PubMed公共卫生专业每日动态

Tubulocystic renal cell carcinoma is a rare renal neoplasm with imaging characteristics that may make it challenging to differentiate from benign cystic lesions. This retrospective single-institution study characterized the multimodality imaging features of pathologically confirmed tubulocystic renal cell carcinoma with emphasis on ultrasound (US) findings. Cases identified between 2016 and 2023 were reviewed for demographic, clinical, and imaging features on computed tomography (CT), magnetic resonance imaging (MRI), and US. Seven patients (6 male, 1 female; mean age 61 ± 8 y) were included, with presentations of abdominal pain (n=2), hematuria (n=1), and incidental detection (n=4). The mean maximal tumor diameter was 2.4 cm (range: 1.4-4.8 cm); 6 lesions were round and 1 was bilobed. On CT, masses demonstrated low attenuation (mean 15 HU) with variable enhancement (mean 23 HU). MRI in 5 cases demonstrated predominantly T1 hypointense and T2 hyperintense lesions, with 1 lesion showing mixed T2 signal intensity; 3 cases showed enhancement, including septa or a mural nodule. Two hyperechoic lesions demonstrated enhancement on MRI, with enhancement corresponding to the hyperechoic portions of the mixed echogenic mass. US in 5 cases showed 3 uniformly hyperechoic, 1 mixed echogenic, and 1 septated hypoechoic mass, all demonstrating posterior acoustic enhancement. CEUS in 1 case revealed septal enhancement. Although CT and MRI features may mimic cysts, US most commonly demonstrates a hyperechoic lesion with posterior acoustic enhancement and may provide important additional diagnostic information when other imaging findings are equivocal.

Lung ultrasound (LUS) is increasingly utilized for diagnosing pediatric pneumonia due to its bedside accessibility, radiation-free nature, and high diagnostic sensitivity. However, broader clinical adoption remains hindered by operator dependency, inconsistent interpretation, and training challenges, particularly among trainees and less-experienced health care providers. Currently, there is an unmet need for practical tools that help trainees reliably detect pneumonia-related ultrasound findings. In this technical innovation study, we evaluated a semi-automated, artificial intelligence (AI)-assisted system designed to identify clinically relevant lung abnormalities, including pleural line thickening, consolidation morphology, and B-line patterns. Our computerized analysis demonstrated the system's technical capability to accurately detect these structural changes with minimal user interaction. Although our primary aim was to assess diagnostic feasibility, the intuitive nature and real-time visual annotations provided by this AI tool highlight its strong potential for future integration into educational contexts. By visually assisting trainees in recognizing key sonographic features, this technology can facilitate learning, improve detection skills, and effectively support the training of health care providers performing pediatric LUS.

Commercial harvesting of bowhead whales (Balaena mysticetus), primarily by British and American whalers during the late-1700s to early-1900s, nearly caused their extinction. While whaling-offtake rates during this period are known, their spatiotemporal footprints are not, creating an important gap in understanding of the species recovery patterns. Using archival logbooks and Bayesian modeling, we reconstructed daily positions for >700 whaling voyages (totaling >90,000 d) across the Arctic, revealing spatiotemporal patterns and causal drivers of these seafaring routes and their hunting successes. We find that whaling operations by British and American whalers expanded rapidly throughout the Arctic, moving in predictable ways through hazardous sea ice conditions, reaching all but the most remote bowhead whale habitats within a century. Extensive sea ice cover formed barriers, delaying access to some profitable whaling grounds and suppressing harvest intensity. These fine-scale processes created important population refugia across the Arctic, forming a network of naturally "protected areas" where cumulative harvest impacts were minimized. Our analyses show that these refugia were larger and persisted longer in bowhead whale populations that are recovering faster today, indicating that modern recovery patterns are likely tied to the spatial patterns of past exploitation.

We tested wild ruminants, boar, and carnivores in northeast Germany for highly pathogenic avian influenza subtype H5 antibodies. Wild ruminants were seronegative, but 3.5% of boar and 12.5%-21.9% of carnivores were seropositive, indicating frequent spillover. Because such events might accelerate mammalian (and ultimately human) adaptation, sustained monitoring remains essential.

Executive function is important ability for individuals to deal with daily living activities, and the Adult Executive Functioning Inventory (ADEXI) with promising psychometric properties was developed to assess executive function in nonclinical adult populations. However, psychometric properties evidence for ADEXI was primarily based on classical test theory; therefore, the current study used Rasch analysis to examine ADEXI to provide additional psychometric properties evidence. Participants aged 18-25 years (n = 1764; 55.9% women) were recruited using a social media platform (Dcard). They completed self-report Mandarin version of the ADEXI (of which includes three subscales of working memory, inhibition, and flexibility) and demographic characteristics (age, gender, and educational level) via online survey. Rasch analyses with differential item functioning (DIF) were used as analytic methods. All ADEXI items aligned with their intended subscales, with fit statistics of mean square ranging between 0.5 and 1.5. Moreover, the 5-point Likert scale of the ADEXI followed its order to indicate the difficulty (i.e., a higher score in the Likert scale indicates a poorer level of executive function). Moreover, no DIF items were displayed for the ADEXI across gender subgroup (men vs. women) or educational subgroup (college or above vs. high school or below). The psychometric properties of ADEXI were satisfactory, as indicated by the Rasch analysis findings. Unidimensionality of each ADEXI subscale was supported, categorical function was in order for the response, and no items displayed DIF. Therefore, the ADEXI can be used to evaluate executive function for general population and to enhance health promotion.

