公共卫生研究摘要 (2025-08-01)
共收录 58 篇研究文章
1. Trends and Disparities in Mortality due to Diabetes Mellitus and Sepsis in the US Adults: 1999-2023.
期刊: Endocrinology, diabetes & metabolism 发表日期: 2025-Sep 链接: PubMed
摘要
Diabetes mellitus (DM) increases susceptibility to infection and worsens outcomes in sepsis, a leading cause of preventable death. However, population-level trends in sepsis-related mortality among diabetic individuals in the United States (US) remain poorly characterised, especially in the context of the COVID-19 pandemic. This study evaluates national patterns, temporal shifts, and demographic disparities in sepsis-related mortality in diabetic patients from 1999 to 2023. We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death database. Sepsis-related deaths with co-listed DM were extracted for US adults between 1999 and 2023. Age-adjusted mortality rates (AAMRs) were calculated and Joinpoint regression was used to estimate annual percentage changes (APCs) and identify significant trends. A total of 483,207 sepsis-related deaths occurred in individuals with DM during the study period. AAMRs declined significantly from 1999 to 2018 (APC: -1.22; p < 0.001), reversed sharply from 2018 to 2021 (APC: +18.14; p = 0.01), and declined again through 2023 (APC: -12.25; p < 0.001). Mortality was highest among older adults (AAMR: 32.63), males (9.72 vs. 7.80 in females), and non-Hispanic Black and American Indian/Alaska Native populations (AAMRs: 17.94 and 17.92, respectively). Hispanic populations showed the steepest pandemic-era increase (APC: +22.49) and subsequent decline (APC: -20.43). Rural areas consistently had higher AAMRs than urban areas (8.77 vs. 8.27), with sharper increases during the pandemic. State-level disparities widened dramatically from 2021 to 2023, and regionally, the South and Midwest exhibited the highest and most persistent mortality burdens. Sepsis-related mortality in diabetic individuals in the US has undergone dynamic shifts over the past 25 years, punctuated by COVID-19 era surges and shaped by deep-rooted demographic, geographic, and structural inequities. These findings warrant integrated diabetes-infection care models, early sepsis recognition, and equity-driven interventions to reduce mortality.
2. The Impact of Vision Impairment on Self-Reported Falls Among Older US Adults: Cross-Sectional and Longitudinal Study.
期刊: JMIR aging 发表日期: 2025-Jul-31 链接: PubMed
摘要
Falls are the leading cause of injury among older adults, with vision impairment recognized as a significant risk factor. However, many existing studies have been limited by small sample sizes, retrospective designs, or insufficient adjustment for confounding factors. To overcome these limitations, we used data from the University of Michigan’s Health and Retirement Study (HRS) to analyze the association between self-reported vision and fall risk among older adults in a large, nationally representative sample. The objective of this study was to investigate the association between vision impairment and falls and assess whether subjective vision impairment predicts future falls in older adults. This cross-sectional and longitudinal analysis used data from the HRS (1996-2020) to assess the relationship between self-reported vision, glaucoma history, and falls among US adults aged 65 years and older. HRS uses a biennial, multistage area probability sample survey design, collecting data with community-dwelling individuals followed up every 2 years until death, tracking health, economic, and social outcomes. Multivariate logistic regression was used to analyze associations between self-reported vision and self-reported falls in the past 2 years. A total of 38,835 respondents contributed 117,834 observations. The weighted proportion of participants reporting falls was 37.9% (95% CI 37.7%-40.1%). Significant risk factors for falls included overall eyesight impairment (adjusted odds ratio [aOR] 1.36, 95% CI 1.20-1.56), distance vision impairment (aOR 1.37, 95% CI 1.32-1.42), near vision impairment (aOR 1.33, 95% CI 1.27-1.37), and glaucoma (aOR 1.15, 95% CI 1.07-1.24). A similar association was observed for serious falls, where overall eyesight impairment (aOR 1.20, 95% CI 1.03-1.44), distance vision impairment (aOR 1.14, 95% CI 1.07-1.22), near vision impairment (aOR 1.12, 95% CI 1.05-1.18), and glaucoma (aOR 1.15, 95% CI 1.05-1.26) were significant. In longitudinal analyses, overall vision impairment (aOR 1.23, 95% CI 1.16-1.29), distance vision impairment (aOR 1.27, 95% CI 1.20-1.38), near vision impairment (aOR 1.23, 95% CI 1.19-1.32), and glaucoma (aOR 1.25, 95% CI 1.13-1.37) increased the risk of future falls. Reported overall vision was significantly associated with the number of falls in both the same (P<.001) and subsequent (P<.001) survey cycles. Both distance and near vision impairment, as well as glaucoma, are associated with a higher risk of falls in older adults and present possible areas for intervention and prevention.
3. The Evolution of Medical Student Competencies and Attitudes in Digital Health Between 2016 and 2022: Comparative Cross-Sectional Study.
期刊: JMIR medical education 发表日期: 2025-Jul-31 链接: PubMed
摘要
Modern health care systems worldwide are facing challenges, and digitalization is viewed as a way to strengthen health care globally. As health care systems become more digital, it is essential to assess health care professionals’ competencies and skills to ensure they can adapt to new practices, policies, and workflows effectively. The aim of this study was to analyze how the attitudes, skills, and knowledge of medical students concerning digital health have shifted from 2016 to 2022 in connection with the development of the national health care information system architecture using the clinical adoption meta-model framework. The study population consisted of 5th-year medical students from the University of Oulu in Finland during 2016, 2021, and 2022. A survey questionnaire was administered comprising 7 background questions and 16 statements rated on a 5-point Likert scale assessing students’ attitudes toward digital health and their self-perceived digital capabilities. The results were recategorized into a dichotomous scale. The statistical analysis used Pearson χ2 test. The Benjamini-Hochberg procedure was used for multiple variable correction. The study included 215 medical students (n=45 in 2016, n=106 in 2021, and n=64 in 2022) with an overall response rate of 53% (43% in 2016, 74% in 2021, and 42% in 2022). Throughout 2016, 2021, and 2022, medical students maintained positive attitudes toward using patient-generated information and digital applications in patient care. Their self-perceived knowledge of the national patient portal significantly improved, with agreement increasing by 35 percentage points from 2016 to 2021 (P<.001) and this trend continued in 2022 (P<.001). However, their perceived skills in using electronic medical records did not show significant changes. Additionally, students’ perceptions of the impact of digitalization on health promotion improved markedly from 2016 to 2021 (with agreement rising from 53% to 78%, P=.002) but declined notably again by 2022. Medical students’ attitudes and self-perceived competencies have shifted over the years, potentially influenced by the national health information system architecture developments. However, these positive changes have not followed a completely linear trajectory. To address these gaps, educational institutions and policy makers should integrate more digital health topics into medical curricula and provide practical experience with digital technologies to keep professionals up-to-date with the evolving health care environment.
4. Capturing Community Perspectives in a Statewide Cancer Needs Assessment: Online Focus Group Study.
期刊: JMIR cancer 发表日期: 2025-Jul-31 链接: PubMed
摘要
Kentucky has the highest all-site cancer incidence and mortality rates in the United States. Conducting needs assessments in a large geographic area, such as an entire state, poses challenges in collecting qualitative data from diverse rural and urban contexts. In 2021, a steering committee was formed to drive a multimethod, statewide cancer needs assessment (CNA) to identify the future priorities for all cancer-related care in Kentucky. We aimed to report on the online focus group component of the CNA by documenting existing community resources and perceived needs across the cancer care continuum. In addition, we aimed to explore the impacts of social determinants of health among populations experiencing health disparities. Through existing partnerships and a national research registry, we recruited adult Kentucky residents who were not employed in health occupations to participate in 11 online 60-minute focus groups, stratified to include multiple target populations and geographic areas. We based our semistructured discussion guide on the cancer care continuum and focused on social determinants of health, health equity, and factors affecting cancer diagnoses and outcomes. We conducted a qualitative line-by-line analysis of the recorded transcripts to identify themes. The participants (N=51; mean 4.63, SD 2.26 per group) lived in 25 different counties, including 35% (18/51) from rural communities, 14% (7/51) from the Appalachian area of Kentucky, and 31% (16/51) who self-identified with a racial or ethnic minority group. We identified 17 primary themes representing community-perceived needs and potential solutions across the cancer care continuum, including novel approaches to make information accessible; messaging not interpreted as blaming or shaming; messaging from individuals who engender trust; screening efforts to reach individuals where they are; ways to address practical barriers to screening and treatment, such as cost and transportation; and ways to increase knowledge about insurance coverage. In addition, we found 83 emergent subthemes specific to race, ethnicity, rural and urban residence, sexual orientation and gender identity, and age. The participants described the need to promote positive, culturally sensitive patient-health care provider communication and to create safe care spaces that consider the ways in which social norms affect cancer care, fight stigma, and improve health equity. By conducting statewide qualitative data collection online, we provided valuable depth of understanding for future programs and research to address cancer incidence and mortality in Kentucky. The findings pointed to several potential actions to address community-perceived needs across the cancer care continuum, including increasing accessible risk reduction information, expanding ways to overcome challenges to screening and treatment, building patient navigation resources, and increasing positive patient-health care provider communication. The findings also suggest that online focus groups can be a valuable component of CNAs to capture cancer-related needs and solutions across large geographic areas and diverse populations.
5. Large Language Model Symptom Identification From Clinical Text: Multicenter Study.
期刊: Journal of medical Internet research 发表日期: 2025-Jul-31 链接: PubMed
摘要
Recognizing patient symptoms is fundamental to medicine, research, and public health. However, symptoms are often underreported in coded formats even though they are routinely documented in physician notes. Large language models (LLMs), noted for their generalizability, could help bridge this gap by mimicking the role of human expert chart reviewers for symptom identification. The primary objective of this multisite study was to measure the accurate identification of infectious respiratory disease symptoms using LLMs instructed to follow chart review guidelines. The secondary objective was to evaluate LLM generalizability in multisite settings without the need for site-specific training, fine-tuning, or customization. Four LLMs were evaluated: GPT-4, GPT-3.5, Llama2 70B, and Mixtral 8×7B. LLM prompts were instructed to take on the role of chart reviewers and follow symptom annotation guidelines when assessing physician notes. Ground truth labels for each note were annotated by subject matter experts. Optimal LLM prompting strategies were selected using a development corpus of 103 notes from the emergency department at Boston Children’s Hospital. The performance of each LLM was measured using a test corpus with 202 notes from Boston Children’s Hospital. The performance of an International Classification of Diseases, Tenth Revision (ICD-10)-based method was also measured as a baseline. Generalizability of the most performant LLM was then measured in a validation corpus of 308 notes from 21 emergency departments in the Indiana Health Information Exchange. Symptom identification accuracy was superior for every LLM tested for each infectious disease symptom compared to an ICD-10-based method (F1-score=45.1%). GPT-4 was the highest scoring (F1-score=91.4%; P<.001) and was significantly better than the ICD-10-based method, followed by GPT-3.5 (F1-score=90.0%; P<.001), Llama2 (F1-score=81.7%; P<.001), and Mixtral (F1-score=83.5%; P<.001). For the validation corpus, performance of the ICD-10-based method decreased (F1-score=26.9%), while GPT-4 increased (F1-score=94.0%), demonstrating better generalizability using GPT-4 (P<.001). LLMs significantly outperformed an ICD-10-based method for respiratory symptom identification in emergency department electronic health records. GPT-4 demonstrated the highest accuracy and generalizability, suggesting that LLMs may augment or replace traditional approaches. LLMs can be instructed to mimic human chart reviewers with high accuracy. Future work should assess broader symptom types and health care settings.
