Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have signi...Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.展开更多
Background:Cardiorespiratory fitness(CRF)is a powerful predictor of mortality and chronic disease risk,yet global patterns and determinants of CRF remain poorly defined,particularly in females and underrepresented pop...Background:Cardiorespiratory fitness(CRF)is a powerful predictor of mortality and chronic disease risk,yet global patterns and determinants of CRF remain poorly defined,particularly in females and underrepresented populations.We conducted a systematic review and quantitative synthesis of directly measured peak oxygen uptake(VO_(2peak))internationally and examined its association with human development and gender ine quality.Methods:Studies were eligible if VO_(2peak)was assessed via direct gas analysis during maximal exercise testing,and if the countries had scores for the Human Development Index(HDI)and Gender Inequality Index(GII).Studies were identified through MEDLINE/PubMed,Embase,CINAHL,and Web of Science.Risks of bias were assessed by an adaptation of the Newcastle-Ottawa Scale.Multivariable linear regression models examined associations between VO_(2peak),age,sex,exercise modality,HDI,GII,and study year.Results:Data included 95 studies from 24 countries with HDI and GII scores,comprising 119,435 adults(42%females)with VO_(2peak)assessed via direct gas analysis during maximal exercise testing.The risk of bias was low.VO_(2peak)was positively associated with HDI(β=14.1)and negatively associated with GII(β=-3.6).Slightly stronger associations were observed in females than males(HDI:β=18.9 vs.β=13.9,GII:β=-4.6vs.β=-3.6).Young females in middle-HDI countries had higher VO_(2peak)than those in low-HDI countries(31.2mL/kg/min vs.28.5 mL/kg/min),with limited additional gams in high-HDI contexts.VO_(2peak)decreased with higher gender inequality,with the largest disparities observed in young females between high-and low-GII countries(26.3 mL/kg/min vs.32.8 mL/kg/min).Conclusion:Global variation in CRF is tied to national levels of human development and gender equality.These findings support prioritizing structural and policy-level interventions that address social and gender disparities in physical activity access and health promotion.Studies from countries with lower HDI and information on ethnicity and socioeconomic status will bridge crucial gaps in understanding factors involved in global CRF levels.展开更多
Overweight and obesity are significant public health concerns worldwide due to their association with many chronic health conditions.This has resulted in the development of various interventions focused on weight loss...Overweight and obesity are significant public health concerns worldwide due to their association with many chronic health conditions.This has resulted in the development of various interventions focused on weight loss to reduce the associated health burden.Physical activity is an important lifestyle behavior associated with enhanced health.Evidence supports that many of the benefits of physical activity are realized independent of initial weight status or whether weight loss is achieved,with some benefits additive to what is achieved with weight loss alone.These benefits include enhanced cardiometabolic,brain,cognitive and psychological health,and others.Moreover,in adults with overweight or obesity,physical activity has independent effects on cardiorespiratory fitness,muscular strength,physical function,and mobility.There are also benefits to body composition,with physical activity improving the quality of key tissues,such as skeletal muscle,which may not occur with diet-induced weight loss.Therefore,physical activity is an important public health target for adults with overweight or obesity to provide a wide range of health benefits that extend beyond those of weight loss alone.However,physical activity recommendations and programming efforts should consider the unique characteristics of adults with overweight or obesity to be most effective,and should support a focus on mobility,physical function,and other health outcomes.展开更多
Background:Investigators from low-,middle-,and high-income countries representing 6 continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire(GAC-PAQ).The GAC-PAQ is ...Background:Investigators from low-,middle-,and high-income countries representing 6 continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire(GAC-PAQ).The GAC-PAQ is designed to assess physical activity(PA)across all key domains(i.e.,school,chores,work/volunteering,transport,free time,outdoor time).It aimed to address multiple gaps in global PA surveillance(e.g.,omission of important PA domains,insufficient cultural adaptation,underrepresentation of rural areas in questionnaire validation studies).The purpose of this study was to assess the content validity of the GAC-PAQ among PA experts,8-to 17-year-olds,and one of their parents/guardians,and to discuss changes made to the questionnaire based on participants'feedback.Methods:Sixty-two experts in PA measurement and/or surveillance from 24 countries completed an online survey that included both closed-and open-ended questions about the content validity of the GAC-PAQ.The proportion of experts who agreed or strongly agreed with the items was calculated.Child-parent/guardian dyads from 15 countries(n=250;10-40 per country)participated in a structured cognitive interview to assess the clarity of the questions and response options,and they were encouraged to provide suggestions to improve clarity and facilitate completion of the questionnaire.Participating countries are:Aotearoa New Zealand,Brazil,Canada,China,Colombia,Czech Republic,India,Malawi,Mexico,Nepal,Nigeria,Spain,Sweden,Thailand,and