Luana Fiengo Tanaka

Background: The assessment of daily-life physical activity (DLPA) using wearables in patients with pulmonary hypertension (PH) can provide information on real-world function, potentially enhancing the evaluation of disease progression. Research Question: What is the existing evidence on sensor-based DLPA assessment in patients with PH and its quality? Study Design and Methods: We searched MEDLINE and Embase from inception to January 13, 2026, extracting data on devices, DLPA outcomes, and associations with clinical outcomes. We obtained pooled estimates through random-effects models and assessed evidence quality using a customized tool. Results: We identified 33 studies (29 adult, 4 pediatric) including 1,257 patients mainly with pulmonary arterial hypertension (PAH), followed by chronic thromboembolic PH (CTEPH), and only rarely with PH due to lung diseases and/or hypoxia. Participants were predominantly female, WHO functional class II-III. Most studies investigated step count and time spent in different physical activity levels, but showed substantial heterogeneity in devices and their utilization. The meta-estimate was 4,811 daily steps. A moderate positive correlation was found between daily step count and six-minute walking distance (6MWD) (r=0.59, 95%CI 0.47-0.69); a weak positive correlation was found between time spent in moderate-to-vigorous physical activity and 6MWD (r=0.38; 95% CI 0.26-0.49). Inconsistent wear-time definition, non-wear reporting and temporal misalignment of DLPA may compromise validity and comparability. Interpretation: Wearable-based DLPA assessment in PH is feasible, though high-quality evidence remains scarce. Future research should standardize procedures, terminology, and reporting of DLPA outcomes. Concordance with established measures such as the 6MWD, and their ability to predict clinical outcomes and disease progression need to be demonstrated.

Introduction: More than half of global cervical cancer cases occur among women older than 50. However, global estimates regarding the human papillomavirus (HPV) prevalence among this population are lacking, especially for women with abnormal cytology. Therefore, we conducted a systematic review and meta-analysis to estimate the worldwide HPV prevalence in women aged 50 and older with abnormal cytology. Methods: We searched PubMed, Scopus and Web of Science for quantitative studies reporting any or high-risk (HR)-HPV prevalence for women 50 years and older with abnormal cytology (atypical squamous cells of undetermined significance and higher). We extracted data on world region, subregion, cervical lesion type, recruitment setting, HPV test, year of study conduct and HPV prevalence from the included studies. We assessed the risk of bias of the included studies using a modified Newcastle-Ottawa scale. We estimated the pooled prevalence and 95% CIs of any-HPV and HR-HPV using random-effects models, considering the world regions. Additionally, we estimated the prevalence by HPV type, lesion type and age groups. Results: Overall, 113 studies met the inclusion criteria, of which 104 were included in the meta-analysis. Among women aged 50 and older with abnormal cytology, the estimated global pooled prevalence of any-HPV from 53 studies, including 14 585 women, was 54.5% (95%CI, 46.0 to 62.8%), and the HR-HPV prevalence from 85 studies, covering 33 672 women, was 43.0% (95%CI, 36.6 to 49.5%). There was a higher HR-HPV prevalence among women with high-grade lesions and women living in the African continent. No major differences in HR-HPV prevalence between the age groups of women over 50 years were found. The most common single HPV types worldwide were 16 and 52, with pooled prevalence estimates of 12.0% (95%CI, 8.0% to 17.7%) and 8.4% (95%CI, 4.4% to 15.4%), respectively. Conclusion: Our findings highlight the relevance of targeted screening interventions among women 50 years and older. To achieve the elimination of cervical cancer, age-inclusive screening strategies should be considered. PROSPERO registration number: CRD42021241365.

