Black youth, especially Black girls, use mental health services less than their white peers, study finds

Black adolescents with mental distress are less likely to use mental health services than their white peers, and Black girls are the least likely to access care, according to new research published in the Canadian Medical Association Journal.

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Canada must protect youth from sports betting advertising, say specialists

Canada must enact strong, effective legislation to protect youth from gambling advertising. Minors are suffering harms from problem gambling despite age restrictions, argue authors in an editorial in CMAJ (Canadian Medical Association Journal).

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ESC/EAS 2025 Update Brings New Recommendations on Cholesterol Management and Risk Assessment

Belgium: The European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) have released a 2025 Focused Update to their 2019 Guidelines for the management of dyslipidaemias, introducing crucial revisions and new recommendations based on recent scientific evidence. The update, published in the European Heart Journal, aims to refine approaches to cardiovascular (CV) risk assessment and lipid-lowering therapies, particularly ahead of the next comprehensive guideline revision.

The Task Force, composed of experts from various European countries and the United States, meticulously reviewed new evidence published up to March 31, 2025, to ensure the guidelines reflect the latest advancements in patient care.
Here are 10 important points or key takeaways from this significant update:
1. Revised Cardiovascular Risk Estimation: The update recommends the use of SCORE2 for apparently healthy individuals under 70 years old and SCORE2-OP (Systematic Coronary Risk Evaluation 2-Older Persons) for those aged 70 to 89 years, to estimate the 10-year risk of both fatal and non-fatal cardiovascular disease (CVD). These new algorithms replace the older SCORE algorithm and consider non-HDL cholesterol, offering a more comprehensive risk assessment.
2. Subclinical Atherosclerosis as a Risk Modifier: The presence of subclinical coronary atherosclerosis, identified through imaging or an increased Coronary Artery Calcium (CAC) score (e.g., >300), should now be considered to improve risk classification. This is particularly relevant for individuals at moderate risk or those around treatment decision thresholds, as it can indicate a higher risk than calculated by SCORE2/SCORE2-OP alone.
3. Bempedoic Acid for LDL-C Lowering: Bempedoic acid is now recommended for patients who are unable to tolerate statin therapy to achieve their low-density lipoprotein cholesterol (LDL-C) goals. It can also be considered as an add-on therapy to the maximally tolerated statin dose, with or without ezetimibe, for high or very high-risk patients. Bempedoic acid typically reduces LDL-C by approximately 23% as monotherapy and by 18% when added to statin therapy.
4. Evinacumab for Homozygous Familial Hypercholesterolaemia (FH): For patients aged 5 years or older with homozygous FH who have not reached their LDL-C goal despite receiving maximum doses of other lipid-lowering therapies, evinacumab should be considered to significantly lower LDL-C levels, with observed reductions close to 50%.
5. Intensified Lipid-Lowering in Acute Coronary Syndromes (ACS): The guidelines emphasize a strategy of early, intensive LDL-C lowering during index hospitalization for ACS. This involves immediate initiation of statin therapy and, when necessary, combination treatment with one or more non-statin therapies with proven CV benefit. This approach supports the principle of “the sooner, the lower, the better” to prevent recurrent CV events in this vulnerable patient population.
6. Lipoprotein(a) [Lp(a)] as a Cardiovascular Risk Enhancer: Lp(a) levels above 50 mg/dL (105 nmol/L) should be considered a cardiovascular risk-enhancing factor in all adults, with higher levels correlating with a greater increase in risk. Measurement of Lp(a) is recommended at least once in an adult’s lifetime, especially in younger patients with FH or premature ASCVD, or in moderate-risk individuals to refine risk classification.
7. High-Dose Icosapent Ethyl for Hypertriglyceridaemia: For high-risk or very high-risk patients with elevated triglyceride levels (fasting triglyceride level 135–499 mg/dL or 1.52–5.63 mmol/L) despite statin therapy, high-dose icosapent ethyl (2 × 2 g/day) should be considered in combination with a statin to reduce the risk of cardiovascular events.
8. Volanesorsen for Severe Hypertriglyceridaemia due to Familial Chylomicronemia Syndrome (FCS): Volanesorsen (300 mg/week) should be considered in patients with severe hypertriglyceridaemia (levels >750 mg/dL or >8.5 mmol/L) specifically attributed to FCS, to lower triglyceride levels and reduce the risk of acute pancreatitis.
9. Statin Therapy for Primary Prevention in People with HIV (PWH): Statin therapy is now recommended for PWH aged ≥40 years in primary prevention, irrespective of their estimated cardiovascular risk and LDL-C levels. This recommendation, based on the REPRIEVE trial, aims to reduce cardiovascular events, with careful consideration of potential drug interactions with antiretroviral therapy.
10. Statins for Cardioprotection in Cancer Therapy: Statins should be considered in adult patients at high or very high risk of developing chemotherapy-related cardiovascular toxicity, such as anthracycline-induced cardiac dysfunction. This reflects growing evidence supporting their cardioprotective role in this specific patient group.
François Mach, Department of Cardiology, Geneva University Hospital, Geneva, Switzerland, and colleagues note that while new recommendations for risk estimation and specific therapies have been introduced, the LDL-C treatment goals and therapeutic guidance based on cardiovascular risk categories have not changed from the 2019 ESC/EAS Guidelines. The intensity of recommended LDL-C lowering continues to be determined by an individual’s level of risk.
Furthermore, the update reiterates that dietary supplements or vitamins without documented safety and significant LDL-C-lowering efficacy are generally not recommended to lower the risk of atherosclerotic cardiovascular disease, with the exception of high-dose, purified icosapent ethyl in the context of hypertriglyceridaemia.
Reference:
Mach, F., Koskinas, K. C., E, J., Tokgözoğlu, L., Badimon, L., Baigent, C., Benn, M., Binder, C. J., Catapano, A. L., De Backer, G. G., Delgado, V., Fabin, N., Ference, B. A., Graham, I. M., Landmesser, U., Laufs, U., Mihaylova, B., Nordestgaard, B. G., Richter, D. J., . . . Shek, A. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias: Developed by the task force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). European Heart Journal. https://doi.org/10.1093/eurheartj/ehaf190

