Resistance exercise may be best type for tackling insomnia in older age: Study

Resistance or muscle strengthening exercise, using weights or the body itself, may be the best type of exercise for tackling insomnia in older age, suggests a pooled data analysis of the available research, published in the open access journal Family Medicine and Community Health.

Aerobic exercise or a mix of strength, aerobic, balance, and flexibility exercises also seem to be effective, the analysis indicates.

Sleep quality tends to decline with age. And up to 1 in five older adults has insomnia, say the researchers. Poor quality sleep is not only linked to a range of serious health problems and cognitive impairment, but it also increases the likelihood of workplace underperformance and absenteeism, they add.

Previously published research suggests that exercise helps to alleviate the symptoms of insomnia, but it’s not clear which type of exercise might be most helpful.

In a bid to find out, the researchers scoured research databases for relevant clinical trials, published up to October 2022 that compared physical exercise with routine activities, usual care, other non-physical activity, or health education in people formally diagnosed with insomnia, using The Global Pittsburgh Sleep Quality Index (GPSQI).

The types of exercise covered by the studies included: aerobic, such as cycling, dancing, swimming, brisk walking, and gardening; resistance, such as using weights, push-ups, and planks; balance, such as step-ups, heel to toe walking; flexibility, such as gymnastics, yoga, and Pilates; and combination exercise encompassing a mix.

Twenty four studies, involving 2045 adults aged at least 60 (average 70), were included in the pooled data analysis. Most were carried out in Asia (56%), North America (16%), South America (16%), and Europe (12%). One in five were carried out in nursing homes.

Over half of the reported exercise intensity was mild to moderate and moderate, with average length of a session just over 50 minutes, and frequency around 2 to 3 times a week. On average, the exercise programmes lasted 14 weeks.

The pooled data analysis included only studies looking at combination exercise and aerobic exercise, because there weren’t enough studies covering the other exercise types.

This analysis showed that combined exercise significantly improved the GPSQI by 2.35 points while aerobic activity improved it by 4.35 points.

When the data were pooled using a network meta analysis–a statistical method that looks at several different ‘treatments’ and combines both direct and indirect effects-strength/resistance exercise was the most effective, improving the GPSQI by 5.75 points.

Aerobic exercise improved the GPQSI by 3.76 points, while combination exercise improved it by 2.54.

Of the comparators, sleep education was the most effective, although what this entailed wasn’t clearly defined in the included studies, and it still wasn’t as good as muscle strengthening/resistance exercise, the analysis showed.

The researchers caution that the design and methodology of the included studies varied considerably, and only a few looked at particular types of exercise. Several didn’t include any information on exercise intensity either.

Some exercises may prove challenging for older people because of restricted physical capabilities, suggest the researchers. But they nevertheless conclude that: “Exercise, particularly strengthening exercise and aerobic exercise, is beneficial for enhancing subjective sleep quality at a clinically significant level compared with normal activities.”

Reference:

Impact of different types of physical exercise on sleep quality in older population with insomnia: a systematic review and network meta-analysis of randomised controlled trials Doi: 10.1136/fmch-2024-003056.

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Batch of Telma AM earlier classified as NSQ now flagged as Spurious

New Delhi: Through a recent revised Drug Alert for January 2025, the Central Drugs Standard Control Organisation (CDSCO) has classified a batch of TELMA AM as Spurious. The batch was earlier classified as Not of Standard Quality (NSQ).

Medical Dialogues team had reported that 93 drug formulations were declared as Not of Standard Quality (NSQ) in January 2025, based on testing conducted by various State Drug Control Authorities. Among these was a batch of TELMA AM (Batch No. 5240367), listed under Glenmark Pharmaceuticals Ltd., Solan (H.P.), which was flagged by the State Drugs Testing Laboratory, Kolkata for “not conforming to I.P. standards.”

Also Read: 93 Formulations Declared Not of Standard Quality as per Data Provided by States: CDSCO Drug Alert

However, the same batch has now also been classified as “purportedly spurious” in CDSCO’s revised alert, with Glenmark informing that it did not manufacture this batch.