6. Suicide Prevention Training Among Occupational Groups: A Cross-Sectional Study of State-Level Policies as of July 2022.
期刊: American journal of public health 发表日期: 2025-Jul-31 链接: PubMed
摘要
We systematically assessed the presence and distribution of state-level policies, specifically statutes and regulations that were in effect as of July 1, 2022, related to training any occupational groups in suicide prevention. Utilizing legal epidemiology methods, we conducted a cross-sectional assessment of all 50 states and the District of Columbia. We identified 824 policies in our initial search and retained 477 in our final policy database. Policies were distributed across 5 occupational settings: educational (n = 142), behavioral health (n = 130), carceral (n = 111), primary and specialty care (n = 60), and other (n = 58). Fourteen policies pertained to multiple settings. On average, each state had 9.4 policies and covered 3 occupational settings. All states had at least 1 policy (minimum: 1; maximum: 42). Training occupational groups in suicide prevention is a widespread strategy, but significant variation exists across states, occupational settings, and specific occupational groups. Further research is necessary to determine whether this is an effective suicide prevention strategy at the population level. (Am J Public Health. Published online ahead of print July 31, 2025:e1-e11. https://doi.org/10.2105/AJPH.2025.308193).
7. Effect of a pay-it-forward strategy on reducing HPV vaccine delay and increasing uptake among 15- to 18-year-old girls in China: A randomized controlled trial.
期刊: PLoS medicine 发表日期: 2025-Jul-31 链接: PubMed
摘要
Catch-up human papillomavirus (HPV) vaccination is challenging in many low- and middle-income countries (LMICs). Pay-it-forward offers an individual a subsidized vaccine, then an opportunity to donate to help others access vaccinations. Our randomized control trial assessed the effectiveness of pay-it-forward in improving HPV vaccination among girls aged 15-18 years in China. This study was conducted from July 6, 2022, to June 9, 2023, in four community health centers (CHCs) in Chengdu, western China. Eligible participants were unvaccinated girls living in the service areas of CHCs. Participants were initially recruited via telephone and, after providing verbal consent, attended in-person visit where they were randomly assigned using the sealed envelope method to either the pay-it-forward arm (received a community subsidy of 47.7 USD covering the first vaccine and an opportunity to support others) or control arm (self-paid vaccination at the market price). Participants were unblinded only after the envelope was opened, while the CHC staff coordinators, physicians prescribing the vaccine, outcome assessors, and data analysts were blinded to the intervention allocation. The primary outcome was the first-dose HPV vaccination rate, verified against clinical records. Data were analyzed using the intention-to-treat approach. We identified 662 participants per phone invitation. A total of 321 participants showed up in the health centers and randomly assigned to the pay-it-forward arm (n = 161) or control arm (n = 160). Most caregivers were female (80.1%, 257/321). In the pay-it-forward arm, 55 of 161 (34.2%) girls received the HPV vaccine, compared with 28 of 160 (17.5%) girls in the control arm (adjusted proportion difference = 17.9%, (95% CI [8.7%, 27.0%]; P < 0.001). Among 55 girls in the pay-it-forward arm who received the vaccination, 37 (67.3%) wrote a postcard message, and 39 (70.9%) of their caregivers donated to support future girls. The financial cost per person vaccinated was $294 in the control arm and $230 in the pay-it-forward arm. The trial had several limitations, including a 54% clinic attendance rate (360 of 662 consented participants attended) and its conduct in a single western province of China. The pro-social pay-it-forward strategy was effective to increase catch-up HPV vaccination among teenage girls. This approach also enhanced vaccine confidence among participants. Pay-it-forward demonstrates promise as an effective intervention to improve vaccine uptake through community engagement. Chinese clinical trial registry ChiCTR2200055542 (https://www.chictr.org.cn/hvshowproject.html?id=183292&v=1.3).
8. Effects of YouTube Health Videos on Mental Health Literacy in Adolescents and Teachers: Randomized Controlled Trial.
期刊: JMIR mental health 发表日期: 2025-Jul-31 链接: PubMed
摘要
Adolescence is a critical period for mental health development, yet prevalences of mental health problems are high among young people. Enhancing mental health literacy in school settings could be an effective strategy for the promotion of mental well-being and prevention of mental health struggles. One promising approach to achieving this goal involves equipping both students and teachers with accessible multimedia resources-such as YouTube Health videos-to enhance their mental health literacy. The study evaluates the effectiveness of a short educational YouTube Health video for promoting mental health literacy in adolescents and teachers. Two independent samples of 352 adolescents and 502 teachers from Germany were recruited from a large panel, representative of the German population with internet access. Participants of each sample were allocated to an experimental group (176 adolescents and 254 teachers) and a control group (176 adolescents and 248 teachers) through randomization. The experimental group watched a YouTube Health video designed to increase mental health literacy, while the control group watched a video similar in style but on a different topic. Before and after watching the publicly available YouTube Health videos, mental health knowledge was assessed as a primary outcome through topic-specific quizzes and a self-report in a web-based survey. In addition, all participants were asked to rate the educational, visual, and overall quality of the YouTube Health videos and their usability in school settings. The primary hypotheses were tested with ANOVAs. The quality and usability items were analyzed descriptively. For the adolescents, there were significant main effects of time (F1,350=46.34, P<.001, η2p=0.117) and group (F1,350=6.05, P=.01, η2p=0.017) and a significant time×group interaction (F1,350=39.15, P<.001, η2p=0.101) on stress-specific knowledge, indicating a higher increase in knowledge in the experimental group than in the control group. Similarly, for teachers, significant main effects of time (F1,500=107.31, P<.001, η2p=0.177) and group (F1,500=58.07, P<.001, η2p=0.104) and a significant time×group interaction (F1,500=82.59, P<.001, η2p=0.142) were found. The same pattern of results was observed for the knowledge self-reports in both the students (time: F1,347=103.65, P<.001, η2p=0.230; group: F1,347=8.59, P=.004, η2p=0.024; time×group interaction: F1,347=29.11, P<.001, η2p=0.077) and teachers (time: F1,500=115.40, P<.001, η2p=0.188; group: F1,500=41.16, P<.001, η2p=0.076; time×group interaction: F1,500=64.24, P<.001, η2p=0.114). Overall, the educational, visual, and overall quality of the videos and their usability in school settings were rated as positive by both adolescents and teachers. The study findings demonstrate that short educational YouTube Health videos are effective tools for the promotion of mental health literacy among both students and their teachers. Overall, this evaluation paves the way for a wider implementation of mental health education in schools in order to create a more supportive and informed environment to promote mental well-being. German Clinical Trial Register DRKS00036854; https://drks.de/search/en/trial/DRKS00036854/details.
9. Factors Associated With Portal and Telehealth Uptake and Use in a Minoritized, Low-Income Community: Mixed Methods Study.
期刊: JMIR formative research 发表日期: 2025-Jul-31 链接: PubMed
摘要
Despite evidence that use of patient portals and telehealth is associated with many health benefits, disparities exist in awareness, adoption, and use. Understanding factors and strategies specific to underserved populations is key to achieving digital equity and better health. This study assesses portal and telehealth experiences among residents of a minoritized and lower-resource area of Dallas, Texas. Using an explanatory sequential design, we conducted surveys and semistructured interviews with English- and Spanish-speaking adults in 15 ZIP Codes surrounding a community-based clinic. We recruited participants via a patient portal, flyers, emails distributed by clinic and community partners, and in person. Surveys were offered online and on paper. We used Fisher exact tests to identify factors associated with telehealth and/or portal use. We also recruited a subsample of survey participants to expound on survey findings in semistructured interviews. Our thematic analysis assessed convergence in survey and interview findings. Among 182 survey respondents, most were older (n=109, 66%; age ≥60 years), African American or Black (n=120, 65%), and female (n=142, 79%); a little more than half (n=97, 54%) had completed ≥1 telehealth appointment, and a majority (n=131, 72%) had used a patient portal at least once. Compared with those who used the portal and/or telehealth, those reporting no use of portal or telehealth were more likely to have a high school education or less (P<.001) or be Spanish speakers (P<.011). A majority, regardless of portal or telehealth use, agreed with health promotion activity survey statements like “Using the Internet for health-related activities makes me feel actively involved with my health care” (n=103, 59%) and “I find the Internet useful for monitoring my health” (n=100, 58%). In interviews with 20 individuals, most of whom were older, Black, female, and had digital technology experience, seven factors were key to increased engagement in portals and telehealth: (1) improving patient autonomy, (2) integrating digital health technology into daily life, (3) receiving recommendations from trusted individuals, (4) appreciating the value of digital health technologies, (5) enlisting the support of care partners or peers, (6) managing severe or chronic illness, and (7) accessing test results rapidly. This study builds on previous work by confirming and contributing insights about factors key to technology uptake and use among underserved populations. Interventions using digital health technologies should focus on these factors to promote digital and health equity and achieve better health outcomes. Future research should explore which clinical settings and contexts are most conducive to increasing digital technology uptake and use, and implementation should leverage partnerships with community groups.
10. Effects of an Exercise Intervention Based on mHealth Technology on the Physical Health of Male University Students With Overweight and Obesity: Randomized Controlled Trial.
期刊: Journal of medical Internet research 发表日期: 2025-Jul-31 链接: PubMed
摘要
Obesity has become one of today’s global health challenges. According to the World Health Organization, in 2022, a total of 2.5 billion adults aged 18 years and older will be overweight, including more than 890 million adults with obesity. Exercise interventions based on mobile health (mHealth) technology are widely available, but the effectiveness and feasibility of interventions using mHealth apps and exercise watches to improve the physical health of male college students with overweight and obesity are unknown, and this study compares the effects of online interventions carried out by mHealth technology and offline interventions guided by physical trainers on the physical health of male college students with overweight and obesity. This study used a randomized controlled trial with a pretest-posttest design, and participants were randomly divided into an online group, an offline group, and a control group. The online group exercised online through the fitness app, and the offline group was instructed by a professional trainer to exercise offline, and both groups wore sports watches to monitor their activities, and the training content was the same. The control group did not carry out any intervention. At the end of the intervention, the BMI of the online and offline groups decreased by 0.89(SD 1.17) and 0.68(SD 0.94)kg/m², respectively (P<.01), and the body fat rate decreased by 1.69%(SD 2.24) in the online group and 2.25% (SD 3.20)in the offline group (P<.01). Several physical fitness indicators, such as muscle mass, increased significantly by an average of 1115.23 (SD 1765.42) g in the online group and 1377.74(SD 2203.05)g in the offline group (P<.05), and lung capacity improved by 536.82 (SD 745.55) and 450.35 (SD 664.47)ml in the online and offline groups, respectively (P<.05). The changes in these indicators between the online and offline groups were not significantly different (P>.05). Additionally, a dose-effect relationship was found between the amount of physical activity and the rate of change in body fat, with a 6.9% increase in the rate of change in body fat for every 1 METh increase in moderate-intensity physical activity, and a 5.4% increase in the rate of change in body fat for every 1 METh increase in high-intensity physical activity. Exercise intervention based on mHealth technology effectively improves the physical fitness of male college students with overweight and obesity, and the effect is consistent with offline intervention. There was a significant dose-effect relationship between the amount of physical activity and the rate of change in body fat, which provided a scientific basis for the development of personalized training programs.