Benzodioxane-derived hydrazones (BDHs) have emerged as promising antioxidant agents due to their redox-modulatory properties, structural versatility, and ability to activate cellular defense pathways. This study evaluated the protective potential of two BDH derivatives-MBDH (methoxy-substituted) and TBDH (thiophene-substituted)-against Cd-induced toxicity, a major environmental health concern associated with multi-organ dysfunction via oxidative stress and mitochondrial impairment. Using LC-MS/MS-based metabolomic profiling together with biochemical assays in a mouse model, we compared the efficacy of BDHs with that of ascorbic acid. Cd exposure resulted in significant metabolic disruption, including reduced levels of amino acids (serine, methionine), elevated lipid peroxidation products (ceramides, phospholipid fragments), and mitochondrial dysfunction. Ascorbic acid (AA) provided partial metabolic and histological protection. MBDH exhibited moderate effects by reducing lipid peroxidation markers and partially restoring some amino acid levels, with a hydroxylated metabolite detected at m/z 328. TBDH, however, demonstrated superior protection, with near-complete normalization of metabolic profiles, formation of a stable metabolite (m/z 304), and marked attenuation in lipid peroxidation. Additionally, TBDH activated the Nrf2 signaling pathway, increased intracellular glutathione levels, and significantly improved histopathology in the liver, brain, and pancreas. It also reduced the levels of systemic inflammatory markers such as CRP, ESR, and procalcitonin. The enhanced performance of TBDH is attributed to its thiophene moiety, which facilitates improved electron delocalization and redox potential. This study highlights TBDH as a potent Nrf2 activator and antioxidant agent capable of mitigating Cd-induced metabolic and oxidative damage, providing a strong basis for the development of BDH-based therapeutics targeting heavy metal toxicity and related oxidative stress disorders.

The Mycobacteria Amplicon Sequencing Tool (https://github.com/guthrielab/MAST) is a modular Nextflow pipeline for antimicrobial resistance prediction and lineage classification of Mycobacterium tuberculosis from amplicon or whole-genome sequencing data sets. The workflow automates read processing, variant calling, and annotation to produce standardized, human-readable reports in DOCX and TSV format.

In the global context of the HIV pandemic, the biopsychosocial environment of key populations remains marked by a culture that fosters stigma and discrimination. These attitudes, based on misconceptions of what it means to live with HIV, transcend the healthcare sphere and negatively impact people's quality of life. In Mexico, systematic documentation of this issue within hospital settings remains limited. The objective of this study was to estimate the frequency of HIV-related stigma and discrimination among healthcare personnel of a secondary-level public hospital, as well as to identify differences by job category. We conducted an observational, descriptive, cross-sectional study from February to March 2025 at a secondary-level public hospital in Cancún, Quintana Roo, Mexico. We applied the short version of the HIV stigma questionnaire proposed by Nyblade et al. A total of 316 healthcare workers from different areas participated. To identify differences in stigmatizing attitudes across professional groups and to explore potential associations between sociodemographic variables and HIV-related beliefs, descriptive statistical analyses were performed, along with non-parametric tests (Kruskal-Wallis, Mann-Whitney U, and Spearman correlations) and post hoc comparisons using Dunn's test with Bonferroni correction. A total of 22.5% of participants reported having witnessed refusal to work with people living with HIV, and 30.1% observed lower-quality care toward them. Additionally, 32.9% agreed that people living with HIV are irresponsible, and 30.4% believed they "do not care about spreading the infection." Significant differences in stigma levels were found across occupational categories (p < 0.001). Medical assistants and interns showed higher levels of stigmatizing attitudes, while family physicians, nursing supervisors, and laboratory staff demonstrated greater empathy. Personally knowing someone living with HIV was significantly associated with greater acceptance of the right to become pregnant (p = 0.047). Stigma toward people living with HIV remains present in hospital environments. There is an urgent need to implement institutional training and awareness programs to reduce discriminatory attitudes and promote respect, accurate information, and empathy among all healthcare staff. En el contexto global del VIH, el entorno biopsicosocial de las poblaciones clave sigue marcado por una cultura que promueve el estigma y la discriminación. Estas actitudes, basadas en concepciones erróneas sobre lo que implica vivir con VIH, trascienden el ámbito sanitario y afectan la calidad de vida de las personas. En México, su documentación dentro de unidades hospitalarias es aún limitada. El objetivo de este estudio fue estimar la frecuencia de estigma y discriminación hacia el VIH en el personal de salud de un hospital público de segundo nivel, así como identificar diferencias según la categoría laboral. Se realizó un estudio observacional, descriptivo y transversal entre febrero y mayo de 2025 en un hospital público de segundo nivel, ubicado en Cancún, Quintana Roo, México. Se aplicó el cuestionario breve de estigma hacia personas con VIH propuesto por Nyblade . Participaron 316 trabajadores de distintas categorías laborales. Con el fin de identificar diferencias en las actitudes estigmatizantes según la categoría profesional y explorar posibles asociaciones entre variables sociodemográficas y las creencias relacionadas con el VIH, se realizaron análisis estadísticos descriptivos, pruebas no paramétricas (Kruskal-Wallis, U de Mann-Whitney, correlaciones de Spearman) y comparaciones con prueba de Dunn y corrección de Bonferroni. El 22,5% del personal reportó haber presenciado rechazo a trabajar con personas que viven con VIH y el 30,1% observó atención de menor calidad hacia ellas. El 32,9% estuvo de acuerdo con que las personas seropositivas son irresponsables y el 30,4% con que “no les importa el contagio”. Se identificaron diferencias significativas en el nivel de estigma entre categorías laborales (p < 0,001). Asistentes médicos y becarios mostraron actitudes más estigmatizantes, mientras que médicos familiares, jefaturas de enfermería y laboratoristas destacaron por su empatía. Conocer personalmente a una persona que vive con VIH se asoció significativamente con una mayor aceptación del derecho a embarazarse (p = 0,047). El estigma hacia las personas que viven con VIH continúa presente dentro del entorno hospitalario. Es apremiante establecer programas de sensibilización y formación continua orientados a reducir actitudes discriminatorias, promoviendo el respeto, la información y la comprensión entre todo el personal de salud.

