Additionally, more large clinical changes (d > 0.8) were found in the VIRTRAEL condition  than in the standard group. Here we show that the CCT with VIRTRAEL is effective in improving cognitive function in older adults and is superior to the standard format. These preliminary findings indicate that CCT is a useful tool potentially applicable in the fight against cognitive symptomatology associated with aging and neurodegenerative diseases. VIRTRAEL represents a breakthrough in this field as it is inexpensive and easily accessible to any older person, regardless of whether they live far from health care resources.The prevalence of people over 60 years of age with cognitive impairment has increased in recent decades. As a consequence, numerous computerized cognitive trainings (CCT) have been developed. This pilot study aimed to determine the effectiveness of the CCT with VIRTRAEL in improving older adults’ cognition. Fifty-five participants ( According to the United Nations Organization (UNO) , the popMost cases of neurodegenerative diseases are multifactorial, in which environmental  and genetic  risk factors interact cumulatively over an individual’s lifetime ,6,7. CogIn recent decades, non-pharmacological interventions have reported significant scientific support as strategies for the prevention and treatment of cognitive impairment ,17. CognAdvances in information and communication technologies have led to the emergence of computerized cognitive training (CCT) aimed to prevent and reduce cognitive impairment ,28,29. MDespite these limitations, studies point to a greater effectiveness of CCT compared to “traditional paper-and-pencil cognitive training (PCT)”. For instance, a recent study by Bernini et al.  found thTo alleviate some of the above limitations, the authors of the present study received public funding and developed the VIRTRAEL computerized cognitive stimulation website . It is a free access platform that includes tests and exercises for the assessment and stimulation of frequently altered cognitive skills in older people, such as attention, learning, memory, and executive functions. All training exercises are of increasing difficulty, with stimuli and contexts familiar to older adults. The rationale for the inclusion of activities, their frequency, sequences, and parameters, are based on paradigms and models from cognitive neuroscience  and neurThe aim of this pilot study was to determine the effectiveness of the VIRTRAEL online platform in improving cognitive status in older adults, in comparison to traditional paper-and-pencil cognitive training. We consider this work necessary to detect possible study failures or problems and to reduce the probability of wasting time, effort, and money in a clinical study with a larger population. We hypothesize that given its characteristics and previous findings, VIRTRAEL will improve performance in attention, learning, memory, and executive function beyond the improvements obtained through a standard stimulation program in older adults.A quasi-experimental repeated measures study was carried out between and within subjects. Seventy-five older adults were recruited, twenty of whom were randomly assigned to the traditional face-to-face condition because the capacity of that group was limited to that number by staffing and space limitations. The remaining participants were assigned to the computerized cognitive training group with VIRTRAEL.Seventy-five older people participated in the study and were divided into two groups: VIRTRAEL, those who received training through the online platform, and a standard group, who received a traditional paper-and-pencil cognitive training. All participants registered for participating in a cognitive training workshop offered in a community center in the province of Granada .The VIRTRAEL group was composed of 55 participants (74.5% women), between 63 and 91 years old, whose mean age was 72.7 years (SD = 6.5). The standard group consisted of 20 participants (75% women) between the ages of 63 and 88 . This sample is consistent with previous studies  and is rThe inclusion criteria were having (1) an age of more than 60 years, (2) a score ≥ 21 on the Mini-Mental State Examination, (3) no clinical signs of dementia , and (4) a basic level of reading and writing skills verified by the examiner. The exclusion criterion was having a medical diagnosis of dementia or any systemic condition associated with cognitive deficits.The dropout rate was 0, as all participants were involved until the end of the study.Participants were assessed individually before and after the intervention using standardized paper-and-pencil tests.The d2 Test of Attention  measuresThe Hopkins Verbal Learning Test-Revised (HVLT-R) ,47, formLetter-Number (L&N), Similarities, and Matrix sequencing subtests from the Wechsler Adult Intelligence Scale  ,50 measuLastly, the Keys Search subtest of the Behavioral Assessment of the Dysexecutive Syndrome (BADS) tests battery was used . This teAll instruments were validated for the cognitive assessment of older adults. Information is included in the manual of each instrument ,49,50,51http://www.everyware.es/webs/virtrael/#home) (accessed on 16 February 2023) was used. It is an online platform, freely accessible upon registration request, designed for cognitive assessment and stimulation of older people. An initial and shortened version called PESCO .Levene’s test showed equality of variances in all dependent variables. ANCOVA analyses showed that the participants in the VIRTRAEL group had a significantly higher improvement than those in the standard group in learning  and verbal memory , working memory (L&N), abstract (Matrix) and semantic (Similarities) reasoning, and planning (Keys Search). No differences were found in attention (d2CON) and recognition memory (HVLT-R Recognition) See .d (pre–post effect size) in the VIRTRAEL group was 0.67 (range= 0.24 to 0.95), whereas in the standard treatment group it was 0.38 (range= −0.16 to 0.84) (See d > 0.8) were found in HVLT-R delayed recall, HVLT-R cued recall, HVLT-R total learning, and Matrix; moderate clinical changes (d = 0.5) in L&N and Similarities; and small clinical changes (d = 0.2) in d2-Concentration, HVLT-R Recognition, and Keys Search.To check the effect size of each group, a within-subject pre–post effect size for every individual in each domain of each variable was calculated, and the group mean was obtained. The average Cohen’s .84) See . In the d > 0.8) in Matrix; moderate clinical changes (d = 0.5) in HVLT-R Recognition and Similarities; and low clinical changes (d = 0.2) in d2-Concentration, HVLT-R total learning, and L&N , delayed recall (p ≤ 0.001), working memory (p < 0.005), abstract (p < 0.002) and semantic reasoning (p < 0.015), and planning (p < 0.021). Additionally, large clinical changes (d > 0.8) were found in the VIRTRAEL condition in verbal learning, delayed recall and cued with semantic keys, and abstract reasoning. In the standard group, a large clinical change was found just in abstract reasoning.In summary, the VIRTRAEL group showed a significant and greater improvement in verbal learning  is a relevant finding due to the centrality and prominence that this component plays within cognitive functioning, and, therefore, its repercussion on the rest of components . To desiFinally, in the planning skill, the size of the effect of the change experienced by the VIRTRAEL group after the program has been small. In most studies with a control group, no significant improvements in executive function are obtained . We hypoThe findings of this study have a series of socio-sanitary implications since people with MCI who initiate cognitive stimulation by computer early reduce their risk of conversion to dementia  comparedAmong the limitations of the study is the small sample size, especially the group of standard cognitive stimulation, which limits the possibilities of generalization of the findings. Since this is a pilot study, the results indicate that it is possible to evaluate the efficacy of VIRTRAEL through a clinical trial with a larger sample size. In addition, the unbalanced size of the groups is a limitation. Although the equality of the variance of the groups minimizes the problem, for greater statistical power it is advisable to increase and balance the sample size in future studies. Another limitation derives from not having a follow-up of the improvements that allow knowing the stability of the cognitive gains reached by the older adults. In addition, no evaluations have been carried out on the transfer of improvements in the functioning of participants in activities of daily living or social participation. On the other hand, the merit of the study is to demonstrate that current technology makes it possible to translate the standard methodology of cognitive stimulation into a computer-based format and, in addition, to improve some of its key aspects. The effect of this achievement is an increase in the magnitude of cognitive improvements for older people. In order for older people to benefit from these advances, with VIRTRAEL they do not need to have previous computer skills, they only need to have access to a computer with an internet connection.In conclusion, from a statistical and clinical point of view, the program of cognitive stimulation VIRTRAEL has a higher effectiveness than standard cognitive stimulation in improving the learning, verbal memory, working memory, and planning of older adults. This has great implications, even more so after the events of the COVID-19 pandemic, since VIRTRAEL is inexpensive and easily accessible to any older person, regardless of whether they live far from health care resources. The results should be interpreted with caution due to the limitations of this pilot study. Studies should be conducted to test the efficacy of the computerized cognitive platform in larger samples and in a population that meets the criteria for mild cognitive impairment, given that this disorder is considered a prodromal stage of Alzheimer’s disease.