11. Methods of estimating prevalence of multiple sclerosis in six European healthcare data sources: a contribution from the ConcePTION project.
期刊: European journal of epidemiology 发表日期: 2025-Jul-31 链接: PubMed
摘要
Multiple sclerosis (MS) is a chronic autoimmune condition primarily affecting women and often diagnosed during childbearing years. This study assessed the impact of the lookback period and calculation method on MS prevalence in three healthcare data sources including women of childbearing age (from Italy, Norway and Wales) and three data sources including pregnant women (from France, Finland and Spain). Women aged 15 to 49 years from 2005 to 2019 were included, data from pregnant women were collected around the pregnancy period. MS cases were identified based on at least one MS diagnosis or one dispensation for an MS-specific medication. All data sources provided inpatient diagnoses and medication data; outpatient diagnoses were available in Norway and Finland, and primary care diagnoses in Norway, Finland and Wales. We assessed MS case detection rate by lookback period, and compared three methods for estimating yearly MS prevalence: period prevalence (PP), average point prevalence (APP) and person-time prevalence (PTP). The estimated lookback periods to identify 95% of MS cases ranged from 6 to 9 years. APP and PTP provided lower prevalence estimates than PP, especially when the lookback to identify MS was short. In women of childbearing age, MS prevalence increased over time with all calculation methods and the highest MS prevalence was observed in Norway (PP of 402 per 100,000 in 2019). Finland showed the highest MS prevalence in pregnant women (PP of 218 per 100,000 in 2018). This study highlights the importance of sufficient lookback and available data to accurately estimate MS prevalence.
12. Impact of Patient Engagement on Blood Pressure Control Among Older Individuals With Hypertension in a Mobile Health Intervention: Longitudinal Analysis Using Latent Growth Curve Modeling.
期刊: Journal of medical Internet research 发表日期: 2025-Jul-31 链接: PubMed
摘要
Limited research has investigated the influence of patient engagement on the long-term effects of mobile health (mHealth) interventions, particularly among older adults. This study aimed to examine the long-term impact of a social media-driven mHealth intervention on blood pressure control among older Chinese individuals with hypertension, through repeated measurements of patient engagement and outcomes at 5 preset time points. The study included older Chinese individuals with hypertension between 2017 and 2022. Participants received a hypertension self-management program via the WeChat social media app (Tencent Holdings Ltd), which provided clinically based digital coaching. Blood pressure measurements were taken repeatedly using a home blood pressure monitor (HBPM) connected to the app at baseline, 3, 6, 9, and 12 months. Patient engagement was evaluated based on the frequency of completed measurements at corresponding follow-ups. Latent growth curve models (LGCMs) served to assess the impact of patient engagement on blood pressure among older individuals with hypertension across preset points. A total of 1723 patients completed the 12-month follow-up (average age 70.1, SD 6.8 years; 890/1723, 51.7% female; and baseline systolic blood pressure 137.2 mm Hg). LGCMs revealed systolic blood pressure decreased significantly over 1 year, notably at 9 months (131 mm Hg, β9=3.244, P<.001), and continued up to 12 months (131.6mm Hg, β12=2.827, P<.001). In addition, a higher frequency of completed measurements was associated with better systolic blood pressure control at 3, 6, 9, and 12 months (β3=-0.016, P=.002; β6=-0.006, P=.02; β9=-0.002, P=.44; β12=-0.003, P=.02). These results remained significant even after accounting for age, sex, and comorbidity status. This study, using LGCMs and repeated measures data, revealed a significant positive impact of patient engagement on long-term blood pressure control in mHealth interventions targeting older individuals with hypertension. These findings stress the importance of integration of patient-centered engagement approach into mHealth programs designed for chronic disease management in aging populations.
13. Changes in E-Cigarette and Cigarette Sales in California and Neighboring States Following a Law Prohibiting Flavored Tobacco Product Sales.
期刊: American journal of public health 发表日期: 2025-Jul-31 链接: PubMed
摘要
Objectives. To assess changes in e-cigarette and cigarette sales, overall and by flavor type, following implementation of California’s law prohibiting flavored tobacco product sales. Methods. E-cigarette and cigarette retail sales data were licensed from Circana, categorized by flavor, and summed into quarters during 2019 to 2024. We used difference-in-differences regressions with 2-way fixed effects to compare quarterly sales per capita before and after implementation of the California law in California, California-adjacent states, and 32 control states. Results. Prohibiting flavored tobacco product sales in California was associated with a 36.98% reduction in total milligrams of e-cigarette nicotine sold and a 10.55% reduction in cigarette pack sales, compared with control states. Declines in flavored product sales were partially offset by increased sales of products marketed as nontobacco flavored that contain synthetic cooling agents or other additives that deliver multisensory flavor experiences. California’s law was not associated with statistically significant sales changes in neighboring states. Conclusions. California’s flavored tobacco law resulted in overall declines in e-cigarette and cigarette sales, without affecting neighboring states. Restrictions on the sale of all tobacco products that deliver multisensory flavor experiences may lead to further declines in sales. (Am J Public Health. Published online ahead of print July 31, 2025:e1-e5. https://doi.org/10.2105/AJPH.2025.308182).
14. Cryo-EM structure of endogenous Plasmodium falciparum Pfs230 and Pfs48/45 fertilization complex.
期刊: Science (New York, N.Y.) 发表日期: 2025-Jul-31 链接: PubMed
摘要
Malaria parasite fertilization occurs in the midgut of a female Anopheles mosquito. Blocking fertilization within the mosquito can prevent malaria transmission. Plasmodium falciparum Pfs230 and Pfs48/45 are critical for male fertility and transmission of the malaria parasite. They form a core fertilization complex, but it is unknown how they interact. We determined a cryo-electron microscopy structure of endogenous Pfs230-Pfs48/45 complex showing that Pfs48/45 interacts with Pfs230 domains 13 and 14. Transgenic parasite lines with these domains removed were defective in Pfs230 gamete localization and showed reduced oocyst formation. Nanobodies against domains 13 and 14 inhibited Pfs230-Pfs48/45 complex formation, reduced transmission and structural analyses revealed their epitopes. These Pfs230 domains were targets of naturally acquired immunity and immune sera from mRNA-lipid nanoparticle immunizations blocked parasite transmission.
15. Environmental health literacy (EHL) and its association with knowledge, attitudes, risk avoidance, and stakeholder trust among residents near a petrochemical industry.
期刊: International journal of environmental health research 发表日期: 2025-Jul-31 链接: PubMed
摘要
Environmental health literacy (EHL) is a critical framework for understanding how individuals process and apply information about environmental exposures and their health implications. This study explores the factors influencing EHL among residents living near petrochemical industries in Taiwan. A validated questionnaire, developed through focus groups with residents and political leaders, assessed demographics, EHL levels, risk avoidance behaviours, environmental knowledge, and trust in stakeholders. The EHL scale measured four domains: accessing, understanding, appraising, and applying information on petrochemical pollutants. Participants included an exposure group (residents near petrochemical industries) and a control group (general population). Multiple regression and moderation analyses were conducted. Findings revealed no significant differences between the groups in EHL scores, risk attitudes, or avoidance behaviours. However, risk perception and trust in stakeholders varied significantly. Age and education influenced all EHL domains. Higher EHL scores correlated with greater environmental knowledge, proactive environmental actions, and diverse information sources. Additionally, EHL interacted with environmental attitudes, affecting knowledge, participation, and trust in stakeholders. These results highlight the role of EHL in bridging environmental awareness and action. Strengthening EHL can enhance individuals’ ability to make informed, health-protective decisions, emphasizing its importance in environmental risk communication and community engagement.
16. Managers' and safety representatives' perspectives on electronic monitoring and occupational health in the transport and logistics industries in Sweden.
期刊: International journal of occupational safety and ergonomics : JOSE 发表日期: 2025-Jul-31 链接: PubMed
摘要
Objectives. Qualitative research on electronic monitoring in relation to occupational health remains limited. This study aimed to explore managers’ and safety representatives’ perspectives on how electronic monitoring in the transport and logistics industries has influenced the work environment, including job demands and available resources. Methods. A qualitative study design employing semi-structured interviews was used to collect open-ended data and explore the views of managers and safety representatives regarding electronic monitoring. Data were analysed using content analysis and consisted of 16 semi-structured interviews with participants from 15 organizations within the transport and logistics industries in Sweden. Results. The content analysis identified two main categories: electronic monitoring and organizational culture (with sub-categories: purpose of electronic monitoring; and electronic monitoring and the social work environment); and electronic monitoring and employee well-being (with sub-categories: electronic monitoring and employee impact; and ethical surveillance practices). Conclusions. Although electronic monitoring in the transport and logistics sectors offers security advantages, it may also adversely affect recovery, autonomy and team cohesion. To mitigate these risks, monitoring systems should be implemented ethically, with transparency and an emphasis on support rather than control. Furthermore, ensuring sufficient recovery time within driver schedules and workflows is essential for promoting occupational health.
17. Characterization of Two 4,5-PCD Isoenzymes Identified from Curvibacter sp. PAE-UM.
期刊: Journal of agricultural and food chemistry 发表日期: 2025-Jul-31 链接: PubMed
摘要
Phthalates (PAEs), such as dibutyl phthalate (DBP), are emerging contaminants in agriculture that are commonly used in plastic films, pesticides, and soil amendments. Their accumulation in water threatens ecosystems and human health. Biodegradation offers a promising solution, but the DBP degradation mechanisms remain unclear. This study identified two 4,5-PCD isoenzymes (PCD34 and PCD67) in Curvibacter sp. PAE-UM. PCD34 showed higher affinity and broader substrate specificity, while PCD67 had better thermal stability and metal ion sensitivity. Both enzymes converted protocatechuate (PCA) to 4CHMS at 45% efficiency in 5 min. Molecular dynamics revealed the stable binding of PCD67, while mutagenesis enhanced PCD34 activity (124.4%) by reducing steric hindrance. These findings may aid in the engineering of strains for PAE bioremediation in agricultural wastewater.
