhengrun Gao","doi":"10.1186/s12916-025-04214-8","DOIUrl":"10.1186/s12916-025-04214-8","url":null,"abstract":"<p><strong>Background: </strong>Chronic stroke patients often experience persistent motor impairments, and current rehabilitation therapies rarely achieve substantial functional recovery. Sensory feedback during movement plays a pivotal role in driving neuroplasticity. This study introduces a novel multi-modal sensory feedback brain-computer interface (Multi-FDBK-BCI) system that integrates proprioceptive, tactile, and visual stimuli into motor imagery-based training. We aimed to explore the potential therapeutic efficacy and elucidate its neural mechanisms underlying motor recovery.</p><p><strong>Methods: </strong>Thirty-nine chronic stroke patients were randomized to either the Multi-FDBK-BCI group (n = 20) or the conventional motor imagery therapy group (n = 19). Motor recovery was assessed using the Fugl-Meyer Assessment (primary outcome), Motor Status Scale, Action Research Arm Test, and surface electromyography. Functional MRI was used to examine brain activation patterns during upper limb tasks, while Granger causality analysis and machine learning evaluated inter-regional connectivity changes and their predictive value for recovery.</p><p><strong>Results: </strong>Multi-FDBK-BCI training led to significantly greater motor recovery compared to conventional therapy. Functional MRI revealed enhanced activation of high-order transmodal networks-including the default mode, dorsal/ventral attention, and frontoparietal networks-during paralyzed limb movement, with activation strength positively correlated with motor improvement. Granger causality analysis identified a distinct information flow pattern: signals from the lesioned motor cortex were relayed through transmodal networks to the intact motor cortex, promoting interhemispheric communication. These functional connectivity changes not only supported motor recovery but also served as robust predictors of therapeutic outcomes.</p><p><strong>Conclusions: </strong>Our findings highlight the Multi-FDBK-BCI system as a promising strategy for chronic stroke rehabilitation, leveraging activity-dependent neuroplasticity within high-order transmodal networks. This multi-modal approach holds significant potential for patients with limited recovery options and sheds new light on the neural drivers of motor restoration, warranting further investigation in clinical neurorehabilitation.</p><p><strong>Trial registration: </strong>All data used in the present study were obtained from a research trial registered with the ClinicalTrials.gov database (ChiCTR-ONC-17010739, registered 26 February 2017, starting from 10 January 2017).</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"380"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivors.","authors":"Ike Dhiah Rochmawati, Jocelyn M Friday, Daniel Ang, Tran Q B Tran, Clea du Toit, Alan Stevenson, Jim Lewsey, Daniel Mackay, Ruth Dundas, Bhautesh Jani, S Vittal Katikireddi, Christian Delles, Sandosh Padmanabhan, Carlos Celis-Morales, Paul Welsh, Frederick K Ho, Jill P Pell","doi":"10.1186/s12916-025-04160-5","DOIUrl":"10.1186/s12916-025-04160-5","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines recommend use of (1) antiplatelet, (2) lipid-lowering, and (3) beta blocker medication, and (4) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) for secondary prevention following myocardial infarction (MI). This study examines whether sociodemographic factors and comorbidity were associated with receipt of guideline-recommended medication, and whether receipt was associated with all-cause mortality.</p><p><strong>Methods: </strong>A cohort study was conducted on West of Scotland patients aged 53 years or above who were discharged from hospital alive after an incident MI between 2014 and 2022. Receipt of guideline-directed therapy was defined as relevant medications dispensed within 3 months of discharge. Age, sex, area-deprivation, care/nursing home residence, year of incident MI, and pre-existing conditions were included as predictors of non-receipt and covariates in the analysis of the association between non-receipt and death.