New risk calculator can better predict stroke to direct the best prevention

Researchers at the University of Vermont have developed a more precise way to assess stroke risk in people with atrial fibrillation (A-Fib), a condition that affects 10.5 million Americans and is a leading cause of stroke.

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Living in hurricane-flooded areas raises older adults’ mortality risk by 9 percent

Hurricanes and related natural catastrophes like flooding are becoming more severe and more frequent around the world. Older people are especially at risk, but relatively little is known about long-term health effects. In 2012, the northeast US was hit by Hurricane Sandy, which resulted in unusable transportation systems, destruction of homes, power loss, and more than 100 casualties.

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Living in hurricane-flooded areas raises older adults’ mortality risk by 9 percent

Hurricanes and related natural catastrophes like flooding are becoming more severe and more frequent around the world. Older people are especially at risk, but relatively little is known about long-term health effects. In 2012, the northeast US was hit by Hurricane Sandy, which resulted in unusable transportation systems, destruction of homes, power loss, and more than 100 casualties.

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A course of psychotherapy for low back pain remains effective for at least three years, finds trial

A type of psychotherapy called cognitive functional therapy (CFT) is the first treatment for chronic disabling low back pain with good evidence that it can effectively reduce disability due to the pain for more than a year, finds a randomized controlled trial (RCT) published in The Lancet Rheumatology.

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A course of psychotherapy for low back pain remains effective for at least three years, finds trial

A type of psychotherapy called cognitive functional therapy (CFT) is the first treatment for chronic disabling low back pain with good evidence that it can effectively reduce disability due to the pain for more than a year, finds a randomized controlled trial (RCT) published in The Lancet Rheumatology.

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‘Healthocide’ coined to describe deliberate attacks on health care as acts of war

The deliberate destruction of health services and systems as an act of war should be termed “healthocide” and medical practitioners should call out and stand firm against this weaponization of health care, insists a thought-provoking commentary published in the open-access journal BMJ Global Health.

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‘Healthocide’ coined to describe deliberate attacks on health care as acts of war

The deliberate destruction of health services and systems as an act of war should be termed “healthocide” and medical practitioners should call out and stand firm against this weaponization of health care, insists a thought-provoking commentary published in the open-access journal BMJ Global Health.

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Childhood verbal abuse shows similar impact on adult mental health as physical abuse

Experiencing childhood verbal abuse shows a similar impact on adult mental health as physical abuse, suggests a large intergenerational study, published in the open access journal BMJ Open.

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Older, White Male Smokers at Higher Risk for Diabetic Foot Ulcers: Study

Researchers have identified that some subgroups of patients with diabetes, older males, smokers, and White ethnicity, are at significantly increased risk of developing diabetic foot ulcer disease (DFUD), a severe condition with a poorer five-year survival rate than most cancers. The study was published in Diabetes, Obesity & Metabolism by Safoora G. and colleagues. The research found that those with higher systolic blood pressure and a higher baseline HbA1c level were more likely to develop DFUD.

DFUD is a long-standing, life-changing diabetic complication that is frequently under-diagnosed with regard to its catastrophizing effects. Previously, almost all risk factor information was derived from small, clinic-based surveys that tended to be cross-sectional in design. The current study sought to address the deficit through the utilization of two large and independent English and Scottish diabetic cohorts, providing one of the largest analyses to date.

The research evaluated a combined total of 391,790 individuals with diabetes—131,042 from England via the Clinical Practice Research Datalink (CPRD), and 260,748 from Scotland via the Scottish Diabetes Research Network-National Diabetes Dataset (SDRN-NDS). The English cohort included primary and secondary care data, whereas the Scottish cohort utilized secondary care and foot clinic data.

Key Findings

Incidence of DFUD:

• In the English cohort, 4.7% of patients developed DFUD during a median follow-up of 4.3 years, representing an incidence rate of 9.0 per 1,000 person-years (95% CI: 8.8–9.2).

• In the Scottish cohort, 2.9% of patients developed DFUD during a median follow-up of 6.3 years, with an incidence rate of 4.4 per 1,000 person-years (95% CI: 4.3–4.5).

Common Risk Factors Identified in Both Populations:

• Age: The older patients had higher chances of developing DFUD.