Cardiovascular magnetic resonance (CMR) is widely used across various cardiac conditions and systematically assesses cardiac anatomical structures and functional dynamics. Machine learning (ML) can accurately predict outcomes and understand the inherent features of clinical data. This study aimed to derive CMR phenotypes related to cardiovascular aging, investigate the relationship between these phenotypes and stroke risk, and relearn these phenotypes using supervised ML. We enrolled 36,467 participants without stroke and extracted CMR parameters from the UK Biobank, with follow-up data extending until September 30, 2023. Using the generative topographic mapping technique, we identified latent grid nodes among participants and then derived phenotypes through agglomerative hierarchical clustering. We used supervised ML models to predict cardiac function phenotypes and used Cox proportional hazards models to assess the association between these phenotypes and long-term stroke risk. We enrolled 36,467 participants in the study. The mean age was 54.9 (SD 7.5) years, with 17,442 (47.8%) male participants. During a mean follow-up time of 14.7 (SD 1.1) years, 500 (1.4%) participants developed stroke and 664 (1.8%) participants died, respectively. After generative topographic mapping modeling, we identified 2 distinct phenotypes: phenotype 1, characterized by adverse cardiac function and an accumulation of cardiovascular risk factors, reflecting cardiovascular aging; and phenotype 2, associated with a lower risk of stroke (hazard ratio 0.695, 95% CI 0.559-0.864; P=.001), which remained significant after accounting for competing mortality (hazard ratio 0.578, 95% CI 0.484-0.691; P<.001). We selected the random forest model as the optimal model for the phenotypes, demonstrating high accuracy (area under the curve 0.914, 95% CI 0.911-0.918 for training and 0.867, 95% CI 0.858-0.876 for validation) and calibration ability (Brier score 0.111, 95% CI 0.109-0.113 for training and 0.132, 95% CI 0.127-0.137 for validation). By integrating unsupervised and supervised ML methods, we identified cardiovascular aging-related phenotypes that demonstrate robust predictive ability for incident stroke, which may have the potential to improve preventive and therapeutic strategies for high-risk populations.

Adherence to antiretroviral therapy (ART) during pregnancy is critical for maternal health and the prevention of vertical HIV transmission. In Uganda, where HIV prevalence remains high, pregnant women living with HIV face intersecting structural and psychosocial challenges, including stigma, food insecurity, and limited social support. Although each factor has been linked to ART nonadherence, less is known about how these factors co-occur within individuals and jointly shape vulnerability to nonadherence during pregnancy. This study used latent profile analysis to identify empirically derived psychosocial vulnerability profiles reflecting the co-occurrence of stigma, food insecurity, and limited social support among pregnant women living with HIV in Uganda and examine whether profile membership is associated with ART adherence. We conducted a cross-sectional analysis of 167 pregnant women living with HIV recruited from 6 health facilities in Uganda between June and December 2020. Measures included experienced HIV stigma, internalized HIV stigma, household food insecurity, and interpersonal social support. Latent profile analysis identified psychosocial profiles, and linear regression models assessed associations between profile membership and ART adherence, adjusting for sociodemographic covariates. A 2-class solution provided the best model fit (entropy=0.93). The higher-risk profile (75/167, 45.1%) was characterized by increased experienced stigma (mean score 1.97, SE 0.05), higher internalized stigma (mean score 2.66, SE 0.07), severe food insecurity (mean score 7.53, SE 0.20), and lower social support (mean score 2.06, SE 0.04). The lower-risk profile (92/167, 54.9%) showed significantly lower internalized stigma (mean score 2.32, SE 0.04; P<.001), lower experienced stigma (mean score 1.72, SE 0.05; P<.001), minimal food insecurity (mean score 0.82, SE 0.15; P<.001), and slightly higher social support (mean score 2.14, SE 0.04; P<.001). Membership in the higher-risk profile was associated with significantly lower ART adherence compared with membership in the lower-risk profile (B=0.88; β=0.40, 95% CI 0.02-0.78; P=.04). Distinct psychosocial profiles are meaningfully associated with ART adherence among pregnant women living with HIV in Uganda. By moving beyond single-risk models, these findings demonstrate the added value of person-centered analytic approaches for identifying subgroups of pregnant women living with HIV exposed to clustered psychosocial and structural vulnerabilities. The findings underscore the need for multicomponent, person-centered interventions that simultaneously address stigma, food insecurity, and limited social support rather than treating these challenges in isolation. Identifying empirically derived vulnerability profiles provides a targeted framework for prioritizing high-risk subgroups and informing contextually appropriate intervention design. Addressing these intersecting vulnerabilities is essential for improving maternal ART adherence and supporting efforts to prevent vertical HIV transmission in high-burden settings.