18. Resolving challenges in the development of a protocol for δ18O determinations on tree-ring cellulose.
期刊: Isotopes in environmental and health studies 发表日期: 2025-Jul-31 链接: PubMed
摘要
Tree rings can provide annual records of environmental and climatic conditions. These records can be obtained through the physical characteristics of tree rings or the isotopic composition of their structural elements. Oxygen isotope chronologies are created by objectively combining data from trees. The diachronic patterns observed in the δ18O of the tree-ring cellulose represent tree-environment interactions. The abundance of 18O in tree-ring cellulose is closely linked to hydroclimate, and is influenced by source water δ18O and atmospheric humidity. Long sequences of annually resolved tree-ring δ18O values have been used, to good effect, in the dating of archaeological timbers and as proxies in the reconstruction of climatic variables. In this research we have established a working methodology for producing and measuring δ18O in tree-ring α-cellulose at the University of Groningen. We have demonstrated an average precision of approximately 0.2 ‰ under a variety of conditions, which exceeds the expected performance of continuous flow IRMS techniques. Difficulties were encountered during the calibration of tree-ring cellulose δ18O determinations using non-cellulose, organic reference materials. A difference in pyrolysis behaviour or one, or more compromised materials, resulted in poor agreement between measured and expected δ18O values on cellulose standards. This opens the possibility for further study. Analysis of cellulose standards alongside water reference materials and an independent quality control standard proved successful, resulting in a number of cellulose standards being accurately placed on the VSMOW-SLAP scale, including the intercomparison and de facto reference material IAEA-C3 holocellulose.
19. Visualization of FDA Adverse Drug Reaction Reports: Development and Usability Study of the VisDrugs Web Server.
期刊: JMIR formative research 发表日期: 2025-Jul-31 链接: PubMed
摘要
Adverse drug reactions (ADRs) are a major concern in drug safety, and the FDA Adverse Event Reporting System (FAERS) provides valuable ADR data. However, analyzing FAERS data is complex and requires bioinformatics expertise. Despite the vast amount of ADR data available, there is a lack of user-friendly tools that enable efficient visualization and comparison of ADRs for researchers and health care professionals. This study aimed to develop VisDrugs, a web-based platform that simplifies ADR visualization and comparison using FAERS data. The platform was designed to assist researchers and clinicians in assessing drug safety through interactive and interpretable graphical representations of ADR patterns. FAERS data were extracted in the American Standard Code for Information Interchange (ASCII) format, covering the period from Q3 (third quarter) 2014 to Q3 2024. About 2,700,000 reports from health care professionals, where only a single drug was implicated, were aggregated and processed using R for statistical analysis and visualization. The results are presented on a web-based platform for web-based analysis. The platform generates pie charts to visualize the most frequently reported ADRs, which are represented and analyzed using preferred terms based on the Medical Dictionary for Regulatory Activities (MedDRA) and forest plots illustrating reporting odds ratios (RORs) for these ADRs. Using Paxlovid (COVID-19 treatment) and hydroxychloroquine (anti-malaria drug) as case studies, we benchmarked VisDrugs using reports for Paxlovid (n=16,708) and hydroxychloroquine (n=6150). Paxlovid was most frequently associated with “COVID-19” (ROR=47.26, 95% CI 45.22-49.40) and “dysgeusia” (ROR=59.65, 95% CI 55.56-64.03). Hydroxychloroquine showed strong associations with “retinal toxicity” (ROR=738.48, 95% CI 583.45-934.71), “retinopathy” (ROR=412.27, 95% CI 344.73-493.03), and “cardiotoxicity” (ROR=48.36, 95% CI 38.86-60.19). In subgroup analyses, female patients had significantly higher risks of retinopathy (3.24-fold) and cardiomyopathy (13.82-fold) compared to male patients, while patients aged >50 years had higher risks of retinopathy (4.20-fold) and cardiomyopathy (7.84-fold) compared to those ≤50 years. All differences were statistically significant (z test, P<.01). The majority of findings align with existing research, thereby validating the platform’s utility. Clinical personnel have evaluated and refined the platform based on user feedback, confirming its efficacy in visualizing complex ADR data and identifying adverse effects across various drug subgroups. VisDrugs is a valuable tool for ADR analysis, offering an intuitive interface for exploring FAERS data. By visualizing and comparing ADRs, it helps researchers and health care providers assess drug safety efficiently. The platform’s demographic analysis features add insights into ADR variations by age and gender, supporting drug safety research. In the future, the website will include more subgroup or condition filtering options, offering personalized ADR analysis and comparison features to meet the diverse research needs of users.
20. Evaluating the Effectiveness of Mobile Apps on Medication Adherence for Chronic Conditions: Systematic Review and Meta-Analysis.
期刊: Journal of medical Internet research 发表日期: 2025-Jul-31 链接: PubMed
摘要
Medication adherence is crucial for managing chronic conditions. Mobile apps may have the potential, through a wide variety of features, to support and improve medication adherence. The purpose of this systematic review was to evaluate the effectiveness of mobile apps in promoting medication adherence for patients managing chronic conditions. MEDLINE (Ovid), Embase (Ovid), and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) evaluating the effectiveness of mobile app interventions in improving medication adherence in patients with chronic conditions. Study design and app features were qualitatively described. Meta-analyses were performed on studies, grouped by medication adherence measurement scale, on the mean differences in medication adherence scores between intervention and control groups, using random effects models. If baseline medication adherence data were available, a difference in differences meta-analysis with a random effects model was also conducted. Bias assessment was conducted using the Cochrane Risk of Bias tool. This review included 14 RCTs published between 2014 and 2022, with sample sizes between 57 and 412 participants and the length of interventions ranging from 30 days to 12 months. A range of patient populations was evaluated, including those with Parkinson disease, coronary heart disease, psoriasis, and hypertension, with hypertension being the most common condition. All 14 studies reported that app interventions improved medication adherence, and 10 RCTs demonstrated statistically significant improvement in medication adherence. Three separate sets of meta-analyses, categorized by the medication adherence measurement scales, were conducted on the mean difference between medication adherence scores between the control and intervention groups: the 8-item Morisky Medication Adherence Scale (MMAS-8; 0.57, 95% CI 0.33-0.80; P<.001, I2=0%, τ2=0, P value for heterogeneity test=.94), 4-item Morisky Medication Adherence Scale (MMAS-4; 0.15, 95% CI -0.12 to 0.42; P=.28, I2=0%, τ2=0, P value for heterogeneity test=.54) and a percentage medication adherence scale (18.85, 95% CI 2.17-35.53; P=.03, I2=63%, τ2=94.89, P value for heterogeneity test=.10). Additionally, with available baseline adherence scores, difference in differences meta-analyses were conducted for studies using the MMAS-8 scale (0.38, 95% CI 0.15-0.62; P=.001, I2=0%, τ2=0, P value for heterogeneity test=.51) and for studies using the MMAS-4 scale (0.55, 95% CI 0.17 to 0.93; P=.005, I2=33%, τ2=0.03, P value for heterogeneity test=.22). The meta-analysis of the MMAS-8 scale, percentage medication adherence scale, and both difference-in-differences meta-analyses demonstrated that app-based interventions improved medication adherence. From the studies included in this review, mobile apps, designed for a wide variety of chronic conditions with a range of features, were shown to improve medication adherence and may be a tool to successfully manage chronic conditions.
21. Predictors of social inclusion among adults with severe mental illness: Results of a cross-sectional study.
期刊: The International journal of social psychiatry 发表日期: 2025-Jul-31 链接: PubMed
摘要
Promoting social inclusion is crucial for people living with severe mental illness (SMI), who often experience high levels of social exclusion. However, research that uses a psychometric social inclusion measure to identify factors that determine varying levels of social inclusion in individuals with SMI is scarce. This study aimed to examine to what extent people with SMI feel socially included and to identify factors associated with perceived social inclusion among people with SMI. A cross-sectional multicenter investigation of psychiatric inpatients and day hospital patients with SMI aged 18 to 65 years (n = 358) was conducted. Perceived social inclusion, sociodemographic, and clinical characteristics were assessed using the Measure of Participation and Social Inclusion for Use in People with a Chronic Mental Disorder (F-INK). Hierarchical multiple linear regression was performed to analyse the association between social inclusion and potential predictors. The participants’ overall level of social inclusion was moderate (F-INK social inclusion total score M = 1.9, SD = 0.6). Age, relationship status, diagnostic group, employment status, and living situation emerged as predictors of social inclusion. Greater subjective social inclusion was predicted by older age (p = .027), being in a committed intimate relationship (p = .037), diagnosis of schizophrenia spectrum disorder (compared to diagnosis of depression, p = .020), being competitively employed or in education (compared to being in sheltered employment, p = .022; compared to being unemployed or receiving a disability pension, p = .007), and living with other people (p = .042). The results confirm deficiencies in social inclusion of people with SMI. Individuals with SMI who are younger, single, have a diagnosis of depression, are in sheltered employment, are unemployed or receiving a disability pension, and are living alone seem to be particularly at risk of experiencing low social inclusion. These findings highlight the importance of psychosocial interventions in rehabilitative mental healthcare.
22. The Relationships Between Sleep, Social Isolation, and Health Care Access to Depression, Post-Traumatic Stress, Number of Medical Diagnoses, and Medication Use Among Long-Haul Truck Drivers: A Cross-Sectional Study.
期刊: Western journal of nursing research 发表日期: 2025-Jul-31 链接: PubMed
摘要
Long-haul truck drivers experience many challenges while working “on the road.” These challenges include, but are not limited to, problems with sleep, access to health care, and loneliness. It is also known that they have tend to have a number of chronic medical conditions, including mental health diagnoses. The purpose of this study was to explore how sleep, loneliness, and health care access are related to depression, post-traumatic stress, number of medical diagnoses, and medication use among long-haul truck drivers. A total of 98 participants were recruited to the study by way of Facebook-based and trucking industry-specific websites. Potential participants reviewed an online study information sheet and clicked forward to the survey, indicating their consent to participate. At that point, participants engaged with a 60-item online Qualtrics survey containing items related to the variables of interest and demographics. Participants were primarily married or partnered white males aged 54 years old. They experienced poor sleep, moderate loneliness and depression, and probable post-traumatic stress. The final model showed that while all the independent variables, except the number of medications prescribed, predicted the dependent variables, sleep quality significantly influences mental health in this sample. Ongoing education of providers, truck drivers, and their employers on the significance of sleep on mental health is essential. Addressing loneliness, using multiple modalities, should be considered. Finally, the importance of mental health and social connections should be stressed by all providers who encounter truck drivers to support their well-being.
23. Solar Panel Installation Workers Exposed to Pesticides During Two Agricultural Applications - Michigan, August 2023 and May 2024.