The main objective of this study was to analyze the mediating role that meaning in life has between emotion dysregulation and depressive symptomatology in Spanish university students. Five hundred and sixty-six Spanish university students participated in the study. All of them completed the Difficulties in Emotion Regulation Scale (DERS), the Patient Health Questionnaire (PHQ-9) and the Purpose in Life Test (PIL-10). A mediation model was performed to test the hypothesis that meaning in life mediates the effect of emotional dysregulation on depressive symptomatology in college students. The results show a positive, moderate, and statistically significant correlation between depression and emotional dysregulation. In addition, a negative, moderate, and statistically significant correlation was found between depression and meaning in life, and a negative, small, and statistically significant correlation between emotional dysregulation and meaning in life. Finally, the results of the mediation model evidence the role of meaning in life in different emotional dysregulation strategies and depressive symptomatology. These findings suggest the importance of incorporating the meaning in life variable in the development and implementation of prevention and treatment programs for psychological disorders. Depression is one of the most prevalent psychological disorders . It is eDepressive disorders are characterized by the presence of a persistent feeling of sadness, irritability, or emptiness, along with a notable decrease in energy that significantly impacts various aspects of individuals’ lives . An impoIndividuals with depressive symptoms often experience difficulties in identifying, understanding, and expressing their emotions, as well as managing unpleasant emotions. This can lead them to excessively control their unpleasant emotions, which paradoxically can result in an increase of them ,b. In faSimilar to the use of maladaptive ER strategies, deficits in emotional functioning have been associated with elevated levels of symptoms in numerous psychological disorders, including depression . In thisAn alternative framework in the study of ER and psychopathology examines broader deficits in functioning and ER . Gratz aOn the other hand, meaning in life (MIL) is another concept of considerable relevance that has been incorporated into the literature as a variable closely related to depressive symptomatology. MIL may prove to be a protective factor against depression by acting as a buffer against negative events , promotiMIL is positively associated with perception and experience of freedom, responsibility and self-determination, fulfilment of life goals, positive view of life, of the future and of oneself, and self-realization . From thAccording to Furthermore, A total of 566 participants, all of whom were Spanish university students living in Spain, took part in this study. The sample consisted of 137 males (24.2%) and 429 females (75.8%), with a mean age of 21.98 years (SD = 4.83). The distribution of participants across academic years was as follows: 31.3% first-year undergraduate, 14.4% second-year undergraduate, 24.5% third-year undergraduate, 14.4% fourth-year undergraduate, 1.6% fifth-year undergraduate, 0.2% sixth-year undergraduate, and 13.6% postgraduate. For the inclusion criteria, participants were required to be university students enrolled in a Spanish university and fluent in Spanish. The exclusion criteria involve participants who report any pre-existing diseases, disorders, or neurological conditions that could potentially influence the outcomes of the study, as carried out in previous literature .The following instruments were used for this study:A sociodemographic questionnaire elaborated for the present study includes questions about age, sex, academic year, degree, city and center where the participants were studying at university.Difficulties in Emotion Regulation Scale  and test–retest reliability (r = 0.88). Regarding the data of this study, excellent internal consistency was found for the total scale, α = 0.94. and the subscales, Inattention (α = 0.81), Confusion (α = 0.84), Non-Acceptance (α = 0.90), Interference (α = 0.89), and Lack of control (α = 0.91).le DERS; . This scPatient Health Questionnaire . The internal consistency for our study sample was adequate (α = 0.86).e PHQ-9; . This isPurpose-In-Life Test-10 Part 1  is derived from the Spanish version of the instrument. In the present study, the internal consistency was slightly higher than in the original study (α = 0.92). PIL-10; . This is PIL-10; , and itsThis investigation is part of a larger project that aims to analyze the risk and protective factors regarding the development of emotional disorders in Spanish university students. Among the variables analyzed, in addition to those included in this study, are personality traits, problem-solving skills, and perceived social support.First, this study was approved by the ethical committee of the Catholic University of Valencia (code UCV2019-2020-087). Then, incidental sampling was performed with significant informants from different centers. Next, the deans and vice-deans of the different faculties were contacted to request authorization to pass the study protocol. After their authorization, the application of the protocol was agreed with the teaching staff. Participants were recruited in their classrooms and gave their informed consent. Participation was voluntary and they received no compensation. Data were collected from September 2020 to October 2021. Finally, an online platform was used to answer the questionnaires so that students could access them via a link or QR code. The database was correctly protected according to the Spanish data protection law.Descriptive, correlational, and then regression analyses were performed. Mediation analysis was performed using Process Macro for SPSS  to test p > 0.05, to ensure that the data followed a normal distribution. Additionally, we tested the homoscedasticity assumption using the Levene test, with a significance level of p < 0.05, to verify that the variability of the residuals was constant across different levels of the predictors. Furthermore, prior to conducting the model analysis, we standardized the variables to facilitate meaningful comparisons. For the mediation relationships, we employed Model 4 according to p-values <0.01, indicating a strong level of significance. Additionally, we examined the lower and upper limits of the confidence interval (LLCI and ULCI) to gain insights into the range of plausible values for the effects observed. To ensure robust results, we performed a bootstrapping procedure with 10,000 samples, which helps to estimate the sampling distribution of the model parameters and provides more reliable inferences.We evaluated the assumptions for both the linear regression model and the mediation model. Specifically, we examined the normality assumption using the Kolmogorov test, with a significance level of More specifically, a regression coefficient (and associated t-test) was first calculated on the mediating variable M (and its inherent paths a and b), the independent variable X on the dependent variable without the inclusion of the moderator (path c’), and the independent variable X on the dependent variable after including the mediator (path c). Theoretical p > 0.05). Nevertheless, the distribution of the variables under study and the skewness and kurtosis were reviewed, which in no case exceeded the value of <1.50.To achieve the aim of this investigation, descriptive and correlational analyses were performed first, followed by the mediation model. Depression and Inattention , whilst a positive, moderate and statistically significant correlation between Depression and Confusion , Non-Acceptance , Interference , and Lack of control .Secondly, regarding the relationship between difficulties in ER and Depression, a positive, small and statistically significant correlation was obtained between Depression and Meaning in Life . Moreover, the relationship between ER and MIL was analyzed. The results can be seen in Inattention and Meaning in Life . Likewise, for the Confusion variable, a small and statistically significant negative correlation was obtained with the Meaning in Life variable . Continuing with the variable Non-Acceptance, a small and statistically significant negative correlation was obtained with the variable Meaning in Life . A small and statistically significant negative correlation was also obtained between the variable Interference and the variable Meaning in Life . The variable Lack of control shows a negative, small and statistically significant correlation with the variable Meaning in Life .Continuing with the relationship between Depression and MIL, we found a negative, moderate, and statistically significant correlation between Finally, a mediation model was tested according to the theoretical model specified in Inattention did not reach the level of statistical significance for the path between this variable and Depression, although the general model reached the level of statistical significance (p < 0.05). As shown in Confusion model reached the level of statistical significance: F = 73.70; MSE = 0.84; p < 0.001, explaining 14% of the variance. As for the Non-Acceptance model, it reached the level of statistical significance: F = 73.004; MSE = 0.86; p < 0.001; explaining 13% of the variance. Continuing with the Interference model, it attained the level of statistical significance: F = 49.67; MSE = 0.90; p < 0.001; explaining 9% of the variance. Finally, the Lack of control model reached the level of statistical significance: F = 83.13; MSE = 0.85; p < 0.001; explaining 14% of the variance.In this way, each path outlined in the model was thoroughly examined for each model based on the different DERS subfactors. The first model of p and the confidence intervals. For this reason, the lower and upper limits for a 95% confidence interval are included within brackets. It is important to note that the confidence intervals, indicated by the brackets, did not encompass the value of zero in any instance.As illustrated in The aim of the current study was to analyze the mediating role that MIL has between ER difficulties and depressive symptomatology in Spanish college students. First, the correlations between the different variables were analyzed to justify the approach of the mediation model, according to the literature reviewed.Inattention is related to depressive symptomatology. Although significant, this relationship is small. This strategy refers to the difficulty in focusing attention and devoting attentional resources to emotional information , except Emotional Inattention, are similar and perform well in the model meaning that they influence in the development of depressive symptomatology, mediated by the MIL. In this sense, several investigations also show that people with higher levels of depressive symptomatology present greater attention to emotions, high levels of emotional confusion, greater affective dysregulation and greater Non-acceptance  represent content that is unequivocally maladaptive.In our mediation model, it is observed that all the emotional dysregulation subfactors  . IncorpoAt a theoretical level, this study is novel because it addresses the mediating role of MIL between ER and depressive symptomatology. Therefore, it expands the information on the implication on these variables and their interrelation in models of psychopathology. From the applied point of view, this study allows the development of prevention and/or treatment programs that promote an adequate MIL, in addition to incorporating this variable in existing multi-component programs that include ER. Among them, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ,b, whichThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Universidad Católica de Valencia Institutional Review Board (Code #: UCV2019-2020-087). The patients/participants provided their written informed consent to participate in this study.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.This work was supported by Universidad Católica San Vicente Mártir; Under grant UCV 2023-255-002.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


