The five chair stand test, abbreviated CST-5, is a 60-second assessment of leg strength, endurance, and balance. Participants begin seated in a chair with their arms folded across their chest, then rise to a full standing position and sit back down five times as quickly as they safely can. The clock captures everything that matters about lower-body function: the explosive power of the quadriceps and gluteal muscles, the cardiovascular capacity to sustain repeated effort, the proprioceptive control needed to keep the body stable through each transition, and the joint mobility that allows a full range of motion at the hips, knees, and ankles. Because standing up from a chair is an activity most people perform dozens of times a day without thinking, failure to do it five times in a row represents a meaningful departure from normal physiological function rather than an abstract laboratory measurement.

Geriatricians have used the CST-5 for years to evaluate elderly patients, and a robust body of work has linked poor performance to elevated risks of falls, frailty, disability, and death in people over 65. What has been missing is evidence about the test’s relevance for middle-aged adults, a group that generally falls outside the scope of physical performance screening. The new study, led by Nicolle A. Mode, Alan B. Zonderman, and Michele K. Evans, set out to fill that gap by following a socioeconomically diverse cohort of 2,943 adults aged 30 to 64 enrolled in Baltimore, Maryland. The researchers measured chair stand performance at four separate study visits and tracked mortality over an 18-year follow-up period spanning 2004 to 2022.

The study’s longitudinal design is what gives its conclusions real weight. Rather than taking a single snapshot of physical ability, the investigators recorded CST-5 results at repeated visits, with participants averaging 2.5 assessments each. At enrollment, the participants had a mean age of 48.7 years, and by the fourth visit their mean age had risen to 59.7 years. Using Cox regression models with time-varying covariates, a statistical approach that allows the analysis to incorporate updated test results as participants aged, the team could ask whether changes in chair stand ability over time tracked with changes in mortality risk. This design helps distinguish between people who were always physically limited and those whose function declined during the study window, offering a more nuanced picture than a single baseline measurement ever could.

The headline finding is stark. People who were unable to complete the five chair stands had a hazard ratio of 2.19 for mortality, with a 95 percent confidence interval of 1.65 to 2.92, compared with participants who finished the test in less than 13.7 seconds. In practical terms, failing the test more than doubled the risk of dying during the follow-up period, and the confidence interval sits comfortably above 1.0, indicating the result is statistically robust. Just as striking is how common test failure was in this relatively young cohort: the proportion of participants unable to complete the CST-5 rose from 19 percent at the first visit to 31 percent at the fourth visit. Nearly one in five adults in their thirties through fifties, an age range when most people assume their bodies are still resilient, could not perform a movement that healthy adults typically manage without effort.

Perhaps the most clinically provocative detail concerns the disconnect between test failure and self-reported function. Among participants who could not complete the CST-5 at the first visit, half reported no difficulties getting out of a chair in their daily lives. This gap between subjective experience and objective performance suggests that many middle-aged adults are unaware of the physiological decline their bodies are quietly undergoing. Daily chair transfers are typically performed at a self-selected, comfortable pace with plenty of recovery time between efforts, which can mask deficits in the strength and endurance that a timed, repeated test exposes. A patient who feels fine standing up from the sofa after dinner may nonetheless lack the lower-body power reserve that predicts long-term survival, and without a standardized test, neither the patient nor the physician would ever know.

Intriguingly, the data suggest that the critical threshold is not speed but the binary ability to finish at all. Among participants who did complete the test, there was no statistically significant difference in mortality risk between slower and faster performers; the hazard ratio comparing the two groups was 1.24, with a 95 percent confidence interval of 0.95 to 1.62, a range that includes the null value of 1.0. In other words, once a person can complete five stands, finishing in 15 seconds rather than 10 does not appear to carry a measurable survival penalty in this cohort. The message for clinicians is therefore refreshingly simple: the first question to ask is not how fast a patient can stand, but whether the patient can stand five times at all. Inability to complete the test is the red flag that demands attention.