the United Arab Emirates.Interviews were conducted in 13 different languages and structured by PA domain.Generic images were included to help participants in answering questions about PA intensity.Results:Expert agreement with the items for each domain exceeded 75%,and their qualitative feedback was used to revise the questionnaire before cognitive interviews.In general,participants found the questionnaire to be comprehensive.Adolescents(12-17 years)found it easier than children(8-11 years)to answer the questions.Several children struggled to answer questions about the duration and intensity of activities and/or concepts related to travel modes,active trips,and organized activities.Many parents/guardians were unsure about the frequency,duration,and intensity of their children's or adolescents'PA at school and/or recommended using more culturally relevant and appropriate images.Some participants misunderstood the concept of activities that“make you stronger”(intended to assess resistance activities)and/or struggled to differentiate between work,volunteering,and chores.Conclusion:Participants'feedback was used to develop a revised,simplified,and culturally adapted GAC-PAQ,which will be pilot-tested in all15 countries in an App that will include country-specific images and narration in local languages.Further research is needed to assess the reliability and validity of the revised GAC-PAQ.展开更多
文摘Liver transplantation is a life-saving procedure for patients with end-stage liver diseases and acute liver failure.With advances in surgical techniques and immunosuppressive regimens,patient survival rates have significantly improved.While the systemic complications of post-transplantation are well recognized,ophthalmic manifestations remain underreported.Ophthalmic complications can significantly impair visual function and increase morbidity in these patients.Prolonged immunosuppression makes the patients susceptible to the opportunistic pathogens such as Cytomegalovirus,Candida,Aspergillus,etc.Other common findings include dry eye disease,cataracts and retinal vascular complications which further contribute to the long-term morbidity in these patients.Early ophthalmic evaluation and prompt management are essential to prevent irreversible vision loss and improve post-transplant outcomes.High index of suspicion and multidisciplinary approach is essential to facilitate early diagnosis and treatment.This review highlights the range of ophthalmic complications observed in liver transplant recipients and underscores the need for future research focused on understanding the underlying pathophysiological mechanisms and refining the prophylactic protocols to improve outcomes in this unique patient population.
基金NJP holds a Future Leader Award from the Novo Nordisk Foundation and European Foundation for the Study of Diabetes(NNF/EFSD NNF21SA0072747)a grant from the Diabetes Wellness Network Sverige(PG21-6524)+5 种基金supported by the Swedish Research Council(2015-00165)the European Research Council(ERC-2023-Ad G 101142093)a Wallenberg Scholars Award from the Knut and Alice Wallenberg Foundation(KAW 2023.0312)the Swedish Research Council for Sport Science(P2023-0093)The Novo Nordisk Foundation Center for Basic Metabolic Research is an independent research center at the Faculty of Health and Medical Sciences,University of Copenhagen,Denmark partially funded by an unrestricted donation from the Novo Nordisk Foundation(NNF18CC0034900,NNF23SA0084103)supported by a postdoctoral fellowship from the Strategic Research Program in Diabetes at Karolinska Institutet。
文摘Background:Cardiorespiratory fitness(CRF)is a powerful predictor of mortality and chronic disease risk,yet global patterns and determinants of CRF remain poorly defined,particularly in females and underrepresented populations.We conducted a systematic review and quantitative synthesis of directly measured peak oxygen uptake(VO_(2peak))internationally and examined its association with human development and gender ine quality.Methods:Studies were eligible if VO_(2peak)was assessed via direct gas analysis during maximal exercise testing,and if the countries had scores for the Human Development Index(HDI)and Gender Inequality Index(GII).Studies were identified through MEDLINE/PubMed,Embase,CINAHL,and Web of Science.Risks of bias were assessed by an adaptation of the Newcastle-Ottawa Scale.Multivariable linear regression models examined associations between VO_(2peak),age,sex,exercise modality,HDI,GII,and study year.Results:Data included 95 studies from 24 countries with HDI and GII scores,comprising 119,435 adults(42%females)with VO_(2peak)assessed via direct gas analysis during maximal exercise testing.The risk of bias was low.VO_(2peak)was positively associated with HDI(β=14.1)and negatively associated with GII(β=-3.6).Slightly stronger associations were observed in females than males(HDI:β=18.9 vs.β=13.9,GII:β=-4.6vs.β=-3.6).Young females in middle-HDI countries had higher VO_(2peak)than those in low-HDI countries(31.2mL/kg/min vs.28.5 mL/kg/min),with limited additional gams in high-HDI contexts.VO_(2peak)decreased with higher gender inequality,with the largest disparities observed in young females between high-and low-GII countries(26.3 mL/kg/min vs.32.8 mL/kg/min).Conclusion:Global variation in CRF is tied to national levels of human development and gender equality.These findings support prioritizing structural and policy-level interventions that address social and gender disparities in physical activity access and health promotion.Studies from countries with lower HDI and information on ethnicity and socioeconomic status will bridge crucial gaps in understanding factors involved in global CRF levels.