</p><p><strong>Results: </strong>Among 12,204 MI survivors, 7898 (64.72%) received all four classes of recommended medications. Non-receipt increased over the study period and was more likely in women, older people, more deprived people, care/nursing home residents, or those with preexisting atrial fibrillation, chronic kidney disease, liver diseases, chronic obstructive pulmonary disease, or psychosis; and was less likely in those who had prior revascularisation. Non-receipt was associated with higher mortality (HR 1.15, 95% CI 1.05-1.26) after adjusting for sociodemographic factors and preexisting conditions. Excess mortality due to area deprivation and care/nursing home residence could be partly explained by non-receipt of ACEi/ARB (9.4% for deprivation; 40.7% for care/nursing home residence) and lipid lowering medication (39.7% for care/nursing home residence).</p><p><strong>Conclusions: </strong>Recommended secondary prevention medications were less likely to be received by women, those deprived, living in care/nursing homes, and with comorbid conditions. Equivalising appropriate ACEi/ARB use for secondary prevention could slightly reduce socioeconomic inequality of cardiovascular mortality.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"381"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sympathetic reactivity to physiological stress is associated with expanded cardiac extracellular volume in humans.","authors":"Hazel C Blythe, Zoe H Adams, Katrina A Hope, Richard P Baker, Melanie J Hezzell, M Saadeh Suleiman, Ana Paula Abdala Sheikh, Nathan Manghat, Konstantina Mitrousi, Angus K Nightingale, Emma C Hart","doi":"10.1186/s12916-025-04197-6","DOIUrl":"10.1186/s12916-025-04197-6","url":null,"abstract":"<p><strong>Background: </strong>Expanded extracellular volume (ECV) is an early marker of myocardial interstitial fibrosis in patients with hypertension. Animal studies suggest that surges in sympathetic nerve activity (SNA) might contribute more to the development of interstitial fibrosis than the resting level of SNA. The aim of this study was to investigate whether resting SNA or greater SNA reactivity to a stressor may be associated with expanded ECV in humans across a range of blood pressures.</p><p><strong>Methods: </strong>This was a cross-sectional study in 19 individuals with varying levels of ambulatory systolic blood pressure (111-153 mmHg, 48 ± 13 years, 26.5 ± 2.6 kg/m², n = 10 diagnosed with hypertension and n = 9 normotensive controls). Beat-to-beat non-invasive blood pressure (Finometer), heart rate (3-lead ECG) and muscle SNA (MSNA; peroneal microneurography) were recorded simultaneously during baseline, and throughout a cold pressor test (physiological stress), with hand immersion in 3-4 °C water. LV chamber size, wall thickness and ECV were assessed using cardiac magnetic resonance imaging.</p><p><strong>Results: </strong>Resting MSNA was not associated with cardiac ECV (B coefficient = - 0.07, 95% CI (- 0.24-0.10), P = 0.549), but SNA reactivity to the cold pressor test was a predictor of ECV independent of daytime systolic blood pressure (B coefficient = 0.12, 95% CI (0.05-0.20), P = 0.007). We determined associations between ECV and MSNA variables using liner regressions, with ECV as the dependent variable.</p><p><strong>Conclusions: </strong>Our findings show that SNA responses to physiological stress were predictive of ECV, whereas resting SNA was not, independent of the level of blood pressure. Thus, surges in SNA during stress might be more important in cardiac remodelling than overall resting levels of SNA. Further studies should test this hypothesis in larger cohorts.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"367"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal multimorbidity patterns and cluster identification: a longitudinal analysis of administrative data.","authors":"Jennifer K Ferris, Brandon Wagar, Alex Choi, Jonathan Simkin, Hind Sbihi, Kari Harder, Kate Smolina","doi":"10.1186/s12916-025-04184-x","DOIUrl":"10.1186/s12916-025-04184-x","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity is analytically and clinically complex, involving multiple interactions between diseases each with unique implications for health. Identifying disease co-occurrence patterns at the population level could aid in disease prevention, management, and care delivery.</p><p><strong>Methods: </strong>Here, we analyzed multimorbidity patterns using linked administrative data from a longitudinal cohort of 1,347,820 individuals with multimorbidity over 20 years in British Columbia, Canada. A directed network-based approach was used to assess disease patterns in multimorbidity by frequency (prevalence) and non-random association (lift). We applied a community detection algorithm to identify multimorbidity disease clusters.