期刊: MMWR. Morbidity and mortality weekly report 发表日期: 2025-Jul-31 链接: PubMed
摘要
Persons who work near farmland are at risk for exposure to pesticides applied on adjoining agricultural areas. Michigan regulations allow solar panel placement on farmland and open areas near farmland. Nonagricultural workers, including construction workers installing or maintaining solar panels, working in open areas on or adjacent to farmland might be exposed to pesticides yet have little knowledge of the possible health effects. Reports to Michigan’s state pesticide surveillance program from hospitals, emergency departments, the state’s poison center, and emergency service companies identified two separate events, the first in August 2023 and the second in May 2024, when workers installing solar panels experienced illness after pesticide exposures. In these two events, a total of 10 solar panel installation workers reported symptoms temporally related to nearby agriculture pesticide applications. Pesticide applicator adherence to product label instructions is critical to preventing bystander exposure. Increasing awareness of the potential for pesticide exposure among nonagricultural workers near farmland might reduce risk. Employers of nonagricultural workers who are working in rural areas should be aware of agricultural activity surrounding their worksites and should consider contacting farmers to determine pesticide application schedules so that nonagricultural workers can be advised to avoid the area or wear protective equipment during application times. Local poison control centers can provide guidance on management of acute exposures.
24. Relationship Between Domestic Animals, Environmental and Behavioral Factors, and Under-Five Diarrhea in Sidama Region, Ethiopia: A Matched Case-Control Study.
期刊: Journal of epidemiology and global health 发表日期: 2025-Jul-31 链接: PubMed
摘要
In Ethiopia’s Sidama National Regional State, diarrhea remains the second most common cause of illness among children under five, despite a decrease in its mortality rate. However, limited research has been conducted in Ethiopia to identify the causes behind the continuing rise in the prevalence of diarrhea in children associated with exposure to domestic animals. Therefore, this study explores the relationship between domestic animal, environmental, and human behavioral factors and confirmed cases of diarrhea in children under five in the Sidama National Regional State of Ethiopia. We conducted a matched-pairs case-control study involving 306 cases and 306 controls in the Sidama region from September 2022 to February 2023. Cases and controls were identified at healthcare facilities, and interviews and observations were completed at residential homes with children under five. We collected data using the KoboCollect application and analyzed it through conditional logistic regressions. The random forest (RF) method with the classification RF model was used to compare its findings with those of the multivariate conditional regression analysis. The statistical analyses were conducted using R v.4.3.2 software. The study indicated that having a caretaker who is a housewife [matched adjusted odds ratio (mAOR) = 3.09, 5% CI (1.09, 8.70)], a mean number of chickens ≥ 5 [mAOR = 5.18, 95% CI (2.70, 9.95)], the absence of soap at handwashing facilities [mAOR = 2.61, 95% CI (1.34, 5.10)], those who travel more than 30 min to fetch water [mAOR = 3.14, 95% CI (1.13, 8.78)], children who are in contact with animal feces [mAOR = 2.44, 95% CI (1.24, 4.82)], and households living with animals [mAOR = 3.28, 95% CI (1.71, 6.30)] showed significant associations with under-five diarrhea. The random forest analysis also identified the first five variables as the main risk factors for diarrhea occurrence among children under-five years of age. Risk factors for diarrhea among children under-five include a high number of chickens, cohabitation with animals, prolonged water-fetching times, poor hand hygiene, and caretakers’ occupational status. Animal feces management, improved water access, and hygiene education are critical to reducing under-five diarrheal diseases.
25. Measurement properties of the PROMIS-29 profile v2.1 in a Norwegian rehabilitation context.
期刊: Journal of patient-reported outcomes 发表日期: 2025-Jul-31 链接: PubMed
摘要
Psychometric properties of the Patient-Reported Outcomes Measurement Information System® Profile 29 (PROMIS-29) Norwegian version has previously been examined in a general population. This multicenter study aimed to examine the internal consistency, construct validity, responsiveness, score distribution and floor/ceiling effects of PROMIS-29 v2.1 in a Norwegian rehabilitation context. Patients receiving rehabilitation services participating in a longitudinal cohort study answered PROMIS-29 at baseline and at 3-month follow-up. Internal consistency was assessed by Cronbach’s alpha and McDonald’s omega. Construct validity was examined through hypothesis testing, using EQ-5D-5L as comparator measure. Hypotheses for correlations of change scores for both questionnaires were tested as an expression of responsiveness. Score distribution and floor/ceiling effects were examined with histograms and descriptive statistics. A total of 828 patients with a mean age of 54.3 years were included for analysis. The internal consistency for each PROMIS-29 domain was confirmed, with alpha and omega values exceeding the threshold of ≥ 0.70. Regarding correlations between PROMIS-29 and EQ-5D-5L, 34 out of 40 hypotheses were confirmed for construct validity and 19 out of 24 for responsiveness, both meeting our a priori criterion of ≥ 75% confirmed hypotheses. There was no floor effect of any PROMIS-29 domain in our sample, and ceiling effect only for anxiety and depression domain scores. Still, this confirmed the applicability of PROMIS-29 in a rehabilitation context. The Norwegian PROMIS-29 has sufficient internal consistency, construct validity and responsiveness for use as an outcome measure for health status and health-related quality of life in rehabilitation. ClinicalTrials.gov NCT03764982 RehabNytte study, registered 2018-12-04.
26. Increasing vaccine uptake in a refugee resettlement community with high social vulnerability.
期刊: Vaccine 发表日期: 2025-Jul-30 链接: PubMed
摘要
Impacted by the trauma of forced migration and resettlement, refugee, immigrant, and migrant (RIM) communities often have higher levels of social vulnerability and lower vaccination rates. The Georgia State University Prevention Research Center (PRC) collaborated with community organizations, residents, clinicians, and elected officials in the refugee resettlement community of Clarkston, GA to address community health needs before and during the COVID-19 pandemic. This collaborative team cultivated community trust and developed strategies to address COVID-19 prevention and vaccine hesitation, including establishing a task force, disseminating culturally and linguistically responsive, factual COVID-19 materials, employing culturally representative vaccine ambassadors, creating an ad campaign promoting vaccination, and holding local vaccination events. Clarkston’s COVID-19 vaccination rates surpassed those of other local areas of high social vulnerability by 20 percentage points. These results suggest multifaceted, targeted vaccine promotion efforts can enhance vaccine uptake and possibly other public health priorities in disadvantaged, diverse, and vulnerable communities.
27. Anesthesia in retinal surgery: A national survey.
期刊: Journal francais d’ophtalmologie 发表日期: 2025-Jul-30 链接: PubMed
摘要
Local-regional anesthesia (LRA) techniques used for vitreoretinal surgery include peribulbar (PBA) and sub-Tenon’s anesthesia (STA). Despite their increasing use over general anesthesia, there are no clear recommendations on their indications and contraindications. Furthermore, French practices in this field have not been evaluated. The objectives of this survey were to describe current French anesthesia practices for vitreoretinal surgery and to identify professionals’ needs. A 23-question questionnaire was sent to French-speaking retinal surgeons via the Club Francophone des Spécialistes de la Rétine (CFSR). Questions focused on the type of anesthesia used according to the surgical indication, the LRA methods used, and surgeons’ needs. The questionnaire was completed by 114 surgeons. PBA and general anesthesia were most frequently used for vitrectomy and scleral buckling, respectively. Private-sector surgeons and surgeons with>10 years of experience used PBA more frequently than public-sector surgeons and surgeons with<5 years of experience. When LRA was used, PBA was clearly preferred to STA. The techniques used and the contraindications to PBA were very heterogeneous. Hypnosis was hardly ever used, even as a complement to another modality. Most surgeons needed guidelines, and a study comparing PBA and STA seemed necessary. This French survey revealed a wide range of practices. The latest data on anesthesia techniques and contraindications in the literature are presented. Further studies are needed, in particular studies comparing PBA and STA, assessing if severe myopia could be a contraindication to PBA, studies on the relevance of ultrasound guidance, and studies on hypnosis and its possible benefits during vitreoretinal surgery.
28. COVID-19 Infection and Mitigation for Young Children With Autism and Other Disabilities.
期刊: Journal of developmental and behavioral pediatrics : JDBP 发表日期: 2025-Jul-30 链接: PubMed
摘要
This study investigated prevalence of positive tests for COVID-19 infection and difficulties with mitigation strategies among young children with autism spectrum disorder (ASD) and other developmental disabilities (DD) compared with children from the general population (population comparison group [POP]). Before the pandemic, children aged 2 to 5 years in the Study to Explore Early Development (SEED) completed a developmental assessment assigning them to a study group (ASD, other DD, or POP). Caregivers were recontacted in 2021 to complete a questionnaire assessing the impact of the pandemic in 2020 when children were aged 3 to 8 years. Modified Poisson regression models assessed the relationship between study group and difficulty with mitigation strategies and nasal swabbing. Caregivers of 1027 SEED participants completed the survey. Prevalence of having 1 or more positive COVID-19 tests was 3 times higher for children in the ASD and DD groups versus the POP group. In adjusted models, children in the ASD group were more likely to have difficulty with all 3 mitigation strategies and nasal swabbing compared with children in the POP group. The DD group were more likely than the POP group to experience difficulty with handwashing and physical distancing. Compared with the general population, youth with ASD and DD were more likely to have at least 1 positive COVID-19 test and difficulty following mitigation strategies. These findings underscore the importance of supporting youth with ASD and DDs in anticipation of future public health emergencies and the annual respiratory disease season.
29. SPINK1 immunohistochemistry: An ancillary tool to diagnose urothelial carcinoma in situ and urothelial dysplasia.
期刊: Pathology, research and practice 发表日期: 2025-Jul-28 链接: PubMed
摘要
Expression of SPINK1 (Serine protease inhibitor Kazal type I), also known as tumor associated trypsin inhibitor (TATI), has been demonstrated in a wide spectrum of benign, inflammatory, and neoplastic conditions. Based on our prior results of its expression in urothelial carcinoma, in this study we further characterized SPINK1 expression in a spectrum of urothelial lesions and investigated its potential diagnostic utility. A total of 396 samples comprising a spectrum of urothelial lesions including benign, premalignant, and malignant lesions were evaluated for SPINK1 expression by immunohistochemistry and amplification by fluorescence in situ hybridization (FISH). In a subset of lesions, immunohistochemistry for CK20, CD44, and p53 was also performed. SPINK1 expression was restricted to umbrella cells or lost in 93 % of normal urothelium. Overexpression of SPINK1 in reactive urothelial atypia, urothelial dysplasia, carcinoma in situ (CIS), and papillary urothelial carcinoma (invasive and non-invasive) was seen in 21 %, 36 %, 87 % and 54 % of cases, respectively. Increasing frequency of SPINK1 loss was observed with higher pathologic stage (48.5 % in pT1, 50 % in pT2, 62.5 % in pT3). When compared with other markers, SPINK1 positivity itself has a sensitivity of 90 % for detecting CIS, a 97 % sensitivity when combined with CK20, and a 98 % sensitivity when combined with p53. No amplification of SPINK1 was detected by FISH in any case. Our study illustrates the differential expression of SPINK1 in various urothelial lesions and shows that SPINK1 immunohistochemistry can be utilized as an ancillary tool with high sensitivity and specificity for diagnosing urothelial dysplasia and CIS in challenging cases.