R2 was very small . BMI had little predictive power for the THI score  and neither RR syst, RR diast, nor HR showed a statistically significant association with THI. Discussion: Our findings suggest that HR, RR and BMI are at most marginally associated with tinnitus status and severity.Introduction: This study aimed to explore whether body mass index (BMI), systolic blood pressure (RR syst), diastolic blood pressure (RR diast) or heart rate (HR) are associated with tinnitus status and/or severity. Methods: To that end, we evaluated the influence of tinnitus status and Tinnitus Handicap Inventory (THI) score on BMI, RR syst, RR diast and HR by comparing data from a large sample of patients presenting to a specialized tertiary referral clinic (N = 1066) with data from a population-based control group (N = 9885) by means of linear models. Results: Tinnitus patients had a significantly lower BMI and higher RR syst, RR diast and HR than non-tinnitus patients; however, the contribution of the case–control status to  According to this proposal, tinnitus should be used to describe the auditory or sensory component, whereas tinnitus disorder reflects the auditory component and associated suffering, which can involve emotional distress, cognitive dysfunction, autonomic arousal, behavioral changes and functional disability  . SpecifiAll patients presenting with chronic subjective tinnitus to the Interdisciplinary Tinnitus Center at the University of Regensburg  from 1 April 2015 to 30 April 2021 were invited to participate in the study. A total of 1066 Patients  provided informed consent that data could be gathered and analyzed for the Tinnitus Research Initiative Database , which wThe control group consisted of 9885 participants  aged 20–75 years from the population-based German National Cohort (NAKO). All study participants were identified based on an age and sex-stratified sample randomly drawn from compulsory registries of residents within the study area of Regensburg.All persons within the control group completed a recruitment protocol, which included provision of detailed information on the study procedures, informed consent collection, completion of a standardized, computer-assisted personal interview (including whether the person had ever been diagnosed with tinnitus by a physician), and basic physical and medical examinations . The study design, sampling method and data collection have been described in detail in previous work . DemograAll statistical analyses were carried out using the statistical software R , version 4.0.5. For our main analyses, we assessed the potential impact of the presence of tinnitus, which was captured based on the case–control status, on the response variables BMI, systolic blood pressure, diastolic blood pressure, and heart rate by means of linear models. The NAKO control group was modeled as the reference level. To determine the best model for each of the response variables, we considered including age and sex as covariates in our linear models. For the sex factor variable, the reference level is “female”.2. Thus, we proceeded in decreasing order of impact (in terms of R2). In addition, F-tests served as model comparison checks. Finally, we checked for normality of the residuals of the final model using QQ-plots and the Shapiro–Wilk test. When normality was not supported by either visual inspection or a statistical test, we repeated the analysis with a robust MM-type regression approach. For this regression type, we relied on the lmrob function from the robustbase package [2-tests for independence. The general level of significance in this study is p < 0.05.We followed a bottom-up approach to determine the best model and assessed potential models by both Akaike information criterion (AIC) and Bayesian information criterion (BIC). Starting with the simplest model, we successively included covariates and interactions with case–control-status most strongly associated with the outcome measured in terms of R package , with th package . Consist2R ranging from 3.9% for heart rate to 21.5% for syst. RR .All of the best robust linear regression models identified in this study incorporated the group effect in conjunction with the covariates age and sex, with total model fits in terms of syst. RR . However2-test . The same applied to a multi-categorical subdivision of syst. RR values: Changing from dichotomization to polychotomization with interval borders 120, 130, 140, 160, and 180  gave a similar result . Furthermore, we saw a correlation with dichotomized HR .Analysis revealed a correlation between case–control status and hypertension yes/no (defined by syst RR ≥ 40mmHg), as independence of the group membership and dichotomized syst. RR  was rejected by a simple χ2R of only 1.1% (BMI contribution of approximately 0.43%), suggesting very limited predictive power. When including RR syst, RR diast, or HR as alternative predictors, no statistically significant results were obtained (results not shown).In addition to the between-group comparisons presented above, we also analyzed whether tinnitus distress assessed by the THI can be predicted by any of the variables collected for the clinical sample. The aim of this study was to investigate the relationship between tinnitus, HR, RR, and BMI using a large clinical sample and a control group from a population-based cohort. The main findings of our study were that tinnitus patients had a lower BMI than controls, but a higher heart rate and higher values for systolic and diastolic blood pressure. While statistically significant, observed effects were small. Specifically, the group factor explained a maximum of 1.4% of the total variance. Thus, the size of the observed effects does not achieve clinical relevance.The relationship between RR and tinnitus has been investigated in a relatively large number of studies, whereas less work is available describing the relationship between tinnitus, BMI, and HR. Further, even within available studies, the pattern of results is unclear. For example, while Mahboubi et al. reported no relationship between BMI and tinnitus in adolescents , a populOur data provide only limited support for the notion that tinnitus distress is related to increased sympathetic activation ,19. WhilA large number of studies have investigated the relationship between blood pressure and tinnitus. Both studies utilizing clinical samples ,6 and poTaken together, our findings suggest only very weak associations between HR, RR, BMI and tinnitus. Interestingly, tinnitus handicap, as measured with the THI, showed no association with HR and RR and only a very weak association with BMI. We initially hypothesized that HR, RR and BMI would be more strongly related to tinnitus disability. Further, we anticipated that people with low tinnitus disability and people with high tinnitus disability, or according to recent nomenclature, people with tinnitus and people with tinnitus disorder , would sTinnitus heterogeneity was not considered in our analysis. Subtyping of tinnitus patients according to pulsatile character or tinnitus pitch might reveal different results and should be considered in future research. While RR, HR and BMI measurements were carried out in both the clinical sample and the population-based sample in a standardized way, the protocol was not identical. Different instruments were used for measurement and the order of measurements, as well as the time intervals between measurements differed. While an effect of these methodological differences on study results cannot be entirely excluded, they were minor and are not believed to have impacted results to a meaningful extent.


Sexually transmitted and blood-borne infections (STBBIs) is a major public health concern in China. This study assessed the overall trends in STBBIs to improve the comprehensive understanding of the burden of STBBIs and provide evidence for their prevention and control.Data for the period from 2005 to 2021 were analyzed across China on infections with hepatitis B or C; syphilis; gonorrhea; and HIV infection. Trends, annual percent change (APC), and average annual percent change (AAPC) in diagnosis rate was analyzed using joinpoint regression models for the five STBBIs together or individually.From 2005 to 2021, the overall diagnosis rate of all five STBBIs increased, with an AAPC of 1.3% [95% confidence interval (CI) -0.5% to 3.1%]. Diagnosis rates of HIV, syphilis and hepatitis C increased individually, but it decreased for infections of hepatitis B and gonorrhea. Joinpoint analysis identified four phases in diagnosis rate of hepatitis C; three phases in diagnosis rate of hepatitis B, HIV infection, and syphilis; two in diagnosis rate of gonorrhea infection.Despite national efforts to prevent and control STBBIs, their overall diagnosis rate has continued to rise in China, and they remain an important public health challenge. Further efforts should be made to educate the general population about STBBIs, particularly HIV. Interventions targeting vulnerable groups should be adopted and their efficacy monitored through regular analysis of trends.The online version contains supplementary material available at 10.1186/s12879-023-08733-8. Sexually transmitted and blood-borne infections (STBBIs) are the most common infections around the world, especially in regions such as sub-Saharan Africa, Southeast Asia, and Latin America . Common Over the past thirty years, China has faced significant challenges in preventing and controlling STBBIs, as factors such as the acceleration of urbanization, frequent population mobility, and changes in sexual attitudes within the country have resulted in high incidence rates of these infections . To addrMany studies have evaluated trends in STBBIs, finding that STBBIs are a serious public health problem in China. However, most of these studies used general descriptive epidemiological methods, which provided only summary information and lacked in-depth analysis of trends . In contTo address these gaps in knowledge, this study used joinpoint regression models to assess the overall trends in five STBBIs  nationwide in China from 2005 to 2021, aiming to improve the comprehensive understanding of the burden of STBBIs and provide evidence for their prevention and control.In China, infectious diseases are classified based on their severity into Class A, Class B, and Class C, totaling 40 diseases (including COVID-19) . The Chihttps://www.phsciencedata.cn/Share/en/index.jsp) and the Chinese Center for Disease Control and Prevention (https://en.chinacdc.cn/). These two sources, both reporting data from the Chinese CDC, provided consistent information based on annual newly diagnosed cases. In this study, we directly collected data on the newly-reported cases and new diagnosis rates for each type of STBBI from 2005–2021 from the two sources. For each of the five STBBIs, we defined the yearly reported diagnosis rate as the number of newly diagnosed cases per capita in a given calendar year. Furthermore, we obtained the year-end population for each year between 2005 and 2021 from the China Statistical Yearbook, published by the National Bureau of Statistics (2022). Total yearly diagnosis rates for the five types of STBBIs from 2005–2021 were calculated by dividing the total number of annual newly diagnosed cases by the respective year-end population for each year.The data in this study were obtained from the Data-Center of China Public Health Science of National Population and Health Science Data Sharing Platform  denotes the location of inflection point (joinpoint), with K indicating the number of inflection points, https://surveillance.cancer.gov/help/joinpoint/setting-parameters/method-and-parameters-tab/number-of-joinpoints). As our study covered a 17-year period, we specified a maximum of three joinpoints.The joinpoint regression model , which crameters , with thrameters . Informaj = 1, 2, …, J) to year .In this study, APC is used to evaluate the internal trends of independent intervals of segmented functions or the overall trend with no joinpoints. AAPC is used to comprehensively evaluate the overall average trend of changes that include multiple intervals. If the inflection point is zero, then AAPC = APC. The APC > 0 means upward trend, APC < 0 means downward trend, and APC = 0 means stable state. The 95% confidence intervals for the APCs and AAPCs were calculated, and a t-test was used to perform hypothesis testing with a significance level of p < 0.05 . We condFrom 2005 to 2021, a combined total of 29.4 million infections involving hepatitis B or C, syphilis, gonorrhea, or HIV were reported in China  and syphilis (AAPC 7.6%). Joinpoint analysis identified three phases in the diagnosis rate of HIV: 2005–2010, when APC was 22.6%; 2010–2013, when APC was 42.1%; and 2013–2021, when APC was 4.1% (Fig. This study showed that the overall diagnosis rate of all five STBBIs were on the rise in China from 2005 to 2021, although the rate of increase appears to be slowing. The overall diagnosis rate increased rapidly from 2005–2007 but leveled off after 2007. This suggests that although the prevention and control of STBBIs in China has made certain achievements in recent years, it remained an important public health challenge in China.Several main factors