Category: 8. Health

A third of UK teenagers who vape will go on to start smoking tobacco, research shows, meaning they are as likely to smoke as their peers were in the 1970s.

A long-term intergenerational study found that the likelihood of starting to smoke among people aged 17 in 2018 was about 1.5% if they did not vape compared with 33% if they did.

The findings suggest that e-cigarettes are increasingly acting as a “gateway” to nicotine cigarettes for children, undermining falling rates of teen smoking over the past 50 years.

The study looked at teenagers in 2018 as it was the most recent year for which there was available comparable data. The likelihood may have increased since then given that vaping and smoking rates among teenagers have both risen in the past seven years.

Vaping

The academics wrote that although the research did not establish a causal link, their findings were “especially concerning” given the rising popularity of vaping, “despite some initial assurances that e-cigarettes would have little appeal to [adolescents]”.

“The success of previous tobacco control efforts and broad shifts in intergenerational risk factors in reducing risk of cigarette smoking may be mitigated when adolescents use e-cigarettes,” they wrote.

Figures compiled by Action on Smoking and Health this year show that 20% of 11- to 17-year-olds in Great Britain have tried vaping, an estimated 1.1 million children. This was the same level as in 2023, after the number of children using vapes in the previous three years had tripled. Smoking among youths also increased from 14% in 2023 to 21% in 2025.

The research, led by the University of Michigan and published in the Tobacco Control journal, drew on intergenerational data from three nationally representative birth cohorts of UK teens born in 1958, 1970 and 2001.

The overall likelihood of cigarette smoking for an average teen (aged 16 or 17) was calculated as 30% for those born in 1958, 22% for those born in 1970, and 9.5% for those born in 2001.

The odds of smoking among 16- and 17-year-olds were estimated based on a common set of childhood risk factors, which included teen vaping for the youngest cohort. Some sociodemographic characteristics, including race and ethnicity, were unaccounted for due to insufficient sample sizes in the earlier cohorts.

Risk factors included whether they had ever drunk alcohol by age 16 or 17; how engaged they were with education at school; poor impulse control reported by the main caregiver at ages 10 or 11; and parental occupation, education and smoking behaviour – including during pregnancy. The researchers found these risks remained broadly similar across the three cohorts.

Analysis showed a steep decline in the prevalence of cigarette smoking among teens, falling from 33% in 1974 to 25% in 1986 and 12% in 2018.

The researchers suggested the decline in the prevalence of teen smoking was the result of tobacco control laws, better public understanding of the health impacts of smoking and a shift away from the perception of smoking as socially acceptable.

The study showed that other behaviours that contributed to the risk of smoking have changed over time.

For example, the percentage of teens who had started drinking by the age of 16 or 17 fell from 94% for the oldest cohort to 83% in the youngest.

The average age at which mothers left education rose from 15.5 in the oldest cohort to 17 in the youngest, the prevalence of parental smoking fell from above 70% in the oldest to 27% in the youngest cohort, and fewer mothers continued smoking while pregnant.

Steve Turner, president of the Royal College of Paediatrics and Child Health, said the research was “incredibly concerning”.

“A major concern about children and young people vaping is that this age group is particularly sensitive to developing a lifelong addiction to the nicotine contained in the vapes. We know that nicotine addiction is harmful,” he said.

“We have all worked so hard to stop young people from smoking and vaping may have undone decades of work.

“Smoking continues to be the leading cause of preventable illness and death in the UK. We all must take urgent steps to prevent young people from being drawn into smoking by vaping.”

July 29, 2025 — The American Heart Association, a global force changing the future of health for all, is recognizing 158 hospitals across the nation with a new Commitment to Quality award that highlights high performance across three or more clinical areas in the Get With The Guidelines program. Hospitals earning this new award demonstrate a comprehensive approach to quality improvement for patient care.

Get With The Guidelines programs help care teams use the latest evidence-based science to guide their treatment decisions. Studies show that following treatment guidelines can help people recover faster, avoid complications and reduce their chances of needing to return to the hospital. The programs are designed to ensure everyone gets care that’s timely, consistent and backed by research.