30. Insights into the vascular aging burden in young adults with embolic stroke of undetermined source.
期刊: Journal of the neurological sciences 发表日期: 2025-Jul-28 链接: PubMed
摘要
This study investigates pre-atherosclerotic changes, vascular aging and clinical cardiovascular disease (CVD) risk scores in young adults with embolic stroke of undetermined source (ESUS) compared to stroke-free controls. The study included 105 ESUS patients and 105 age- and sex-matched stroke-free controls aged 18 to 49 years. Clinical and laboratory characteristics and arterial stiffness measurements were recorded. Vascular aging indexes were defined according to age-adapted values and definitions. Clinical scores PREVENT and SCORE2 were calculated. Associations were investigated using logistic regression adjusting for several factors associated with vascular aging. Young ESUS patients had higher rates of central obesity, smoking, heavy alcohol consumption and patent foramen ovale compared to stroke-free controls. ESUS patients had higher odds of having excessive intima-media thickness (IMT) of the right carotid artery (OR 3.02, 95 %CI:1.31-6.92). They also had significantly higher odds of having elevated estimated pulse wave velocity (ePWV>9 m/s; OR 8.48, 95 %CI:2.16-33.4), high pulse pressure (PP ≥ 60 mmHg; OR 3.13, 95 %CI:1.28-7.68), a 10-year CVD risk above 5 % based on the PREVENT score (OR 8.53, 95 %CI:1.59-45.7), and a 10-year CVD risk above 2.5 % based on SCORE2 (OR 26.5, 95 %CI:3.6-193.6) estimated at the time of their stroke. Despite a low burden of established CVD, young ESUS patients harbored pathology in the vascular aging measures including IMT, ePWV, and PP. Clinical risk scores such as PREVENT and SCORE2 may effectively identify young adults at high risk of developing ESUS.
31. Ultrasound-assisted ethanol induced gelation of egg white: Effects on gel properties, water distribution and microstructure.
期刊: Ultrasonics sonochemistry 发表日期: 2025-Jul-26 链接: PubMed
摘要
This study explored the mechanism by which ultrasound (0-180 W) assisted ethanol (25 % and 30 %) enhances the gel properties of egg white gel (EWG). The results showed that ultrasonic treatment (stabilized at 120 W) prominently improved hardness, springiness and water holding capacity (WHC) (approximately 2 times, 1.5 times and 1.3 times higher than those of control group). Notably, the gel properties of EWG30% group consistently outperformed those of EWG25% group. The results of physicochemical properties revealed that ultrasound-assisted ethanol treatment promoted the aggregation of soluble particles (the particle sizes was 3.10 and 1.69 times larger than that in EWG25% and EWG30%; while the solubility was increased by 29.69 % and 66.19 %, respectively). Disulfide bonds were identified as the predominant intermolecular force in the gels, accounting for over 70 %, while hydrogen bond content increased approximately 2.5-fold following treatment. The free water in EWGs exhibited a shift toward immobile water. SDS-PAGE analysis illustrated that lysozyme and ovomucoid participated in the aggregation process. Regarding gel structure, the β-sheet increased by 2.66 % and 15.48 % at ethanol concentrations of 25 % and 30 %, respectively, accompanied by a reduction in fluorescence intensity, further confirming ultrasound-assisted ethanol induced aggregation of egg white protein (EWP). Meanwhile, the gel microstructure became more compact, forming a highly ordered network directly correlated with the enhanced gel properties. Collectively, these findings demonstrate that ultrasound-assisted ethanol induction is an effective modification strategy for enhancing the gel properties of egg white, providing valuable insights for its practical applications.
32. Discrepancies between plantar pressure devices: Evaluating cross-system reliability for biomechanics, clinical use and predictive modelling.
期刊: Foot (Edinburgh, Scotland) 发表日期: 2025-Jul-23 链接: PubMed
摘要
Plantar pressure measurement systems are widely used to assess foot function and gait, yet discrepancies in sensor design, measurement protocols, and population characteristics can undermine data comparability. This study investigated three platform‑based and two in‑shoe systems to evaluate key parameters such as the contact area, maximum force, force‑time integral, peak pressure, pressure‑time integral, maximum mean pressure and contact time. Fifteen healthy adults walked at a self‑selected pace, providing a total of 360 footprints from the platforms (barefoot) and 1200 footprints from the in‑shoe devices (shod). Each footprint was then divided into hindfoot, midfoot, and forefoot regions. A two‑way repeated‑measures ANOVA (systems × regions) revealed that mean values (MV) and coefficients of variation (CV) frequently differed among devices, indicating limited cross‑system comparability. Moreover, intraclass correlation coefficients for peak pressure ranged between poor (<0.5) and, on rare occasions, moderate (0.5-0.75), further confirming substantial variability. These discrepancies highlight the importance of standardising calibration, data extraction, and analysis protocols, as even devices based on similar resistive or capacitive technologies can produce dissimilar outcomes. Environmental factors such as footwear selection and lab‑based “targeting” errors also contribute to inconsistencies. These challenges are especially relevant as emerging technologies integrate high-resolution wearable sensors with artificial intelligence to support real-time clinical decision-making, disease prediction and personalised interventions. Establishing uniform reporting and validation standards will be essential to ensure robustness and comparability in both traditional biomechanical studies and future AI-driven applications.
33. Support for decision-making guidance in England: a pragmatic review.
期刊: Medical law review 发表日期: 2025-Jul-14 链接: PubMed
摘要
Law and policy concerning personal decision-making increasingly recognizes a role for support to enable greater autonomy and legal recognition for adults whose decision-making ability may be limited. Support for decision making (SFDM) is embedded in England and Wales under the Mental Capacity Act 2005 (MCA). It has also gained traction internationally through the UN Convention on the Rights of Persons with Disabilities (CRPD), to which the UK is a signatory. However, these two legal reference points diverge in their understanding of SFDM, which presents challenges for putting it into practice. A pragmatic review methodology identified 40 resources containing SFDM guidance, providing insight into its implementation and conceptualization in England. An analysis indicates the need for authoritative guidance that provides more multifaceted advice, recognizing key variables including: the nature of the decision, source of decision-making difficulties, and the relationship of the supporter. Gaps in guidance provision are also identified for decision-makers, third parties, and the mental health context. The resources largely conceptualize SFDM as a means to enable mental capacity. However, recent developments propose a CRPD-aligned approach that includes SFDM in the context of substituted decisions. This generates a dualistic model of SFDM in England, raising new questions in this area.
34. Management of intravenous leiomyomatosis: a comprehensive review of surgical and perioperative considerations.
期刊: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 发表日期: 2025-Jul-10 链接: PubMed
摘要
Intravenous leiomyomatosis is a rare condition in which a smooth muscle tumor originates from the uterus and extends into the pelvic and systemic vasculature, frequently involving the inferior vena cava and the right atrium. Despite its benign histology, intravenous leiomyomatosis poses significant clinical challenges due to its potential to cause life-threatening complications. Conventional management involves a combined surgical approach: intracardiac tumor resection performed via sternotomy, with abdominal and pelvic tumor removal, including hysterectomy, conducted through laparotomy. Alternatively, an abdominal-only approach allows for complete tumor resection through inferior vena cava incision and hysterectomy without sternotomy. Surgical timing is an important consideration, with single-stage procedures addressing all tumor components in 1 operation, while 2-stage procedures separate cardiac and abdominal/pelvic resections into distinct surgeries to reduce risks in patients with extensive cardiac involvement or limited surgical tolerance. Post-operative management includes careful resumption of anti-coagulation for several months to prevent thromboembolic complications, particularly in patients with vascular involvement. Hormonal therapy, such as aromatase inhibitors, is considered for patients with residual disease. Advanced imaging techniques, including magnetic resonance imaging, computed tomography, and echocardiography, are essential in both preoperative planning and post-operative surveillance to ensure optimal surgical strategy and to help monitor for residual tumors. Multidisciplinary collaboration is crucial in the management of intravenous leiomyomatosis, ensuring a comprehensive approach that optimizes patient outcomes.
35. Water, sanitation, and hygiene (WASH) factors and the incidence of communicable diseases in Urban Bangladesh: Evidence from municipal areas.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Jul 链接: PubMed
摘要
Safe drinking water, sanitation, and hygiene (WASH) are crucial for health and development, especially in low- and middle-income countries (LMICs) where WASH-related diseases are prevalent. Bangladesh, with high poverty rates and a large population, faces significant WASH challenges. This study examines the association between hygiene-related factors and communicable diseases in two Bangladeshi municipalities. A descriptive cross-sectional study was conducted from June 1 to July 30, 2021, in Savar and Satkhira municipalities, chosen for their diverse socioeconomic and geographic characteristics. A stratified random sampling method targeted poor, marginalised, and socially excluded populations. A total of 607 interviews were conducted using a structured questionnaire, collecting data on socio-demographics, hygiene practices, and disease history. Participants were included if they were adults (aged 18 or older), had resided in the municipality for at least one year, and provided informed consent to participate. Data were analysed using SPSS, employing chi-square tests and logistic regression to assess associations between variables. The study revealed that 24.1% of participants had a communicable disease, with diarrhoea being the most common. Significant predictors of communicable diseases included gender, with females being more likely affected (OR: 3.21, 95% CI: 1.19 to 8.66, p = 0.003), and the source of drinking water, with tube well users at higher risk (OR: 2.81, 95% CI: 1.13 to 7.02, p = 0.015). Poor hand hygiene significantly increased disease risk (OR: 12.31, 95% CI: 2.86 to 53.03, p < 0.001). Communicable diseases are prevalent in Bangladeshi municipalities, primarily driven by poor WASH conditions. Enhancing access to safe drinking water and implementing community-based WASH interventions, such as hygiene education campaigns, improved sanitation infrastructure, and school-based awareness programs, are vital for reducing the disease burden. Further research should explore the effectiveness and scalability of these targeted strategies.
36. Two mutations in NS2B are responsible for attenuation of the yellow fever virus (YFV) vaccine strain 17D.
期刊: PLoS pathogens 发表日期: 2025-Jul 链接: PubMed
摘要
Vaccines have done more to improve the health of humankind over the past century than almost any other technology. Among vaccines, the live-attenuated yellow fever (YF) vaccine (17D) is highly effective, providing long-lasting immunity against yellow fever virus (YFV) infection with a single dose. Developed in the 1930s through extensive serial passage of the virulent YFV-Asibi strain through mouse and chicken embryonic tissue, 17D acquired several mutations that render it attenuated in humans and non-human primates. Over the past century, 17D has become a widely studied immunogen and has also been developed into a vaccine platform for other pathogens. Despite this, most studies of 17D have focused exclusively on the host, without clearly defining the virus-intrinsic features of attenuation. Consequently, the genetic determinants of 17D attenuation remain unknown and are assumed to be multigenic. Here, we leverage the hamster host, which recapitulates many important features of human YF disease, to understand the genetic basis of 17D attenuation. We developed a YFV reverse genetics system and generated hamster-adapted Asibi/17D chimeric viruses, discovering that viruses containing 17D-derived mutations in the viral gene NS2B were significantly attenuated in the hamster. Further analysis revealed that the two non-synonymous mutations in NS2B that distinguish 17D from Asibi, I37L and I109L, act cooperatively to mediate attenuation, with both mutations required to fully prevent key features of YF disease including liver injury and coagulopathy. These findings establish NS2B as an important and unexpected determinant of YFV-17D attenuation in vivo. In addition to the implications of these findings for improving the efficacy and safety of the 17D vaccine platform, this discovery also provides a new direction for understanding more generalized principles and mechanisms of durable vaccine-induced immunity.