may explain the increase in overall STBBI diagnosis rate during 2005–2019. First, the rapid economic and technological development in the country, together with the popularity of social media, have facilitated sexual encounters and a more open attitude towards sexuality in general, leading to increases in diagnosis rate of AIDS and gonorrhea . AdditioThe slowing down in the increase in STBBI diagnosis rate during 2019–2021 may be due, in part, to the COVID-19 pandemic. On the one hand, government efforts to limit the spread of the causative virus led to partial and total city lockdowns, restrictions on gathering and socializing, as well as traffic restrictions . All theAmong the five STBBIs explored in this study, numbers of infections of hepatitis B and gonorrhea declined during the study period. Among these two, hepatitis B showed the highest diagnosis rate, which reflects the relatively high prevalence of this virus in China and widespread screening for it . Indeed,These efforts, while effective, still have a long way to go, given that hepatitis B accounted for the greatest number and proportion of STBBIs during our 17-year study period. Indeed, one third of the 240 million people living with chronic hepatitis B worldwide reside in China , 34. TheNeisseria gonorrhea [Gonorrhea diagnosis rate steadily decreased until 2011, at which point it slowly started to rise again. This trend is consistent with the findings of Wang YJ's study . This coonorrhea , increasonorrhea . Policieonorrhea .The increase in diagnosis rate of HIV and syphilis during the study period may reflect an increase in sexual behavior, especially as people make use of social media to search for sexual partners . HIV preInflection points for syphilis diagnosis rate were detected in 2010 and 2019. From 2005 to 2010, the rapid increase in syphilis diagnosis rate could be accounted for by the considerable increase in congenital syphilis. Prior to 2010, health care efforts to prevent mother-to-child transmission focused on the prevention and control of HIV, and syphilis was not prioritized, possibly contributing to its inadequate prevention and control . SyphiliThe diagnosis rate of hepatitis C showed an upward trend throughout the study period, but this leveled off after 2012, which is similar to the findings of Zhang MY's study . After 2Our analysis leads to the following recommendations for future prevention and control of STBBIs in China. The general population should be educated about STBBIs, and anti-STBBI interventions should focus on vulnerable populations. Routine immunization and vaccination against hepatitis B should be expanded to all adults , 49. SinTo our knowledge, this study is the first to use joinpoint regression models to evaluate the overall trends in STBBIs in China from 2005–2021. While the findings are of immediate relevance to researchers and policymakers, they should be interpreted carefully in light of some limitations. First, our data came from Chinese CDC reports, and a potential limitation of this study could be the impact on STBBIs trends due to changes in reporting practices and guidelines, as well as possible underreporting. Moreover, there were disparities in the STBBIs data between the CDC sources and the GBD and WHO sources. This disparity could potentially lead to inconsistent outcomes when comparing this study to those employing GBD and WHO sources. Nevertheless, we maintain faith in the Chinese CDC data's credibility as the most authoritative source in China, offering valuable insights for developing relevant policies and conducting research on STBBIs. Second, our study design is not causal inference, limiting the ability to determine which factors have caused the observed trends in STBBIs. Therefore, while this study discussed some possible factors for the trends in STBBIs, further research is needed to establish causal relationships. Third, our analysis was based on national STBBI data, which could be repeated in the future using province-level data to examine STBBI trends at greater resolution. Finally, we lacked data on STBBI diagnosis rate by age group, and were unable to standardize diagnosis rate.From 2005 to 2021, the overall diagnosis rate of STBBIs in China showed a continuous upward trend, but the overall growth rate slowed, suggesting that STBBI prevention and control in China has achieved some success. However, diagnosis rate of HIV, syphilis and hepatitis C continues to increase. Our results suggest the need to educate the general public about STBBIs and to target interventions to vulnerable groups. Finally, our analysis highlights the need for regular analyses of diagnosis rate trends in order to allow timely adjustment of public health policy.Additional file 1.


Background: It is not clear whether rehabilitation after surgery for trigger finger is effective. The aim of this study was to reveal its effectiveness for trigger finger. Methods: This study was a randomized, controlled trial that included patients who underwent operations for trigger fingers. The patients in the rehabilitation group had postoperative occupational therapy (OT) for 3 months, while the patients in the control group were not referred for rehabilitation but received advice for a range of motion exercises. We evaluated the severity of trigger finger, Disability of Arm-Shoulder-Hand (DASH) score, pain-visual analogue scale (VAS), grip strength, whether they gained a full range of motion (ROM), and complications before and after surgery. Results: Finally, 29 and 28 patients were included in the control and rehabilitation groups, respectively. At final follow-up, the DASH score, grip strength, and ROM were significantly improved in the rehabilitation group compared to that preoperatively. At final follow-up, pain was significantly improved in both groups from that preoperatively. There were no significant differences in the results, including the DASH score, grip strength, ROM and pain-VAS between the control and rehabilitation groups at the final follow-up. Subgroup analysis showed that there is a significant difference in the DASH score of patients doing housework or light work and those with a duration of symptoms >12 months between the control and rehabilitation groups at the final follow-up. Trigger finger is one of the most common conditions treated by hand surgeons. The prevalence in the general population was reported to be 3% . SeveralSome studies revealed the effectiveness of rehabilitation after some kinds of surgeries, including the fixation of extremity fractures and joint replacement ,8,9. RehThis study was a prospective, multicenter, randomized, controlled trial (RCT). Approval was obtained from the institutional ethics committee at Okayama University Hospital (1903-002).The participants were selected from a consecutive group seen at three institutions from April 2019 to March 2021. Inclusion criteria were (1) older than 20 years old, younger than 90 years old; (2) continued subjective symptoms of pain, triggering along the A1 pulley after a few injections into the flexor sheath; and (3) willingness to undergo an operation for trigger finger. We excluded patients who had (1) other fingers with symptoms of trigger finger; (2) an inflammatory or pathologic etiology, including rheumatoid arthritis, of the trigger finger; (3) a finger joint problem by osteoarthritis or joint fracture; or (4) other surgeries during the follow-up period.Participants were assigned to the intervention or control group. An independent investigator (R.N.) made a computer-randomized list for each hospital to conceal the treatment allocation. The randomization list was stratified with a block size of four. Based on the lists, the investigator prepared sequentially numbered and sealed envelopes containing the assigned postoperative schedule. After the participants agreed to participation in this study and underwent surgery for trigger finger, the researcher opened the consecutive envelope to figure out the assigned schedule. Blinding of the participants was precluded because of referral to postoperative rehabilitation.All participants underwent open surgery under local anesthesia by one surgeon. After an incision was made at the level of the A1 pulley, blunt dissection was performed on the A1 pulley. A small dissection scissor was used to make an incision longitudinally and open the A1 pulley. Free movement of the flexor tendon was ensured without triggering. Finally, the skin was closed with interrupted 5-0 nylon sutures. The patients took non-steroidal anti-inflammatory drugs (NSAIDS) on demand after surgery.Participants in the rehabilitation group received a referral for postoperative occupational therapy (OT), such as stretching and an active and passive range of motion exercises within a week after surgery. They also received scar treatment, including friction massage and taping, and strengthening, including the use of grippers, weights, balls with different degrees of firmness, or other aides.The exact type of exercise was left to the hand therapist’s discretion in accordance with the condition of participants’ hands and their preferences. Additionally, therapists gave appropriate individual advice on activities of daily living and lifestyle for each participant.Participants in the control group were not referred for rehabilitation after surgery. They received only the orientation and advice for active and passive ROM exercises at distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints from the primary surgeon during the clinical phase, to be performed by themselves. They were explained that the heel of the hand on the healthy side presses on the back of the hand on the affected side to reach full flexion during passive ROM exercises and that passive extension is also performed using the hand on the healthy side.Participants were examined and interviewed before and 1, 3, and 6 months after surgery, and the primary time point was 6 months. The follow-up period was determined by referring to other RCTs of treatments for trigger finger ,15. We eThe primary endpoints were the effect of postoperative rehabilitation on hand function, such as DASH and grip power. An estimation of the sample size was performed to determine the number of patients who reached an alpha value of 0.05 and a power of 80%. This sample size was based on the assumed primary outcome (DASH score) differences in population means of 6.0, a within-group standard deviation of 8.0, and an approximately equal number of cases in each group. Finally, the calculated sample size with an anticipated loss to follow-up of 15% was 68 patients.t-test were used to compare dichotomous and continuous data, respectively. The group differences were analyzed by one-way ANOVA followed by Bonferroni post hoc testing. Statistical analyses were performed using R for Windows (Ver. 4.0 accessed on 24 April 2020). The two-sided significance level was set at p < 0.05.We performed an intention-to-treat analysis among participants. A participant in the rehabilitation group who converted to the no rehabilitation group was analyzed within the rehabilitation group. The independent investor (R.N.) performed a statistical analysis. Fisher’s exact test and the Student Patient characteristics are shown in p < 0.001, grip strength; p = 0.004, restriction of ROM; p = 0.008).In both groups, the pain was significantly improved between that occurring preoperatively and 6 months postoperatively. We summarized the differences between pre- and 6-month-postoperative outcomes in p = 0.04). In the patients with a duration of symptoms > 12 months, the postoperative DASH score of the rehabilitation group was also significantly better than that of the control group (p = 0.005). There are no statistically significant differences in the subanalysis of other factors, such as age, gender, and DM, between the rehabilitation and control groups.Rehabilitation made the DASH score in patients performing housework or light work improve significantly 6 months postoperatively (One patient in the rehabilitation group had a superficial incision infection that was treated with debridement and an antibacterial drug. There were no other adverse events during this study.This study showed that the outcomes, including the DASH score, grip power, and restriction of ROM, at 6 months were only significantly improved after surgery in the rehabilitation group. Pain-VAS was significantly improved in both groups. However, there are no significant differences in the outcomes between the control and rehabilitation groups. In the patients performing housework or light work or the patients with a duration of symptoms over 12 months, there were significant differences in the DASH score 6 months after surgery between the two groups.The effect