2026-04-01
Yunjie Li, Lin Wang, Lujing Gao
Background: The association between depressive symptoms and cardiovascular diseases is well established. However, their impact on the incidence of stroke in individuals with cardiovascular-kidney-metabolic (CKM) syndrome remains unclear. Objective: This study aims to investigate the impact of depressive symptoms at different stages of CKM syndrome on the incidence of new-onset stroke. Methods: This study used data from the China Health and Retirement Longitudinal Study. Depressive symptoms at baseline were assessed using the Center for Epidemiologic Studies Depression Scale, with stroke incidence determined through standardized follow-up questionnaires. Cox regression and restricted cubic spline regression were used to evaluate the association between depressive symptoms and stroke risk. Results: The analysis included 9593 participants (n=5180, 54.92% male; mean age of 60.89, SD 9.39 y), classified into CKM stages 0 to 3. Fully adjusted Cox regression showed that each 1-point increase in depressive score was associated with a 3% higher stroke risk (hazard ratio 1.03, 95% CI 1.02‐1.04; <.001). Restricted cubic spline regression confirmed a significant positive linear relationship between depressive symptoms and stroke incidence (<.001). Conclusions: This cohort study demonstrates a positive linear association between depressive symptoms and increased stroke incidence in individuals with CKM syndrome (stages 0‐3). These findings highlight the importance of emotional health management, suggesting that effective depression treatment may help reduce stroke risk through inflammation reduction and lifestyle improvements.
2026-03-26
Xin Wei, Lijuan Fu, Wencai Jiang, Xianjie Zhang, Rui Zhou
Background: Postoperative sleep is closely associated with recovery among patients undergoing surgery. Objective: This study aimed to analyze the research status and developmental trends in postoperative sleep between 2014 and 2024. Methods: Publications were retrieved from the Web of Science Core Collection. Microsoft Excel and VOSviewer were used to analyze the papers in terms of publication trends, countries, institutions, authors, journals, and keywords. Results: A total of 964 papers were obtained for the bibliometric analysis. The number of publications on this topic has increased gradually over the last 10 years. Zhu Junchao was the most prolific author in the field, and Chung Frances had the most citations. China had the most publications, followed by the United States. Scientific institutions in China, such as China Medical University and Capital Medical University, have led the way in terms of publication numbers. A total of 40 journals have published at least 5 papers. , with 19 publications, ranked first in publication count. The papers published in the , , , , and had higher citation counts on average. The high-frequency keywords were “sleep quality,” “postoperative pain,” “quality of life,” and “surgery,” while “lung cancer,” “enhanced recovery after surgery,” “breast cancer,” and “dexamethasone” emerged as new topics in this area. Conclusions: There has emerged a large body of literature on postoperative sleep over the past 10 years. Authors and organizations from China are leading contributors, followed by those from the United States. Anesthesiology is a critical discipline in this field. Postoperative pain is closely related to postoperative sleep and has become a major research focus. Recent studies have mainly focused on lung cancer and breast cancer surgeries. Enhanced recovery after surgery has become an emerging keyword.
2026-03-09
Lijun Xiang, Yun Xiao, Ming Cai, Jing Qin, Ting Wang, Xueming Xiang, Jun Ke, Ganlin Peng
Background: Neurodegenerative diseases are a major and growing global health burden. Their pathogenesis is complex, and effective therapies remain limited. Gene editing and stem cell–based strategies are reshaping the therapeutic landscape. However, the field has not been systematically examined through bibliometric analysis. Objective: We aimed to define the intellectual landscape of global research on gene editing and stem cell therapy for neurodegenerative diseases from 2005 to 2024, highlight evolving hotspots, track the field’s evolution, and identify major bottlenecks limiting clinical translation. Methods: We retrieved 1821 publications from the Web of Science Core Collection (2005-2024). We performed a multidimensional bibliometric analysis using CiteSpace and VOSviewer. We assessed publication output, country and institutional contributions, key authors and journals, co-cited references, and keyword networks. These analyses were used to track the field’s evolution and pinpoint emerging themes. Results: In total, 9978 researchers from 90 countries and 2515 institutions contributed to this literature. Annual publications increased from 28 in 2005 to 179 in 2024, with stepwise growth over time. The United States ranked first in output (n=780) and in citation impact (total local citation score=2784; total global citation score=40,009). China and India ranked second and fifth in output, respectively, but their average citation impact was lower than that of the leading countries. The University of California, San Francisco, and Johns Hopkins University remained consistently influential. Boulis NM, Bankiewicz KS, and Feldman EL were among the most prominent contributors. was the leading journal in this area. Keyword analyses pointed to a growing intersection between genetics and immunology. Major topics included nanotechnology-based delivery, adeno-associated virus vectors, small interfering RNA, intrathecal microsphere injection, autophagy, blood-brain barrier (BBB) targeting, clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), and induced pluripotent stem cells. Burst detection highlighted “open label” as a recent hotspot. This likely reflects rising translational activity and early clinical testing. Conclusions: The field is moving from technology development toward clinical translation. Anglo-American countries currently drive both productivity and influence. China and India contribute heavily to volume but need a stronger impact. CRISPR/induced pluripotent stem cell platforms and BBB-focused delivery remain central frontiers. The rise of “open-label” studies suggests accelerating clinical momentum. Future progress will require safer and more efficient delivery, clearer standards, and larger global consortia to harmonize protocols and speed translation.