37. Medical student barriers to mental healthcare.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Medical education is associated with different mental disorders, a growing concern. Additionally, several barriers have been reported that hinder the use of mental health care services among physicians in training. To identify the main barriers faced by medical students in seeking professional help and care the mental health. Cross-sectional observational study of descriptive and analytical type, in medical students (n = 305), in whom the BACE (Barriers to Care Evaluation) instrument was applied and Pearson’s correlation coefficient was applied. Based on mean subscale values of the instrument, the barriers from highest to lowest were: stigma (x- = 0.69, SD = 0.264), attitudinal (x- = 0.67, SD = 0.472) and structural (x- = 0.63, SD = 0.396). The characteristics most correlated with barriers included female gender, identification with gender and sexual diversity, having a mental health disorder, and exhibiting suicidal behavior (p < 0.05). These findings are key in the creation of approaches to mitigate the impact these barriers have on the mental health care of medical students. La educación médica está asociada a diferentes trastornos mentales, problema que va en aumento, y además se han evidenciado barreras que dificultan el uso de servicios de atención entre los médicos en formación. Identificar las principales barreras que enfrentan los estudiantes de medicina para buscar ayuda profesional y atender su salud mental. Estudio observacional transversal de tipo descriptivo y analítico, en estudiantes de medicina (n = 305), en quienes se aplicó el instrumento BACE (Barriers to Care Evaluation). Se utilizó el coeficiente de correlación de Pearson. De acuerdo con los valores de las medias globales de las dimensiones del instrumento, las barreras, de mayor a menor, fueron el estigma (x– = 0.69, DE = 0.264), las actitudinales (x– = 0.67, DE = 0.472) y las estructurales (x– = 0.63, DE = 0.396). Las características que se vieron mayormente correlacionadas con las barreras fueron ser mujer, pertenecer a la comunidad de la diversidad sexual y de género, tener algún trastorno de salud mental y tener conducta suicida (p < 0.05). Estos hallazgos son clave para la creación de propuestas que mitiguen o disminuyan las dificultades en la atención de la salud mental de los estudiantes de medicina.
38. Challenges for public health regarding diseases among older adults in Mexico.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
39. The Prognostic Nutritional Index predicts poor postoperative outcomes in patients undergoing video-assisted thoracic surgery for an infectious etiology.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
The Prognostic Nutritional Index (PNI) as a prognostic tool for the postoperative outcomes in patients undergoing thoracic surgery due to an infectious etiology remains unexplored. To evaluate the PNI as predictor of poor postoperative outcomes in patients undergoing surgery for a thoracic infection. A retrospective analysis in patients undergoing VATS during January 2019 to December 2023, including 61 patients. We performed a ROC curve analysis to identify the optimal PNI cut-off value to classify the patients into groups: A high (HR) and low-risk (LR) group. Chi-square, Fisher exact, and Mann-Whitney tests were used to compare them. A multivariate analysis with Cox regression was also performed. The optimal PNI cut-off value was 28.69, with AUC 0.860 (p = 0.001), sensitivity 88.9%, specificity 78.8%. 42 patients were low-risk, while 19 high-risk. There was a significant difference in 30-day mortality between groups (HR 42% vs LR 2%, p < 0.001) as well as in 30-day major complications (HR 68% vs LR 16%, p < 0.001). A multivariate analysis revealed that PNI-based risk group was an independent predictor of mortality (p = 0.008) and major complications (p < 0.001). The PNI is a valid predictor of poor postoperative outcomes in patients undergoing VATS for a thoracic infection. La utilidad del PNI como herramienta pronóstica en pacientes que requieren cirugía torácica por etiología infecciosa no ha sido explorada. Evaluar el PNI como predictor de resultados postoperatorios adversos en pacientes con infecciones torácicas que requieren cirugía. Análisis retrospectivo de 61 pacientes operados por VATS debido a infección torácica, entre 2019-2023. Se realizó un análisis con curva de ROC para identificar el punto de corte del PNI que dividiera los pacientes en dos grupos: Uno alto y otro bajo riesgo. Las pruebas de Chi cuadrada, exacta de Fisher y Mann Whitney fueron utilizadas para la comparación entre grupos. Adicionalmente, se realizó un análisis multivariado con regresión de Cox. El punto de corte óptimo fue 28.69, con AUC 0.860 (p = 0.001), sensibilidad 88.9%, especificidad de 78.8%. 42 pacientes fueron clasificados como bajo riesgo, y 19 como alto riesgo. Hubo diferencia en mortalidad (2% vs 42%, p < 0.001) y complicaciones mayores (16% vs 68%, p < 0.001) a 30 días. El análisis multivariado demostró que el PNI fue un predictor independiente de mortalidad (p = 0.008) y complicaciones mayores (p < 0.001). El PNI es un predictor válido de resultados postoperatorios adversos en pacientes que son operados con VATS por etiologías infecciosas.
40. Gastroesophageal reflux disease and pregnancy: recommendations for safe treatment.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Gastroesophageal reflux disease (GERD) is common during pregnancy, affecting up to 80% of pregnant women. Treatment aims to relieve symptoms and not harm the fetus. Our objective is to provide guidance on the safe treatment of GERD in pregnancy. An electronic search of the English-language literature was performed in MEDLINE, PubMed, and Cochrane, to identify randomized controlled trials, observational studies, management recommendations, and reviews of GERD and its treatment during pregnancy. The search period was defined from 1992 to 2024. Treatment during pregnancy should be gradual, starting with lifestyle changes. If symptoms are severe, calcium-containing antacids or alginates should be started as the first pharmacological measure (grade A recommendation). If symptoms persist, sucralfate may be introduced (grade C recommendation), followed by a histamine-2 receptor antagonist (grade B recommendation). Proton pump inhibitors are reserved for women with intractable symptoms or complicated GERD; all are Food and Drug Administration category B drugs except omeprazole, which is category C (grade C recommendation). There are drugs that are contraindicated during pregnancy, and others that have not been thoroughly studied in this situation. La enfermedad por reflujo gastroesofágico (ERGE) es frecuente durante el embarazo, pues afecta hasta al 80% de las embarazadas. El tratamiento pretende aliviar los síntomas y no dañar al binomio. Nuestro objetivo es brindar orientación sobre un tratamiento seguro de la ERGE en el embarazo. Se realizó una búsqueda electrónica de la literatura en idioma inglés en MEDLINE, PubMed y Cochrane, para identificar ensayos controlados aleatorizados, estudios observacionales, recomendaciones de manejo y revisiones sobre la ERGE y su tratamiento durante el embarazo. El periodo de búsqueda se definió de 1992 a 2024. El tratamiento durante el embarazo debe ser escalonado, comenzando con cambios del estilo de vida. Si los síntomas son graves, se debe iniciar con antiácidos que contengan calcio o alginatos, como primera medida farmacológica (recomendación de grado A). Si los síntomas persisten, se puede introducir sucralfato (recomendación de grado C); seguido de un antagonista del receptor de histamina 2 (recomendación de grado B). Los inhibidores de la bomba de protones están reservados para mujeres con síntomas intratables o ERGE complicada; todos ellos son de categoría B de la Food and Drug Administration, excepto el omeprazol, que es de categoría C (recomendación de grado C). Existen fármacos que están contraindicados durante el embarazo, y otros que no han sido estudiados en esta situación.
41. Efficacy comparison of single-dose thoracic epidural analgesia with morphine and erector spinae plane block for open thoracotomy analgesia.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Postoperative pain after thoracotomy can be severe. To assess whether low-dose morphine-assisted thoracic epidural analgesia (TEA) reduces pain (as measured by the visual analogue scale - VAS) and opioid consumption more than erector spinae plane block (ESP) in patients after thoracotomy. 140 patients scheduled for elective thoracotomy (69 with TEA and 71 with ESP) were evaluated. VAS scores, respiratory capacity, nausea, vomiting, pruritus and opioid consumption were recorded at different intervals after the operation (30 min, 2, 6, 12 and 24 hours). Patients with TEA had significantly lower VAS scores in all postoperative measurements compared to the ESP group (p < 0.001). Respiratory capacity was also higher in the TEA group (p < 0.001). Postoperative opioid consumption was lower in the TEA group (p < 0.001), although there were no differences in intraoperative consumption (p = 1). Thoracic epidural analgesia with low-dose morphine improves long-term postoperative pain control compared with ESP block. El dolor postoperatorio después de una toracotomía puede ser intenso. Evaluar si la analgesia epidural torácica asistida con morfina en dosis bajas (TEA) reduce más el dolor (medido con la escala visual analógica - EVA) y el consumo de opioides que el bloqueo del plano erector de la columna (ESP) en pacientes tras una toracotomía. Se evaluaron 140 pacientes programados para toracotomía electiva (69 con TEA y 71 con ESP). Se registraron las puntuaciones de EVA, capacidad respiratoria, náuseas, vómitos, prurito y consumo de opioides a diferentes intervalos tras la operación (30 min, 2, 6, 12 y 24 horas). Los pacientes con TEA presentaron puntuaciones de EVA significativamente menores en todas las mediciones postoperatorias comparados con el grupo ESP (p < 0.001). También, la capacidad respiratoria fue mayor en el grupo TEA (p < 0.001). El consumo de opioides postoperatorios fue menor en el grupo TEA (p < 0.001), aunque no hubo diferencias en el consumo intraoperatorio (p = 1). La analgesia epidural torácica con morfina en dosis bajas mejora el control del dolor postoperatorio a largo plazo en comparación con el bloqueo ESP.