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What actually happens in your brain when you change your mind?

Imagine a game show where the host asks the contestant to randomly pick one option out of three: A, B or C.

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Ifinatamab deruxtecan demonstrates high response rate in previously treated extensive-stage small cell lung cancer

Patients diagnosed with recurrent or progressive extensive-stage small cell lung cancer (ES-SCLC) may benefit from treatment with ifinatamab deruxtecan (I-DXd), a B7-H3–directed antibody–drug conjugate, according to data presented at the International Association for the Study of Lung Cancer (IASLC) 2025 World Conference on Lung Cancer (WCLC) in Barcelona, Spain.

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First-in-human trial shows promising results for antibody-drug conjugate in relapsed small cell lung cancer

A first-in-human Phase I study of SHR-4849 (IDE849), a Delta-like ligand 3 (DLL3)-directed antibody-drug conjugate (ADC), demonstrated manageable safety and early signs of anti-tumor activity in patients with relapsed small cell lung cancer (SCLC).

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Women With Pre-Pregnancy Chronic Conditions Face Greater Risk of Severe Maternal Complications: Study Shows

Canada: Women entering pregnancy with multiple chronic conditions (MCC) face significantly higher risks of severe maternal complications, including morbidity and mortality, according to a large population-based study from Ontario, Canada. The study also found that emergency department visits and hospitalizations were more frequent among these women, highlighting the need for tailored, multidisciplinary care.    

The research, led by Hilary K. Brown from the Department of Health and Society, University of Toronto Scarborough, along with colleagues, was published in BJOG: An International Journal of Obstetrics & Gynaecology. The study analyzed data from females aged 13–54 years with recognized pregnancies between 2012 and 2021, examining how the presence and type of chronic conditions before conception influenced maternal health outcomes up to 42 days postpartum.

Using modified Poisson regression models adjusted for age, parity, income, rurality, and immigrant or refugee status, the team assessed the impact of the number of chronic conditions, complex MCC (defined as three or more conditions affecting at least three body systems), and co-occurring cardiometabolic conditions. The outcomes measured included perinatal emergency department (ED) use, hospitalizations, and severe maternal morbidity or mortality (SMM-M).

Based on the study, the researchers reported the following findings:

• The study analyzed 1,373,193 pregnancies.

• Among these, 894,042 women had no pre-pregnancy chronic conditions, 357,398 had one condition, 94,427 had two conditions, and 27,326 had three or more conditions.

 • Maternal risk increased stepwise with the number of chronic conditions.

• Adjusted relative risks (aRR) for severe maternal morbidity or mortality (SMM-M) within 42 days postpartum were:

• 1.38 for women with one chronic condition

• 1.82 for women with two chronic conditions

• 2.75 for women with three or more chronic conditions

• Women with complex MCC (three or more conditions affecting at least three body systems) had an aRR of 2.92.

• Women with three or more cardiometabolic conditions had an aRR of 5.45.

 • Emergency department visits increased with the number of chronic conditions, with women having three or more conditions showing a 1.86-fold higher risk.

• Hospitalizations were also higher, with a threefold increased likelihood for women with three or more chronic conditions compared with those without chronic conditions.

These findings emphasize that MCC, particularly when complex or cardiometabolic in nature, is strongly associated with adverse maternal health outcomes. The authors suggest that multidisciplinary, patient-centered care could help mitigate these risks and improve postpartum recovery.