The researchers also tested whether the association held up when other known mortality risk factors were taken into account. Adding additional covariates to the statistical models did not change the main findings, indicating that the CST-5 captures physiological information that standard risk factors miss. This independence matters because it implies the test is not merely a proxy for age, body weight, or self-reported health status. Instead, it appears to integrate the function of multiple body systems, including muscle mass and quality, neuromuscular coordination, cardiovascular reserve, and joint integrity, into a single number that reflects overall biological resilience. No questionnaire or blood panel currently provides that kind of integrated functional snapshot so cheaply and quickly.

The practical appeal of the CST-5 lies in its extraordinary simplicity. The test requires nothing more than a sturdy chair, a stopwatch, and about a minute of a clinician’s or patient’s time. There are no laboratory fees, no calibration, no specialized training beyond basic instruction, and no exposure to radiation or contrast agents. In an era when health screening increasingly depends on expensive imaging and biomarker panels, a test that costs essentially nothing yet doubles as a mortality predictor for middle-aged adults is a rare and valuable commodity. The authors argue that the CST-5 may provide important clinical information for middle-aged adults in an easy-to-administer format, and the new evidence gives that argument considerable force.

For the public, the takeaway is both sobering and actionable. Middle age is when the physiological foundations of late-life health are quietly laid, and the ability to rise from a chair five times in succession turns out to be a surprisingly sensitive barometer of those foundations. Failing the test does not seal anyone’s fate, but it should prompt a conversation with a healthcare provider about strength training, physical activity, and the underlying conditions that may be eroding muscle and balance. Half of the people who failed the test in this study felt perfectly capable of getting out of a chair, which means self-assessment is not enough. A one-minute test administered at a routine checkup could reveal a risk that neither patient nor doctor suspected, and the earlier that risk is identified, the more years remain to do something about it.

Subject of Research: The five chair stand test as a predictor of mortality risk in middle-aged adults

Article Title: Middle-aged chair stands predict mortality risk

Article References: Mode, N. A., Zonderman, A. B., & Evans, M. K. (2026). Middle-aged chair stands predict mortality risk. PLOS Aging and Health, 1(2), e0000026. https://doi.org/10.1371/journal.page.0000026

Image Credits: AI Generated

DOI: 10.1371/journal.page.0000026

Keywords: chair stand test, mortality risk, middle-aged adults, physical performance, leg strength, longitudinal study, Cox regression, aging, functional assessment, screening, PLOS Aging and Health, balance

The researchers focused on lactate, a metabolite that has long occupied a central place in critical care monitoring. Lactate accumulates when tissues are deprived of adequate oxygen or when cellular metabolism is disrupted, and elevated blood lactate is a well-established marker of shock and tissue hypoperfusion in adults and children alike. In neonates with NEC, however, lactate has traditionally been interpreted as a static snapshot: a single number drawn at a single moment, compared against a threshold. The Chinese team reasoned that this approach discards most of the information contained in the data. A lactate level of 6 millimoles per liter means something quite different depending on whether it is falling from 9 or climbing from 3, and capturing that direction and velocity could, in principle, reveal a patient’s trajectory toward recovery or collapse.

To test that idea, the investigators turned to a statistical technique known as group-based trajectory modeling, or GBTM. Rather than treating each patient’s serial lactate measurements as an individual curve to be eyeballed, GBTM uses finite mixture modeling to identify latent subgroups within a population—clusters of patients whose measurements follow statistically similar patterns over time. Each patient is assigned to a trajectory group based on a posterior probability, and in this study the researchers required that probability to exceed 0.7 before an assignment was accepted, a threshold that guards against forcing patients into groups they only weakly resemble. The approach, borrowed from criminology and developmental psychology where it has been used to chart patterns of behavior over life courses, is gaining traction in clinical medicine precisely because real-world intensive care data are messy, irregularly sampled, and incomplete.