Background: Lung cancer (LC) survivors are at increased risk for developing a second primary cancer (SPC) compared to the general population. While this risk is particularly high for smoking-related SPCs, the published standardized incidence ratio (SIR) for lung cancer after lung cancer is unexpectedly low in countries that follow international multiple primary (IARC/IACR MP) rules when compared to the USA, where distinct rules are employed. IARC/IACR rules rely on histology-dependent documentation of SPC with the same location as the first cancer and only classify an SPC when tumors present different histology. Thus, SIR might be underestimated in cancer registries using these rules. This study aims to assess whether using histology-specific reference rates for calculating SIR improves risk estimates for second primary lung cancer (SPLC) in LC survivors.Methods: We (i) use the distribution of histologic subtypes of LC in population-based cancer registry data of 11 regional cancer registries from Germany to present evidence that the conventional SIR metric underestimates the actual risk for SPLC in LC survivors in registries that use IARC/IACR MP rules, (ii) present updated risk estimates for SPLC in Germany using a novel method to calculate histological subtype-specific SIRs, and (iii) validate this new method using US SEER (Surveillance, Epidemiology, and End Results Program) data, where different MP rules are applied.Results: The adjusted relative risk for lung cancer survivors in Germany to develop an SPLC was 2.98 (95% CI 2.53–3.49) for females and 1.15 (95% CI 1.03–1.27) for males using the novel histology-specific SIR. When using IARC/IACR MP rules, the conventional SIR underestimates the actual risk for SPLC in LC survivors by approximately 30% for both sexes.Conclusions: Our proposed histology-specific method makes the SIR metric more robust against MP rules and, thus, more suitable for cross-country comparisons.

Aims/hypothesis: The aim of the study is to describe the time trend of type 2 diabetes incidence in the largest state of Germany, Bavaria, from 2012 to 2021, and to compare the incidence rates during the pandemic period (2020–2021) to the pre-pandemic period (2012–2019). Methods: This secondary data analysis uses health claims data provided by the Bavarian Association of Statutory Health Insurance Physicians (KVB), covering approximately 11 million insurees, accounting for 85% of the total population of Bavaria, Germany. Newly diagnosed type 2 diabetes cases in adults (≥20 years) coded as E11 (Diabetes mellitus, Type 2) or E14 (Unspecified diabetes mellitus) under ICD-10, German modification (ICD-10-GM) for the study period 2012 to 2021 were included. Annual and quarterly age-standardised incidence rates (ASIR) stratified by sex, age and region were calculated using the European standard population. Sex-specific crude incidence rates (CIR) were calculated using 10-year age groups. Regression analyses adjusted for time trends, seasonal effects, and pandemic effects were used to analyse the incidence trend and to assess the effect of the pandemic. Results: Overall, 745,861 new cases of type 2 diabetes were diagnosed between 2012 and 2021: 50.4% (376,193 cases) in women. The male/female ratio remained stable over the observation period, while the median age at diagnosis decreased from 62 to 59 years in men and from 66 years to 61 years in women. ASIR were consistently higher for men compared with women, with the yearly difference remaining stable over time (2012: 18%; 2021: 20%). An overall decreasing trend in ASIR was observed during the study period, with a strong decrease from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021 for both sexes. For men, ASIR decreased from 1514 per 100,000 person-years in 2012 to 995 per 100,000 person-years in 2021 (4.6% average annual reduction), and for women from 1238 per 100,000 person-years in 2012 to 796 per 100,000 person-years in 2021 (4.8% average annual reduction). This downward trend was also observed for age groups above 50 years. Regression analyses showed no significant change in incidence rates during the pandemic period (2020 and 2021) compared with the pre-pandemic period. Conclusions/interpretation: For the first time, a 10-year incidence trend of type 2 diabetes is reported for Germany, showing a strong decline from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021. The incidence trend of type 2 diabetes appears not to have been affected by the first 2 years of the COVID-19 pandemic. Despite an overall increasing prevalence, the incidence is decreasing, potentially resulting from robust screening by family physicians, reducing the median age at diagnosis by 3 to 5 years. However, further investigation is needed to fully identify the reasons for the declining incidence trend. Continued incidence monitoring is necessary to identify the long-term trend and the potential effect of the pandemic on diagnoses of type 2 diabetes. Graphical