The study also notes that MCC is socially patterned, disproportionately affecting individuals with lower socioeconomic status, which may amplify healthcare costs and mortality risks. Future research is needed to identify which socioeconomic factors influence these associations, as well as to evaluate a broader range of perinatal and extended postpartum outcomes to better support mothers with MCC and their infants.

“Overall, this study provides important evidence for healthcare providers, underscoring the necessity of preconception risk assessment and comprehensive care planning for women with multiple chronic conditions to reduce maternal complications and improve pregnancy outcomes.

Reference:

Brown, H. K., Fung, K., Cohen, E., Dennis, L., Grandi, S. M., Rosella, L. C., Varner, C., Vigod, S. N., Wodchis, W. P., & Ray, J. G. Multiple Chronic Conditions Before Pregnancy and Risk of Adverse Maternal Health Outcomes: Population-Based Cohort Study. BJOG: An International Journal of Obstetrics & Gynaecology. https://doi.org/10.1111/1471-0528.18347

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De-escalation of DAPT provides benefits in patients after CABG: ESC Study

Compared with dual antiplatelet therapy (DAPT), a de-escalated DAPT strategy resulted in similar graft occlusion rates and reduced clinically relevant bleeding in patients who underwent coronary artery bypass grafting (CABG), according to late-breaking research presented in a Hot Line session today at ESC Congress 2025.

Saphenous vein grafts remain the most frequently used conduits in CABG; however, failure rates are high, with 3−12% occluding before hospital discharge and 8−25% failing at 1 year.

“After CABG, decreased risk of saphenous vein graft failure has been observed with 12 months of DAPT (aspirin plus a P2Y12 inhibitor) but this was accompanied by an increased risk of bleeding,3” explained Investigator of the TOP-CABG trial, Doctor Xin Yuan from the State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China.

“Rather than receiving DAPT for 12 months, a de-escalated strategy of DAPT for 1 or 3 months then aspirin monotherapy for 9 or 11 months is associated with similar ischemic benefits and better bleeding safety in patients after percutaneous coronary intervention (PCI). Mirroring PCI, the first 3 months after CABG surgery is a high-thrombotic-risk phase, but studies of de-escalated DAPT are lacking. Thus, we designed the TOP-CABG trial to compare the effects of de-escalated DAPT and DAPT on patency and bleeding events for 1 year after CABG.”

TOP-CABG trial was a double-blind, parallel-controlled randomised trial conducted at 13 hospitals in China. Patients older than 18 and younger than 80 years old were recruited if they were undergoing planned CABG for the first time with at least one saphenous vein graft. Patients were randomised 1:1 to de-escalated DAPT (ticagrelor 90 mg twice daily plus aspirin 100 mg once daily for 3 months, then placebo twice daily plus aspirin 100 mg once daily for 9 months) or to DAPT (ticagrelor 90 mg twice daily plus aspirin 100 mg once daily for 1 year).

The primary noninferior efficacy endpoint was 100% occlusion of the saphenous vein graft within 1 year after CABG at the per-graft level, with occlusion assessed by coronary computed tomography angiography or coronary angiography. The prespecified noninferiority margin was 3.5%. The primary superior safety endpoint was clinically relevant bleeding at the per-patient level (Bleeding Academic Research Consortium [BARC] classification ≥2) within 1 year.

The 2,290 patients included had a mean age of 61.5 years and 20.6% were female.

Noninferiority was demonstrated for the primary efficacy endpoint of graft occlusion, which occurred in 10.79% of patients’ grafts in the de-escalated DAPT group and 11.19% in the DAPT group (difference −0.31%; 95% confidence interval [CI] −3.13 to 2.52; p=0.008). The primary safety endpoint of clinically relevant bleeding was less frequent with de-escalated DAPT vs. DAPT (8.26% vs. 13.19% of patients; HR 0.62; 95% CI 0.48 to 0.81; p<0.001).

There was no difference between the groups for secondary outcomes including graft failure, any graft stenosis, any graft occlusion or major adverse cardiac and cerebrovascular events.

Doctor Yuan concluded: “In the largest CABG trial to date, a de-escalation strategy offered a better balance between graft patency protection and bleeding risk than DAPT. These findings may help to inform future guidelines regarding the benefits of a shorter period of DAPT during the early phase after CABG.”

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Daily Incense Exposure and Recent Antibiotic Use Increase Risk of Sinus Infection in Children, Study Finds

Taiwan: Children exposed to daily incense burning or those who had recently taken antibiotics face a significantly higher risk of developing acute bacterial paranasal sinusitis (ABPS), according to a recent study published in BMC Infectious Diseases. The research, led by Ting-Fang Chiu and colleagues from the Department of Pediatrics at Taipei City Hospital, highlights key environmental and medical factors contributing to this common pediatric infection.