The batch in question — Batch No. 5240367, with a manufacturing date of March 2024 and expiry of February 2027 — carries Glenmark’s name on the label. However, the company has officially clarified that it did not manufacture this particular batch.

“The actual manufacturer (as per label claim) has informed that the impugned batch of the product has not been manufactured by them and that it is a spurious drug,” the CDSCO stated in its revised alert.

The matter is now under active investigation. While the product is currently listed as “purportedly spurious,” the final classification will depend on the outcome of the ongoing inquiry.

Drug Alert for the Month of January–2025 (Revised)

List of Drugs, Medical Devices, Vaccine and Cosmetics declared as Not of Standard Quality/Spurious/Adulterated/Misbranded for the Month of January– 2025 (Revised)

S.

No

Name of

Drugs/medical device/cosmetics

Batch No.

Date of Manufacture

Date of Expiry

Manufactured by

Reason for failure

Drawn By

Firm’s reply

Remarks

79.

TELMA AM

5240367

Mar-24

Feb-27

Under

Investigation

Does not confirm to I.P.

–

The actual manufacturer (as per label claim) has informed that the impugned batch of the product has not been manufactured by them and that it is a spurious drug.

The product is

purported to be spurious,

however, the

same is subject to outcome of

investigation

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Is increased sleepiness in 80s tied to higher dementia risk?

A study in Neurology, led by Yue Leng, PhD, and Sasha Milton, followed the sleep patterns of 733 older female participants to see if specific patterns of change were associated with a higher risk of dementia. The participants, whose average age was 83, were monitored by wrist devices that track movement and time spent asleep. They had normal cognition at the start of the study.

At the end of the study, five years later, 13% had developed dementia. This included 25 participants (8%) with stable sleep patterns, 39 (15%) with declining nighttime sleep patterns and 29 (19%) with increasing sleepiness. After adjusting for factors like age, education, diabetes and hypertension, those with increasing sleepiness had double the risk of the stable sleepers.

This study is one of the first to look at how sleep patterns change over time and relate to dementia risk. It adds to a body of recent UCSF-led research that shows poor sleep quality in midlife, delayed dream phase and extended napping are linked to a higher risk of dementia.

It is unknown if worsening sleep increases the risk of dementia or if dementia leads to worsening sleep. Some scientists believe both theories may be correct. 

Reference:

Sasha Milton, Clémence Cavaillès Five-Year Changes in 24-Hour Sleep-Wake Activity and Dementia Risk in Oldest Old Women, https://doi.org/10.1212/WNL.0000000000213403

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Sex Hormones Increase Endometrial Cancer Risk in Postmenopausal Women: Study

Researchers have identified in a new study that high levels of circulating sex hormones have a greater risk of endometrial cancer (EC) in postmenopausal women but a lower risk with high levels of sex hormone-binding globulin (SHBG). The study was conducted by Pengfei Z. and fellow researchers published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

Endometrial cancer, a prevalent gynecologic malignancy, is recognized as hormonally sensitive. Although endogenous sex hormones like estrogens and androgens have long been suspected to play a role in EC risk, results from different studies have been inconsistent. This new meta-analysis sought to combine the evidence regarding the association between several circulating sex hormones such as estrogens, androgens, and SHBG and EC risk, with specific emphasis on postmenopausal women where the hormonal alterations are more significant and the risk for EC is elevated.

The authors performed systematic searches in the PubMed, Web of Science, and Scopus databases to find relevant observational studies. Sixteen included studies were identified as eligible in the final analysis, and they had data that were pooled through a random effects model. The strength of association between hormone level and risk for EC was analyzed using odds ratios (ORs) and 95% confidence intervals (CIs). There was also an analysis of the non-linear dose–response association and the test of the effects of possible modifiers including age, menopausal status, type of cancer, study design, geographic location, and levels of covariate adjustments.

Key Findings

Strong and statistically significant associations between increased levels of certain endogenous hormones and increased EC risk were identified by the meta-analysis:

  • Total testosterone: OR 1.70 (95% CI not reported)

  • Free testosterone: OR 1.75

  • Dehydroepiandrosterone sulfate (DHEAS): OR 1.39

  • Androstenedione: OR 1.58

Estrogens also showed strong associations with increased EC risk:

  • Estrone: OR 1.55

  • Unconjugated estrone: OR 1.86

  • Estradiol: OR 1.38

  • Unconjugated estradiol: OR 2.14

  • Estriol: OR 1.75

  • Unconjugated estriol: OR 1.99

  • Conjugated estrogens had no marked association with EC risk, implying that the type of estrogen can be very important.