Get With The Guidelines awards are given for conditions including stroke, heart failure, heart attacks, cardiac arrest, Type 2 diabetes and atrial fibrillation. Award levels range from bronze to gold plus status, depending on how long and how well a care team meets key measures. Hospitals receiving the Commitment to Quality award have achieved Silver awards or higher in at least three American Heart Association programs for 2025.

“Delivering high-quality cardiovascular care requires a systemwide commitment to using proven treatments and putting patients at the center of every decision,” said Donald Lloyd-Jones, M.D., Sc.M., FAHA, past volunteer president of the American Heart Association and current volunteer chair of the Association’s Quality Oversight Committee. “Hospitals earning the Commitment to Quality award show what’s possible when health care teams work together to apply the latest science across multiple areas of patient care. Their dedication is helping more people live longer, healthier lives.”

Visit U.S. News & World Report to view the full list of recipients by state and award. Learn more about Get With The Guidelines at www.heart.org/quality.

Detailed data from the phase 2 VIVA-MIND study (NCT03919162) of varoglutamstat (Vivoryon Therapeutics) revealed that the oral small molecule inhibitor of glutaminyl cyclases was safe in patients with early-stage Alzheimer disease (AD) but had no effect on primary and secondary efficacy outcomes.¹

Presented at the 2025 Alzheimer’s Association International Conference (AAIC), held July 27-31 in Toronto, Canada, the comprised patients from the first dose cohort testing 600 mg of varoglutamstat (n = 52) vs placebo (n = 57). Of these, 74% completed the 24-week treatment period and 31% lasted through week 72. At week 72, investigators observed no statistically significant least-square (LS) mean differences between the investigational cohort and placebo in Clinical Dementia Rating-Sum of Boxes (CDR-SB), the primary end point (–0.05; 95% CI, –1.03 to 0.92).

Vivoryon noted it will still announce biomarker results and pharmacokinetic/pharmacodynamic (PK/PD) data in the future. The trial was originally going to test 3 descending doses (600 mg, 300 mg, 150 mg BID) of varoglutamstat; however, following the negative data, it was terminated prematurely.

In the latest analysis, led by Howard H. Feldman, MDCM, FRCP, a professor of neurosciences at the University of California, San Diego, patients on the investigational therapy failed to distinguish themselves from placebo on a number of secondary outcomes as well. These included CFC2 (LS mean difference, 0.97; 95% CI, –3.34 to 5.28), ABC score (0.10; 95% CI, –0.10 to 0.30), FAQ (–0.60; 95% CI, –4.22 to 3.01), Alzheimer’s Disease Assessment Scale-cognitive subscale 13 (2.03; 95% CI, –2.29 to 6.36), or Neuropsychiatric Inventory (–3.09; 95% CI, –7.81 to 1.62).

In terms of safety, varoglutamstat was considered safe and well tolerated, although there were more treatment discontinuations because of adverse events (AEs) in the investigational arm (11.3%) than placebo (3.4%). At least 1 treatment-emergent AE occurred in 84.9% of varoglutamstat-treated patients vs 76.8% of those on placebo. Serious AEs and AEs of special interest occurred in 18.9% and 1.9% of those on varoglutamstat, respectively, compared with 8.9% and 5.4% of those on placebo.

READ MORE: Structured Lifestyle Program Leads to Greater Cognitive Improvements in At-Risk Individuals Over Self-Guided Intervention

Otherwise known as PQ912, varoglutamstat is one of the unique agents in the AD pipeline, acting as an oral inhibitor of glutaminyl cyclases, which are known to reduce the pyroglutamate formation of amyloid-ß and CCL2. In the trial, more patients were apolipoprotein e-4 carriers (72.9%) and more had an initial diagnosis of mild cognitive impairment due to AD (62.4%) than mild probable AD (37.6%). Coming into the trial, both groups had similar baseline Montreal Cognitive Assessment total scores, Mini-Mental State Exam scores, and CDR-SB scores.