The messiness was substantial. The team analyzed 106 neonates with NEC drawn from the Pediatric Intensive Care Database, a publicly available, de-identified repository established with approval from the Institutional Review Board of the Children’s Hospital of Zhejiang University School of Medicine. Because the study was a secondary analysis of de-identified data involving no more than minimal risk, patient informed consent was waived, and the work was conducted in accordance with the Declaration of Helsinki. The cohort was divided into three clinically meaningful strata: 63 neonates managed without surgery, 18 who underwent surgery within three days of diagnosis, and 25 who went to surgery later than three days. Lactate measurements taken within the first 24 hours after surgery were excluded from the modeling, a methodological choice designed to prevent the metabolic perturbation of the operation itself from contaminating the preoperative and postoperative trajectory patterns the researchers wanted to isolate.

What emerged from the modeling was striking. In the non-surgical group, GBTM identified a small but ominous trajectory pattern: a high-and-rising lactate course in which patients began with an initial lactate of 11.39 millimoles per liter and climbed by an additional 4.93 millimoles per liter per day. Only two of the 63 non-surgical neonates, or 3.2 percent, followed this pattern—but both died within 48 hours, a mortality rate of 100 percent for that subgroup. The finding, though based on a tiny number of patients, illustrates the central promise of trajectory analysis: a pattern that unfolds over serial measurements may flag impending catastrophe earlier than any single threshold crossed at one point in time.

The surgical strata told a different and, in some respects, equally informative story. All 43 infants who underwent surgery, whether early or late, survived their hospitalization, and their lactate trajectories were characterized as stable or clearing—that is, the models captured lactate values that either held steady at moderate levels or declined over the observation window. The contrast between the two non-surgical infants on a steeply rising course and the surgical patients whose lactate curves bent toward resolution offers a tantalizing hypothesis: that the direction of lactate change, rather than its absolute value, may help distinguish babies who are failing medical management from those whose disease is controlled, and may even inform the timing of the difficult decision to operate.

Because exploratory models built on small samples can be fragile, the authors took steps to assess robustness. They applied bootstrap resampling with 300 replicates to the non-surgical group, repeatedly refitting the trajectory model to resampled versions of the data to see whether the estimated parameters held steady. They did: every parameter in the non-surgical group’s model showed a coefficient of variation below 30 percent, indicating that the trajectory estimates were not artifacts of a few unusual patients or a chance configuration of the dataset. This kind of stability check is an important, if often overlooked, discipline in trajectory modeling, where the number and shape of latent groups can otherwise shift unsettlingly with small perturbations of the input data.

The study’s limitations are as instructive as its findings. With 106 patients in total and only two infants in the fatal high-and-rising group, the results are explicitly exploratory and cannot support clinical decision-making on their own. The retrospective design means the lactate measurements were drawn from routine clinical practice rather than a standardized protocol, introducing the very missingness and irregular sampling that the authors acknowledge as a defining challenge of real-world data. The Bayesian Information Criterion was used to guide model selection, but model choice in GBTM always involves judgment as well as statistics, and different criteria can favor different numbers of groups. Most importantly, no prospective validation has yet been performed; the association between a rising lactate trajectory and early mortality in NEC remains a hypothesis generated by the data, not a confirmed predictive rule.

Even so, the conceptual contribution is significant. Neonatology has long sought dynamic risk markers for NEC, and serial biomarker modeling of the kind demonstrated here offers a framework that could eventually incorporate not just lactate but other laboratory and physiologic signals—C-reactive protein, platelet counts, blood gas parameters—into composite trajectory profiles. If future prospective studies confirm that a steeply rising lactate course precedes death within 48 hours in medically managed NEC, bedside dashboards could one day alert clinicians to a deteriorating trajectory hours before conventional thresholds are breached, buying precious time to escalate care or intervene surgically. For now, the study stands as a careful, methodologically transparent proof of concept: in the fragile population of newborns with necrotizing enterocolitis, the trend of a number may matter as much as the number itself, and the mathematics of trajectories may help clinicians read that trend before it is too late.