This comprehensive meta-analysis results in the determination that higher endogenous sex hormone levels both androgens and estrogens are predictive of a markedly elevated risk for endometrial cancer in postmenopausal women. Higher levels of SHBG, conversely, would decrease the risk for EC. These results point toward hormone profiling as a worthwhile adjunct to risk assessment for EC and highlight an increased need for monitoring in women postmenopausal with a heightened level of hormones.

Reference:

Zhu, P., Ren, J., Sun, J., Geng, J., Wang, H., & Ma, M. (2025). The association of endogenous sex hormones with endometrial cancer risk: A systematic review and meta-analysis. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 113997, 113997. https://doi.org/10.1016/j.ejogrb.2025.113997

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Which are Effective options for Prevention of postoperative nausea and vomiting in Thyroidectomy Patients?

Postoperative nausea and vomiting (PONV) represent a major concern in surgical patient care, with incidence rates as high as 30% for the general population and reaching 80% in high-risk groups. Despite existing effective protocols for the management of PONV in the operating room and post-anesthesia care units (PACUs), gaps usually arise when patients transition to wards or intensive care units (ICUs), leading to prolonged recovery periods, increased healthcare costs, and diminished patient satisfaction. To tackle these issues, a novel continuum-based PONV prophylaxis protocol (CBPPP) has been developed, accompanied by a checklist for practical application in clinical settings. The formulation of the CBPPP began with a systematic review of existing guidelines, systematic reviews, meta-analyses, and primary research on PONV prevention. Recent review leveraged extensive databases including PubMed, Cochrane Library, Scopus, and Embase, emphasizing studies from the last decade to ensure contemporary relevance. Contributions from the Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting greatly aided the understanding of effective antiemetic pharmacotherapy and perioperative interventions.

Data Synthesis and Collaboration

Data synthesis was meticulously undertaken to map PONV risk factors, evaluate antiemetic strategies, and explore adjunct measures for both intraoperative and postoperative care. This process enabled the development of tailored stratified approaches specific to varying risk profiles among surgical patients. The protocol emerged from collaboration with a multidisciplinary team consisting of anaesthesiologists, surgeons, and clinical pharmacologists. The feedback gathered from this team emphasized critical aspects such as practicality, feasibility, and potential implementation barriers, which were addressed in the final protocol draft.

Structure of CBPPP

CBPPP is structured in four pivotal phases: preoperative, intraoperative, PACU, and postoperative. During the preoperative phase, a thorough risk assessment is conducted, utilizing established criteria such as the Apfel score, which encompasses risk factors like gender, smoking status, history of PONV or motion sickness, and opioid use. Adequate prophylaxis planning is critical, paving the way for a structured approach to managing potential PONV occurrences.

PACU Phase Recommendations

In the PACU phase, the protocol encourages immediate reassessment of the patient’s response to antiemetics upon arrival. A key recommendation includes monitoring for nausea and vomiting within the first 24 hours post-surgery and adjusting prophylactic measures accordingly. This immediate feedback loop is vital for optimizing patient care and minimizing the risk of PONV.

Need for Validation

The development of this protocol does not negate the need for further validation; prospective studies and randomized controlled trials are necessary to adequately evaluate the efficacy and feasibility of the CBPPP in real-world settings. The introduction of a supporting checklist is intended to facilitate the practical application of the protocol within clinical workflows, promoting a standardized approach to PONV prophylaxis.

Goals of CBPPP

Ultimately, the continuum-based PONV prophylaxis protocol aims to enhance patient outcomes significantly, improve recovery times, and increase overall patient satisfaction. This structured and evidence-based approach underscores the commitment to addressing the challenges of PONV management throughout the perioperative continuum, signaling a step towards improved surgical patient care.

