Bmc Med
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Exposure to illicit substances during pregnancy may have long-term impacts on children's neurodevelopment. This study explores subsequent risks for intellectual disability, autistic disorders, and attention deficit and hyperactivity disorders in children born to mothers exposed to illicit substances before or during pregnancy. ⋯ This is one of the first studies using large population-based data linked to criminal records to reveal increased risks of intellectual disability and ADHD in children with prenatal exposure to illicit substances compared to matched unexposed controls. Our results also highlight the importance of preventive measures and interventions for the well-being of both the mother and the child.
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The maintenance of cognitive function is essential for quality of life and health outcomes in later years. Cognitive impairment, however, remains an undervalued long-term complication of type 2 diabetes by patients and providers alike. The burden of sustained hyperglycemia includes not only cognitive deficits but also the onset and progression of dementia-related conditions, including Alzheimer's disease (AD). ⋯ These efficacious treatments create a new gold standard of managing hyperglycemia-one which is consistent with the "complication-centric prescribing" mandates issued in type 2 diabetes treatment guidelines. The increasing longevity enjoyed by our populace places the onus on clinical care to play the "long game" in using targeted treatments for glucose control in patients with, or at risk for, cognitive decline to maintain cognitive wellness later in life. This article reviews critical emerging data for scientists and trialists and translates new enhancements in patient care for practitioners.
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Multicenter Study Observational Study
Efficacy, safety, and biomarker analysis of first-line immune checkpoint inhibitors with chemotherapy versus chemotherapy for advanced gastric cancer: a multicenter, retrospective cohort study.
Recent phase III randomized controlled trials have demonstrated that first-line immune checkpoint inhibitors (ICIs) improve prognosis in advanced HER-2-negative gastric cancer patients with programmed death ligand 1 (PD-L1) combined positive score (CPS) higher than 5. However, these findings are not confirmed in real-world settings, and the benefits in PD-L1 CPS < 5 patients remain controversial. ⋯ Adding ICIs to first-line treatment significantly prolongs survival in overall patients and in those with PD-L1 CPS 1-4 or unknown. This study also provides valuable insights into prognostic markers and resistance mechanisms, potentially guiding immunotherapy strategies.
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Pain is a complex problem that is triaged, diagnosed, treated, and billed based on which body part is painful, almost without exception. While the "body part framework" guides the organization and treatment of individual patients' pain conditions, it remains unclear how to best conceptualize, study, and treat pain conditions at the population level. Here, we investigate (1) how the body part framework agrees with population-level, biologically derived pain profiles; (2) how do data-derived pain profiles interface with other symptom domains from a whole-body perspective; and (3) whether biologically derived pain profiles capture clinically salient differences in medical history. ⋯ Overall, we provide evidence for a shift in pain medicine delivery systems from the conventional, body-part-based approach to one anchored in the pain experience and holistic profiles of patient function. This transition facilitates a more comprehensive management of chronic diseases, wherein pain treatment is integrated into broader health strategies. By focusing on holistic patient profiles, our approach not only addresses pain symptoms but also supports the management of underlying chronic conditions, thereby enhancing patient outcomes and improving quality of life. This model advocates for a seamless integration of pain management within the continuum of care for chronic diseases, emphasizing the importance of understanding and treating the interdependencies between chronic conditions and pain.
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Evidence indicates that neurodivergent (ND) populations may be more at risk of experiencing adverse childhood experiences (ACEs), compared to neurotypical (NT) populations. However, this evidence has typically not examined a comprehensive set of ACEs and has only included ND individuals on the basis that they have a diagnosis. Very little research has examined the impacts of ACEs on negative adulthood outcomes for ND populations. The current study aimed to examine the associations between neurodivergence and experiences of ACEs, and the impact of being ND and experiencing ACEs on health, wellbeing, and criminal justice outcomes. ⋯ The combination of being ND and experiencing ACEs could additively increase risks of experiencing poor wellbeing and criminal justice outcomes by a greater extent than expected. Preventing and responding to ACEs in ND populations should be a priority to reduce risks of poor health, wellbeing, and criminal justice outcomes in this population.