基金supported by the National Institutes of Health for the Kansas Center for Metabolism and Obesity Research(award No.P20GM144269)support from the Center for Advancing Translational Sciences of the National Institutes of Health(award No.KL2TR002367)supported by the National Center for Advancing Translational Sciences of the National Institutes of Health(award No.TL1TR002368)。
文摘Overweight and obesity are significant public health concerns worldwide due to their association with many chronic health conditions.This has resulted in the development of various interventions focused on weight loss to reduce the associated health burden.Physical activity is an important lifestyle behavior associated with enhanced health.Evidence supports that many of the benefits of physical activity are realized independent of initial weight status or whether weight loss is achieved,with some benefits additive to what is achieved with weight loss alone.These benefits include enhanced cardiometabolic,brain,cognitive and psychological health,and others.Moreover,in adults with overweight or obesity,physical activity has independent effects on cardiorespiratory fitness,muscular strength,physical function,and mobility.There are also benefits to body composition,with physical activity improving the quality of key tissues,such as skeletal muscle,which may not occur with diet-induced weight loss.Therefore,physical activity is an important public health target for adults with overweight or obesity to provide a wide range of health benefits that extend beyond those of weight loss alone.However,physical activity recommendations and programming efforts should consider the unique characteristics of adults with overweight or obesity to be most effective,and should support a focus on mobility,physical function,and other health outcomes.
基金supported by a Project Grant(Grant No.PJT183705)an Early Career Investigator Prize(Grant No.ECP 184184)from the Canadian Institutes of Health Research+7 种基金a Prentice Institute Research Affiliate Fund Grant from the Prentice Institute for Global Population and Economy(Grant No.G00004116)a Te Herenga Waka Victoria University of Wellington Division of Science Health Engineering Architecture and Design Innovation Faculty Strategic Research Grant(Grant No.FSRG-SHEADI-10724)The Thailand Physical Activity Knowledge Development Centre(TPAK)/Thai Health Promotion Foundation provided funding for the cognitive interviews and pilot study in Thailand(Grant No.66-P1-0473)The University Pablo de Olavide provided a scholarship for 2 undergraduate students working on the project(codes PPI2207 and PPI2308)In the Czech Republicthe study was supported by Palacky University IGA(Grant No.IGA_FTK_2023_017)supported by the Division of Intramural Research at the National Institute on Minority Health and Health Disparities of the National Institutes of Healthsupported by the Key Project of the National Philosophy and Social Science Foundation of China(23&ZD197)。
文摘Background:Investigators from low-,middle-,and high-income countries representing 6 continents contributed to the development of the Global Adolescent and Child Physical Activity Questionnaire(GAC-PAQ).The GAC-PAQ is designed to assess physical activity(PA)across all key domains(i.e.,school,chores,work/volunteering,transport,free time,outdoor time).It aimed to address multiple gaps in global PA surveillance(e.g.,omission of important PA domains,insufficient cultural adaptation,underrepresentation of rural areas in questionnaire validation studies).The purpose of this study was to assess the content validity of the GAC-PAQ among PA experts,8-to 17-year-olds,and one of their parents/guardians,and to discuss changes made to the questionnaire based on participants'feedback.Methods:Sixty-two experts in PA measurement and/or surveillance from 24 countries completed an online survey that included both closed-and open-ended questions about the content validity of the GAC-PAQ.The proportion of experts who agreed or strongly agreed with the items was calculated.Child-parent/guardian dyads from 15 countries(n=250;10-40 per country)participated in a structured cognitive interview to assess the clarity of the questions and response options,and they were encouraged to provide suggestions to improve clarity and facilitate completion of the questionnaire.Participating countries are:Aotearoa New Zealand,Brazil,Canada,China,Colombia,Czech Republic,India,Malawi,Mexico,Nepal,Nigeria,Spain,Sweden,Thailand,and the United Arab Emirates.Interviews were conducted in 13 different languages and structured by PA domain.Generic images were included to help participants in answering questions about PA intensity.Results:Expert agreement with the items for each domain exceeded 75%,and their qualitative feedback was used to revise the questionnaire before cognitive interviews.In general,participants found the questionnaire to be comprehensive.Adolescents(12-17 years)found it easier than children(8-11 years)to answer the questions.Several children struggled to answer questions about the duration and intensity of activities and/or concepts related to travel modes,active trips,and organized activities.Many parents/guardians were unsure about the frequency,duration,and intensity of their children's or adolescents'PA at school and/or recommended using more culturally relevant and appropriate images.Some participants misunderstood the concept of activities that“make you stronger”(intended to assess resistance activities)and/or struggled to differentiate between work,volunteering,and chores.Conclusion:Participants'feedback was used to develop a revised,simplified,and culturally adapted GAC-PAQ,which will be pilot-tested in all15 countries in an App that will include country-specific images and narration in local languages.Further research is needed to assess the reliability and validity of the revised GAC-PAQ.