In December 2024, Vivoryon announced new data from VIVA-MIND supporting varoglutamstat’s potential to improve kidney function. An analysis of kidney function data demonstrated a statistically significant improvement of at least 4 mL/min/1.73 m2 in the estimated glomerular filtration rate in patients treated with 600 mg BID of varoglutamstat vs placebo across all visits and all patients (weighted average weeks 4-72; P = 0.004*; total treated n=109; varoglutamstat n=52, placebo n=57). Overall, these data reinforced the potential of varoglutamstat as a treatment for diabetic kidney disease (DKD) and backed the previously completed phase 2b VIVIAD study (NCT04498650).²

VIVIAD, a European-based trial testing varoglutamstat in 259 patients with MCI and mild AD, failed to meet its primary end point of a combined z-score of the Detection test, the Identification test, and the ‘One Back’ test of the Cogstate Neuropsychological test battery. In addition, the study did not meet its key secondary end points measuring cognition, Instrumental Activities of Daily Living Questionnaire, and electroencephalogram global theta power.³

Click here for more AAIC 2025 coverage.

REFERENCES
1. Feldman HH, Messer K, Zhang J, et al. The VIVA-MIND study: Topline Results from Phase 2 RCT of Varoglutamstat in Early AD. Presented at: AAIC 2025; July 27-31; ABSTRACT 105693
2. Vivoryon Therapeutics N.V. Presents Topline Phase 2 Data fromVIVA-MIND Strongly Supporting Varoglutamstat’s Potential toImprove Kidney Function. News release. Vivoryon Therapeutics. News release. December 9, 2024. Accessed July 28, 2025. https://www.vivoryon.com/vivoryon-therapeutics-n-v-presents-topline-phase-2-data-fromviva-mind-strongly-supporting-varoglutamstats-potential-toimprove-kidney-function/
3. Vivoryon Therapeutics N.V. Provides Update on VIVIAD Phase 2b Study of Varoglutamstat in Early Alzheimer’s Disease. News release. Vivoryon Therapeutics. March 4, 2024. Accessed July 28, 2025. https://www.vivoryon.com/vivoryon-therapeutics-n-v-provides-update-on-viviad-phase-2b-study-of-varoglutamstat-in-early-alzheimers-disease/

If the 10,000-step target has ever felt like too much, here’s some good news: science now says you can ease up. According to a new review study published in The Lancet Public Health, you can get meaningful health benefits, including a decreased risk of dementia, from fewer steps—around 7,000 per day.

Walking has long been promoted as one of the simplest ways to improve your health. It requires little more than a good pair of shoes and can be done almost anywhere. Regular walking is consistently associated with reduced risks of chronic conditions such as heart disease, diabetes and cognitive decline.

Many individual studies have examined the relationship between daily steps and those specific health conditions. However, there are relatively few comprehensive systematic reviews that analyze multiple health outcomes together. This new study fills that gap by looking at how daily step counts relate to a wide range of important health issues.

How Was This Study Conducted?

Researchers from the University of Sydney reviewed and analyzed 57 long-term studies that tracked people’s daily steps and health over time. Of those, 31 studies had enough data to be combined for a detailed analysis of how different step counts were linked to various health risks. Depending on the condition, the number of participants in the analysis ranged from about 62,000 for type 2 diabetes to more than 161,000 for overall mortality.

Along with diabetes and all-cause mortality, the researchers looked at how step counts were related to cardiovascular disease, cancer, cognitive function, mental health, physical function and fall risk.

What Did the Study Find?

Compared to walking 2,000 steps a day, the study found that walking 7,000 steps lowered the risk of dementia by 38%, only slightly less than the benefits observed at 10,000 steps.

That same step count was also linked to a 47% lower risk of death and a 22% lower risk of type 2 diabetes—almost matching the benefit seen at 10,000 steps.

Additionally, significant health improvements were noted when people increased their daily steps from 2,000 to between 5,000 and 7,000.

The researchers say that while 10,000 steps a day can be a good goal for active individuals, 7,000 steps is linked to meaningful health benefits and may be a more achievable target for many. However, while this study was large and comprehensive, its findings should be interpreted with some caution due to limited data and potential biases in the included research. More studies are needed to confirm these results.

How Does This Apply to Real Life?

The idea of reaching 10,000 steps a day can feel daunting—especially if you’re managing a busy schedule, mobility issues or a chronic condition. This new study shows that walking around 7,000 steps a day is enough to lower your risk of heart disease, dementia, depression and early death in a meaningful way.

Even small increases make a difference. Going from 2,000 to 4,000 steps a day—about a 20- to 30-minute walk if you walk 100 steps per minute—can improve your health. And if you’re already walking more than 7,000 steps, keep it up. Staying active continues to pay off, particularly for older adults.

