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Assessing health and social care needs of chronic patients in rural areas: Protocol for the CAMP mixed-methods observational study

Chronic diseases remain one of the most pressing public health challenges in Europe, disproportionately affecting older adults and residents of rural and underserved areas. Structural barriers to healthcare access, insufficient social support networks, and fragmented service delivery models amplify health disparities in these communities. In response, proximity-based and integrated care models have emerged as promising strategies, especially under national initiatives such as Italy’s National Recovery and Resilience Plan (PNRR). The CAMP (Chronic health Assessment and Mapping of Proximity needs) study is a cross-sectional, observational, non-interventional protocol designed to identify and characterize the unmet health and social care needs of adults living with chronic conditions in rural areas of Southern Italy. Using a mixed-methods approach, the study integrates standardized quantitative tools—the SF-36, EQ-5D, Barthel Index, and MSPSS—with semi-structured interviews to assess quality of life, functional autonomy, access barriers, and perceived social support. The study population includes adults aged ≥18 years with at least one chronic condition, recruited through general practitioners and social services. Descriptive and multivariate analyses will be used to explore associations between clinical and social variables, while thematic analysis will be applied to qualitative data. Expected outcomes include a comprehensive mapping of service gaps and resource distribution, as well as feasibility assessments for implementing community hospitals and telemedicine models. The findings will inform evidence-based territorial health planning and contribute to shaping more equitable and integrated care strategies for vulnerable populations. This protocol was preregistered on the Open Science Framework on May 26, 2025 (DOI: https://doi.org/10.17605/OSF.IO/YHD87 ).

Mapping the state-of-the-art of the barriers for personalized preventive approaches worldwide: A scoping review of reviews

Introduction The growing prevalence of chronic diseases globally raised the public health need to improve the effectiveness of preventive medicine through the integration of big data, biological biomarkers and omics technologies. The implementation of personalized preventive approaches in real-world settings is constrained by several barriers. This scoping review aimed to map the barriers hindering the adoption of personalized preventive approaches for chronic diseases in health systems. Materials and Methods PubMed, Web of Science, Scopus and gray literature sources were consulted from 2017 to 2024, to collect reviews on personalized preventive approaches implementation’s barriers. Additionally, we conducted a thematic analysis in order to categorize the identified barriers. The review followed Arksey-O’Malley guidelines and PRISMA-ScR checklist, Results 283 barriers were extracted from 37 reviews, and categorized into six main domains, namely “Research” (30 reviews), “Organizational Aspects” (27 reviews), “Healthcare Professionals” (28 reviews), “Ethical, Legal, and Social Issues” (29 reviews), “Public” (24 reviews), and “Financial concerns” (23 reviews). The research domain was characterized by lack of generalizability, clinical efficacy and cost effectiveness evidence. Organizational barriers included operational inefficiencies and unclear implementation frameworks. Healthcare professionals struggle with insufficient personalized prevention literacy. Ethical concerns, data privacy issues, and health inequities represent a burden to deal with for actual translation into practice, as well as the general mistrust of individuals and inadequate financial mechanisms, Conclusions Our findings showed how several factors threaten the progress of many innovations in the field of personalized prevention across different populations and chronic diseases, highlighting the need for further efforts in personalized preventive approaches implementation.

HPV testing in cervical cancer formalin-fixed paraffin embedded tissues: Reliability of the Xpert HPV test and high-risk HPV genotypes distribution in Tunisia

Objectives This study aims to assess the performance of the Xpert HPV test for the detection and genotyping of high-risk HPVs (HR-HPV) on FFPE cervical cancer (CC) tissues and to determine the distribution of HR-HPV genotypes in a CC Tunisian series. Methods The Xpert HPV test was conducted on purified DNA from 134 FFPE CC tissues. A single-tube multiplex polymerase chain reaction (PCR) served as a comparator assay to evaluate Xpert HPV performance in detecting and genotyping HR-HPVs. Discordant cases were tested using uniplex PCR. Results The Xpert HPV test generated valid results in 131/134 (97.8%) samples. Sensitivity, specificity, positive and negative predictive values of Xpert HPV for HR-HPV detection among valid samples were 99.16%, 100%, 100%, and 92.31%, respectively. Agreement between Xpert HPV and multiplex PCR for HPV detection was observed in 131/134 cases (97.8%), with a kappa value of 0.892. Agreement between Xpert HPV and Multiplex PCR for HR-HPV genotyping was 96.6%. Combining assays results and after confirmation with uniplex PCR, HR-HPVs were detected in 119/134 (88.8%) samples and 11 HR-HPV genotypes were detected with a predominance of HPV 16 (71%), followed by HPV 31 (8%) and HPV 18 (5%). Conclusion This study demonstrated a high accuracy of the Xpert-HPV test for HR-HPVs detection and genotyping in FFPE CC tissues and revealed a distinct distribution of HR-HPVs in Tunisia.