BackgroundEmotional and behavioral problems (EBPs) in children significantly influence developmental domains, including interpersonal relationships, academic performance, and life skills.MethodsA cross-sectional study was adopted with purposive sampling. The study includes 120 children aged 6-14 years from West Bengal, equally divided into groups with and without EBPs. Standardized tools such as the Pediatric Symptom Checklist (PSC), Child Interpersonal Relationships and Attitudes Assessment (CIRAA), Academic Performance Scale (APS), and Life Skills Assessment Scale (LSAS) were used.ResultsChildren with EBPs significantly scored lower in interpersonal relationships (p = .015) and life skills (p < .001) compared to peers without EBPs. However, they seem to scored slightly better in academic performance (p = .026). Correlation analyses showed a weak but significant relationship between EBPs and interpersonal relationships (r = 0.198, p = .030), a negative correlation with academic performance (r = -0.217, p = .017), and a moderately strong positive correlation with life skills (r = 0.457, p < .001).ConclusionThese EBPs obstruct the development of interpersonal and life skills, while their impact on academics varies with contextual factors. Thus, the study stresses that interventions should provide academic support, social-emotional learning and life skills training in schools and communities. Our recent study examined how emotional and behavioral problems in children affect their daily lives and development. We have collected the data from 120 children between 6 and 14 years old in India. We wanted to understand how these challenges impact three important areas of children’s lives: their relationships with others, their performance in school, and their ability to handle everyday tasks and situations. Using several assessment tools designed for children, we measured how well the kids were doing in each of these areas. We found that children dealing with emotional and behavioral problems had noticeably more difficulty forming and maintaining relationships with friends, family, and teachers compared to children without these issues. They also struggled significantly more with everyday life skills things like managing their time, solving problems, making decisions, and coping with stress. We found that emotional and behavioral problems had a moderate to strong relationship with life skills difficulties, meaning children with more emotional challenges typically struggled more with handling daily situations. The connection with relationships and academic performance was weaker but still noticeable. Our study’s key message is clear: emotional and behavioral problems in children create real obstacles in developing social connections and practical life skills, even though their effect on schoolwork may vary. This means that schools and communities need to provide comprehensive support not just helping children keep up academically, but also teaching them how to manage emotions, build healthy relationships, and develop the skills they need to navigate life successfully.

Frailty and age are major outcome drivers in hip fracture surgery, but their interaction has not been considered in neuraxial versus general anesthesia comparisons. Using the Hospital Frailty Risk Score (HFRS), we examined this interaction. In this retrospective cohort study (2016-2023, Premier Healthcare Database), adults undergoing hip fracture surgery with neuraxial or general anesthesia were included and stratified by age quantiles (≤71, 72-86, ≥87 years) and HFRS (low, intermediate/high). The primary outcome was an in-hospital composite of mortality and major system complications. Intensive care unit (ICU) admission and high opioid use or prolonged length of stay (LOS) ≥75th percentile were also assessed. We used mixed-effects models and reported odds ratios (OR) and 95% confidence intervals (CIs). Among 623,122 patients, neuraxial (versus general) anesthesia was associated with lower odds of the composite outcome in patients ≥87 years with intermediate/high frailty (OR, 0.88 and 95% CI, 0.83-0.94; P < .001). Overall, neuraxial anesthesia was linked to higher odds of respiratory complications (OR, 1.06 and 95% CI, 1.01-1.10; P = .03), driven by patients ≤71 years with intermediate/high frailty, and lower odds of renal failure (OR, 0.87 and 95% CI, 0.83-0.92; P < .001), primarily among those ≥72 years with intermediate/high frailty. Neuraxial anesthesia was also associated with higher cardiac complication odds (OR, 1.07 and 95% CI, 1.02-1.12; P = .008), particularly in patients aged 72 to 86 years with intermediate/high frailty. Mortality odds were lower overall (OR, 0.83 and 95% CI, 0.74-0.93; P = .003), driven by patients ≥87 years with intermediate/high frailty. Neuraxial anesthesia was associated with higher odds of prolonged LOS in patients aged 72 to 86 years with low frailty (OR, 1.16 and 95% CI, 1.04-1.31; P = .035), but lower odds in those ≥87 years with intermediate/high frailty (OR, 0.92 and 95% CI, 0.87-0.97; P = .012). It was associated with lower odds of high opioid use overall and within each subgroup. ICU admission odds were higher in patients ≤71 years with intermediate/high frailty (OR, 1.16 and 95% CI, 1.05-1.29; P = .019) but lower in those ≥87 years with intermediate/high frailty (OR, 0.82 and 95% CI, 0.75-0.90; P < .001). Neuraxial anesthesia was linked to higher odds of discharge home (OR, 1.08 and 95% CI, 1.04-1.12; P < .001), except among ≥87-year-old intermediate/high frailty patients, where odds were lower (OR, 0.90 and 95% CI, 0.81-0.99; P = .041). Neuraxial versus general anesthesia showed modest overall benefits after hip fracture, varying by age-frailty subgroup, supporting frailty-guided anesthetic decisions clinically.Level of evidence: III. Retrospective cohort study.