And while the study required the use of pedometers, you don’t need a fancy fitness tracker or a perfect walking routine—and you don’t need to do all your walking at once to see benefits. Try adding a short walk after lunch or dinner, parking farther away from the grocery store or taking your phone calls on the go. The key is consistency—walk every day, whenever you can.

Our Expert Take

You don’t need 10,000 steps a day to see real health gains. This study shows that around 7,000 steps daily can significantly lower your risk of dementia and other health conditions, and you may even live longer. Even small increases matter. Be consistent and walk whenever you can—every step truly makes a difference.

Cholesterol plays a vital role in the body, providing structural support to cells and serving as a building block for hormone synthesis. However, when cholesterol accumulates or is improperly distributed, it can contribute to the development and progression of disease. In a new study, published in Proceedings of the National Academy of Sciences, Yale School of Medicine (YSM) researchers showed that excess cholesterol stored in the liver can directly drive fibrosis in the context of metabolic disease.

Led by Gerald I. Shulman, MD, PhD, the study aimed to identify key molecular triggers of metabolic dysfunction–associated steatohepatitis (MASH), a progressive liver disease marked by fat accumulation, inflammation, and fibrosis. According to Shulman, George R. Cowgill Professor of Medicine (Endocrinology) and professor of cellular and molecular physiology at YSM, understanding the drivers of fibrosis is critical to improving outcomes for patients with MASH.

“Once fibrosis develops, it becomes very difficult to reverse and may ultimately progress to end-stage liver disease,” he says.

Interestingly, says Shulman, it wasn’t the total amount of cholesterol in the liver that mattered most, but rather where it was stored. Specifically, cholesterol accumulated within liver fat droplets emerged as a key driver of liver inflammation and fibrosis.

“It’s not just how much cholesterol is present, it’s about where it ends up,” says Shulman. “In this case, it was the cholesterol in the lipid droplets that triggers the damage. When it comes to lipids and liver disease, it’s all about location.”

The number of medications a patient is taking can serve as a strong predictive marker for patient outcomes in lymphoma, chronic lymphocytic leukemia (CLL), and multiple myeloma (MM), a new report suggests.

The study was based on the premise that the number of medications a patient is taking is a good—and possibly superior—proxy for their comorbidity burden. It was published in the journal HemaSphere.¹

Corresponding author Christian Brieghel, MD, PhD, of the Danish Cancer Institute, and colleagues, explained the comorbidities are common in older patients and often act as a limiting factor for treatment options. The Charlson Comorbidity Index is a widely used and well-validated method of assessing comorbidity in cases of cancer and other diseases, they added.

Yet, Brieghel and colleagues said incorporating a patient’s prescription medication information into comorbidity analyses might help refine comorbidity assessment in cases “where the indication for a medication is narrow and specific for the underlying medical condition (e.g., antidiabetics for type 2 diabetes and antimicrobials against infections).” Routine biochemistry can also help refine the prognostic impact of comorbidity burden, they said.

One way to use prescription medications to characterize comorbidities is to note polypharmacy status. The term “polypharmacy” generally refers to patients who are taking 5 or more different medications at the same time. Previous research suggests those patients are exposed to greater risks of mortality, adverse drug reactions, and longer hospitalizations, Brieghel and colleagues noted.²

In the new study, Brieghel and colleagues decided to assess the prognostic value of a patient’s prescriptions or polypharmacy per se as a proxy for multimorbidity in lymphoid cancers.¹ They gathered a prediagnostic one-year medication history from the Danish prescription registry for 46,803 newly diagnosed patients with either lymphoma, CLL, or MM. They said Denmark is an ideal venue for such an analysis because very few drugs are available without a prescription in the country.

Patients’ prescriptions were analyzed based on drug class, polypharmacy, and total number of prescription medications. Those data were compared against overall survival (OS), hospitalization, and severe infection rates, and then the results were adjusted for age, sex, and other confounding factors.

They found that polypharmacy was associated with worse outcomes, including a hazard ratio (HR) of 1.4 for OS, hospitalization, and severe infection (P < .001).