</p><p><strong>Results: </strong>Mood and anxiety disorders and hypertension were the most common disease predecessors in prevalence networks, with differences between age groups. Lift networks revealed non-random disease associations. Some indicate potential etiological disease relationships (e.g., breast cancer preceding heart disease in young women), shared risk profiles (e.g., chronic obstructive pulmonary disease and lung cancer), or overlapping disease constructs (e.g., Parkinsonism and dementia). Disease clusters often centered around a single disease as a common predecessor or consequence, representing potential multimorbidity profiles, which may be relevant for patient subgrouping or management.</p><p><strong>Conclusions: </strong>Insights from these analyses can complement traditional chronic disease surveillance methods, flagging disease patterns for further interrogation into their impacts on function, mortality, and health service utilization.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"370"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12219922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of self-sampling and enhanced strategies for HPV prevention among men who have sex with men in China: a modeling study.","authors":"Zhen-Hao Wu, Yu-Jing An, Zhen-Xing Chu, Xin-Ru Li, An-Yang Hou, Yong-Jun Jiang, Qing-Hai Hu","doi":"10.1186/s12916-025-04131-w","DOIUrl":"10.1186/s12916-025-04131-w","url":null,"abstract":"<p><strong>Background: </strong>Human papillomavirus (HPV) testing on self-collected samples (self-sampling) can address the challenges with facility-sampling among men who have sex with men (MSM). However, its cost-effectiveness and effective combination with vaccination must be evaluated, particularly in the absence of national HPV vaccination immunization programs among men.</p><p><strong>Methods: </strong>We constructed a decision-analytic Markov model to assess the cost-effectiveness of the status quo, HPV self-sampling at different intervals, vaccination alone, and HPV self-sampling-vaccination combination based on the incremental cost-effectiveness ratio (ICER), from a healthcare system perspective. Univariate and probabilistic sensitivity analyses were conducted to evaluate the robustness of the proposed model.</p><p><strong>Results: </strong>A lifetime cost-effectiveness analysis on a hypothetical cohort comprising 100,000 MSM aged 12 years at baseline projected that combining screening and vaccination generated incremental costs of US$49,638-219,213 million while accruing 189,881-271,564 quality-adjusted life-years (QALYs) compared with the status quo. Incorporating HPV self-sampling significantly improved the cost-effectiveness of traditional interventions. Remarkably, combining annual HPV self-sampling with nine-valent vaccination proved the most cost-effective at a willingness-to-pay (WTP) threshold three times the Chinese per-capita gross domestic product (GDP). This strategy yielded an ICER of $775 per QALY compared to the status quo and was 55.7% possible to be cost-effective with a WTP threshold three times the per-capita GDP, outperforming other strategies.</p><p><strong>Conclusions: </strong>Implementing annual HPV self-sampling along with nine-valent vaccination is projected to be the most cost-effective among MSM in China. Reducing the costs of HPV self-sampling and vaccination is crucial for guaranteeing that future initiatives produce favorable economic outcomes. These findings provide valuable guidance for formulating policies on HPV prevention among MSM in China.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"362"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12217994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A conceptual model of factors potentially influencing prescribing decisions for chronic conditions: an overview of systematic reviews.","authors":"Matthew Gittus, Alicia O'Cathain, Katherine Miller, Anja Oklopcic, Albert C Ong, James Fotheringham","doi":"10.1186/s12916-025-04194-9","DOIUrl":"10.1186/s12916-025-04194-9","url":null,"abstract":"<p><strong>Background: </strong>Nearly half of all adults are affected by chronic conditions with long-term medications often being the primary intervention. Although models like that of Murshid and Mohaidin contribute to our understanding of prescribing behaviours, they are not specific to chronic conditions and may not reflect the full range of influencing factors relevant to long-term care. Better understanding the factors that may influence healthcare professionals' decision-making could help inform policy and guidelines as well as identify targets for future research and interventions.