BACKGROUND/AIM:Although hormone receptor-positive (HR+) invasive ductal carcinoma (IDC) is the most common breast cancer subtype, there is limited evidence describing how demographic and clinical features vary across U.S. regions. Understanding geographic disparities is essential for improving screening and treatment planning. To examine regional variations in demographic, socioeconomic status (SES), and stage-at-diagnosis characteristics among U.S. patients with HR+ IDC. PATIENTS AND METHODS:This cross-sectional study used data from the National Cancer Database (NCDB) for patients diagnosed with HR+ IDC between 2004 and 2020. Patients were categorized into 6 U.S. geographic regions: Northeast, Southeast, Midwest, Southwest, Mountain, and Pacific, based on the Commission on Cancer facility location. Descriptive and comparative analyses evaluated age, sex, race and ethnicity, insurance type, income, urban-rural residence, and American Joint Committee on Cancer stage. RESULTS:Among 136,280 patients (mean age, 64.4 years; 98.8% female), racial and SES composition differed significantly across regions. Black patients comprised 19.5% of the Southeast cohort and 18.1% of the Southwest cohort, compared with 2.9% in the Mountain region. The Asian population was highest in the Pacific (13.1%). Low-income households (<$63,000) were most prevalent in the Southwest (74.7%) and Southeast (69.5%), while the Pacific region had the highest proportion of higher-income households (46.4%) and metropolitan residents (94.3%). Stage III-IV disease at diagnosis occurred most often in the Southwest (17.6%) and least in the Northeast (14.0%). CONCLUSION:Significant variation exists in the demographic and SES profile of patients with HR+ IDC, corresponding to differences in stage at diagnosis, and BC-related overall outcomes. These disparities likely reflect inequities in screening access, SES, and healthcare infrastructure, underscoring the need for region-specific public health strategies. Targeted regional interventions and equitable screening expansion are warranted to reduce geographic disparities and improve overall BC-related outcomes.
The objective of this systematic review was to synthesize evidence on the early clinical exposure (ECE) and its effectiveness, student experiences, and outcomes in undergraduate dental education. In August 2025, the systematic search was carried out in PubMed, Scopus, and Web of Science. The quantitative, qualitative, and/or mixed-methods peer-reviewed studies evaluating ECE to undergraduate dental students were included. Summary synthesis of included studies was carried out. The risk of bias and quality assessment was assessed with Cochrane Risk of Bias 2, ROBINS-I tool, Joanna Briggs Institute, and Critical Appraisal Skills programme. Nine studies (2007- August 2025) from a range of countries were included. ECE interventions were chairside demonstration, peer-assisted shadowing, simulation, clinical/community placements, and hybrid models. There is evidence of effectiveness of ECE in knowledge, psychomotor skills, and affective domains. In addition, student experiences were reported as positive and significant increases in satisfaction, confidence, motivation, clinical reasoning and other learning gains such as professional identity, empathy, and communication. Six out of nine included studies were non-randomized studies. All the non-randomized studies were reported methodological biases, including small single-center samples, self-report measures, short follow-up periods, and rated as some concern and high risk of bias. ECE in undergraduate dental education promising contribution to the cognitive, psychomotor, and affective domains and reduces transition stress to clinical training. However, presence of methodological bias in included studies undermines the evidence. Future studies with robust objective performance measures, multicentre designs, and longitudinal follow-up should be carried out to better establish the educational and clinical impact of ECE in dental education.
Functional constipation affects up to 15% of the global population, significantly affecting the quality of life and imposing substantial clinical and economic burdens. Colonic transit time (CTT) studies have emerged as a pivotal diagnostic tool for distinguishing various types of functional constipation (i.e., slow transit constipation, normal transit constipation, and ano-rectal dyssynergia), thereby guiding personalized treatment strategies and enabling precise monitoring of therapeutic response. CTT studies using radiopaque markers (ROM) have been the most widely used technique by researchers worldwide. Despite its affordability and high diagnostic yield, the ROM CTT study remains grossly underutilized in routine clinical practice largely due to a pervasive lack of awareness among physicians regarding its methodological nuances and clinical advantages. This narrative review systematically examined the multifaceted role of ROM CTT studies in clinical practice. It underscored how ethnic, dietary, and lifestyle factors profoundly influence colonic motility, thereby necessitating the development of population-specific diagnostic protocols. The review also highlighted the significant variability in imaging methodologies, such as differences in radiographic timing and patient positioning (supine vs erect), which further complicate the interpretation and reliability of CTT assessments. By drawing on a wide spectrum of research, this review advocated for enhanced physician education and the implementation of standardized, evidence-based protocols. Such initiatives are critical to optimizing the diagnostic accuracy and clinical utility of ROM CTT studies, ultimately leading to more effective management of refractory constipation and improved patient outcomes.