Subject of Research: Lactate trajectory patterns as prognostic markers in neonatal necrotizing enterocolitis

Article Title: Lactate trajectory patterns in neonatal necrotizing enterocolitis: an exploratory retrospective cohort study using group-based trajectory modeling

Article References: Qu, A., Kong, S., & Wang, Z. (2026). Lactate trajectory patterns in neonatal necrotizing enterocolitis: an exploratory retrospective cohort study using group-based trajectory modeling. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07788-1

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07788-1

Keywords: necrotizing enterocolitis, lactate, neonatology, group-based trajectory modeling, trajectory analysis, predictive markers, neonatal sepsis, retrospective cohort study, pediatric intensive care, mortality risk, biomarkers, metabolic pathways

Candidozyma auris has earned a reputation as one of the most concerning healthcare-associated fungal pathogens of the modern era. Unlike many of its fungal relatives, it persists stubbornly in the hospital environment, colonizes surfaces and medical equipment, spreads between patients in healthcare facilities, and frequently displays resistance to the antifungal drugs clinicians rely upon most. First recognized as a human pathogen less than two decades ago, it has since been reported on multiple continents, triggering outbreaks in intensive care units and prompting public health agencies to classify it as a serious global health threat. Its ability to survive routine disinfection and to be misidentified by conventional laboratory methods has made containment exceptionally difficult, and each new clinical dataset contributes valuable intelligence about how the organism behaves in actual patient care.

The Turkish research team set out to answer a question that has divided the field: does C. auris candidemia actually kill more patients than candidemia caused by other Candida species, or does it merely appear more lethal because it disproportionately infects patients who are already gravely ill? To address this, the investigators conducted a single-center retrospective cohort study, identifying every adult patient with candidemia seen at their institution and classifying infections by species. Identification was performed using MALDI-TOF mass spectrometry, a rapid proteomic technique that has become the gold standard for distinguishing C. auris from look-alike yeasts that older biochemical panels frequently confuse with it. Accurate speciation matters enormously here, because misidentification has historically hampered both surveillance and appropriate treatment.

The clinical profiles of the two patient groups differed in telling ways. Patients with C. auris candidemia had spent significantly longer in the hospital before their bloodstream infection developed, a pattern consistent with a healthcare-associated pathogen that colonizes patients during extended stays. They also more frequently had central venous catheters, the indwelling lines that provide fungi with a direct portal into the bloodstream, and greater exposure to corticosteroids, which suppress immune defenses. These exposures are classic risk factors for invasive candidiasis in general, but their heightened frequency in the C. auris group underscores how thoroughly this organism is woven into the fabric of modern intensive medical care. The findings reinforce the picture of C. auris as an opportunist that exploits the very devices and drugs that keep critically ill patients alive.

When the researchers examined crude outcomes, the headline number was striking in its symmetry: 30-day all-cause mortality was 62.3 percent among patients with C. auris candidemia and 62.5 percent among those with non-auris Candida infections, a difference of essentially zero. On the surface, this suggests the emerging pathogen is no deadlier than its established cousins. But crude comparisons in observational data can be deeply misleading, and the investigators knew that the patients harboring C. auris arrived at their infections with a different constellation of vulnerabilities. To disentangle the effect of the organism itself from the effect of patient characteristics, they turned to more sophisticated statistical machinery.

The team employed a multivariable Firth-penalized logistic regression model, a technique designed to produce more stable estimates when outcomes are imbalanced or sample sizes are modest, and they handled missing data through multiple imputation. The model was constructed with clinical input to ensure that the variables adjusted for reflected genuine medical knowledge rather than statistical convenience. After adjustment, C. auris candidemia was associated with higher estimated odds of 30-day mortality, with an adjusted odds ratio of 1.967, meaning the odds of death were nearly doubled relative to non-auris candidemia. However, the 95 percent confidence interval ranged from 0.954 to 4.055 and included the null value of one, with a p value of 0.067, meaning the association fell just short of conventional statistical significance.

To translate the regression results into more intuitive risk terms, the researchers used g-computation to estimate standardized marginal mortality risks. Under this approach, the adjusted 30-day mortality was estimated at 69.7 percent for C. auris candidemia compared with 59.3 percent for non-auris Candida candidemia, corresponding to an adjusted risk difference of 10.4 percentage points, with a confidence interval spanning from minus 0.2 to plus 21.3 points. In other words, once patient severity was accounted for, the data hinted that C. auris infections carry a genuinely elevated mortality burden, potentially adding roughly ten deaths per hundred patients, but the uncertainty around that estimate means the true effect could range from negligible to substantial. The authors are explicit that these findings should be interpreted as associative rather than causal, and that larger prospective multicenter studies across diverse healthcare settings are needed to confirm them.