Evaluating the Cauchy combination test for count data

The Cauchy combination test (CCT) is a p -value combination method used in multiple-hypothesis testing and is robust under dependence structures. This study aims to evaluate the CCT for independent and correlated count data where the individual p -values are derived from tests based on normal approximation to the negative binomial distribution. The correlated count data are modelled via copula methods. The CCT performance is evaluated in a simulation study to assess the type 1 error rate and the statistical power, and compare it with existing methods. Our results indicate that the number of combined tests, the negative binomial success parameter, and sample size significantly affect the type 1 error rate of the CCT under independence or moderate correlation. The CCT has more control over managing the type 1 error rate as the strength increases in the Gumbel-Hougaard copula. In general, the choice of copula and the strength of its correlation have a significant influence on type 1 error rates for both the CCT and MinP tests. Our simulation findings support the broader applications of the CCT under multivariate copulas that model upper-tail dependence with higher correlations. This knowledge may have significant implications for practical applications.

Distinguishing the offensive and defensive performances of starters and substitutes between high-level and low-level teams in elite women’s basketball games

The primary goals of this study were to differentiate the offensive and defensive performances of starters and substitutes between high- and low-level teams in elite women’s basketball. This study examined 432 players from 36 women’s basketball teams who competed in the Tokyo Olympics, the 2022 Women’s Basketball World Cup, and the Paris Olympics. The rank-sum ratio was used to quantify and describe offensive and defensive performances of starters and substitutes, while the independent sample t -test, Pearson correlation, and Spearman Rho correlation were employed to test the differences and relationships between the various variables at a 0.05 level of significance. The results indicated that the offensive and defensive performances of both starters ( r   = 0.932) and substitutes ( r   = 0.848) had a significant correlation with the final rankings. Compared to high-level teams, low-level teams showed significant differences in points (p   = 0.017), two-point (p   = 0.015) and three-point (p   = 0.000) shooting percentages, assists (p   = 0.004), and steals (p   = 0.040) for starters, as well as points (p   = 0.033) and defensive rebounding (p   = 0.027) for substitutes. Additionally, both starters and substitutes significantly correlated with points, two-point and three-point shooting percentages, defensive rebounds, and assists ( r   > 0.600).

Knowledge and practice of breast self-examination and associated factors among women with breast cancer in Kabul, Afghanistan

Background Breast cancer is the leading cause of cancer-related mortality among women worldwide, and it has poor prognosis if diagnosed at late stages. Common breast cancer detection methods include mammography, clinical breast exams (CBE), and breast self-examination (BSE). Breast self-examination is the most cost-effective strategy for early detection in low- and middle-income countries. Objective To evaluate the knowledge and practice of breast self-examination, along with associated factors, among women with breast cancer visiting Ali Abad Teaching Hospital in Kabul, Afghanistan in 2025. Methods This cross-sectional study was conducted among 290 Afghan women aged 20–80 who were either currently or previously admitted to the Oncology department of Ali Abad Teaching Hospital for regular follow-ups or treatment. Data was collected using an interviewer-administered questionnaire between January and February 2025. Chi-square tests were conducted to examine the associations between BSE knowledge, BSE practice, and potential explanatory factors. Those that showed significant associations in the bivariate analyses were considered potential confounders and included in multivariable logistics regression analysis. Results The mean age of participants was 42.9 ± 14.7. Majority of the participants were illiterate (83.8%) and unemployed (95.9%). Women with education of secondary level or higher were more likely to practice BSE than those who were illiterate (AOR: 3.65, 95% CI: 1.06–12.76). Participants with good knowledge level were more likely to practice BSE than those who had a poor knowledge of BSE (AOR: 5.28, 95% CI: 2.45–12.48). In addition, women who had heard of BSE were more likely to practice it compared to those who had not (AOR: 4.31, 95% CI: 1.37–19.25). Conclusions In this study, education, knowledge score, and awareness of BSE (i.e., having heard of BSE) were selected as important predictors for practice of BSE via both bivariate and multivariate logistic regression analysis. While about 50% of participants demonstrated good knowledge of BSE, only 18% were practicing it, and among those who did, only about 30% were performing it at the right time and frequency. These findings highlight the importance of educational programs with an aim to increase breast cancer awareness among women in Afghanistan, and to promote breast self-examination as a low-cost, accessible tool for early detection – helping to alleviate cancer burden in the country.