</p><p><strong>Methods: </strong>An overview of systematic reviews was undertaken, following the 2020 PRISMA guidelines. PubMed, Embase, Web of Science, Cochrane Library and Google Scholar were searched from 01/01/2013 to 7/11/2023. Quality assessment was undertaken using the AMSTAR 2 tool. Screening, data extraction and synthesis were conducted. Confidence in findings was assessed using the GRADE-CERQual tool. An existing generic conceptual model of prescribing was adjusted to specifically reflect chronic conditions.</p><p><strong>Results: </strong>Twenty-six reviews published between 2013 and 2023 were included, synthesising 689 primary studies. Patient factors that may influence prescribers' decisions included age, ethnicity, education and level of rurality of residence. Prescribers describe assessing individual patient characteristics when weighing the risks and benefits, with a tendency to prioritise risks-especially for patients with multiple comorbidities or complex needs. Prescribers' approach to risk may be influenced by their clinical experience, care setting and assessment tools. High workload and competing priorities may lead to clinical inertia in terms of delaying or preventing medication initiation. Shared decision-making may not always be shared equally between patients and prescribers. Beyond direct medication costs, prescribers may also consider broader healthcare costs, such as the need for monitoring and use of support staff for monitoring. External factors such as guidelines may be helpful in navigating risks, with their effectiveness potentially enhanced when they offer specific recommendations tailored to prescribers' population characteristics.</p><p><strong>Conclusions: </strong>Prescribers may need to navigate multiple challenges when making prescribing decisions for people with chronic conditions. This overview of systematic reviews suggests possible interrelated factor categories influencing prescribing decisions. The conceptual model may be used as a framework for future research and development of interventions.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"364"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12217990/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activities, longevity gene, and all-cause mortality among older adults: a prospective community-based cohort study.","authors":"Lanjing Xu, Jun Wang, Xinwei Li, Yang Li, Chen Chen, Zinan Xu, Yuan Xia, Zihan Lu, Jinghui Zhou, Min Zhang, Yuan Wei, Bing Wu, Zheng Zhang, Fangyu Li, Yufei Luo, Guangdi Chen, Yuebin Lv, Xiaoming Shi","doi":"10.1186/s12916-025-04176-x","DOIUrl":"10.1186/s12916-025-04176-x","url":null,"abstract":"<p><strong>Background: </strong>The health benefits of physical activity (PA) have been well recognized, while which types of PA are most beneficial are still unclear, especially for older adults. The study aimed to explore associations of different PAs (physical work, regular exercise, and leisure activities) with mortality among Chinese older adults, considering genetic risk.</p><p><strong>Methods: </strong>A total of 9690 older adults from the Chinese Longitudinal Health Longevity Survey (CLHLS, 1998-2018) were included. Self-reported PAs information on physical work, regular exercise, and leisure activities were collected through face-to-face interviews. Leisure activities were interviewed about their engagement in 6 typical activities (i.e., housework tasks, personal outdoor activities, gardening, rearing domestic animals/pets, playing cards/mahjong, and attending in social activities). A weighted genetic risk score (GRS) was constructed based on 11 lifespan-related loci and divided into two groups according to the median scores (0.21). The Cox proportional risk model was used to assess the association between different types of PAs and genetic risk with all-cause mortality.</p><p><strong>Results: </strong>During 63,832 person-years of follow-up, 5678 deaths were documented. The hazard ratios (HRs) for all-cause mortality between different PAs (lowest activity vs highest activity) were 0.85 (95% CI 0.79-0.92) for leisure activities, 0.93 (95% CI 0.87-0.99) for regular exercise, and 0.93 (95% CI 0.86-1.01) for physical work, respectively. Compared with low leisure activities, high leisure activities were associated with 16% reduction in all-cause mortality for individuals with low longevity GRS (HR 0.84, 95% CI 0.76-0.93), and 14% reduction in all-cause mortality for individuals with high longevity GRS (HR 0.86, 95% CI 0.78-0.96). Adherence to regular exercise was associated with 11% reduction in all-cause mortality for individuals with high longevity GRS (HR 0.89, 95% CI 0.81-0.97), while there was no statistically significance for those with low longevity GRS (HR 0.97, 95% CI 0.89-1.06) compared with those without regular exercise. There was no additive or multiplicative interaction between PAs and longevity genetics (P_interaction > 0.05).