In addition, the investigators found that the more medications a patient was taking at diagnosis, the worse their outcomes. Patients taking 0 to 3 medications had an HR for OS of 1.0, while patients taking 4 to 7 medications had an HR of 1.2, those taking 8 to 11 medications had an HR of 1.4, and those taking more than 11 medications had an HR of 1.9. A similar pattern held true for hospitalization and severe infection.

Brieghel and colleagues also found that the classes of drugs patients took also had prognostic significance. For instance, immunostimulants and blood substitutes had a significant negative impact on OS, while gynecologicals and sex hormones were associated with favorable outcomes. The former group are likely to be people who had started supportive therapy prior to their cancer diagnosis, while the latter patients were more likely to be young and female, they noted. When adjusted for age and sex, sex hormones still had a positive prognostic value for OS, they said.

“Taken together, these results indicate that patients being prescribed certain medications most likely represent patient selection as the key factor of outcome rather than a causal effect of the medication itself,” the authors said, though they added that their study was not designed to report causality.

The investigators also found that, in patients with Hodgkin lymphoma, mantle cell lymphoma, and MM, the time to next treatment shrank with each additional medication.

They concluded that the number of medications a patient is taking can serve as a strong independent prognostic indicator and “should be considered a key baseline characteristic in randomized clinical trials and in clinical practice for LC (lymphoid cancer) patients.”

References

1. Brieghel C, Lacoppidan T, Packness E, et al. Polypharmacy independently predicts survival, hospitalization, and infections in patients with lymphoid cancer. Hemasphere. 2025;9(7):e70172. doi:10.1002/hem3.70172

2. Li Y, Zhang X, Yang L, et al. Association between polypharmacy and mortality in the older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2022;100:104630. doi:10.1016/j.archger.2022.104630

The investigation of severe pertussis in children has become a major research focus both domestically and internationally, with a consensus that severe cases are predominantly concentrated among infants, especially those aged ≤ 3 months [17]. Our study also demonstrated a higher proportion of infants ≤ 3 months in the severe group, with statistically significant differences. In terms of geographical distribution, 55% of children with severe pertussis in our study resided in rural areas, which is significantly higher than in the general group. This is likely related to lower vaccination rates, insufficient medical resources, and difficulties in controlling transmission in rural areas. A study from South Africa found that pertussis incidence in rural communities (0.21 per 100 person-weeks) was 2.3 times higher than in urban areas, which matches our findings [18].

Prematurity is a well-known predictor of severe pertussis and pertussis-related death in children [19, 20]. Our study found that preterm infants were more common in the severe group compared to the general group, and this factor had the highest predictive value in the Nomogram model. This is primarily due to the underdeveloped respiratory and immune systems of preterm infants. Specifically, the insufficient secretion of IFN-γ by CD4⁺ T cells and impaired antigen-presenting function of dendritic cells (DCs) in preterm infants further increase their susceptibility and severity of pertussis. A study on maternal pertussis vaccination and neonatal pertussis antibody concentrations showed that vaccination with Tdap during the third trimester of pregnancy was associated with higher neonatal pertussis toxin antibody concentrations compared to unvaccinated mothers [21]. In China, it is recommended that pregnant women receive pertussis vaccination between 26 and 34 weeks of gestation. Therefore, preterm infants who are delivered early may have lower levels of maternal IgG antibodies transferred through the placenta compared to full-term infants, thus increasing their susceptibility and severity of pertussis. Further research is anticipated in this area.

Pertussis vaccines can be categorized into whole-cell pertussis vaccine (wP) and acellular pertussis vaccine (aP). Currently, there is a significant variation in pertussis vaccination strategies across different countries. Since January 1, 2025, China has implemented a new immunization schedule nationwide, which includes administering a dose of acellular pertussis vaccine at 2, 4, 6, 18 months, and 6 years of age [22]. Timely and complete vaccination against pertussis remains the most specific and effective measure to reduce the incidence of severe pertussis in children. A single-center retrospective study of 967 pertussis cases over an 8-year period in Beijing, China, showed that not receiving pertussis vaccination was an independent risk factor for severe pertussis (OR = 0.229, 95% CI: 0.071–0.736, P = 0.013) [23]. Our study also confirmed that incomplete pertussis vaccination is an independent risk factor for severe pertussis with good predictive value in the prediction model.