What are the characteristics of people who use nicotine pouches and what types of pouches are being used? Data from an online cross-sectional survey of UK adults

Introduction Use of nicotine pouches is rising but little independent data exist on the types of pouches used by UK adults. This study therefore assesses: (1) demographic characteristics associated with using nicotine pouches; (2) nicotine content, flavours, brands, and frequency of use of nicotine pouches. Methods Online cross-sectional Qualtrics survey of N = 2,967 UK adults (≥18 years) conducted May/June 2024. The sample were drawn from Prolific Academic using quotas (age, biological sex, ethnicity). Measures included demographics, vaping status, smoking status, frequency of nicotine pouch use, and pouch brand, flavour, and nicotine content used most often. Results Overall, 2.9% (n = 85) currently used, and an additional 10.1% (n = 299) had tried, pouches. Ever use declined with age and was most common among males (AOR = 1.80, 95%CI = 1.40–3.31) and those who currently vaped (AOR = 7.19, 4.80–10.75) or smoked (AOR = 5.80, 3.82–8.80). Nicotine pouch use was rare among adults who never smoked (3.0%) or never vaped (2.7%). Among adults who had ever used nicotine pouches (n = 384), half used Nordic Spirit (49.7%), most used mint/menthol flavours (60.7%), the most popular nicotine content was 11–20 mg (34.6%) although many did not know the nicotine content (28.4%), and around a fifth (19.5%) reported using them every day, with an additional fifth (21.9%) a few times a week, and a quarter tried once or twice (25.5%). Conclusions Among UK adults, nicotine pouches were predominantly used by those who currently/formerly smoke or vape and were also most popular among males and younger adults. Mint/menthol and 11–20 mg pouches were most popular and use frequency patterns varied substantially.

Still spurious: A comment on attempts to revive cognitive ability tilts

Ability tilts are within-individual differences between scores on two ability measures, e.g., math – verbal ability. We have shown in a series of reports that correlations between tilts and other variables are spurious consequences of associations to the constituent variables. Recently, Woodley of Menie et al. suggested that findings of incremental validity of tilts, over and above one of the constituent variables, refuted our claims of spuriousness. However, we show here that incremental validity of tilts are spurious consequences of incremental validity of the constituent variables. Moreover, Woodley of Menie et al. presented new results where so-called “tilt super-residuals” were attributable to shared environmental factors and they concluded that this finding confirmed a hypothesis that individuals specialize with respect to cognitive niches as an effort to adapt to stable environmental factors, alternatively do not specialize in the case of an unstable environment. However, we show that variance on “super-residualized” tilts attributable to shared environmental factors is a spurious consequence of adjusting for a variable (e.g., age) that is identical within twin couples. In summary, findings involving ability tilts still appear to be spurious.

Microbial drinking water quality deterioration during distribution and household usage, determined together with citizen scientists

During transport and storage of drinking water the microbial water quality might deteriorate. Here, we studied the vulnerability of non-chlorinated drinking water produced by two treatment plants to deterioration, by involving citizen scientists. Citizen scientists in Amsterdam sampled their drinking water directly from their kitchen tap after overnight stagnation, after flushing and after storage in containers like reusable plastic bottles. Subsequently, prokaryotic cell counts, ATP concentrations and the prokaryotic community composition were determined in the laboratory. The results showed that citizen scientists were able to reliably sample drinking water. The microbiological parameters measured remained stable during drinking water transport in the distribution system, whereas overnight stagnation in the premises plumbing system could result in fluctuations in the microbial biomass parameters and slightly altered the prokaryotic composition. Drinking water storage in containers resulted in a substantially increase in microbial biomass, a decrease in bacterial diversity and a shift in bacterial community composition. Furthermore, sampled drinking water from the distribution system had a specific community composition related to either plant A or B, which could be used to determine the origin of drinking water sampled from mixed zones in the distribution system. Overall, we conclude that stored drinking water is highly susceptible to microbial deterioration. In addition, ATP and flow cytometry cell counts are poor indicators for microbial regrowth in the distribution system and citizen scientists seem able to reliably sample drinking water for microbial analyses.