Public health emergencies such as pandemics, natural disasters, and epidemics may require rapid, high-stakes decisions often made by elected officials with limited public health training. Artificial intelligence (AI) holds significant promise to enhance the quality, transparency, and timeliness of governmental decision-making during such crises. This paper examines the potential of AI as a decision-support tool for elected officials while identifying key technical, logistical, ethical, and policy challenges. Technical considerations include model accuracy, data representativeness, and privacy protection, while ethical imperatives center on fairness, transparency, and accountability to prevent amplification of existing health disparities. The paper further explores workforce development needs, emphasizing AI literacy and cross-sector collaboration to enable informed use of AI insights. This viewpoint presents a novel AI Decision Support Lifecycle framework specifically designed for governmental public health emergency response, mapping six phases from problem definition through post-emergency evaluation. We provide stakeholder-specific recommendations for model developers, health agencies, and elected officials, and illustrate practical application through a detailed case example and use cases. Drawing on empirical evidence regarding digital health technologies and AI governance, we emphasize that technology deployment alone is insufficient. Successful implementation requires complementary investments in organizational capacity, data infrastructure, workforce training, community engagement, and continuous evaluation. AI integration also requires robust governance frameworks, continuous model evaluation, and alignment with existing crisis management structures. Policy recommendations highlight the importance of ethical AI frameworks, risk assessments, and public engagement to foster trust. Ultimately, AI can strengthen public health decision-making if developed and implemented responsibly within transparent and equitable systems.

Patient-reported outcomes (PROs) and experience measures (PREMs) are essential in assessing patient outcomes and experiences in comparative effectiveness research and clinical practice. While validated measures exist for colorectal cancer (CRC) screening, none address colon polyp surveillance. We aimed to develop and validate PRO/PREM items for this purpose. Using a mixed-methods instrument development design, we conducted semistructured interviews with 14 older adults with a history of colon polyps and 9 primary care physicians and then tested a 16-item PRO/PREM questionnaire. We conducted exploratory factor analyses (EFAs; N=449), confirmatory factor analyses (CFAs; N=466), and test-retest reliability (N=155) to assess validity and reliability. Interviews revealed 6 PRO/PREM domains: Test Satisfaction, Test Convenience, Testing Complications, Assistance Needed, Confidence in Test, and Cancer Worry. Whereas the EFA results supported a 3-factor solution, the CFA results supported a 1-factor, 4-item model of Test Experience/Satisfaction. Test-retest reliability for this composite Test Experience/Satisfaction score was good. Test-retest reliability was moderate for 12 of the individual PRO/PREM items and poor for 3 items. To our knowledge, this is the first study to develop and validate PRO/PREM items for adults undergoing colon polyp surveillance. Although subsequent research is required to assess the predictive validity of these items, our findings provide strong initial support for their psychometric properties, and this study represents an essential first step toward implementing PRO/PREM items for colon polyp surveillance in research and clinical settings.

Sedentary employees face increased chronic health risks due to physical inactivity, immobility, and unhealthy eating behavior. Although mobile health (mHealth) interventions show promise in improving lifestyle behaviors, their effectiveness in occupational settings remains underexplored. Building on previous workplace interventions, this study developed and evaluated a mobile-enabled web app, SIMPLE HEALTH, developed with Din-J Design Co, Ltd, integrating activity tracking, healthy eating, and behavioral support for sedentary employees. This study evaluated the short-term effects of a 12-week mHealth intervention on physical activity, sedentary behavior, dietary habits, and cardiometabolic health indicators among sedentary employees in Taiwan. A 2-arm quasi-experimental study was conducted at 2 aerospace industrial workplaces. A total of 101 sedentary employees (mean age 46.9, SD 12.2 years; 52/101, 51.5% female) were enrolled from 2 worksites that were assigned by coin toss to either the intervention condition (n=50) or the control condition (n=51). The intervention group participated in the SIMPLE HEALTH program, an mHealth intervention grounded in Social Cognitive Theory and the Ecological Model, consisting of 8 components: activity tracking, goal setting, behavior logging, reminders, personalized advice, educational and motivational electronic booklets, and individual and team challenges. The control group received 6 print educational booklets. Cardiometabolic biomarkers, objectively measured physical activity (Fitbit Charge 3; Fitbit Inc), occupational sitting (occupational sitting and physical activity questionnaire), and dietary behavior (3-day photographic food records and the healthy eating behavior inventory) were assessed at baseline and 12 weeks. Data were analyzed using generalized estimating equations following the intention-to-treat principle. At 12 weeks, the intervention group showed a significant increase in step counts (adjusted mean difference, MD 1227.13, 95% CI 2.90-2451.36; P=.049), a more favorable between-group change in moderate physical activity (adjusted MD 0.17, 95% CI 0.01-0.33; P=.04), and favorable dietary behaviors, including reduced intake of calories (adjusted MD -144.59, 95% CI -276.57 to -12.60; P=.03), carbohydrates (adjusted MD -19.88, 95% CI -37.99 to -1.78; P=.03), fats (adjusted MD -6.99, 95% CI -13.69 to -0.29; P=.04), and grains (adjusted MD -1.46, 95% CI -2.43 to -0.50; P=.003), and increased vegetable intake (adjusted MD 0.47, 95% CI 0.06-0.88; P=.02), compared to the control group. Favorable trends were noted in diastolic blood pressure (adjusted MD -2.38, 95% CI -4.99 to 0.22; P=.07) and soft lean mass (adjusted MD 0.34, 95% CI -0.06 to 0.75; P=.10). Both groups showed significant within-group improvements in low-density lipoprotein cholesterol (intervention: P=.01; control: P=.03), body fat percentage (intervention: P<.001; control: P=.01), waist circumference (intervention: P=.001; control: P=.002), and occupational sitting (intervention: P<.001; control: P=.03), and occupational walking (intervention: P=.01; control: P=.046), but between-group differences were nonsignificant. The 12-week mHealth intervention improved physical activity and dietary behaviors and showed favorable trends in cardiometabolic indicators among sedentary employees. These findings support integrating mHealth programs into employee wellness initiatives to promote healthy behaviors, mitigate productivity loss, and reduce chronic disease burden. Further research should assess long-term sustainability, scalability, and cost-effectiveness in diverse occupational settings.