Reference –

Singh MP, Gupta A, Bhardwaj S. Continuum based postoperative nausea and vomiting prophylaxis protocol: Development and real world implementation checklist. Indian J Anaesth 2025;69:402-5

Y. Cho et al. (2021). Pharmacologic Interventions For Postoperative Nausea And Vomiting After Thyroidectomy: A Systematic Review And Network Meta-Analysis. *PLoS ONE*, 16. https://doi.org/10.1371/journal.pone.0243865

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Vitamin D Key Player in Colorectal Cancer Prevention Through Immune Regulation and Inflammation Control, Review Reveals

Hungary: A recent review published in Nutrients suggests that higher vitamin D levels may significantly reduce the risk of colorectal cancer (CRC), with some studies showing up to a 58% reduction in risk. By analyzing 50 previous studies, the review emphasizes vitamin D’s role in preventing CRC by reducing inflammation and promoting cancer cell death. These effects are crucial for both CRC prevention and management.

However, the researchers stress the need for large-scale trials to determine optimal vitamin D dosages and to better understand the underlying mechanisms. Given the widespread vitamin D deficiency, particularly in areas with limited sunlight, increasing intake through vitamin D-rich foods or supplements could be a beneficial strategy to reduce CRC risk.

Vitamin D, synthesized in the skin through UV-B exposure, plays a vital role in calcium and phosphorus homeostasis. Beyond this, it modulates the immune system, reduces inflammation, induces apoptosis, and supports anti-angiogenesis. Available in two forms—D3 (from animal sources) and D2 (from plants)—D3 is more potent. The active form, 1,25-dihydroxyvitamin D, regulates key physiological processes and has anti-inflammatory and anti-carcinogenic effects, making it essential in preventing diseases like colorectal cancer.

Mónika Fekete and colleagues from the Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary, explored the physiological functions and anti-cancer properties of vitamin D, particularly in CRC. Their review also addresses the global prevalence of vitamin D deficiency and evaluates clinical trials assessing the impact of vitamin D supplementation on CRC outcomes.

In the review, researchers sifted through over 10,000 studies on colorectal cancer and vitamin D, narrowing it down to 50 after filtering out duplicates and irrelevant studies. The selected studies involved adult human participants with colorectal cancer, its precursors, or vitamin D deficiency, and those who received vitamin D supplementation.

Key Highlights:

  • Vitamin D supports various bodily functions, including nerve cell communication, blood pressure regulation, and prevention of respiratory infections.
  • It is important in maintaining gut health, thyroid hormone levels, blood sugar regulation, and mitigating aging effects.
  • Vitamin D acts as an antioxidant, reducing inflammation, suppressing autoimmune responses, and supporting immune cell function.
  • Previous research highlighted vitamin D’s ability to inhibit uncontrolled cell growth, angiogenesis (new blood vessel formation), and promote apoptosis in abnormal cells.
  • Vitamin D deficiency is strongly linked to an increased risk of colorectal cancer, as it exacerbates intestinal inflammation, promoting cancer progression.
  • A meta-analysis of 31 studies found that those with the highest vitamin D intake (80 ng/mL) had a 25% reduced risk of colorectal cancer compared to those with the lowest intake (10 ng/mL).
  • The Nurses’ Health Study showed that women with the highest vitamin D intake had a 58% reduced risk of colorectal cancer compared to those with the lowest intake.
  • The Iowa Women’s Health Study found that high calcium and vitamin D intake reduced colorectal cancer risk by about 50%.
  • The Spanish PREDIMED study and studies using vitamin D supplementation showed similar protective effects.
  • Vitamin D supplementation reduced the likelihood of polyp development by 33% and the risk of high-risk adenomatous polyps by 43%, according to a Canadian study.
  • Vitamin D is crucial in preventing and treating colorectal cancer by reducing inflammation, regulating immune responses, promoting cancer cell death, and inhibiting tumor growth.
  • For individuals with colorectal cancer, vitamin D may improve survival rates and reduce mortality.

Overall, the findings emphasize vitamin D’s vital role in preventing and treating colorectal cancer by influencing cancer cell proliferation, inflammation, and apoptosis, as well as the activity of the Sirtuin protein family.