2026-03-02
Jennifer R Job, Caroline Nicholson, Ruby Strauss, Debra Clark, Anita Pelecanos, Claire Jackson
Background: Frailty increases with age and is associated with increased vulnerability to adverse health outcomes. International guidelines recommend screening for frailty in primary care; however, this is not routine practice in Australia. Once identified, frailty progression has the potential to be halted or reversed with early intervention. The FRAIL (Fatigue, Resistance, Ambulation, Illnesses, Loss of weight) Scale Tool, a simple and validated screening and management tool, offers a feasible approach for integration into the Australian health assessment for those aged 75 years and older (75+HA), which can be performed annually by primary care providers. Objective: This study explores the rates of frailty, resources required to support management, and the determinants of implementing frailty screening and providing management for older Australians at the 75+HA. Methods: A mixed methods evaluation was conducted in 24 general practices across 2 Australian Primary Health Network regions, Sydney North and Brisbane South. The FRAIL Scale Tool was implemented during the 75+ health assessment, and data were collected on FRAIL Scale scores, hospitalization rates, recommended frailty interventions, and barriers to frailty management. Practice staff perceptions of the long-term sustainment of the FRAIL Scale Tool were assessed using the Provider Report of Sustainment Scale. Semistructured qualitative interviews were conducted with practice staff and patients, exploring barriers and enablers to implementing frailty screening and management. Guided by the Consolidated Framework for Implementation Research, transcripts were coded and themes developed. Results: Of the 1484 patients aged ≥75 years who were screened, 223 (15%) patients were frail, 616 (41.5%) patients were prefrail, and 645 (43.5%) patients were robust. People who were frail were more likely to be female, older, and have more prescribed medications. Of those screened as frail, 23 (11%) had a nonelective hospitalization in the 3 months prior to screening compared with 28 (5%) who screened as prefrail and 5 (1%) who screened as robust (=.012). Management recommendations commonly included medication reviews, aged care packages, assessment for depression, and exercise programs. Barriers identified to accessing interventions included health, transport, cost, and time. Survey and qualitative findings highlighted that the FRAIL Scale Tool was easy to use, integrated well into existing workflows as part of the 75+HA, and sustained use would be supported by software integration. Patients valued the assessment and tailored health support offered by trusted primary care providers. Conclusions: Incorporating the FRAIL Scale Tool into the annual health assessment for people aged 75 years and older provides a funded opportunity for addressing frailty in general practice. Patients and staff value the Tool’s simplicity and the opportunity to raise awareness and manage frailty proactively. Incorporating the Tool into practice software systems would enhance adoption. Broader implementation research in diverse settings and with Aboriginal and Torres Strait Islander populations is needed to improve frailty prevention and management.