Leukocytosis is a characteristic manifestation of pertussis, primarily caused by pertussis toxin (PT) [24]. A significant increase in white blood cell (WBC) count is associated with pulmonary hypertension, and autopsy results have shown leukemic thrombi in the pulmonary vessels of children with pertussis [25]. In our study, one patient had a WBC count as high as 117 × 10⁹/L and had a poor prognosis. High WBC counts are closely related to rapid disease progression and increased mortality risk. However, there is variation among studies in the definition of leukocytosis [26,27,28]. In this study, a WBC count > 30 × 10⁹/L was used as the cutoff value for predicting severe pertussis, and it was identified as an independent risk factor for severe pertussis in children.

In our study, the serum levels of IgA, IgG, and complement C3 were significantly lower in the severe group compared to the mild group, suggesting that children with severe pertussis may have impaired humoral immune function. Kurvers et al. reported two monozygotic twins with congenital C3 deficiency who developed severe pertussis, further highlighting the need to be vigilant for severe pertussis in children with significantly weakened humoral immunity [29].

Lymphocyte subsets, as important indicators of immune response, play an indispensable role in the occurrence and development of severe pertussis. The commonly tested lymphocyte subsets include T lymphocytes (CD3⁺), B cells (CD19⁺), and NK cells (CD16/56⁺). T cells are further divided into two subsets: helper T cells (CD4⁺) and cytotoxic T cells (CD8⁺) [30]. Our study found that the absolute values of CD3⁺, CD4⁺, CD8⁺, CD19⁺, and CD16/56⁺ cells were significantly higher in the severe group than in the mild group, and the counts of CD3⁺, CD4⁺, and CD19⁺ cells were identified as risk factors for severe pertussis. Currently, there is considerable attention on Th1/Th17 cells in the immune response to pertussis. Th1/Th17 cells, important subsets of CD4⁺ cells, induce Th1 cell polarization and IL-23 expression upon exposure to Bordetella pertussis, leading to the proliferation of Th17 cells. The secretion of IL-17 by these cells is involved in the pathogenesis of prolonged spasmodic cough and severe pertussis [12, 31]. In our study, the increased CD4⁺ cell count in the severe group may suggest an elevated presence of Th17 cells, although this remains speculative and warrants further investigation. It is important to note that our findings are associative in nature, and additional research is needed to establish a direct link between Th17 cells and severe pertussis in humans. Furthermore, CD16/56⁺ cells are core cells of the innate immune system, and their deficiency can lead to severe disseminated pertussis infection [32]. An animal study by Ashley E et al. showed that neonatal mice infected with Bordetella pertussis had immature NK cell phenotypes in their lungs, with no upregulation of the IFN-γ-inducing cytokine IL-12p70, resulting in insufficient IFN-γ release and subsequent widespread bacterial dissemination [33]. This suggests that infant pertussis may resemble severe pertussis in NK cell-deficient neonatal mice. Although the number of CD16/56⁺ cells was significantly higher in the severe group in our study, their function may be impaired, which also requires further investigation. Additionally, our study found no significant differences in the ratios of CD3⁺, CD4⁺, CD8⁺, CD19⁺, and CD4⁺/CD8⁺ between the two groups, indicating that immune imbalance may be more dependent on absolute lymphocyte counts rather than proportions. While our study suggests a correlation between elevated CD4⁺ cell counts and the severity of pertussis, we acknowledge that definitive evidence linking Th17 cells to the pathogenesis of severe pertussis is not yet provided. The findings presented here are primarily associative and require further validation in future studies. Existing literature, largely based on animal models, has highlighted a potential role for Th17 cells in respiratory infections, but further research is needed to substantiate their involvement in human pertussis cases.

Our study has constructed a prediction model for severe pertussis based on peripheral blood lymphocyte subsets, with a C-index of 0.899, which is significantly better than traditional clinical indicators. Furthermore, the nomogram offers a straightforward and practical tool for risk assessment, facilitating more informed decision-making and efficient resource allocation. Ultimately, the model enables clinicians to identify high-risk children at an early stage, allowing for timely interventions such as the early administration of immunoglobulin, mechanical ventilation, and, in more severe cases, extracorporeal membrane oxygenation (ECMO) or exchange transfusion. These early interventions are crucial for the diagnosis and management of severe pertussis in children, as well as for preventing serious complications, including pertussis encephalopathy and pulmonary hypertension.