Beyond the comparison between species, the study identified the factors that independently predicted death within 30 days across the entire cohort. Older age, higher scores on the Sequential Organ Failure Assessment, or SOFA, scale, the presence of septic shock, corticosteroid use, and hemodialysis were all associated with higher adjusted odds of mortality. These determinants are familiar from the broader candidemia literature: they reflect the reality that bloodstream fungal infections are most lethal in patients whose organs are already failing and whose immune systems have been blunted by illness or medication. The consistency of these predictors with prior research lends credibility to the study’s methodology and suggests the dataset behaves as expected, strengthening confidence in the species-specific comparisons.

The antifungal susceptibility findings carry important practical implications for treatment. Among C. auris isolates, echinocandin non-wild-type phenotypes were uncommon, which is welcome news because echinocandins are the recommended first-line therapy for invasive candidiasis and are often the drug class of choice against C. auris. However, elevated minimum inhibitory concentrations for amphotericin B were observed in approximately one-third of tested isolates, a troubling signal for an older but still-used antifungal that clinicians may reach for when first-line options fail or are unavailable. Meanwhile, resistance to fluconazole was frequent among tested Candida parapsilosis isolates, a reminder that antifungal resistance is not confined to the emerging pathogen and that susceptibility testing remains essential for guiding therapy across all Candida species. Susceptibility results were interpreted using applicable EUCAST clinical breakpoints or epidemiological cut-off values, and where no interpretive criteria existed, results were reported descriptively, reflecting the ongoing challenge that interpretive standards for some antifungal-organism combinations are still evolving.

The study’s conclusions are measured but consequential. C. auris candidemia, the authors report, is characterized by a distinct profile of healthcare-associated exposures and a distinct antifungal susceptibility pattern, and while crude mortality appears similar to other candidemia, adjusted estimates point toward higher mortality that remains statistically imprecise. For clinicians, the message is twofold: patients colonized or infected with C. auris deserve vigilant attention to modifiable risk factors such as catheter management and careful stewardship of corticosteroids, and treatment decisions should be anchored in susceptibility data rather than assumptions. For public health officials, the findings add to the accumulating evidence that C. auris is not simply another Candida species but a pathogen with its own epidemiology, its own resistance landscape, and potentially its own mortality penalty. As the global footprint of this fungus continues to expand, studies like this one, grounded in real-world clinical data and rigorous statistical adjustment, will be essential for calibrating the response. The research received no specific funding, was approved by the Etlik City Hospital clinical research ethics committee, and was conducted in accordance with the Declaration of Helsinki, with the requirement for informed consent waived given its retrospective design.

Subject of Research: Comparison of clinical characteristics, antifungal susceptibility, and 30-day mortality in Candidozyma auris versus non-auris Candida candidemia

Article Title: Clinical characteristics, treatment strategies, and factors associated with 30-day mortality in Candidozyma auris versus non-auris Candida candidemia: a retrospective cohort study

Article References: Kuzi, S., Çiçek Şentürk, G., Kul, G., Haykır, A., Yılmaz, N., Korkmaz, N., Bulut, D., Aslan, M., Yapar Toros, G., Şencan, İ., & Tütüncü, E. E. (2026). Clinical characteristics, treatment strategies, and factors associated with 30-day mortality in Candidozyma auris versus non-auris Candida candidemia: a retrospective cohort study. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14401-4

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14401-4

Keywords: Candidozyma auris, candidemia, antifungal resistance, 30-day mortality, bloodstream infection, echinocandins, amphotericin B, fluconazole resistance, septic shock, healthcare-associated infection, MALDI-TOF, risk factors

Natural menopause occurs when menstrual periods stop permanently without surgery, chemotherapy, or other medical intervention. Although menopause typically occurs later in life, premature menopause is generally defined as occurring before age 40, while early menopause occurs between ages 40 and 45. The new study used a broader research definition of early natural menopause, including women whose menopause occurred before age 48. These conditions affect an estimated 6% of women worldwide and have previously been linked to increased risks of cardiovascular disease, dementia, and premature death.