Individuals with schizophrenia or bipolar disorder face a significantly elevated risk of obesity, primarily due to weight gain associated with psychiatric medications and lifestyle factors. While digital self-monitoring tools offer scalable solutions, their application remains underexplored in psychiatric populations. To address these gaps, this type 1 hybrid effectiveness-implementation study investigates the preliminary effectiveness and implementation feasibility of a mobile health-assisted weight management intervention for patients with severe mental illness. This study aims to evaluate the preliminary effectiveness and implementation feasibility of a mobile health-assisted weight management intervention for patients with severe mental illness transitioning from inpatient care to community-based recovery. This single-center, open-cohort stepped-wedge cluster randomized trial with a 2-month step duration will recruit 204 patients from 6 clinical units. Clusters are randomized into 2 waves, with staggered transitions to a digital intervention, including smart scales, health apps, and biweekly educational modules, over a 6-month observation period. The design evaluates the intervention across the transition from inpatient care to community-based recovery. The primary outcome is the proportion of participants achieving ≥5% weight loss at month 6. Implementation feasibility is assessed through device technical success and intervention adherence (defined as ≥50% completion of weekly weigh-ins and daily dietary logs). Participant data collection began in May 2023 and was completed by June 2025 with a total of 204 participants. The publication of key findings and results is anticipated in late 2026. This protocol describes a pragmatic, technology-supported intervention designed to address metabolic side effects in a tertiary psychiatric setting. By bridging the gap between acute hospitalization and community recovery, this hybrid stepped-wedge cluster randomized trial provides a crucial framework for integrating digital metabolic monitoring into routine clinical workflows for vulnerable populations.

The Sustainable Development Goals (SDGs) aim to eradicate poverty and inequality while ensuring that all individuals enjoy good health. Among these, target 3.1 seeks to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. However, progress toward this target has been limited, particularly in low- and middle-income countries (LMICs), where health care delivery remains constrained by limited resources. While digital innovations have increasingly been adopted to improve health care access and service delivery, a significant proportion of populations in LMICs continues to experience inadequate access to essential maternal health services. This gap underscores the need for affordable, sustainable, and contextually appropriate strategies that are cost-effective in improving maternal health outcomes in underserved communities. This study leverages the principles of frugal innovation and information and communication technologies for development (ICT4D) to propose a frugal-oriented ICT4D framework to deliver low-cost digital maternal health solutions in LMIC settings. The framework seeks to optimize the use of available resources, foster equitable access to maternal health care, and contribute toward achieving SDG 3, particularly target 3.1. The study was conducted in both rural and urban-poor settings in Kenya using a 2-phased quantitative approach. In phase 1, eight theoretical themes relevant to maternal health uptake were explored. These themes were represented on color-coded sorting cards, which participants ranked according to perceived importance. Phase 2 involved administering structured survey questionnaires to collect empirical data. The study included a total of 32 participants, whose insights provided a foundation for analyzing the significance of contextual factors influencing maternal health service utilization. The weighted scores for 3 of the 8 predetermined theoretical themes-such as resources, information services, and social support programs-emerged as the most influential factors shaping maternal health promotion (N=32). Resources ranked highest (n=6, 18.81%), followed by information services (n=6, 17.99%), while social support programs accounted for 9.64% (n=3) of the overall influence. These findings highlight critical enablers and barriers within the maternal health care landscape and provide a nuanced understanding of contextual dynamics that affect the uptake of maternal health services. The results informed the design of a frugal-oriented ICT4D framework that prioritizes low-cost digital interventions tailored to resource-limited settings. Despite increasing recognition of digital innovations as tools for health care transformation in LMICs, adoption of existing capital-intensive solutions remains low due to financial and infrastructural constraints. This study emphasizes the importance of adopting frugal innovation and ICT4D principles in designing low-cost, scalable digital health interventions to improve access to maternal health care. Implementing such approaches can address resource limitations, enhance maternal health outcomes, and support progress toward SDG 3, particularly target 3.1. The proposed framework provides a foundation for future research and practical interventions aimed at sustainable, equitable maternal health service delivery in LMIC contexts.

Prolonged sitting disrupts lower-limb endothelial and microvascular function, likely via reduced shear stress and blunted microvascular reactivity. We examined whether Tabata-style high-intensity interval training (HIIT) mitigates this sitting-induced vascular dysfunction. Twenty-two healthy young adults (age 20.3 ± 0.8 years) were randomly assigned to a control group (n = 11) or a training group (n = 11); each group comprised seven men and four women. Participants completed 8 weeks of HIIT (4 sessions/week) using a cycle ergometer and bodyweight exercises. Before and after the intervention, participants underwent a 3 h period of sitting during which popliteal artery flow-mediated dilation (FMD) and reactive hyperaemic blood flow were assessed; plasma nitrate/nitrite and endothelin-1 were also measured at rest. Sitting reduced popliteal artery blood flow and shear rate in both groups before and after training (P < 0.05). Popliteal artery FMD decreased after sitting at baseline in both groups and remained lower after sitting in the training group post-intervention. However, post-sitting FMD at week 8 was higher in the HIIT group than in controls after adjustment for pre-sitting FMD. Post-sitting blood-flow area under the curve was decreased by sitting in both groups before and after the intervention (P < 0.05), and resting nitrate/nitrite and endothelin-1 did not change with training. These results indicate that 8 weeks of HIIT does not prevent sitting-induced impairments in endothelial function or microvascular function. Although the HIIT maintained higher post-sitting FMD, HIIT alone was insufficient to counteract the acute endothelial and microvascular dysfunction imposed by sitting.