of postoperative rehabilitation was revealed in some kinds of surgeries ,11,17. IEarly motion after upper limb surgery is effective. Many studies demonstrated benefits of early motion, including preventing restriction of ROM, faster healing, decreased disability time, and decreased risk of reflex sympathetic dystrophy ,19,20. AThere were no significant differences in the results, including the DASH score, pain, grip strength, and ROM, between the control and rehabilitation groups in this study. However, both groups could improve these results after surgery. These results imply that simple advice about range of motion exercises may be sufficient for patients after open surgical release.Some studies have revealed the relationship between long-standing symptoms and postoperative outcomes in relation to various kinds of surgeries ,24,25. IThis study also revealed that postoperative rehabilitation for trigger finger was effective for patients performing housework or light work, while there was no significant difference in the postoperative DASH score between those doing heavy manual work with rehabilitation and without it. The postoperative passive and active motion of fingers resulting from doing heavy manual work may act as an adequate range of motion exercises for patients with trigger finger.DM has an influence on the development of trigger finger ,28. It wThis study has some limitations. First, participants could not be blinded due to the nature of the rehabilitation intervention. However, we performed allocation concealment of the participants and minimized the bias in the randomization process. Second, we could not control participants’ uncertainty about the use of their hands after surgery in daily life and pain medication because the patients could take NSAIDS on demand for pain control. We could also not perfectly standardize physiotherapy because the type of exercise was left to the different therapists’ discretion in accordance with the condition of hands. These factors may have influenced the outcomes. Third, this was not a long-term follow-up study. However, it was revealed that there were no statistical differences in clinical outcomes, including VAS and Quick DASH, at 6 months and 12 months after percutaneous or open release for trigger finger . AdditioIn conclusion, rehabilitation and simple advice after open surgery for trigger finger improved subjective and objective outcomes. Rehabilitation was particularly effective for patients performing housework or light work and for those with long-standing symptoms. The information will help surgeons select patients to refer to OT postoperatively.


Obesity is considered one of the biggest public health problems, especially in the background of the coronavirus disease 2019 (COVID-19) lockdown. It is urgent to find interventions to control and improve it. We performed this systematic review and meta-analysis to summarize the effect of traditional Chinese exercise on obesity.We searched PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), and WanFang database for updated articles published from the inception of each database to June 2022. Randomized controlled trials (RCTs) on traditional Chinese exercise in weight reduction were included, and related data were extracted. The random-effects model was used to adjust for the heterogeneity of the included studies, and funnel plots were used to examine publication bias.A total of 701 participants were included in the 10 studies. Compared with the control group, the outcome of body weight , body mass index , body fat mass , waist circumference , hip circumference , and waist-to-hip ratio  in the intervention group had significant differences. Egger’s test and funnel plots showed that the potential publication bias of the included studies was slight (p = 0.249).Traditional Chinese exercise is an effective treatment for obesity; people under the COVID-19 lockdown could do these exercises to control weight. However, a precise and comprehensive conclusion calls for RCTs on a larger scale with more rigorous designs considering the inferior methodological quality and limited retrieved articles.www.crd.york.ac.uk/PROSPERO/, identifier CRD42021270015. The preStudies have manifested that physical exercise is an effective way to achieve weight loss whether in women or in children –14. HoweAlthough meta-analyses have shown the effectiveness of TCE in knee osteoarthritis, stroke, and cognitive outcomes for older adults –22, whet22.1We searched PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database (VIP), the Chinese Biomedical Literature Database (CBM), and WanFang Database for updated articles published from the inception of each database to 1 June 2022. At the same time, we searched for gray literature that met the inclusion criteria in Open Grey, Clinical Trials.gov, and WHO Clinical Trial Registration Center. When duplicate publications were identified, we chose the most complete and recent trial. Two investigators (YY and ZY) independently retrieved all related studies in the database and excluded duplicate publications. The search strategy for PubMed is presented in 2.2Our meta-analysis is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)  Statemen2 and America ≥30.0 kg/m2 for adults); 4) the intervention group must do TCE, such as tai chi, qigong, Baduanjin, Yijinjing, or Wuqinxi, whether combined with other interventions like control group or not. The control group does casual exercise or only diet education, auricular plaster therapy, acupoint catgut-embedding therapy without exercise, etc.The inclusion criteria are as follows: 1) the studies must be RCTs; 2) age of participation >18 years; 3) diagnostic criteria for obesity in the study are employed according to the region and ethnic group (Asia-Pacific ≥25.0 kg/mExclusion criteria are as follows: 1) the participation according to the region and ethnic group did not meet the body mass index (BMI) of obesity; 2) age of participation ≤18 years; 3) the intervention group did not do TCE or the control group also did TCE.2.3Two independent researchers (YY and ZY) read the title, abstract, and full text, screened the literature according to the inclusion and exclusion criteria, and cross-checked the results. If there is a disagreement, a third researcher (QX) will be consulted. Data extracted from the included literature included the following: first author, publication time, mean age or age range, sample size of the study, measures, intervention group and control group taken, duration time, and outcomes.2.4The quality of the included studies was assessed by the revised Cochrane risk of bias tool (ROB 2.0) in the Cochrane Handbook for Systematic Reviews of Interventions. The following parameters were evaluated: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result. Each item was determined to be at high risk of bias, some concerns (unclear risk of bias), or low risk of bias. The combined evaluation of the above items resulted in overall bias.2.52 > 50%), a random-effects model was used for meta-analysis. Publication bias of major outcome indicators was analyzed by funnel plot in RevMan 5.4 software. When the funnel plot was symmetrical on both sides, the possibility of publication bias between studies was considered low.Review Manager software (Revman 5.4 Cochrane Collaboration) was used to meta-analyze the selected studies. The odds ratio (OR) was used as the effect size index for dichotomous variables, and the mean difference (MD) was used as the effect size index for continuous variables, with 95% confidence intervals (CIs) in forest plots. Sensitivity analysis and subgroup analysis will be used to analyze the source of heterogeneity. For the sensitivity analysis, it can help find the source of heterogeneity by reestimating the combined effect using the one-by-one elimination method. For subgroup analysis, the studies may be divided into different subgroups according to the duration time, different types of TCE, etc., and whether it could be shown that the subgroup factors were the source of heterogeneity. When high heterogeneity exists , BMI, body fat mass (BFM), waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR). The main characteristics of the 10 articles were summarized in 3.3Results of risk of bias assessment for all included studies were summarized in 3.43.4.12 = 70%, p = 0.0008).Seven studies , 32, 33 2 = 0%]  and Yijinjing  . Therefore, these studies were combined using the random-effects model.All 10 included studies –33 total2 = 40%; p = 0.12]   Figure 63.4.42 = 86%, p = 0.003). The sensitivity analysis was carried out one by one, and it was found that when the research by Yu . The data analysis indicated that WC in the TCE group was lower than that in the control group   Figure 73.4.52 = 70%, p = 0.002). Sensitivity analysis suggested that after removing the research by Yu . The data indicated that the TCE group had an effect in decreasing HC as compared with that in the control group   Figure 83.4.62 = 0%, p < 0.00001)  Figure 93.5The publication bias of outcomes was evaluated using funnel plots based on the 10 studies. It can be seen that the funnel plot was not symmetrical, which indicated that no significant publication bias existed  lockdown, which should be paid more attention to and adopt measures to control. It is the cause of many cardiovascular and cerebrovascular diseases  and may We have shown that TCE works significantly in decreasing BW, BMI, BFM, WC, HC, and WHR, which means it plays a positive role in weight reduction and weight loss maintenance. These effects are consistent with the results of individually included RCTs. For different types of TCE, subgroup analyses indicated that there was no significant difference among tai chi, Baduanjin, Yijinjing, and Wuqinxi in BW and BMI. And there was no significant difference among duration time, whether the time is more than 16 weeks or less; they both work. Many studies reported other outcomes, such as triglycerides, serum total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and blood pressure , 40. ObeOur study has several strengths. Firstly, a detailed search strategy is employed by searching different kinds of databases and trial registries. Moreover, no language limitation is set to ensure inclusion of as much data as possible from appropriate studies. Additionally, we try to find heterogeneity between the studies included in our study and to decrease it, which make the results more convincing. Furthermore, our study is the first systematic review and meta-analysis to evaluate the efficacy of TCE on obesity; it could provide evidence for clinical workers that would help them make better clinical decisions. Moreover, we offer ways to control weight at home for those with obesity, which is very necessary in the background of the lockdown.Our review has several limitations as well. First, the sample size of this meta-analysis was relatively small. As a result, the unknown risk of bias caused by incomplete data could constrain our results. Second, the research results are not restricted by the language of the published articles. Moreover, the intervention of the intervention group of the study is TCE, which is from China, thus eight of the studies are Chinese, which may be of relatively low quality. Third, the intervention protocol varied significantly in the aspect of exercise type , duration time (from 10 weeks to 12 months), frequency (1–14 times per week), continued time of each exercise (from 30 to 60 min), and at the same time, the control group received different interventions as well; this may be the reason for the heterogeneity of the article.Despite these limitations, this meta-analysis provides information on the association between TCE and obesity.5In summary, the results of our meta-analysis indicated that TCE may have statistically significant effects on decreasing participants’ BW, BFM, BMI, HC, WC, and WHR, which indicated that it helps to control obesity. The findings presented in the meta-analysis may have important implications worldwide, especially in the COVID-19 lockdown. However, a precise and comprehensive conclusion calls for RCTs on a larger scale with more rigorous designs considering the inferior methodological quality and limited retrieved articles.The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.Data curation: ZY, YY, QX, and KH; Formal analysis: ZY and QG; Investigation: ZY and XW; Methodology: ZY, YY, and QX; Project administration: ZY; Resources: YY, ZY, and XW; Software: ZY and XW; Supervision: ZY, KH, and QG; Validation: YY and KH; Visualization: ZY and YY; Writing – original draft: ZY, KH, and YY; Writing – review and editing: ZY and XW. All authors contributed to the article and approved the submitted version.