The researchers analyzed health and social data from nearly 20,000 women with early natural menopause. Rather than examining a single social factor in isolation, they created a cumulative measure based on 14 social determinants of health. Participants were then classified into favorable, intermediate, or unfavorable groups according to their overall social circumstances. This approach was designed to capture the reality that disadvantage rarely occurs one factor at a time: unemployment may coincide with lower income, unstable housing, limited education, reduced access to healthcare, and chronic psychosocial stress.

Social determinants of health include the conditions in which people are born, grow up, learn, work, live, worship, spend leisure time, and age. These circumstances can influence exposure to stress, environmental hazards, health information, nutritious food, preventive medicine, and high-quality medical care. They can also shape whether a person is able to follow treatment recommendations or obtain timely evaluation for symptoms. By combining multiple determinants into a single risk profile, the researchers sought to measure the cumulative biological and social pressure that may influence health after early menopause.

Participants were followed for a median of 10.8 years, allowing the investigators to examine health outcomes over a substantial period. The analysis showed that women in more disadvantaged social circumstances experienced significantly worse health trajectories than those with more favorable circumstances. Their risks were elevated for all-cause mortality, meaning death from any cause, and for cardiovascular disease, which includes conditions affecting the heart and blood vessels. The study also identified a pronounced association between cumulative disadvantage and incident dementia, referring to newly diagnosed disease during follow-up.

Among the 14 social variables examined, unemployment showed the strongest independent association with both all-cause mortality and incident dementia. The finding does not establish that unemployment directly causes either outcome, but it highlights employment status as a potentially important marker of broader economic and psychological strain. Loss of work can reduce income, health insurance, social connection, daily structure, and access to services. Long-term unemployment may also contribute to chronic stress and depression, biological processes that have been associated with inflammation, impaired cardiovascular health, and cognitive decline.

Early loss of ovarian function may provide part of the biological context for these findings. Estrogen influences vascular function, lipid metabolism, bone health, and several processes involved in brain maintenance. When estrogen exposure declines earlier than expected, women may spend more years with potential vulnerability to cardiovascular and neurological disease. Social adversity could intensify that vulnerability through factors such as hypertension, poor sleep, chronic inflammation, smoking, limited physical activity, or delayed medical care. The study’s results suggest that biological risk and social conditions may interact rather than operate independently.

The researchers found no significant association between the social-determinants-of-health measures and incident cancer in this group. That contrast is important because it indicates that the effects of social disadvantage were not uniform across every major health outcome. The results instead point to a particularly strong relationship with mortality, cardiovascular disease, and dementia. Because the study was observational and based on statistical associations, the findings cannot prove a direct causal pathway. Differences in health behaviors, access to treatment, pre-existing illness, and other unmeasured factors may also have influenced the results.

The authors argue that social history should become a routine component of care for women with premature or early menopause. A clinical assessment could include employment and financial security, education, housing, transportation, social support, access to healthcare, and exposure to discrimination or chronic stress. Identifying these issues early could help clinicians connect patients with cardiovascular screening, mental-health services, employment or social assistance, and strategies to protect cognitive health. “Disrupting this complex interaction will require a routine, comprehensive assessment of social determinants of health as a fundamental principle” in menopause care, said Stephanie Faubion, medical director for The Menopause Society. The study underscores that early menopause is not only a reproductive milestone but also a potential signal for long-term health monitoring—especially when it occurs alongside persistent social disadvantage.

Subject of Research: People

Article Title: Combined social determinants of health, mortality, and adverse health outcomes in early natural menopause

News Publication Date: 12-Aug-2026

Web References: https://menopause.org; https://menopause.org/wp-content/uploads/press-release/MENO-D-26-00058.pdf

References: Menopause. DOI: 10.1097/GME.0000000000000002866

Keywords: early natural menopause, premature menopause, social determinants of health, unemployment, cardiovascular disease, dementia, mortality, women’s health, socioeconomic disadvantage, healthy aging