Regarding sample size, our model includes six predictive variables, and with 40 severe cases, it meets the events-per-variable (EPV) guideline of 5–10 events per variable for model development. Additionally, we conducted a precise sample size calculation using the “sampleSize” method in R, as described by Riley et al. [34]. Based on an expected R² of 0.2, six predictors, and an outcome prevalence of 10–15% [35], a total sample size of approximately 239 was deemed sufficient; our current sample size meets this requirement. However, several limitations should be noted: (1) The single-center retrospective design and small sample size may lead to selection bias, and we agree that larger, multicenter studies are needed to enhance model robustness; (2) We did not measure the direct association between Bordetella pertussis bacterial load and immune function or cytokines; (3) We did not assess the impact of different genotypes of Bordetella pertussis on the severity of severe pertussis in children. Future research will focus on multicenter, large-sample prospective studies, combined with single-cell sequencing technology to elucidate the dynamic changes in peripheral blood cell subsets and cytokines, and further validate the generalizability of the model.

New study findings published in JAMA Network Open demonstrate that individuals with type 2 diabetes (T2D) had significantly worse financial outcomes compared to individuals without diabetes. Determined by 7 financial outcomes that were studied, individuals with T2D were more likely to have below-prime credit scores, medical and non-medical debt in collections, 60-plus-day debt, debt charge-offs, bankruptcy filings, and foreclosure, emphasizing a greater financial burden compared to other patients.^1,2

“Our data point to substantial financial hardships for patients with type 2 diabetes and help explain why so many ration medicine and don’t follow the health care recommendations that could help them control their disease,” Joshua Joseph, co-author and associate professor of endocrinology, diabetes, and metabolism at Ohio State, said in a news release.²

Diabetes and Financial Strain

Diabetes significantly impacts financial well-being, with 20% to 25% of adults rationing insulin and 30% rationing other supplies, according to study authors. This leads to medication nonadherence, increasing risks of delayed medical care, food insecurity, hospitalizations, and mortality. Although the financial burdens are known, their specific impact on financial outcomes is not widely understood. To further assess these financial outcomes, researchers conducted a study that aimed to link patient electronic health records with commercial credit and government age data for over 4 years. The study authors noted that this research will also explore the relationship between the prevalence of T2D and financial indicators.^1,2

Greater Financial Burden in Patients With T2D

In the economic evaluation study, researchers analyzed electronic health records linked to credit records and employment information of adults aged 18 years or older with at least 1 medical encounter at a primary care health center in Ohio between October 1, 2017, and December 31, 2021. To be included in the analysis, individuals needed a reported glycated hemoglobin (HbA_1c) value, a diagnostic code for T2D, or a prescription for antidiabetic medications.¹

A total of 166,285 patient data were used in the study, with a mean age of 52.3 years, with 55.0% being female and 45.0% male. The racial breakdown was 0.2% American Indian/Alaska Native/Native Hawaiian/Pacific Islander, 3.5% Asian, 19.1% Black, and 73.2% White, with 0.8% identifying as multiracial. Of the total participants, 69,371 had a diagnosis of T2D.^1,2

To determine the financial burden, researchers compared the 41.7% of individuals with T2D to individuals without diabetes that was determined through a blood test. In the analyzed group, 50.8% had no earned income, and 32.6% were covered by Medicare. Individuals with diabetes were, on average, older and less frequently female or of Hispanic ethnicity. However, a higher percentage of individuals with diabetes were Black race. Additionally, individuals with diabetes were also more likely to have no wage earnings at baseline (65.1% vs 40.6%), and for those who did have earnings, the average earnings were lower ($11,477 vs $15,400).^1,2

“Finances are a major challenge for many of the patients I treat, so much so that we are asking them questions around what we call the social determinants of health in our patient visits,” Joseph said in a news release.²

The findings suggest that individuals with T2D may experience more adverse financial outcomes compared with individuals without diabetes, highlighting the need for pharmacists and health care providers to consider when treating individuals with T2D.^1,2

“Our results really speak to the importance of screening diabetes patients for finances and debt issues,” Joseph said in the news release. “But beyond screening, we also need to ensure they have access to resources in the community that can help them to ultimately improve their financial situations. It is critical for their health and well-being.”