Outpatient nutritional counseling by a registered dietitian is often performed to prevent weight loss, but evidence supporting this practice is insufficient. In this study, we aimed to clarify the effectiveness of four-time outpatient nutritional counseling in weight-loss prevention compared with conventional intervention limited to one-time nutritional counseling. This study was designed as a retrospective cohort study. The target population was postoperative patients with stage IA and IB gastric cancer. Groups that received one-time and four-time nutritional counseling included patients who underwent gastrectomy from May 2014 to April 2017 and May 2017 to December 2019, respectively. The one-time group received counseling at discharge; the four-time group received counseling at discharge, at the first outpatient visit, and at 3 and 6 months postoperatively. There were 58 patients in the one-time group and 27 patients in the four-time group, with a significant difference in length of hospital stay (p = 0.042). Thirty-six patients (62.1%) in the one-time nutritional counseling group and 12 (44.4%) in the four-time group had a weight loss of 5% or more from hospital discharge to 6 months postoperatively. The adjusted risk ratio for the effectiveness of four counseling sessions compared with one session was 0.69 . In subgroup analysis, the effect of nutritional guidance was greater for patients with body mass index ≥23 kg/m2, but this depended on the outcome and number of cases, and there was no essential difference between the groups. In postoperative patients with stage IA and stage IB gastric cancer, four sessions of outpatient nutrition counseling may be not superior to one counseling session in preventing weight loss. Gastric cancer is the fifth most common human malignancy and the third most frequent cause of cancer-related death worldwide. Incidence rates are markedly elevated in parts of East Asia, such as in Mongolia, Japan, and the Republic of Korea, which has the highest rates worldwide in both sexes . Weight Currently, outpatient nutritional counseling by a registered dietitian for patients with cancer is usually performed to prevent weight loss; however, the evidence is insufficient regarding this practice –15. PrevAgainst this background, in the present study, we aimed to clarify the effect of continual (four-session) outpatient nutritional counseling for weight loss prevention in patients with gastric cancer, in comparison with conventional intervention limited to one-time nutritional counseling.This was a retrospective cohort study, and data were collected in a review of the medical records. Groups that received one-time or four-time outpatient nutrition counseling included patients who received counseling at discharge from gastrectomy between May 2014 and April 2017 and between May 2017 and December 2019, respectively. The one-time counseling group received nutritional counseling at discharge; the four-time counseling group received nutritional counseling at discharge, at the first outpatient visit and at 3 and 6 months postoperatively.To eliminate the effect of adjuvant chemotherapy, we excluded patients with stage II or higher disease and those with a history of other cancer. Patients who did not receive at least three counseling sessions in the four-time counseling group were also excluded.In the four-session group, nutritional counseling was provided under a physician’s direction at discharge from the hospital, at the first outpatient visit, and at 3 and 6 months after surgery. An original questionnaire was used, designed to capture individual nutritional characteristics through essential items for tailored nutritional guidance. This tool was honed through repeated use in individual consultations, leading to refinements and modifications to its current format. Items on the questionnaire included items on the questionnaire included postoperative discomfort (such as early dumping syndrome or late dumping syndrome), chewing and swallowing functions, eating habits , living environment, the burden on cooking staff, and performance status. Based on the questionnaire responses, semi-structured and customized counseling sessions were conducted. Nutritional counseling was tailored based on these responses.A dietitian advised each patient to chew slowly and well, to eat smaller portions, and to eat more frequently to prevent dumping syndrome and compensate for decreased digestion and stomach acid secretion capacity. Additionally, to prevent weight loss, we checked patients’ usual food intake, advised them regarding correct eating habits, and encouraged them to take oral nutritional supplements.For the one-session group, nutritional counseling was conducted in a similar manner but was provided solely at the time of discharge from the hospital, using the guidance and methods from the four-session group.To explore the effectiveness of nutritional counseling in preventing weight loss, the presence or absence of a weight loss rate of ≥5% from hospital discharge to 6 months postoperatively was used as the primary outcome. Patients’ weight was measured at the first outpatient visit, at discharge, and at 6 months. The weight change (%) was calculated by dividing the weight at 6 months postoperatively minus the weight at discharge by the weight at discharge. There is consensus among the dietitians and surgeons who participated in this study that weight loss greater than 5% is clinically significant; therefore, this primary outcome was considered appropriate.Baseline variables at the time of discharge were age, sex, body mass index (BMI), weight, percentage weight loss from the preoperative period to discharge, the extent of gastrectomy, surgical approach, stage of the disease, pretreatment, diabetes, chronic kidney disease, length of hospital stay, and blood biochemical parameters . The gastrectomy extent was classified as total gastrectomy (TG), proximal gastrectomy (PG), distal gastrectomy (DG), or pylorus-preserving gastrectomy (PPG). Pretreatment mainly comprised endoscopic mucosal dissection.t-test for continuous variables. Univariable and multivariable Poisson regression analyses were also performed to calculate risk ratios, 95% confidence intervals (CIs), and p-values. The variables with p<0.1 in the background table  and mean ± standard deviation, respectively. Fisher’s exact test was used to compare groups for categorical variables and the nd table  and varind table , which wThis study complied with the Ethical Principles for Medical Research Involving Human Subjects published by the Ministry of Health, Labour and Welfare and the Ministry of Education, Culture, Sports, Science, and Technology. To obtain data from the medical records, we disclosed the purpose and methods of this study to the study patients on the home-page of the Shizuoka General Hospital website and guaranteed their right to refuse participation in the study. Identifiable information, such as individual names, etc., was deleted from the obtained data and only the anonymized data were used for this study. The Ethics Committee of Shizuoka Prefectural General Hospital approved the study .In this study, 58 patients were included in the one-time nutritional counseling group and 27 patients were included in the four-time nutritional counseling group. The patient background at discharge is shown in The median (min–max) time from discharge to the first outpatient visit and to the 6-month time point was 14 (5–38) days and 176 (121–204) days, respectively. The number of patients with weight loss of 5% or more from hospital discharge to 6 months postoperatively was 36 (62.1%) in the one-time nutritional counseling group and 12 (44.4%) patients in the four-time group. Univariable Poisson regression analysis showed that pretreatment, but not nutritional counseling groups, predicted ≥5% weight loss in association with BMI at discharge and percent weight loss from the preoperative period to discharge .The crude risk ratio (95% CI) for the effectiveness of four-time counseling compared with one-time counseling was 0.73 (0.38–1.42) . In mult2 and BMI ≥23 kg/m2 were respectively 3.32 (0.23–47.02) and 0.09 (0.01–1.26), and the result of their corresponding interaction test was p = 0.014. No other subgroup analyses had significant interaction tests.Among subgroup analyses in In this study, we examined the effectiveness of continual outpatient nutrition counseling in preventing weight loss among 85 postoperative patients with stage IA and IB gastric cancer. The results showed that overall, intensive outpatient nutrition counseling intervention was not effective in preventing weight loss. The preventive effect of outpatient nutrition counseling on weight loss from discharge to 6 months was greater in patients with higher BMI.Hye et al.  investigMore than simple nutritional counseling may be needed for weight maintenance in postoperative patients with cancer. In a randomized controlled trial in a Korean cancer center, 56 patients with stage I to III gastric cancer who underwent gastrectomy were separated into two groups, either following a patient participation-based diet and usual care or receiving two in-person and two telephone interventions. At 12 weeks, there was no significant difference in weight change . In a raThe results of this study of 85 patients showed that the point estimate of the adjusted odds ratio was 0.69, indicating that the four nutrition counseling sessions group may have been superior to the one nutrition counseling session group. However, the corresponding confidence interval included 1, which was not statistically significant. Here, in a logistic regression in which the response and exposure variables were binary without considering confounding, the sample size was 85 cases as in this study, the <5% weight loss rate for the one nutrition counseling group was 0.379, the proportion of the four-nutrition counseling group was 0.318, the odds ratio for the four times group compared to the one times group was 0.69 and the significance using a two-tailed Wald test with a significance level of 5%, the power is 8.5%. In other words, the type 2 error rate for the test was 91.5% and could not be detected. However, the determination of no effect by the test in this study supports the results of three previous randomized controlled trials , 14, 15 It has been reported that ghrelin administration suppresses weight loss in TG . With TGIn our study, the weight loss rate after discharge, when outpatient nutrition counseling was initiated, was higher in patients with relatively low weight loss from the preoperative period to discharge. Therefore, it is desirable to have a method of intervening in this population such that nutritional guidance will positively affect weight loss. It is also important to investigate why these individuals did not lose weight during hospitalization.There are several limitations to this study. First, although the research period was extensive, this was a single-center, small-sample, retrospective cohort study; future validation in a large, multicenter, randomized controlled trial is necessary. Second, while we estimated the average causal effect, our adjustments might have accounted for only some confounders, potentially overlooking unobserved ones. Specifically, unadjusted age Click here for additional data file.S2 TableCI, confidence interval; OR, odds ratio; BMI, body mass index; TG, total gastrectomy; DG, distal gastrectomy; PG, proximal gastrectomy; PPG, pylorus-preserving gastrectomy.(DOCX)Click here for additional data file.S3 TableBMI: body mass index, TG: total gastrectomy, DG: distal gastrectomy, PG: proximal gastrectomy, PPG: pylorus-preserving gastrectomy, CI: confidence interval. NE: not evaluable.(DOCX)Click here for additional data file.