2026-03-02
Anil Arora, Yogesh Garje, Shagupta Shaikh, Shruti Dharmadhikari, Chintan Khandhedia, Neeraj Markandeywar, Amey Mane, Suyog C Mehta, Ashish Kumar
Background: Nonalcoholic fatty liver disease (NAFLD) and its progressive form, nonalcoholic steatohepatitis (NASH), represent an increasing clinical and public health burden in India. Despite their high prevalence, there are limited data on their diagnostic and management approaches among Indian health care providers. Real-world evidence on how Indian gastroenterologists and hepatologists diagnose and manage these conditions remains limited. Objective: This study aimed to understand the current disease perspectives, diagnostic modalities, and management practices for NAFLD and NASH among Indian hepatologists and gastroenterologists. Methods: A nationwide, web-based cross-sectional survey was conducted online between May 2023 and July 2023 among practicing gastroenterologists and hepatologists from health care setups, clinics, and hospitals located across India. The structured, self-administered questionnaire included 34 items covering 3 domains: disease perspectives (n=16), diagnostic modalities (n=4), and management strategies (n=14). Descriptive statistics were used to summarize responses as counts and percentages. Results: A total of 609 physicians completed the online survey (gastroenterologists: n=556, 91.3%; hepatologists: n=53, 8.7%). For 336 (55.2%) physicians, NAFLD accounted for 25% to 50% of the patients consulted per month, and 220 (36.1%) physicians reported that 10% to 20% of patients with NAFLD had NASH. Obesity (n=583, 95.7%) and diabetes (n=579, 95.1%) were cited as leading risk factors for NAFLD. Transient elastography was the diagnostic tool preferred by 558 (91.6%) physicians, followed by NAFLD fibrosis score (n=378, 62.1%) and Fibrosis-4 score (n=356, 58.5%); only 154 (25.3%) physicians used liver biopsy. For treatment, 414 (68%) physicians managed patients using pharmacotherapy and dietary and lifestyle modifications, while 195 (32%) relied on lifestyle modification alone. Antioxidant vitamins (n=543, 89.2%) and saroglitazar (n=522, 85.7%) were the most frequently prescribed therapies. The main barriers to optimal NASH management reported were lack of patient awareness (n=466, 76.5%) and limited availability of effective pharmacological options (n=303, 49.8%). Conclusions: This large, nationwide survey highlights that NAFLD and NASH constitute a major part of gastroenterology and hepatology practice in India. Although transient elastography and pharmacological agents such as saroglitazar and vitamin E are widely used, considerable heterogeneity exists in diagnostic and management approaches. The lack of patient awareness and effective treatment options remain the major hurdles in managing NAFLD and NASH. These findings underscore the need for the wider implementation of existing India-specific consensus recommendations, continued physician education, and future research focusing on tailored interventions in the management of NAFLD and NASH for the Indian population.
2026-02-27
Danielle Hazime, Liza Raffi, Elizabeth Burner
Background: The rising cost of unscheduled acute health care, particularly for emergency department (ED) visits, poses significant financial burdens. In 2021, aggregate costs for treat-and-release ED visits in the United States accounted for an estimated US $80 billion, while the total annual cost of diabetes was US $412.9 billion in 2022—representing about 1 in every 4 health care dollars, 61% of which are directly linked to diabetes. Objective: This study explores the impact of a mobile health (mHealth) intervention with augmented social support delivered via guided SMS text messaging on health care use among patients with diabetes through a secondary analysis of the TExT-MED+FANS (Trial to Examine Text-Messaging in Emergency Patients With Diabetes + Family and Friends Network Support) randomized controlled trial. Methods: The trial involved 173 participants randomized into either a FANS mHealth-augmented social support or an active control group that received the same support curriculum via mailed pamphlet; “augmented” social support refers to recruiting both individuals with diabetes and a designated family member or friend (“supporter”) to participate. Supporters in the FANS arm received structured SMS guidance on how to assist the participant with diabetes in managing their condition. Health care use outcomes, including ED visits, hospitalizations, and clinic visits, were compared between groups during and after the intervention period using linear regression models on change in health care visits in the last year, with subgroup analysis by participant sex and supporter relationship. Results: Results showed significant reductions in acute unscheduled care visits for both groups during and after the intervention, with the FANS group experiencing a reduction of 1.04 visits during the intervention and 1.10 visits after the intervention, while the mailed pamphlet group had reductions of 1.47 and 1.53 visits, respectively (both <.001). Clinic visits increased by 1.78 during the intervention phase (=.01) but were not sustained postintervention. Hospitalizations modestly decreased in both groups, but the decrease was statistically significant only for the mailed pamphlet group (=.002). Sex and supporter relationship differences were observed, with females supported by spouses in the active control group showing the largest decrease in unscheduled care visits. Conclusions: The findings suggest that mHealth interventions combined with structured social support can improve diabetes management and reduce health care costs. Although these conclusions are specific to this study, they align with prior research demonstrating the benefits of social support and mHealth interventions. These findings may inform future programs, including the design of low-cost, scalable interventions in resource-limited settings. Trial Registration: ClinicalTrials.gov NCT03178773; https://www.clinicaltrials.gov/study/NCT03178773 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2019.03.003