Background: Women’s empowerment is an important factor for HIV prevention, but the association with HIV-related indicators has never been quantified. In this study, we examined the association between women’s empowerment and selected HIV-related indicators. Methods: We used the latest Demographic and Health Surveys that included HIV testing among other biomarkers of 31 countries in sub-Saharan Africa. Empowerment was measured by the Survey-based Women’s EmPowERment (SWPER) index and was compared to the HIV-related indicators: HIV status, HIV testing (ever and in the past 12 months), condom use at last high-risk sex, the ability to ask the partner to use a condom, and the ability to refuse sex. Results: 208,947 women were included in the analysis, of whom 100,924 (48%) were considered highly empowered and 21,933 (10%) as lowly empowered. There was no association between empowerment and HIV status (OR = 1.12, 95% confidence interval [CI] 0.98–1.28). Highly empowered women were more likely to have ever been tested for HIV (OR = 1.67, 95% CI 1.60–1.74) but less likely to have been tested for HIV in the past 12 months (OR = 0.92, 95%CI 0.88–0.96). Highly empowered women were more commonly able to ask the partner to use a condom (OR = 1.69, 95% CI 1.63–1.75) and to refuse sex (OR = 1.78, 95%CI 1.72–1.85). Conclusions: Women’s empowerment does not seem to be linked to HIV status, but it is strongly associated with a woman’s ability to make decisions about their sexual behavior. Empowering women and young girls has the potential to contribute toward achieving the United Nations’ goal of ending AIDS by 2030.

Objective: The study aimed to evaluate the risk of maternal death and fetal death among pregnant women infected with SARS-CoV-2. Methods: This is a retrospective cohort study among pregnant women with secondary data from the National Live Births System (Sistema Nacional de Nascidos Vivos), National Mortality System (Sistema Nacional de Mortalidade), and e-SUS Health Surveillance System (Sistema e-SUS Vigilância em Saúde). Pregnant women confirmed for COVID-19 had positive RT-PCR between March 2020 and May 2021, pregnant women without COVID-19 were those without notification for disease. Maternal death, fetal death, and stillbirth were assessed as primary outcomes. Results: We included 68,673 pregnant women not notified as suspected of COVID-19 and 1,386 with a confirmed diagnosis of COVID-19. Among pregnant women with COVID-19, 1013 (73.0%) were aged 20 to 34 years, 655 (47.2%) were brown, 907 (65.4%) had ≥ 8 years of education, in the third trimester of pregnancy (41.5%), undergoing cesarean section (64.5%). In adjusted analyses, COVID-19 in pregnancy had a higher risk of maternal death (relative risk [RR] 18.73–95% confidence interval [95%CI] 11.07–31.69), fetal death/stillbirth (RR 1.96–95%CI 1.18–3.25), preterm birth [RR 1.18–95%CI 1.01–1.39], cesarean delivery (RR 1.07–95%CI 1.02–1.11), and cesarean delivery occurring before the onset of labor (RR 1.33–95%CI 1.23–1.44). Conclusion: COVID-19 may contribute to unfavorable pregnancy outcomes. Results showed that pregnant women infected with SARS-CoV-2 had a higher risk of maternal death, fetal death/stillbirth, preterm birth, cesarean delivery, and cesarean section occurring before the onset of labor.

Background: Cervical cancer (CC) screening is generally recommended until age 65. The incidence of CC could be underestimated, particularly in older women, due to a lack of hysterectomy correction. Furthermore, elderly women (≥65 years) are more often diagnosed with late‐stage disease and have worse outcomes than younger patients. This study aims to provide an in‐depth overview of CC in Germany.Methods: Incidence rates of CC (ICD‐10 C53) were determined using data from the German Centre of Cancer Registry data (ZfKD) of six federal state registries. Incidence was corrected by using hysterectomy prevalence values from a real‐world study. The distribution of treatment modalities (surgery, chemotherapy, radiation therapy) was assessed. Relative survival was calculated using the period approach (2011–2015). Survival was stratified by tumor (T) stage and histological type.Results: In total, 14,528 CC cases were included, 27.6% of which occurred in elderly women. Cumulative (2001–2015) age‐standardized incidence rates were 12.5 per 100,000 women without hysterectomy correction and 15.5 per 100,000 women after hysterectomy correction (+24% relative change). A lower proportion of elderly women were treated, especially in advanced tumor stages. Younger women (20–64 years) had a higher 5‐year relative survival compared to elderly women: 76.7% versus 46.9%, respectively. Survival was worse with increasing stage and for glandular histological subgroups, particularly among elderly women.Conclusions: CC incidence in elderly women is underestimated and survival is lower compared to younger women in Germany. Due to the high disease burden in elderly women, screening and treatment strategies need to be improved.