There is limited data on the importance of food insecurity in a rich country such as Switzerland.Food insecurity has been defined as “This is a cross-sectional analysis of data from a structured survey in an elderly population of Switzerland. The data was assessed between June and August 2021 in the course of a 7-year phone call follow-up from the EFFORT trial, which included medical inpatients at nutritional risk from 2014 to 2018. A validated questionnaire (Six-Item Short Form 2012 of the U.S: Household Food Security Survey Module) was used to assess food security status.Of the 433 included patients, 30 (6.9%) were food insecure. A significant association between food insecurity and age, governmental financial support and self-reported loneliness was found. When compared with the food secure group, there was a significant lower quality of life measured by the EQ-5D VAS.In an older Swiss population of patients at nutritional risk, food insecurity was named as a contributing factor for malnutrition in about 7% of patients, particularly younger individuals with financial support, and self-reported loneliness. In the assessment of malnutrition, physician and dieticians should ask for food insecurity and if detect take appropriate actions. The survey was conducted between June and August 2021 in the course of a 7-year phone call follow-up of the trial. This study included medical patients at nutritional risk hospitalized between 2014 and 2018. Nutritional risk during the initial hospital stay was defined by the Nutritional Risk Screening 2002 (NRS 2002) tool and all patients with a score ≥ 3 points  and with2.2.We used the validated Six-Item Short Form 2012 of the U.S: Household Food Security Survey Module . The six2.3.Sociodemographic characteristics  were reported at study inclusion and age was extrapolated to the current date. Nutritional data  and Barthel Index , living 2.4.Health outcomes  and quality of life [measured by EQ-5D ] were al2.5.t-test, while categorical variables are shown in numbers and percentages and were analyzed by Pearson’s χ2 test. Uni- and multivariate logistic regression analyses were used to investigate possible predictive factors for food insecurity. For the analysis of associated adverse health outcomes, we used linear and logistic regression and adjusting for age. All statistical analyses were performed using Stata version 15.1 (StataCorp). p < 0.05 was considered statistically significant, and all tests were 2-tailed.Continuous variables are expressed as mean and standard deviation (SD) and compared using student’s 3.From April 2014 to February 2018, 5,015 patients were screened and 2028 included in the initial EFFORT trial. During the 7-year follow-up 1,137 patients died and 279 were lost to follow-up. 152 patients withdrew informed consent and 27 had a missing food security questionnaire. The final analysis cohort thus consisted of 434 patients . Baselin3.1.In the univariate logistic regression analysis, we found significant associations between food insecurity and age , governmental financial support  and self-reported loneliness (OR 3.34 95%CI 1.54–7.26). These results remained robust in the multivariate analysis. There was no significant association between food insecurity and sex, education, housing situation, or region .3.2.We constructed a simple predictive score for food insecurity containing three items: age < 65, financial support and self-reported loneliness. We assigned one point to each of these parameters. As shown in 3.3.After adjustment for age, we found a trend toward higher risk for hospitalization in the food insecure group , while there was no significant difference in the number of hospitalizations per person. Additionally, the odds for falls were 2.5-fold higher in the food insecure group .Regarding the nutritional status, there were no difference in the prevalence of malnutrition defined by the MUST score . Total weight change did not differ between food secure and food insecure individuals. However, individually, food insecure participants showed significant higher weight loss among participants who reported weight loss .When compared to the food secure group, there was a significant lower quality of life measured by the EQ-5D index and the EQ-5D VAS when adjusted for age. There was no difference in activities of daily living and functional decline, measured by the Barthel Index and change of the Barthel Index.4.In this cross-sectional study with an elderly, multimorbid population, we found a prevalence of 6.9% for food insecurity. Significant predictors for food insecurity included lower age, need for financial support and self-reported loneliness. Food security tended to have a significant impact on health care use, falls and quality of life without directly influencing the severity of nutritional status.In 2020, a survey done in the general Swiss population estimated the prevalence of moderate to severe food insecurity to be around 2.2% . That isYounger age was one of the risk factors for food insecurity, which we were able to identify. Similarly, in Canada, the prevalence of food insecurity was shown to be lower in households with seniors’ incomes as their primary income . This inAnother significant predictor for food insecurity in our analysis was need for financial support. Of all food insecure participants, 50% received financial support and most food insecure participant, who received financial support were in working age. Similar results were found in the report “Household Food Insecurity in Canada 2021” with 63% of households relying on social assistance were food insecure . This raThe second important question is, how does food insecurity influence clinical outcomes. In our regression analysis, there was a trend toward lower hospitalization rates and less falls in food secure patients. Previous studies showed that food insecure people are more vulnerable to chronic disease , 23. ChrUsing the Malnutrition Universal Screening Tool (MUST) under the assumption that there is no acute illness present, we found no difference in the prevalence of malnutrition between food secure and food insecure participants. Other studies, which investigated the impact of food insecurity on malnutrition risk, could find an increased risk for malnutrition in food insecure participants , 24, 25.When compared with the food secure group, there was a significant lower quality of life measured by the EQ-5D VAS and EQ-5D Score. This is congruent with what another study has shown: food insecurity having a significant impact on quality of life .In previous studies, food security was associated with impaired mobility and lower activities of daily living . In our 4.1.This is one of the first studies to report food security in a Swiss at-risk population using a standardized and validated screening tool. Additionally, the survey was conducted during a time of rising food insecurity and is therefore highly relevant. We are aware of several limitations. First, in this cross-sectional study design, outcomes happened before food security was recorded and therefore there is no proof of causality. Due to the study design, the results should be seen as hypothesis-generating and used as basis for further larger investigations in this field. Second, the population is very selected because it includes only survivors of the EFFORT study population. With our data, we can only make limited conclusions for the entire Swiss population. Because we do not have data from all regions of Switzerland, some regional differences should be expected, especially between different language regions. And it is expected that we will miss certain important subpopulations with food insecurity in our study population. For example, healthy single mothers. In the US, food insecurity is highest for single mother households and households with income below the poverty line . Third, 4.2.In an elderly Swiss population, food insecurity was present in about 7% of the participants, particularly younger individuals with financial support, and self-reported loneliness. As food insecure individuals tended to have a higher health care use and an impaired quality of life, further scientific attention should be paid to the association between food insecurity, disease and health outcomes including strategies to improve food security status. In the assessment of malnutrition, physician and dieticians should ask for food insecurity and if detect take appropriate actions. Large, population-based assessment would be helpful to assess the prevalence and burden of food insecurity in Switzerland to understand the true magnitude of the problem.schuetzph@gmail.com.The data analyzed in this study is subject to the following licenses/restrictions: Our analyzed data will be available to others with the publication of this manuscript on receipt of a letter of intention detailing the study hypothesis and statistical analysis plan, as already outlined in the primary EFFORT publication. Signing a data access agreement is asked from all applicants. Requests to access these datasets should be directed to The studies involving humans were approved by the Ethics Committee of Northwest and Central Switzerland (EKNZ). The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.MR and NK-B contributed to the conception and design of the study and performed the statistical analysis. NK-B organized the database. MR wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.The Swiss National Science Foundation  and the Research Council of the Kantonsspital Aarau, Switzerland (1410.000.058 and 1410.000.044) provided funding for the original trial.