“While recent studies highlight the importance of maintaining optimal vitamin D levels to reduce CRC risk and improve treatment outcomes, they also reveal limitations, such as the inability to define the exact mechanisms of vitamin D’s protective effects,” the authors stated. They concluded, “This emphasizes the need for more large-scale randomized clinical trials to determine optimal dosages and formulations for therapeutic use.”

Reference:

Fekete, M., Lehoczki, A., Szappanos, Á., Zábó, V., Kaposvári, C., Horváth, A., Farkas, Á., Major, D., Lipécz, Á., Csípő, T., & Varga, J. T. (2024). Vitamin D and Colorectal Cancer Prevention: Immunological Mechanisms, Inflammatory Pathways, and Nutritional Implications. Nutrients, 17(8), 1351. https://doi.org/10.3390/nu17081351

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COVID-19 Infection Significantly Reduces Sperm Quality in Men, finds study

Researchers have discovered in a new study that COVID-19 infection is highly related to a reduction in sperm quality among men, indicating that the virus can negatively affect male reproductive health. The research reached the conclusion that men who contracted COVID-19 had lower quality semen compared to those who had not been infected, and changes were statistically significant. The study was conducted by Lulu Yuan and fellow researchers published in the journal of Scientific Reports.

The study constituted two large elements: a cross-sectional study that included 604 male participants and a longitudinal study that comprised 140 COVID-19-infected men and 149 uninfected natural controls. The cross-sectional analysis included men who donated semen specimens following a proven COVID-19 infection. The longitudinal arm of the study followed semen samples from the same patients prior to and subsequent to infection. To provide comparison, the control group for the longitudinal study was composed of uninfected men who provided two semen specimens over the same duration.

Researchers measured both conventional and high-tech sperm quality indicators, such as total sperm count, percentage of grade A sperm, progressive and total motility, sperm DNA fragmentation index (DFI), and chromatin maturity.

Results

In the cross-sectional study, men with COVID-19 had lower sperm quality compared to uninfected controls:

  • Total sperm count: 159.58×10⁶ vs. 185.42×10⁶; P = 0.042

  • Percentage of grade A sperm: 5.37% vs. 8.45%; P = 0.009

  • Progressive motility: 24.74% vs. 28.73%; P = 0.023

  • Total motility: 32.04% vs. 36.91%; P = 0.022

  • Sperm DNA fragmentation index (DFI): 17.50% vs. 11.75%; P = 0.030

In the longitudinal study, in which participants were examined before and after infection, a consistent pattern of sperm quality deterioration was seen:

  • Total sperm count: decreased from 173.63×10⁶ to 131.80×10⁶ (Δd = -20.49×10⁶); P = 0.018

  • Grade A sperm percentage: decreased from 8.50% to 2.61% (Δd = -3.18%); P < 0.001

  • Progressive motility: decreased from 24.88% to 19.82% (Δd = -5.07%); P < 0.001

  • Total motility: decreased from 32.25% to 26.64% (Δd = -5.62%); P < 0.001

  • DFI: increased from 26.49% to 32.10% (Δd = 5.61%); P = 0.039

The research presents strong evidence that COVID-19 infection can seriously undermine sperm quality in men and, potentially, fertility. With a high percentage of infected patients showing loss in sperm concentration, motility, and DNA integrity, the findings support the importance of fertility evaluations for men who have recovered from COVID-19. The findings also emphasize the significance of fertility monitoring over the long term in male patients after infection.

Reference:

Yuan, L., Sun, W., Dong, Z. et al. COVID-19 infection was associated with poor sperm quality: a cross-sectional and longitudinal clinical observation study. Sci Rep 15, 11380 (2025). https://doi.org/10.1038/s41598-025-94570-5

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Subjective Cognitive Decline Affects Over Half of Hemodialysis Patients: Researchers Call for Early Interventions

China: A recent study, published in BMC Nephrology has shed light on the prevalence and associated factors of subjective cognitive decline (SCD) in patients undergoing maintenance hemodialysis (MHD), emphasizing the clinical significance of early assessment and intervention. The cross-sectional study found that more than half of patients receiving MHD experience SCD, with frailty emerging as a key contributing factor.