The High School to University Transition: Exploring the interplay of territory, socioeconomic factors, and gender dynamics

Education inequalities persist globally, particularly in Italy, often influenced by factors beyond student ability. This paper aims to study the pure territory effect on education inequalities controlling for other factors such as gender, socioeconomic status, and high school performance. As in a clinical study, we evaluate the effect of multiple treatments represented by territorial clusters on the students’ enrolment choices. The inverse of propensity score estimates obtained with a gradient-boosted model (GBM) procedure are used as weights of a multinomial logistic regression model to evaluate the probability of enrolling at the university inside or outside their own place of residence. The study highlights the importance of considering the complex interplay between territory and economic variables in explaining inequalities in the transition from high school to university. Especially in northern regions, we show that the territorial effect on mobility choices, was covered by socioeconomic status and previous educational attainment. In the southern regions, the results highlight a more pronounced territorial heterogeneity regarding the choice to move to another region compared to northern regions.

Enhancing healthcare equity by using open-source pediatric medical devices in low resource settings: An exploratory international survey of pediatric clinicians

Children in low-resource settings suffer from a high burden of treatable diseases that could be addressed with contextually appropriate technologies. However, numerous barriers to providing such technology to children in these settings exist. We propose that using open-source medical devices, where any qualified operator can freely make, modify, or distribute a product, may be a viable strategy to increase access to medical therapies in low-resource settings. However, given the novelty of open-source models, we sought to conduct an exploratory global survey on the perspectives and opinions of medical providers on the feasibility of this approach. Among 101 surveys completed by providers representing 34 countries, we found that the majority (89%) of respondents lacked experience working with open-source devices in low-resource settings; many respondents felt comfortable with providing an open-source pediatric medical device in a low-resource setting; lack of funding was the most significant barrier to successfully deploying these technologies; locally identified need was the most important factor to consider when conducting such projects; and respondents from the USA found no ethical issues with implementing open-source devices in low-resource settings, but respondents from outside the USA did find ethical issues with the same work. Our survey shows that most respondents in relevant specialties did not have experience working in either pediatric global health or with open-source medical devices in low-resource settings. Our survey may have revealed a potential unexplored frontier in addressing inequities in health care by enhancing access to equipment and technologies in areas of the world with the highest burdens of treatable pediatric disease, while also identifying ethical and cultural obstacles that warrant consideration.

Characterizing the cognitive and mental health benefits of exercise and video game playing

Two of the most actively studied modifiable lifestyle factors, exercise and video gaming, are regularly touted as easy and effective ways to enhance brain function and/or protect it from age-related decline. However, some critical lingering questions and methodological inconsistencies leave it unclear what aspects of brain health are affected by exercise and video gaming. In this cross-sectional global online study, we recruited over 1000 people and collected data about participants’ physical activity levels, time spent playing video games, mental health, and cognitive performance using tests of short-term memory, verbal abilities, and reasoning skills from the Creyos battery. The amount of regular physical activity was not significantly related to any measure of cognitive performance; however, more physical activity was associated with better mental health as indexed using the Patient Health Questionnaire (PHQ-2) and Generalized Anxiety Disorder (GAD-2) screeners for depression and anxiety. Conversely, we found that more time spent playing video games was associated with better cognitive performance but was unrelated to mental health. We conclude that exercise and video gaming have differential effects on the brain, which may help individuals tailor their lifestyle choices to promote mental and cognitive health, respectively, across the lifespan.

Trends in alcohol consumption in middle-aged and older adults, assessed with self-report and the alcohol marker phosphatidylethanol – A longitudinal HUNT study