</p><p><strong>Conclusions: </strong>Leisure activities, as a low-risk, low-intensity, simple and inexpensive PA, rather than regular exercise, might bring the greatest health benefits, even for individuals with less longevity genes, highlighting the importance of providing individualized PA recommendations for older adults.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"361"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12220457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physiological serum uric acid concentrations correlate with arterial stiffness in a sex-dependent manner.","authors":"Oliver Thews, Thomas Schmid, Alexander Kluttig, Andreas Wienke, Melanie Zinkhan, Wolfgang Ahrens, Till Bärnighausen, Hermann Brenner, Stefanie Castell, Berit Lange, Wolfgang Lieb, Karin Halina Greiser, Marcus Dörr, Lilian Krist, Stefan N Willich, Volker Harth, Nadia Obi, Michael Leitzmann, Annette Peters, Börge Schmidt, Matthias B Schulze, Henry Völzke, Matthias Nauck, Stephanie Zylla, Anke Hannemann, Tobias Pischon, Ilais Moreno Velásquez, Matthias Girndt, Claudia Grossmann, Michael Gekle","doi":"10.1186/s12916-025-04195-8","DOIUrl":"10.1186/s12916-025-04195-8","url":null,"abstract":"<p><strong>Background: </strong>In humans, uric acid is a product of purine metabolism that impacts the vascular system. In addition to effects on arterial vascular tone, associations between serum uric acid concentrations-even in the physiological range-and arterial hypertension and vascular-mediated end-organ damage due to an impact on vascular stiffness have been postulated.</p><p><strong>Methods: </strong>Therefore, we aim to investigate a possible cross-sectional association between serum uric acid concentrations in the physiological range and differences in arterial pulse wave velocity (PWV), an indicator of vascular remodeling, with a focus on possible differences between female and male individuals. We analyzed cross-sectional phenotypic and laboratory parameters, including PWV from 70,649 individuals in the population-based German National Cohort (NAKO) in a sex-specific manner. In parallel, we applied a machine learning approach to identify and quantify factors associated with PWV in a hypothesis-free manner.</p><p><strong>Results: </strong>Our analysis uncovered a positive association between serum uric and PWV which was detected even if only individuals with urate values in the physiological range were included (n = 64,095). This correlation was more pronounced in women than in men. In multivariable linear regression models, we observed an association of uric acid (mmol/l) with PWV (m/s) of β = 1.12 (95% confidence interval (CI): 0.78; 1.45) in males and β = 1.35 (1.05; 1.66) in females, independent of other factors known to affect vascular stiffness. In addition, the machine learning approach identified uric acid as a major factor associated with PWV. The positive association was not restricted to hyperuricemia but evident even in the physiological concentration range. Based on the data from studies on the impact of aging on PWV, it is estimated that an increase in serum uric acid concentration by 0.1 mmol/l corresponds to an increase of approx. 7 years of age in females and of 4 years in males.</p><p><strong>Conclusions: </strong>Already in the physiological concentration range, uric acid is positively associated with parameters of arterial stiffness. This association is more pronounced in females as compared to males. This finding provides a mechanistic explanation for the increased risk of vascular end-organ damage associated with higher serum uric acid concentrations and supports the observed greater benefit of therapeutic uric acid lowering in female. Future intervention studies have to address the mechanistic causality of the observed effect.</p>","PeriodicalId":9188,"journal":{"name":"BMC Medicine","volume":"23 1","pages":"356"},"PeriodicalIF":7.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12211650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144538887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}