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The rounding-up of vincristine doses was significantly associated with increased neuropathy occurrence (p < 0.001), while dose rounding-down was significantly associated with a decrease in neuropathy in both groups of patients (p < 0.001). Conclusions: Our findings demonstrate that autonomic neuropathy is the most common vincristine-related neuropathy, regardless of the patient’s age. Dose rounding is a significant determinant of vincristine-induced neuropathy in both groups. Further studies are needed to evaluate the variables that exacerbate or prevent neuropathy associated with the first-time use of vincristine.Background: Vincristine is a vital constituent of chemotherapeutic regimens. Vincristine-induced neuropathy is a challenging adverse effect that impacts quality of life and treatment course. The dose rounding of chemotherapies is a strategy that is commonly used in clinical practice. Nevertheless, the frequency of developed neuropathy in vincristine first-time users and the potential association with dose rounding remains elusive. Methods: A retrospective analysis was conducted on patients administered vincristine for the first time between 2016 and 2022 using the King Saud University Medical City (KSUMC) database. Patients were stratified into pediatric and adult groups. Neuropathy frequency, its association with demographic and clinical parameters, and the Impact of dose rounding were assessed using SPSS software version 28. Results: Approximately 34.6% of patients were diagnosed with neuropathy after vincristine administration. Autonomic neuropathy was common among affected adults and pediatric patients , while cranial neuropathy was more frequent in pediatric patients. Higher BSA ( Vincristine is a chemotherapeutic agent belonging to the group of vinca alkaloids, which has been frequently used in cancer treatment regimens since its approval for treating acute lymphoblastic leukemia (ALL) in the early 1960s ,3. VincrNeuropathy, particularly autonomic and peripheral sensory–motor neuropathy, is a dose-limiting and dose-dependent adverse effect frequently reported in cancer patients treated with vincristine ,7. NeuroThe dose rounding of biological and cytotoxic agents within 5–10% of the ordered dose to eliminate the use of the next vial is a commonly implemented clinical practice to minimize waste and cut down healthcare expenditures without losing its clinical effectiveness ,19,20. HThis study was a retrospective audit of patients admitted to the oncology center at King Saud University Medical City (KSUMC) between 2016 and 2022 and received, for the first time, at least one dose of a vincristine-based chemotherapy regimen . The InsTo assess the impact of dose rounding on neuropathy, all vincristine doses administered to every patient were calculated based on their BSA, measured just before their scheduled doses, and compared to their actual administered doses. Accordingly, doses were categorized as rounded up, rounded down, not rounded at all, or missing . Based on all the administered doses for each patient, the patients were categorized into one of the following four groups: (1) rounding up ± no rounding ; (2) rounding down ± no rounding ; (3) no rounding at all ; and (4) mixed or missing .t-test for continuous variables and a chi-squared test for categorical variables were used to assess the significance of differences in adult and pediatric patients. Correlations between neuropathy, baseline characteristics, and clinical parameters were estimated separately in adult and pediatric groups. The correlation between neuropathy and dose rounding was also estimated in adult as well as pediatric patients. All statistical analyses were performed using SPSS software version 28 ; a p-value < 0.05 indicated significant results.A Student’s A total of 524 patients were identified in the initial screening for this study. Of these, 141 were duplicates, 22 had administered vincristine before 2016, and 6 had undocumented clinical variables. This yielded 355 patients receiving vincristine for the first time between 2016 and 2022 to be included in the analysis of the frequency of neuropathy . Two patOf the 355 patients, there were 147 pediatric and 206 adult patients with a mean age of 5.32 and 49 years, respectively . The majRegardless of the patient’s age, 34.6% of them developed neuropathic symptoms following vincristine use a, among p = 0.044), and the concurrent use of azole antifungals (p < 0.001) were significantly associated with an increase in the frequency of neuropathy in adult patients, as presented in p = 0.019) associated with the absence of neuropathic symptoms in adult patients (p = 0.038), serum creatinine (Scr) (p = 0.044), and numerically higher levels of total bilirubin levels (p = 0.062), as depicted in p = 0.081; Further analyses were conducted to determine other factors that could affect the incidence of neuropathy in these patients. patients b. Regardp < 0.001). On the other hand, patients who received one or more rounded-down dose of vincristine had a reduced incidence of neuropathic pain   a. The ob< 0.001) b,c. A toIn this study, we sought to determine the frequency of neuropathy and investigate any association with dose rounding in patients diagnosed with solid, hematologic, and lymphatic malignancies who were administered, for the first time, vincristine-based chemotherapy. Approximately one-third (n = 123) of patients  developed neuropathy after vincristine administration. Regardless of age, most patients reported symptoms of an autonomic type of neuropathy, including hypotension, constipation, urinary retention, and incontinence, while the remaining patients suffered from peripheral, cranial, or a combination of multiple types of neuropathies.Mounting evidence suggests a strong association between vincristine use and the development of different types of neuropathies in pediatric patients at different rates. For instance, Wali Y. et al. reported that 18.4% of pediatric patients developed vincristine-related peripheral and autonomic neuropathies . Furtherp = 0.077). When examining the clinical parameters, significantly higher BSA and creatinine serum levels were found in pediatric patients suffering from neuropathy compared to patients with no symptoms of neuropathy. The results also show that the presence of vincristine-induced neuropathy is associated with a statistically insignificant elevation of ALT (p = 0.135), AST (p = 0.235), and total bilirubin levels (p = 0.062; Several factors were analyzed for their potential impact on the rate of neuropathy, including gender, type of malignancy, presence of different and multiple comorbidities, and the concurrent use of azole antifungals. None of those seemed to significantly affect the rate of reported neuropathy in pediatric patients a. While Several lines of evidence have reported that the incidence of neuropathy, mainly the peripheral type, is approximately 30–40% in adult patients treated with vincristine . Furtherp < 0.05; p < 0.001; Our data show that the absence of pre-existing respiratory and endocrinological diseases is significantly associated with lower rates of vincristine-induced neuropathy in adult patients (The dose rounding of cytotoxic agents has been advocated in oncology as a cost-saving strategy for streamlining workloads and facilitating drug administration ,19,20. DThis study identified the factors that can affect vincristine-induced neuropathy and the effect of dose rounding on the frequency of neuropathy occurrence in pediatric and adult patients in Saudi Arabia. The findings from our study may help clinicians and decision makers revise vincristine-containing treatment protocols and interventions to avoid the potential development of adverse neuropathy effects while maintaining effectiveness. Nevertheless, our study results should be interpreted cautiously to avoid imprecise generalization to other cases where dose rounding is implemented.Several limitations and challenges exist in our study that are worth highlighting. First, the rate of neuropathy was based on the patient’s complaint of neuropathy symptoms solely, and no tests were performed to confirm them. Unfortunately, given the retrospective nature of this study, we had no control over applying such tests. Although this could potentially impact the rate of existing neuropathy, we noticed that no clinical tests were performed, even when patients complained of foot drop or tingling/numbness/burning in their extremities after vincristine administration, which certainly indicated the presence of neuropathy. Despite using a retrospective study design, we believe that using different tools, such as questionnaires directed towards patients, or using a different study design, such as a prospective study, in addition to tests confirming neuropathy occurrence capture the exact rate better.Second, other factors that may have interfered with vincristine metabolism directly or indirectly, such as using neurokinin inhibitors to mitigate chemotherapy-induced nausea and vomiting, were not determined. Although such data are critical, the main focus of our study was the impact of vincristine dose rounding on the frequency of neuropathy.Third, we did not determine the association between the total amount and number of administered doses and the occurrence of neuropathy. This sounds important; however, the considerable variation in the number and number of doses, even among those who developed neuropathy, would lead to an overlap with those who had no neuropathy and thus, conceal any associated significance.Fourth, the dose rounding of the vincristine dose may also have an influence on tumor response. Although this is clinically important, this seems impossible to demonstrate in our study due to the small number of patients and lack of following-up data for our patients.Despite these limitations, our study is the first of its kind in the oncology field, and all limitations will be considered in the upcoming studies. Our future direction would be to differentiate between early onset vs. late-onset neuropathy among those who were administered vincristine for the first time. Furthermore, we will determine the range to which we can round doses up without developing side effects, including neuropathy, and round down without impacting treatment effectiveness.Our study demonstrated that autonomic neuropathy was the most common type of vincristine-related neuropathy. A more serious type of neuropathy, cranial neuropathy, was observed more frequently among pediatric patients. Dose rounding was a significant determinant of neuropathy development in pediatric and adult patients. The concurrent use of azole antifungals notably enhanced vincristine-mediated neuropathy in adult patients. In light of these results, studies are still needed to continue evaluating the confounders and preventative measures that can exacerbate or prevent the development of vincristine-induced neuropathy, respectively. Furthermore, more studies are still warranted to assess the safe yet effective range of vincristine dose rounding for first-time users.