REFERENCES

1. Pesavento M, Loibl C, Moulton S, et al. Type 2 Diabetes and Financial Outcomes. JAMA Netw Open. 2025;8(7):e2523453. doi:10.1001/jamanetworkopen.2025.23453

2. A financial toll on patients with type 2 diabetes. EuerkAlert!. News release. July 28, 2025. Accessed July 29, 2025. https://www.eurekalert.org/news-releases/1092484

MONTREAL, Canada—Whether a patient undergoes coronary artery calcium (CAC) screening depends on the type of doctor they see, with large sex differences observed over the past decade at a single healthcare system, according to retrospective data.

From 2013 to 2023, researchers led by Ato Howard, MD (University of Pittsburgh Medical Center, PA), found that higher-risk female patients were more often referred for a CAC scan when they saw a cardiologist compared with a generalist—defined as a physician who practices community medicine, family medicine, geriatrics, or internal medicine. Additionally, they showed that generalists ordered scans for lower-risk patients regardless of sex compared with cardiologists, but male patients had a lower risk than females who were scanned.

The differences observed between physician types are not unexpected, Howard told TCTMD, as cardiologists would be more likely to keep up with clinical guidelines, which changed in 2019. In the US, measuring CAC is recommended (class IIa) as a noninvasive screening tool for patients at intermediate risk when there is uncertainty about starting statin therapy.

“You would expect cardiologists to at least be more familiar with the cardiology guidelines and also be more familiar with the fact that patients can have traditional and nontraditional risk factors,” he said. “You would expect them to be ordering the studies on the patients who are not necessarily at the highest risk because already they’re high risk and so they already should be treated and not necessarily need further risk stratification.”

A CAC scan is helpful for identifying patients at risk for atherosclerotic cardiovascular disease (ASCVD) who might be “missed” by those traditional risk factors, Howard continued. The findings “made us feel good about ourselves, that we saw that cardiologists were ordering them more for women. In our population of patients, the women tended to have higher risk factor markers for atherosclerotic disease.”

The retrospective study, which was presented recently at the 2025 Society of Cardiovascular Computed Tomography (SCCT) meeting, included 9,868 patients (mean age 60 years; 50.6% female) who underwent CAC scanning at a large healthcare system between 2013 and 2023.

About one-third of patients were referred by cardiologists and the remaining two-thirds by generalists. Female patients were older than males on average (62 vs 58 years) and were at greater risk for ASCVD as measured by a risk-enhancing score that was based on age and several other risk factors and comorbidities (2.22 vs 2.03; P < 0.001 for both).

In our population of patients, the women tended to have higher risk factor markers for atherosclerotic disease. Ato Howard

Importantly, use of CAC scans increased steadily throughout the study for both sexes and type of referring physicians, with a slowed annual growth observed between 2017 and 2021 and an inflection point thereafter likely caused by a surge of patients being seen following the change in guidelines, increased reimbursement, and the end of the COVID-19 lockdown protocols, Howard said.

Cardiologists overall referred higher-risk patients for CAC scanning compared with generalists (2.31 vs 2.02; P < 0.001). Women remained higher risk than men regardless of whether they were referred by a cardiologist (2.35 vs 2.25; P = 0.04) or generalist (2.13 vs 1.93; P < 0.001).

The reasons why physicians in the study made the referrals remain unclear, according to Howard. “I think it showed us that cardiologists are actually maybe using the coronary artery calcium study in a way that maybe they’re looking for patients who generally would be missed more often than not,” he said. It’s possible some female-specific risk factors like pregnancy and timing of menopause, which were unaccounted for, might have led to differences in referrals, he added.

“At least for now, we’re able to identify that there is some signal that there’s a difference in the ordering patterns between providers, and especially if they’re either a cardiologist or not a cardiologist,” Howard continued.

He said he’d like to see similar data from other centers to see how they compare. Ultimately, “it goes to show at least how we should be approaching our patients—always trying to think about how a test can be helpful for people and also trying to think about what the test is going provide from an information standpoint to help us make a decision,” he concluded. “Theoretically, we could be making a difference by testing the patients who are actually going to benefit from it if we’re able to find something that they can be treated for.”