National University of Health Sciences

Background:Chronic pain represents a pressing public health problem affecting more than one in five American adults. Yet, primary prevention efforts aimed at stopping pain before it begins remain substantially underutilized. Chronic life stressors (CLS)-including financial strain, personal health problems, and caregiving burdens-are upstream, modifiable psychosocial risk factors that may drive pain incidence in aging populations. Identifying and addressing these stressors at the population level offers a promising, non-pharmacological pathway for preventing new-onset pain. Methods:We used data from the 2018 and 2020 Health and Retirement Study (HRS), a nationally representative longitudinal study of U.S. adults aged 50 and older (N = 14,133). Among 2,622 individuals reporting no pain at baseline (2018), we examined the association between eight CLS domains and pain incidence in 2020 using unadjusted and adjusted logistic regression models, adjusting for gender, race/ethnicity, education, marital status, employment status, and self-rated health. Results:In unadjusted models, moderate-to-severe self-health problems (OR = 2.13, 95% CI: 1.63-2.79, p < 0.001), physical/mental health problems in a spouse or child (OR = 1.46, 95% CI: 1.11-1.93, p = 0.007), and financial strain (OR = 1.62, 95% CI: 1.16-2.27, p = 0.005) were significantly associated with pain incidence. In fully adjusted models, moderate-to-severe self-health problems remained significant (OR = 1.62, 95% CI: 1.20-2.19, p = 0.002), and cumulative CLS exposure predicted pain incidence (OR = 1.13, 95% CI: 1.05-1.23, p = 0.002), with each additional stressor increasing pain odds by 13%. Conclusion:These findings provide longitudinal evidence that life stressors are upstream, modifiable determinants of new-onset pain among adults 50 and older, as well as viable targets for public health prevention programs. Population-level implementation of social needs screening, combined with clinical and community-based support, offers a proactive strategy to prevent the transition from no pain to chronic pain. These results support a paradigm shift from reactive pain management toward salutogenic, prevention-oriented public health approaches that promote healthy aging and reduce downstream pharmaceutical dependence.

This systematic review evaluated natural language processing (NLP) approaches for detecting cognitive impairment in electronic health record clinical notes. Following PRISMA guidelines, we analyzed 18 studies (n = 1,064,530) that employed rule-based algorithms (67%), traditional machine learning (28%), and deep learning (17%). NLP models demonstrated robust performance in identifying cognitive decline, with median sensitivity 0.88 (IQR 0.74–0.91) and specificity 0.96 (IQR 0.81–0.99). Deep learning architectures achieved superior results, with area under the receiver operating characteristic curves up to 0.997. Major implementation challenges included incomplete electronic health record data capture, inconsistent clinical documentation practices, and limited external validation. While NLP demonstrates promise, successful clinical translation requires establishing standardized approaches, improving access to annotated datasets, and developing equitable deployment frameworks.

IntroductionBullying and victimization in adolescence is associated with mental health problems including depression. Depression in East Asian adolescents presents similarities and differences from that in Western adolescents. This review reports on the prevalence and psychosocial associations of bullying and depression in East Asian adolescents.MethodsElectronic databases (Medline, and Embase) were searched for English language articles on bullying and its associations for a span of 10 years (1st January 2013 to 19th January 2024). Searches were limited to studies conducted in East Asia involving adolescents 10-19 years of age.ResultsOut of 1,231 articles initially identified, 65 full-text articles (consisting of 44 cross-sectional and 21 cohort studies) met the inclusion criteria and were included for qualitative synthesis & analysis. Prevalence rates of bullying ranged from 6.1% - 61.3% in traditional bullying victimization and 3.3% to 74.6% in cyberbullying victimization with higher rates in at-risk groups (e.g., adolescents with internet addiction). Psychosocial associations of bullying and depression which were similarly found in Western cultures include individual factors of coping style and gender; family factors of functioning and sibling relationships; and community factors of friendship and school-connectedness. In contrast, unique East Asian risk factors included being different (i.e., sexual minority status) and teachers as bullies.ConclusionFindings of this scoping review suggest that strong relationships within families, peers and the school community coupled with adolescents’ positive coping style are protective against the negative effects of bullying. Conversely, poor parent-child attachment in the midst of family dysfunction, poor engagement with peers and the school community together with low self-esteem predispose East Asian adolescents to depressive symptoms as a result of victimization. Similar to Western cultures, adolescents who are bully-victims and poly-victims are most vulnerable to depression. As a significant proportion of bullying occurred in school, future research could focus on a whole-school intervention approach to counter bullying.

In oncology, the conventional reliance on the maximum tolerated dose (MTD) strategy for chemotherapy may not optimize treatment outcomes for individual patients. CURATE.AI is an AI-derived platform that utilizes a patient's own, small dataset to dynamically personalize only their own dose recommendations. The primary objective of this feasibility trial was to assess the logistical and scientific feasibility of providing dynamically personalized AI-derived chemotherapy dose recommendations for patients with advanced solid tumors at/for treatment with single-agent capecitabine, capecitabine in combination with oxaliplatin (XELOX), or capecitabine in combination with irinotecan (XELIRI). CURATE.AI demonstrated adaptability to clinically relevant situations encountered by patients often treated with palliative intent of care. High rates of user adherence were demonstrated, which could be in part due to the high engagement of the physicians in selecting data and boundaries for CURATE.AI operations.

Pulmonary fibrosis is the most prevalent and severe form of end-stage interstitial lung disease. Macrophages are crucial players in inflammation-induced pulmonary fibrosis, but the mechanisms driving macrophage polarisation and their specific roles in pulmonary fibrosis pathogenesis remain poorly understood. Here, we demonstrate that both YAP and TAZ are activated in lung macrophages from patients with pulmonary fibrosis as well as in mice with bleomycin-induced pulmonary fibrosis. Myeloid-specific Yap/Taz deletion resulted in reduced recruitment of monocyte-derived alveolar macrophages (Mo-AMs), impaired inflammatory responses, decreased pulmonary fibrosis and enhanced alveolar epithelial cell regeneration following bleomycin treatment. Conversely, the expression of a constitutively active YAP mutant (YAP5SA) exacerbated bleomycin-induced pulmonary fibrosis by increasing Mo-AM recruitment, elevating expression of pro-inflammatory and pro-fibrotic markers, and impairing alveolar epithelial cell regeneration. We demonstrate that YAP/TAZ-CCL2 (C-C motif chemokine ligand 2) signalling plays a crucial role in bleomycin-induced pulmonary fibrosis, as blocking CCL2 with a neutralising antibody effectively abrogated the YAP5SA-induced recruitment of Mo-AMs, inflammatory and fibrotic responses. Additionally, we reveal that the YAP/TAZ-MBD2-TGF beta 1-pSMAD2 signalling axis is crucial not only for pro-fibrotic macrophage polarisation, but also for their cross-talk with lung fibroblasts, driving the fibroblast-to-myofibroblast transition. Collectively, these findings suggest that targeting aberrant YAP/TAZ activity to modulate inflammatory and fibrotic response could be a promising strategy for the prevention and treatment of pulmonary fibrosis.