The researchers identified associations between SCD and employment status, sex, reduced grip strength, poor nutritional status, and frailty, collectively explaining 38.8% of its variance. Conducting early cognitive assessments in MHD patients may help mitigate long-term cognitive deterioration.

Subjective cognitive decline is prevalent among adults and is a known risk factor for long-term cognitive impairment. However, its impact on patients with end-stage renal disease undergoing maintenance hemodialysis remains understudied. The connection between frailty and SCD in this population is also not well understood. To bridge this gap, Huaihong Yuan, West China School of Nursing, Sichuan University, Chengdu, China, and colleagues aimed to identify factors influencing SCD in MHD patients and explore its association with frailty.

For this purpose, the researchers conducted a cross-sectional study from December 2023 to April 2024, recruiting 171 patients from West China Hospital of Sichuan University through convenience sampling. Demographic and sociological characteristics were assessed using a general information questionnaire. Subjective cognitive function, frailty, nutritional status, and grip strength were evaluated using SCD-Q9, TFI, SGA, and a grip dynamometer, respectively. Univariate analyses identified factors linked to SCD, while linear regression examined their relationships. Spearman’s correlation assessed the association between SCD and frailty.

The study led to the following findings:

  • The average subjective cognitive decline score among 171 MHD patients was 4.00.
  • SCD was present in 95 patients (55.56%) with scores greater than 3.
  • Linear regression analysis identified sex, work status, grip strength, nutritional status (SGA), and frailty as key influencing factors, accounting for 38.80% of SCD variation.
  • Spearman’s analysis showed a significant positive correlation between SCD and frailty (r = 0.431).

The researchers highlighted that subjective cognitive decline is prevalent in maintenance hemodialysis patients, with sex, employment status, grip strength, nutritional status, and frailty as key contributing factors. Given its impact on long-term cognitive function, early assessment and targeted interventions are crucial.

“While our study offers valuable insights, its single-center, small-sample nature and lack of biochemical analysis limit generalizability. Future multi-center cohort studies with random sampling and expanded biochemical evaluations are needed to better understand the underlying mechanisms and refine intervention strategies for improving cognitive health in MHD patients,” the researchers concluded.

Reference:

Li, J., Gao, Y., Li, X. et al. Prevalence, associated factors and clinical implications of subjective cognitive decline linked to frailty in patients receiving maintenance hemodialysis: a cross-sectional study. BMC Nephrol 26, 92 (2025). https://doi.org/10.1186/s12882-025-04020-7

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Support Growing for Medication Abortion and Alternative Care Models Post-Dobbs: JAMA

Recent study focused on investigating changes in national support and personal interest in advance provision (AP) and over-the-counter (OTC) access to medication abortion following the Dobbs v Jackson Women’s Health Organization case. The researchers conducted two nationally representative surveys before and after Dobbs, targeting AFAB individuals aged 15 to 49 years. The results showed a significant increase in national support for AP and OTC access to medication abortion after Dobbs, indicating growing interest in alternative models of abortion care. Specifically, support for AP increased from 48.9% to 55.1%, and support for OTC access rose from 49.4% to 55.2%.

Promising Approach to Abortion Care

The study highlighted the potential of AP and OTC models to offer a promising approach to abortion care, especially for individuals living in states with abortion bans. Personal interest in AP and OTC access also increased after Dobbs, with the OTC model being particularly appealing, especially among marginalized populations facing obstacles in accessing reproductive healthcare services. The findings pointed to the importance of expanding access to medication abortion through these alternative models, emphasizing the benefits of earlier access, convenience, and privacy.

Factors Influencing Support

Significant demographic and health-related factors influenced individuals’ views on AP and OTC access. The study identified variations in support based on ideological perspectives, age, political party affiliation, religion, history of abortion, and experiences of medical mistreatment and barriers in accessing healthcare services. Overall, both AP and OTC access models received positive feedback, with individuals recognizing advantages such as earlier access to abortion, privacy, and convenience, as well as concerns about incorrect pill usage and lack of answered questions.