Acute bacterial paranasal sinusitis is a frequent upper respiratory tract infection among children. To identify potential risk factors, researchers conducted a case-control study from January 2020 to December 2021, involving 228 participants aged between 4 and 18 years. Participants were categorized into three groups: children diagnosed with ABPS, those with allergic rhinitis but without ABPS, and a healthy control group.
The analysis revealed the following findings:
  • Children diagnosed with acute bacterial paranasal sinusitis (ABPS) were generally younger compared to those who did not have the infection.
  • Two major risk factors stood out in the study: daily exposure to residential incense and recent antibiotic use.
  • Incense exposure was linked to more than double the risk of developing ABPS, with an adjusted odds ratio (aOR) of 2.45.
  • Antibiotic use within the previous three months was associated with an even higher risk, showing an eight-fold increase in the likelihood of ABPS, with an adjusted odds ratio (aOR) of 8.04.
  • Interestingly, some commonly assumed factors did not show adverse effects in this analysis.
  • Nose blowing, which is often considered risky during sinus infections, was actually found to be harmless and even correlated with a better treatment response.
  • On the other hand, nasal irrigation offered no significant advantage in treatment outcomes and did not reduce the likelihood of developing ABPS.
  • The authors acknowledged certain limitations. The reliance on self-reported data through questionnaires may introduce recall bias, as participants might not accurately remember past exposures or antibiotic usage. Additionally, the study did not measure the exact duration or concentration of incense exposure, which could influence the strength of the association. Moreover, detailed medical records regarding previous antibiotic prescriptions, including reasons for use, were lacking, which might affect the interpretation of findings.
The study concludes that minimizing daily incense exposure and avoiding unnecessary antibiotic use are critical steps in reducing the risk of ABPS in children. While nose blowing appears safe, nasal irrigation does not offer any proven benefit in either prevention or treatment outcomes. The researchers emphasized the need for further studies to explore how environmental factors and prior medical treatments interact in influencing sinus infections among children.
Reference:
Chiu, TF., Hu, YL., Du, JC. et al. Risk factors of acute bacterial paranasal sinusitis in children: a case control study. BMC Infect Dis 25, 1059 (2025). https://doi.org/10.1186/s12879-025-11299-2

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Delayed Hip Fracture Surgery Increases 30-Day Mortality in Older Adults, finds study

A new study published in the journal of BMC Surgery revealed that longer waiting times before hip fracture surgery were linked to higher 30-day mortality risk in elderly patients, with a threshold of around 42 hours marking significantly increased risk.

This study from the Affiliated Kunshan Hospital of Jiangsu University conducted a retrospective cohort study of 818 patients aged 65 and older who underwent surgery for hip fractures between January 2017 and July 2022. The study examined patient outcomes relative to surgical delays, highlights the importance of timely surgical intervention to improve survival chances in older individuals.

The study evaluated a broad range of clinical and demographic factors. These included patients’ age, gender, body mass index (BMI), type of hip fracture, surgical procedure performed, anesthesia risk (measured by American Society of Anesthesiologists score), operation time, month and week of hospital admission, and key laboratory test results. By controlling for these covariates through logistic regression analysis, this study isolated the independent effect of waiting time on 30-day mortality.

The analysis demonstrated a clear positive association between waiting time and the risk of death within 30 days of surgery. Specifically, the results indicated that every additional 10 hours of surgical delay was linked to a 13.6% increase in 30-day mortality (odds ratio [OR] 1.136; 95% confidence interval [CI], 1.027–1.256; P = 0.0136).

The relationship between waiting time and mortality was not linear. Statistical modeling revealed a threshold effect, when the waiting period was less than 42.4 hours, there was no detectable increase in 30-day mortality risk.

However, delays beyond 42.4 hours were associated with a sharply elevated risk of death. This nonlinear pattern emphasizes that while minor surgical delays may not be fatal, longer postponements can have serious, life-threatening consequences.

The findings carry significant implications for hospitals and healthcare policymakers. In many clinical settings, delays in hip fracture surgery occur due to resource constraints, patient stabilization needs, or scheduling bottlenecks. The evidence from this study suggests that efforts to reduce waiting times could markedly improve survival outcomes in elderly patients.

Overall, the study highlights the urgent need to treat hip fractures in older adults as a medical emergency requiring prompt surgical intervention. The identified threshold of 42 hours may serve as a clinical benchmark for prioritizing surgical scheduling and optimizing patient outcomes.

Source:

Xu, M.-Z., Lu, K., Ye, Y.-W., Xu, S.-M., Shi, Q., Gong, Y.-Q., & Li, C. (2025). Waiting time and 30-day mortality association in elderly patients having hip fracture surgery. BMC Surgery, 25(1). https://doi.org/10.1186/s12893-025-03140-z

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