Background Alcohol is a leading risk factor for disease burden. We examined longitudinal trends in sex and age-specific alcohol consumption among middle-aged and older subjects who had participated in the population-based Trøndelag Health Study (HUNT) in Norway since the 1990s. Methods This study included 23,151 individuals aged ≥43 years when they participated in the HUNT2 Survey (1995–1997) and who also had participated in the HUNT3 Survey (2006–2008), and/or the HUNT4 Survey (2017–2019). We used self-reported data to examine trends and identify sex- and age-specific differences in abstinence from alcohol, current drinking, risky drinking (≥8 units of alcohol/week), and heavy episodic drinking (≥5 or ≥6 units of alcohol in one sitting at least monthly). Concentrations of the objective alcohol marker phosphatidylethanol (PEth) were available in subsamples from HUNT3 to HUNT4. Results The proportion of subjects with self-reported alcohol abstinence and with PEth concentrations <0.03 µmol/l increased from HUNT2 and/or HUNT3 to HUNT4, while heavy episodic drinking and PEth concentrations ≥0.03 µmol/l decreased from HUNT3 to HUNT4 in both sexes in most age groups, and more in men than in women. There was an increase in risky drinking from HUNT2 to HUNT4 in women and men aged 43–64 years in HUNT2. Men were more likely to consume alcohol than women measured with both self-report and with PEth in most age groups. Among those aged ≥65 years in HUNT2 a convergence between the sexes regarding abstinence and heavy episodic drinking was observed which was mostly caused by changes in men. Conclusion Drinking patterns among middle-aged and older Norwegians have changed since the 1990s with a trend toward more abstinence and less heavy episodic drinking and PEth concentrations ≥0.03 µmol/l in both women and men with increasing age. There is a trend of more risky drinking with age among both sexes.

Opioid-sparing anesthesia versus opioid-free anesthesia for postoperative recovery quality in breast cancer surgery patients: A systematic review and Bayesian network meta-analysis

Background Breast cancer is the most common malignancy among women, and patients require rapid transition to adjuvant therapy post-surgery. Opioid-based anesthesia (OBA) is widely used but carries risks such as postoperative nausea and vomiting (PONV), immunosuppression, and hyperalgesia, which may delay recovery. Opioid-sparing anesthesia (OSA) and opioid-free anesthesia (OFA) may reduce these risks, but their effects on postoperative quality of recovery (QoR) are unclear. This study compares the effects of these three anesthetic strategies on early postoperative QoR in breast cancer surgery using a Bayesian network meta-analysis. Methods Following PRISMA guidelines (PROSPERO ID: CRD420251065588), a systematic search was conducted in PubMed, Cochrane Library, EMBASE, and Web of Science from inception to June 1, 2025. Included were randomized controlled trials (RCTs) comparing OSA, OFA, and OBA in adult breast cancer surgery that reported QoR scores. Risk of bias and evidence quality were assessed using the Cochrane tool and GRADE system. Bayesian random-effects analysis was performed with the R package gemtc . Continuous data were reported as mean differences, and categorical data as odds ratios. Results Seventeen RCTs with 1,254 patients were included. Bayesian network meta-analysis showed that OSA significantly outperformed OBA in 24-hour postoperative QoR (d = 0.050, 95% CrI: 0.038–0.062; SUCRA = 85.3%), and OFA was also superior to OBA (d = 0.044, 95% CrI: 0.020–0.068; SUCRA = 64.7%). No significant difference was found between OSA and OFA (d = −0.006, 95% CrI: −0.029–0.018). Secondary outcomes SUCRA showed that OFA was most effective in controlling postoperative nausea and vomiting (99.4%) and pain management (81.4%), while OSA excelled in emotional well-being (96.2%) and physical comfort (76.6%). For physical independence, OFA (85.1%) outperformed OSA (63.5%), with no differences in psychological support. Intraoperative opioid reduction showed an inverted U-shaped relationship with QoR improvement (p = 0.0004). Conclusion OSA is the optimal strategy for enhancing overall quality of recovery within 24 hours after breast cancer surgery. Although OFA excels in PONV reduction and pain control, OSA offers more balanced benefits across multiple QoR dimensions. An individualized anesthetic approach is recommended, aiming for opioid minimization rather than complete elimination.

Knowledge and personal values on fertility preservation procedures in Korean women

This study aimed to identify the knowledge of young general Korean female population on reproductive aging, as well as to investigate the personal values regarding fertility preservation (FP). A cross-sectional online survey study of 500 Korean female population on reproductive aging (18–40 years old) was performed. Knowledge regarding fertility preservation and its procedures was generally low. Correct knowledge about FP procedures was less than 50% for most of the questions. The rate of incorrect answers regarding FP knowledge overpassed 50%, which were related to loss of fertility and birth defects due to cancer treatment, and the rate of successful pregnancy for egg and embryo freezing. We also identified the personal values that influenced the willingness of women to undergo FP procedures. These included the following: 1) pregnancy success rate; 2) side effects of FP procedures; 3) delay of cancer treatment due to FP procedure; 4) risk of cancer recurrence; and 5) medical costs of FP procedures. Over 80% of the participants considered all five values important, with almost no distinctions. Despite the general awareness of FP, this study highlights the lack of knowledge and significant misconceptions regarding FP relative to fertility and cancer treatment among Korean women, which should be addressed properly with targeted education. Additionally, this study demonstrates diverse personal values participants hold regarding FP and the desire their values to be respected during the decision-making process of FP procedure facilitating shared decision-making (SDM).