• Sex: Males were more vulnerable.

• Ethnicity: Individuals of White ethnicity were having greater incidence rates.

• Lifestyle: Smokers were much more likely to develop DFUD.

• Clinical indicators: Greater systolic blood pressure and baseline HbA1c levels were strongly related with subsequent DFUD.

This study provides strong evidence to support the targeting of these high-risk groups in diabetes care programs. These findings can provide the impetus for more effective prevention strategies, lowering the life-changing costs of diabetic foot ulcer disease.

Reference:

Gharibzadeh S, Lee J, Highton P, Greenlaw N, Gillies C, Zaccardi F, Brennan A, Pollard DJ, Valabhji J, Game F, Stanley B, Leese G, Gray L, Tesfaye S, Webb D, Wild S, Shabnam S, Davies M, Khunti K, Petrie J, Gregg E. Risk factors for development of diabetic foot ulcer disease in two large contemporary UK cohorts. Diabetes Obes Metab. 2025 Jun 24. doi: 10.1111/dom.16519. Epub ahead of print. PMID: 40555701.

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One in Three Hospitalised Adult Tetanus Patients Die: Meta-Analysis Finds

China: A systematic review and meta-analysis published in BMJ Open has highlighted the alarming mortality rate among hospitalised adult patients with tetanus and identified key factors that significantly influence survival outcomes.

The study, conducted by Zhenlin Chen and colleagues from the Department of Emergency, Zhangzhou Affiliated Hospital of Fujian Medical University, analysed data from 22 observational studies comprising 1,618 adult patients admitted with tetanus between January 2000 and February 2024.

The study revealed the following findings:

  • The pooled analysis showed an overall mortality rate of 32% among hospitalised adult tetanus patients, highlighting the persistent threat of this preventable disease despite medical advancements.
  • The findings emphasize the need for enhanced preventive strategies, including better adult vaccination coverage and timely wound care education, particularly for individuals over 40 years of age.
  • Age ≥40 years was identified as a significant risk factor for mortality (RR = 1.89).
  • An incubation period of less than seven days was linked to higher mortality risk (RR = 2.10).
  • The onset of symptoms within two days increased the likelihood of death (RR = 2.06).
  • Severe disease, indicated by the Ablett classification ≥III, was strongly associated with mortality (RR = 3.40).
  • The presence of autonomic dysfunction was a major predictor of poor outcomes (RR = 4.84).
  • The need for mechanical ventilation significantly increased the mortality risk (RR = 2.46).
  • These identified factors can help clinicians in early risk assessment and implementing targeted management strategies to improve survival in hospitalised tetanus patients.

According to the authors, the meta-analysis is the first of its kind to systematically evaluate mortality and associated risk factors in hospitalised adults with tetanus. Data were extracted independently by two reviewers from four major databases—PubMed, Web of Science, The Cochrane Library, and Embase. Statistical heterogeneity was assessed using the I² statistic, with subgroup and meta-regression analyses performed to explore potential sources of variation among the studies.

While the study provides valuable insights, the authors acknowledged certain limitations. Only four databases were searched, which may have resulted in the exclusion of relevant studies. Additionally, both univariate and multivariate analyses were considered for risk factor extraction, and the small sample size for certain variables may have affected the robustness of the results. Differences in statistical methodologies across studies were also noted as a factor warranting cautious interpretation.

Despite these constraints, the findings carry significant clinical and public health implications. The high mortality rate reinforces the urgent need to strengthen tetanus control measures, particularly focusing on adult immunisation and early intervention for high-risk patients. The identification of specific risk factors provides a framework for targeted care, potentially reducing fatalities in hospitalised cases.

The researchers stress that further large-scale, multicentre prospective studies are necessary to validate these findings and provide more detailed clinical insights. Until then, prioritising vaccination coverage, improving awareness of wound care, and promptly identifying patients at elevated risk could serve as key strategies in reducing tetanus-related deaths among adults.

Reference:

Chen Z, Lin Z, Zhang W, et alMortality and risk factors in hospitalised adult patients with tetanus: a systematic review and meta-analysis. BMJ Open 2025;15:e101782. doi: 10.1136/bmjopen-2025-101782

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