In vitro fermentation models with strains of Lactiplantibacillus plantarum and Bacillus subtilis were used to track the structural changes in polyphenolic composition in wild blueberry treatments after 72 h fermentation, and to compare metabolites from exogenous fermentation to those reported to be produced by human gut-derived catabolism. Shifts in the profiles of flavonoids, anthocyanins, proanthocyanidins, phenolic acids, and phenolic acid conjugates (some putatively identified for the first time in wild blueberries) were quantified. While glucuronide and sulfate conjugates of phenolic acids (which rely on human enzymes) are not produced in vitro, exogenous fermentation can, depending on the conditions, replicate a broad range of the bioactive phenolic acids generated by endogenous fermentation of wild blueberries in the human gut. Exogenous fermentation may therefore yield more standardized and physiologically relevant phenolic profiles than an unfermented blueberry extract for use in translational preclinical research on berry health benefits.

This diagnostic study examines the performance of the updated Pediatric Emergency Care Applied Research Network rule in determining the risk for invasive bacterial infections in an international sample of infants.

Successful clinical trials require robust patient enrollment, yet study sites often struggle to identify potentially eligible patients, particularly in pediatric populations. During a stepped-wedge, cluster randomized clinical trial, ENhanced Recovery in CHildren Undergoing Surgery (ENRICH-US), concerns about adequate recruitment led us to assess the relationship between site characteristics and enrollment rates. We conducted a mixed-methods, explanatory, sequential design study using (a) secondary quantitative data from the Pediatric Health Information System (PHIS) database to identify potentially eligible patients (ages 10-18 undergoing elective gastrointestinal surgery) at 10 ENRICH-US study sites and (b) qualitative data from semi-structured focus groups to assess site-specific enrollment barriers and facilitators. The number of potentially eligible patients identified through PHIS (07/01/20-04/30/23) was compared to the actual ENRICH-US enrollment to calculate site enrollment rates. Semi-structured interviews (10/01/19-04/01/23) were then analyzed to identify themes of barriers and facilitators. Of 485 potentially eligible patients, 312 (64.3%) were enrolled. Enrollment rates varied (27.6%-88.5%). High-enrollment rate sites (>60%) had dedicated staff, engaged study leaders, clinical trial experience, and expanded the intervention beyond the study population. Automated tools facilitated patient identification, mitigating personnel turnover challenges. Using secondary quantitative databases to assess clinical trial enrollment is a novel approach. When combined with qualitative insights, these data can inform strategies to enhance recruitment and enrollment.

Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, yet their underlying immune mechanisms are still incompletely understood. A central limitation of current frameworks is that they largely conceptualize immune responses at the level of individual cell types, without fully accounting for how spatial context shapes cellular behavior. Over the past decade, bulk and single-cell transcriptomic approaches have substantially expanded our understanding of immune heterogeneity in cardiovascular tissues, revealing diverse macrophage, lymphocyte, and stromal populations implicated in disease progression. However, these approaches inherently disrupt tissue architecture and therefore fail to capture how immune cells operate within structured microenvironments. Recent advances in spatial transcriptomics, multiplexed imaging, and single-cell multi-omics now enable the interrogation of gene expression within intact tissues, providing direct insight into the spatial organization of immune responses. These technologies reveal that cardiovascular inflammation and repair are not diffusely distributed processes but are instead organized into discrete, spatially constrained niches. Within these niches, cellular identity, anatomical positioning, and local signaling gradients converge to regulate key processes including inflammation, fibrosis, and vascular remodeling. Evidence from myocardial infarction, atherosclerosis, and vascular injury demonstrates that microenvironments such as inflammatory foci, fibrotic border zones, and lipid-rich plaque regions orchestrate dynamic interactions among macrophages, T cells, fibroblasts, and endothelial cells. Here, we synthesize recent advances in spatial immunomics to propose a conceptual shift from cell-centric to niche-centric models of cardiovascular disease, framing tissues as structured immune ecosystems. We discuss computational strategies that integrate single-cell sequencing, spatial transcriptomics, and imaging data to reconstruct cellular neighborhoods and infer intercellular communication networks, while highlighting current limitations in resolving causality from spatial correlations. Finally, we explore the translational potential of spatial immunomics, including the identification of spatially defined biomarkers, the development of niche-targeted therapeutic strategies, and the construction of predictive models linking tissue architecture to clinical outcomes.