Phase-probability shaping for speckle-free holographic lithography

Mechanisms of multi-species mealybug invasions in Hainan Island of China: Integrating niche, distribution, and habitat drivers

Mealybugs, highly invasive pests causing global agricultural damage, threaten China’s tropical Hainan Island—a critical biosecurity zone. This study investigates spatial patterns, interspecific interactions, and environmental drivers of 15 invasive mealybug species using integrated ecological niche modeling (Maxent), niche/range overlap analyses, Joint Species Distribution Models (JSDM), and Structural Equation Models (SEM). Our research revealed that a strong coastal-inland richness gradient emerged, where humid tropical climates and monoculture plantations supported 11–15 species in eastern coasts, whereas topographic complexity limited invasions to 0–5 species in forested mountains. In parallel, high niche overlap (I ≥ 0.67) among species reflected climate-mediated thermal tolerance and habitat-driven broad host preferences. Range overlap patterns diverged: high-overlap pairs (e.g., Planococcus minor and Paracoccus marginatus , I   > 0.8) coexisted via adaptation to 24–28°C and generalist hosts, whereas low-overlap pairs (e.g., Icerya purchasi and Phenacoccus nigra , I  = 0.37) segregated through host specificity. Mechanistically, JSDM confirmed these patterns, revealing competitive exclusion where resource overlap and thermal adaptation divergence occurred (e.g., P. marginatus vs. Dysmicoccus brevipes ), versus coexistence promoted by host specialization (e.g., Ceroplastes psidii ’s rubber tree specificity versus P. marginatus ’s generalism), reproductive strategy divergence (parthenogenesis vs. seasonal outbreaks), and external environmental factors. Ultimately, SEM analyses and Linear regression identified significant positive correlations between habitat conditions and species suitability (R² = 0.71, p < 0.001), with habitat type as the dominant driver (total effect = 0.48), where climate and topography indirectly regulated suitability through habitat characteristics (e.g., elevation, latitude) while pest-infested areas directly enhanced suitability (path coefficient = 0.24). Our research framework elucidates multi-species invasion assembly mechanisms, new insights and theoretical support for the management of 15 invasive mealybug species, providing a solid foundation for optimizing future species distribution models, and validating the methodological value of integrated modeling (JSDM-SEM) in disentangling invasion complexities.

Distinct spatiotemporal patterns of white matter hyperintensity progression

Adverse events of androgen receptor pathway inhibitors in prostate cancer from real world data

Purpose While clinical RCTs have clearly evidenced that the use of androgen receptor pathway inhibitor (ARPI)s for patients with advanced prostate cancer, can significantly delay disease progression, there is insufficient evidence on their safety profiles to warrant their unqualified implementation as the treatment of choice or with which to choose between them. We aim to provide more substantial evidence for adverse event (AE)s of ARPI by analyzing real-world data (RWD) to select optimal ARPI for individual treatment. Materials and Methods We used data from the Food and Drug Administration Adverse Event Reporting System (FAERS) in the US, between April 30, 2014 and April 30, 2024. Results We estimated proportional risk ratio (PRR)s of AEs in the US. We also compared the likelihood of AEs by age, reporter type, and ARPI groups: 1) Group 1, Enzalutamide with other medications; 2) Group 2, Apalutamide with other medications; 3) Group 3, Darolutamide with other medications; 4) Group 4, Abiraterone with other medications; 5) Group 5, Abiraterone + Enzalutamide with other medications. We identified 107,582 AEs among 44,856 US residents who were treated with ARPIs for prostate cancer. By ARPI groups, the AE of GI was the highest in Group 1 and Group 3, and the AE of vascular was the highest in Group 4 and Group 5. In particular, Group 2 showed very statistically significantly higher levels of PRR 3.558 (95%CI: 3.489–3.627) of skin-related AE compared to other groups. Conclusion Our study provides important insight that we analyzed RWD and evaluated comparative drug safety across all type of prostate cancer. Although we could not make a conclusion whether which is the safest ARPI, we can suggest that each ARPIs have different types of AEs hence we can use this information during choosing ARPIs for prostate cancer patients.

Author Correction: Float-stacked graphene–PMMA laminate