Conclusion

In conclusion, the study emphasized the increased national support and interest in expanded access to medication abortion through AP and OTC models. These findings suggested a shift towards less medicalized models of abortion care, particularly in response to restrictive abortion policies. The researchers recommended further research to explore the safety, acceptability, and feasibility of implementing these models, highlighting the importance of policy support and insurance coverage to make these approaches widely available to the public.

Key Points

– The study investigated changes in national support and personal interest in advance provision (AP) and over-the-counter (OTC) access to medication abortion post the Dobbs v Jackson Women’s Health Organization case.

– There was a significant increase in national support for AP and OTC access to medication abortion after Dobbs, indicating a growing interest in alternative models of abortion care. – Support for AP increased from 48.9% to 55.1%, and support for OTC access rose from 49.4% to 55.2%.

– The study highlighted the potential of AP and OTC models to offer a promising approach to abortion care, especially for individuals in states with abortion bans.

– Significant demographic and health-related factors influenced individuals’ views on AP and OTC access, including ideology, age, political affiliation, religion, abortion history, and experiences with healthcare services.

– The findings pointed to a shift towards less medicalized models of abortion care and recommended further research to explore the safety, acceptability, and feasibility of implementing AP and OTC models, emphasizing the need for policy support and insurance coverage.

Reference –

M. A. Biggs et al. (2025). Changes In Support For Advance Provision And Over-The-Counter Access To Medication Abortion. *JAMA Network Open*, 8. https://doi.org/10.1001/jamanetworkopen.2024.54767

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Low-Grade Inflammation Increases Risk of Psoriasis, Especially in Severe Cases: Study Finds

Denmark: A large population-based study published in the British Journal of Dermatology, involving more than 100,000 individuals, has found that low-grade systemic inflammation is significantly associated with an increased risk of developing psoriasis, especially in moderate-to-severe cases.

Inflammatory markers—such as the systemic immune-inflammation index (HR 1.78), neutrophil-to-lymphocyte ratio (HR 1.56), and C-reactive protein (HR 2.83)—were identified as independent predictors of psoriasis, underscoring their potential role in its pathogenesis. Traditionally linked to cardiovascular and metabolic disorders, these biomarkers now appear to play a key role in the development of this chronic inflammatory skin condition.

Biomarkers of low-grade systemic inflammation are often elevated in individuals with psoriasis compared to healthy individuals. However, it has remained unclear whether this inflammation plays a causal role in the development of psoriasis or is simply a result of the disease. To address this, Charlotte Näslund-Koch, Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark, and colleagues aimed to determine whether low-grade systemic inflammation—assessed through indicators such as the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP)—serves as an independent risk factor for the onset of psoriasis.

For this purpose, the researchers analyzed data from the Copenhagen General Population Study, enrolling adults aged 20–100 between 2003 and 2015. Participants underwent physical exams, completed lifestyle questionnaires, and provided blood samples to measure SII, NLR, and CRP. Psoriasis cases were identified using ICD codes from national health records. Associations were assessed using Cox regression models, adjusting for age, sex, smoking, alcohol use, physical activity, education, hypertension, dyslipidemia, and obesity.

The study revealed the following findings:

  • The study included 105,418 individuals with a median age of 58 years, 55% of whom were women.
  • Higher levels of systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP) were associated with an increased risk of developing psoriasis.
  • Individuals with values above the 90th percentile for SII, NLR, and CRP had multivariable adjusted hazard ratios of 1.78, 1.56, and 2.83, respectively, compared to those with lower levels.
  • These associations remained consistent, though slightly reduced, when considering cases of mild psoriasis treated with topical calcipotriol (alone or with corticosteroids).

Low-grade systemic inflammation—reflected by elevated levels of systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, and C-reactive protein (CRP)—was found to be independently associated with an increased risk of developing psoriasis in a large population-based study. The risk was particularly pronounced in individuals with moderate-to-severe disease.

“These findings strengthen the hypothesis that chronic low-grade inflammation may actively contribute to the development of psoriasis, rather than being merely a result of the condition,” the authors concluded.

Reference:

Bojesen, S. E., Skov, L., & Kobylecki, C. J. Low-grade systemic inflammation is associated with risk of psoriasis in a general population study of more than 100,000 individuals. British Journal of Dermatology. https://doi.org/10.1093/bjd/ljaf147

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