Identifying infections during autopsy is challenging in forensic pathology. Although microbiological testing can assist in diagnosis, distinguishing true pathogens from contaminants is often difficult. Molecular methods, such as PCR, may support diagnostic conclusions. On August 22, 2024, a 30-year-old woman was admitted to the Department of Emergency Medicine, Clinical Centre, University of Debrecen, Hungary, with severe vomiting and diarrhea. Her medical history included treated congenital adrenal hyperplasia. Within 30 min of admission, she developed sudden cyanosis and respiratory insufficiency. Despite resuscitation efforts, the patient died shortly after arrival. Two days before hospitalization, she had collected sewage samples from the Kraszna River (Hungary) as part of her job. According to her colleagues, she did not wear any protective equipment (mask, gloves, or coveralls). The samples were later analyzed at the National Center for Public Health and Pharmacy and tested positive for Norovirus. Postmortem examination, including microbiological and molecular investigations (BioFire FilmArray GI multiplex PCR), confirmed Norovirus infection. These findings supported the hypothesis that viral infection significantly contributed to rapid clinical deterioration. This case highlights the utility of molecular microbiology in forensic investigations. Multiplex PCR panels, routinely used in clinical diagnostics, can provide valuable evidence in postmortem settings, particularly in acute gastrointestinal deaths where autopsy findings are non-specific. Early patient education in congenital adrenal hyperplasia may prevent fatal outcomes in similar cases.

Titanium dioxide nanoparticles (TiO2 NPs), widely used as food additives, frequently coexist with high-fat diets (HD) in modern dietary patterns, yet their combined in vivo toxicity remains poorly understood. This study investigated the multi-organ effects of co-exposure to TiO2 NPs or food-grade E171 and HD in male C57BL/6J mice. Mice were randomly assigned to six groups and fed regular or high-fat diets containing 1 wt% TiO2 NPs or E171 for 13 weeks. Histopathology, serum biochemistry, organ coefficients, and open-field behavioral tests were used to assess tissue injury and functional alterations. Co-exposure to TiO2 NPs and HD markedly exacerbated tissue damage across multiple organs. In the liver, more severe ballooning degeneration, necrosis, and inflammatory infiltration were observed, accompanied by altered liver enzymes and reduced organ coefficients. Intestinal injury was characterized by crypt distortion and increased inflammation, particularly in the HD + TiO2 group. Testicular tissues showed disorganized seminiferous tubules, loss of spermatogenic cells, and interstitial hyperplasia. In the brain, hippocampal neurons exhibited pyknosis and disarray, with decreased brain coefficients and impaired exploratory behavior. E171 induced similar but milder effects. These findings indicate that HD enhances TiO2 NPs induced multi-organ toxicity, highlighting the health risks of realistic co-exposure to dietary nanoparticles and high-fat foods.

In this study, a healthy iPSC line SDQLCHi087-A was successfully generated by reprogramming from peripheral blood mononuclear cells using integration-free episomal plasmids. The iPSC line presented a normal karyotype, expressed high levels of pluripotent markers, and exhibited the ability to differentiate to three germ layers in vitro. The cell line serves as a valuable control for studies of molecular pathogenesis and the development of disease models.

Women in the United Kingdom face noticeable challenges in accessing and receiving reproductive health care. The emotional impact of these challenges is seldom evaluated. Recent research and wider societal discourse suggest that many women experience 'gaslighting', a form of psychological manipulation where their health concerns are not taken seriously, leading to feelings of dismissal and resulting in withdrawal from mainstream healthcare services. This can culminate in delayed diagnoses and poorer health outcomes. A qualitative systematic review of the literature investigating gaslighting and dismissal in women's reproductive health in the UK, with a focus on how these experiences differ across intersecting identities such as ethnicity, sexuality, and socioeconomic status. Search of qualitative literature across key databases including PubMed, PsycInfo, CINAHL plus, Web of Science, Medline, Scopus, Embase, Science Direct, and HMIC retrieving 25,258 papers. The review identified no papers explicitly addressing gaslighting in women's reproductive health in the UK. However, seven related studies were found containing relevant themes (e.g. dismissal), providing a basis for the review. A thematic summary based on the extracted data resulted in the development of four themes 1) dismissal of symptoms and needs (patients experiences, systemic issues), 2) marginalised experiences (ethnic minority women, LGBTQ+ people), 3) stigma and fear of judgement, and 4) poor communication and limited autonomy. The review highlights the need for more targeted research in this area as the scarcity of literature underscores the importance of exploring the emotional impact and framing of dismissal as gaslighting by women in reproductive healthcare. Better conceptualisation and understanding could inform practice and policy changes aimed at validating women's experiences and improving equity in reproductive healthcare access and outcomes.

Lead (Pb) and cadmium (Cd) are common environmental pollutants. Our previous population study revealed a significant positive association between Pb and Cd exposure and the micronuclei frequency among lead smelting workers. However, the underlying mechanisms remain unclear. In this study, human lymphoblastoid TK6 cells were used to investigate the genotoxicity and its mechanisms induced by individual or combined exposure to Pb and Cd. Our results showed that Pb and Cd exposure, alone or in combination, triggered oxidative stress, as evidenced by reduced antioxidant enzyme activity (GSH, SOD and CAT) and increased content of ROS and GSSG. Both metals induced pronounced DNA damage, as shown by elevated Tail DNA% in the Comet assay and γ-H2AX fluorescence intensity. Furthermore, Pb and/or Cd exposure caused inhibition of the DNA repair proteins, including BRCA1, CtIP, RAD52, and XRCC2, indicating impaired DNA repair capacity; and upregulated Bax expression and the Bax/Bcl-2 ratio and Caspase-3 with downregulation of Bcl-2. Notably, Pb and Cd co-exposure produced an antagonistic effect, modulating oxidative stress indicators, cell-cycle arrest, DNA damage markers, DNA repair and apoptosis-related proteins. These findings demonstrate that Pb and Cd induce oxidative stress, DNA damage, inhibition of DNA repair, and apoptosis in TK6 cells. Our study provides new insights into the mechanisms of heavy metal combined exposure-induced genotoxicity and identifies potential molecular targets for intervention.