42. Surgical and medical complications associated with mucormycosis in a tertiary hospital.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Mucormycosis is an infection caused by Mucorales. Management includes surgical treatment and antifungals. To describe the surgical and medical complications associated with mucormycosis in a third-level hospital. Records of patients with mucormycosis treated between 2019 and 2022 were collected. A total of 25 patients were obtained, 17 (68%) men and 8 (32%) women. Surgical complications occurred on admission in 16% and early in 4% of cases. The most frequent medical complications were soft tissue infection on admission (84%) and late sepsis (52%). Amphotericin B deoxycholate was used in all cases, finding hypokalemia in 20 (80%), hypomagnesemia in 18 (72%), and acute kidney injury in 15 (60%). The most commonly performed surgery was surgical debridement on admission (76%). Surgical complications occurred mainly on admission (16%). The most frequent medical complications were soft tissue infection on admission (84%) and late sepsis (52%). Due to the high cost of the liposomal and lipid forms of amphotericin, the use of amphotericin B deoxycholate continues to persist in our setting, which leads to a high degree of renal toxicity and hydroelectrolytic alterations. La mucormicosis es una infección causada por Mucorales. El manejo incluye tratamiento quirúrgico y antifúngicos. Describir las complicaciones quirúrgicas y médicas asociadas a la mucormicosis en un hospital de tercer nivel. Se recabaron registros de pacientes con mucormicosis atendidos entre 2019 y 2022. Se obtuvó un total de 25 pacientes, 17 (68%) hombres y 8 (32%) mujeres. Las complicaciones quirúrgicas se presentaron al ingreso en el 16% y tempranamente en el 4% de los casos. Las complicaciones médicas más frecuentes fueron infección de tejidos blandos al ingreso (84%) y sepsis tardía (52%). Se utilizó anfotericina B desoxicolato en todos los casos, encontrando hipopotasemia en 20 (80%), hipomagnesemia en 18 (72%) y lesión renal aguda en 15 (60%). La cirugía mayormente realizada fue el desbridamiento quirúrgico al ingreso (76%). Las complicaciones quirúrgicas se presentan principalmente al ingreso (16%). Las complicaciones médicas más frecuentes fueron infección de tejidos blandos al ingreso (84 %) y sepsis tardía (52%). Debido al alto costo de las formas liposomal y lipídica de anfotericina, en nuestro medio sigue persistiendo el uso de anfotericina B desoxicolato, lo que conlleva un alto grado de toxicidad renal y alteraciones hidroelectrolíticas.
43. Seroprevalence of infectious agents in blood donors from a hospital on the Southern border of Mexico.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Blood transfusion and its derivatives are an essential therapeutic action in the different hospital services. Despite the strict haemovigilance carried out in blood banks, there is still a residual risk of contracting infectious diseases through blood transfusion. To determine the seroprevalence of infectious agents in blood donors. Retrospective and observational study. The detections were made in blood donors who came to the blood bank of the General Hospital Zone No. 1 of Tapachula, Chiapas, Mexico, during the period from August 2020 to December 2023. The general seroprevalence was 3.94%, with syphilis being most frequently found (1.37%), followed by brucellosis (1.17%), human immunodeficiency virus (0.55%), hepatitis C (0.34%), hepatitis B (0.19%), and Chagas disease (0.19%), with 0.10% of co-infection cases. The seroprevalence of infectious agents in blood donors described in this study allows us to know an epidemiological overview of what happened in a city on the Southern border of Mexico, reaffirming syphilis as a re-emerging disease in this zone, with high prevalences of brucellosis and human immunodeficiency virus. La transfusión de sangre o de sus derivados es una acción terapéutica esencial en los distintos servicios hospitalarios. A pesar de la estricta hemovigilancia que se lleva a cabo en los bancos de sangre, sigue existiendo un riesgo residual de contraer enfermedades infecciosas a través de una transfusión. Determinar la seroprevalencia de agentes infecciosos en donantes de sangre. Estudio retrospectivo y observacional. Las detecciones fueron realizadas en donantes sanguíneos que acudieron al banco de sangre del Hospital General de Zona No. 1 de Tapachula, Chiapas, México, durante el periodo de agosto de 2020 a diciembre de 2023. La seroprevalencia general fue del 3.94%, encontrando con mayor frecuencia sífilis (1.37%), seguida de brucelosis (1.17%), virus de la inmunodeficiencia humana (0.55%), hepatitis C (0.34%), hepatitis B (0.19%) y enfermedad de Chagas (0.19%), con un 0.10% de casos de coinfección. La seroprevalencia de agentes infecciosos en donantes de sangre en el estudio permite conocer un panorama epidemiológico de lo ocurrido en una ciudad de la frontera sur de México, reafirmando a la sífilis como una enfermedad reemergente en la zona y con altas prevalencias de brucelosis y virus de la inmunodeficiencia humana.
44. Clinical outcomes of patients with emphysematous pyelonephritis according to type of treatment and classification of severity by Huang-Tseng.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Emphysematous pyelonephritis (EP) is an acute, necrotizing infection of the renal parenchyma and surrounding tissues, characterized by the presence of gas in the renal parenchyma and adjacent structures. To analyze the outcomes of patients with EP, treated at the General Hospital of Mexico. An observational, analytical study was carried out, between January 2018 and December 2023. Clinical data, urine cultures and tomographic findings (severity classification by Huang-Tseng) were collected. 51 clinical records were included, 64.7% women, and average age 52 years. 70% lived with diabetes type 2 and 60% had uro-renal lithiasis, about 30% had severe EP. 80% of cases were resolved with treatment based on antibiotics and drainage by interventional radiology. There was an average of 10 days of hospitalization and fatality of 5.9%; the severity of the acute kidney injury showed an association with mortality (p ≤ 0.05). The combined use of antibiotics with drainage of the abscess through interventional radiology was associated with a decrease in morbidity and mortality in these cases. La pielonefritis enfisematosa (PE) es una infección aguda y necrotizante del parénquima renal y los tejidos circundantes, caracterizada por la presencia de gas en el parénquima renal y las estructuras adyacentes. Analizar los desenlaces de pacientes con PE atendidos en el Hospital General de México. Se realizó un estudio observacional, analítico, entre enero de 2018 y diciembre de 2023. Se recabaron datos clínicos, urocultivos y hallazgos tomográficos (clasificación de gravedad por Huang-Tseng). Se incluyeron 51 expedientes clínicos, el 64.7% correspondientes a mujeres, y el promedio de edad fue de 52 años. El 70% vivía con diabetes tipo 2 y el 60% tenía litiasis urorrenal; cerca del 30% tuvo PE grave. El 80% de los casos se resolvieron con tratamiento basado en antibióticos y drenaje por radiología intervencionista. Hubo un promedio de 10 días de internamiento y una letalidad del 5.9%; la gravedad de la lesión renal aguda mostró asociación con la mortalidad (p ≤ 0.05). El uso conjunto de antibióticos y drenaje del absceso mediante radiología intervencionista se asoció con una disminución de la morbimortalidad en estos casos.
45. The new epidemic in Indigenous peoples: the adiposity syndrome in poverty.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
The incorporation of industrial foods in Indigenous peoples has generated health problems in families, related to the excessive accumulation of adipose tissue, Diabetes mellitus type II, metabolic liver disease, defined as “adiposity in poverty syndrome”. To analyze the frequency of diseases of the adiposity syndrome in poverty in Indigenous peoples in transition to modernity in the Wixarika region of the state of Jalisco, Mexico. An epidemiological, cross-sectional analytical design with sampling segmented by community size is applied. 238 cases over 30 years old of 221 families from three communities are studied. Statistical analysis is performed by nonparametric tests, with significant p < 0.05. There is a significant difference in the frequencies of adiposity syndrome by community size, by locality and between traditional communities and those in the process of westernization. The study provides a sociohistorical approach to the problems of Indigenous peoples from critical epidemiology. In the Wixaritari populations there are changes in health conditions, determined by the degree of social development and by their incorporation into the processes of Westernization. La incorporación de alimentos industriales en los pueblos originarios ha generado problemas de salud en las familias, relacionados con la acumulación excesiva de tejido adiposo, diabetes mellitus tipo 2, afectación hepática metabólica, definidos como “síndrome de adiposidad en la pobreza”. Analizar la frecuencia de enfermedades del síndrome de adiposidad en la pobreza en pueblos originarios en transición a la modernidad en la región wixárika del estado de Jalisco, México. Se aplicó un diseño epidemiológico transversal analítico, con muestreo segmentado para comunidades elusivas y dispersas y por el tamaño de comunidades. Se estudiaron 238 casos mayores de 30 años de 221 familias de tres comunidades. El análisis estadístico se realizó con pruebas no paramétricas, y se estableció un valor de p < 0.05 como significativo. Existió diferencia significativa en la frecuencia del síndrome de adiposidad por el tamaño de la comunidad y la localidad, así como entre las comunidades tradicionales y en proceso de occidentalización. El estudio aporta un abordaje sociohistórico de la problemática de los pueblos originarios desde la epidemiología crítica. En las poblaciones wixaritari se presentan cambios en las condiciones de salud, determinados por el grado de desarrollo social y por su incorporación a los procesos de occidentalización.
46. Prevalence and associated factors of hypersensitivity to tropical fruits among Mexican adults.
期刊: Gaceta medica de Mexico 发表日期: 2025 链接: PubMed
摘要
Although tropical fruits (TF) are an important part of the diet in many regions worldwide, epidemiological data on hypersensitivity to tropical fruits (HSTF) are scarce globally. This study aims to determine the prevalence of HSTF in adults, identify the most common symptoms and foods associated with it, and identify factors linked to its occurrence. A structured questionnaire was administered to a sample of Mexican adults to identify symptoms associated with TF consumption. Two study groups were formed: one without HSTF and another with HSTF. A total of 930 adults participated in the study; 35 had HSTF (prevalence of 3.8%; 95%CI: 2.7%-5.2%). The kiwi (13/930, 1.4%), pineapple (8/930, 0.9%), and avocado (7/930, 0.8%) had the highest prevalence. The main symptoms caused by TF were pharyngeal tightness (15/35, 44.1%), oral itching (12/35, 34.3%), and lip itching (9/35, 25.7%). Multivariate analyses identified asthma (aOR: 3.46, p = 0.014), atopic dermatitis (aOR: 7.08, p = 0.002), and a family history of urticaria (aOR: 8.15, p < 0.001) as factors associated with HSTF. This study indicates that approximately 4% of surveyed adults experience symptoms after consuming TF and identifies asthma, atopic dermatitis, and a family history of urticaria as significant factors associated with HSTF. Aunque las frutas tropicales (FT) son una parte importante de la dieta en muchas regiones del mundo, los datos epidemiológicos sobre la hipersensibilidad a las frutas tropicales (HFT) son globalmente escasos. Determinar la prevalencia de HFT en adultos, identificar los síntomas y los alimentos más comúnmente asociados con esta condición, y analizar los factores vinculados a su aparición. Se administró un cuestionario estructurado a una muestra de adultos mexicanos para identificar síntomas asociados con el consumo de FT. Se conformaron dos grupos de estudio: uno sin HFT y otro con HFT. Participaron en el estudio 930 adultos, de los que 35 presentaron HFT, lo que supone una prevalencia del 3.8% (IC 95%: 2.7-5.2). Las FT con mayor prevalencia de HFT fueron el kiwi (13/930, 1.4%), la piña (8/930, 0.9%) y el aguacate (7/930, 0.8%). Los principales síntomas causados por las FT fueron opresión faríngea (15/35, 44.1%), prurito oral (12/35, 34.3%) y prurito en los labios (9/35, 25.7%). Los análisis multivariados identificaron el asma (ORa: 3.46; p = 0.014), la dermatitis atópica (ORa: 7.08; p = 0.002) y los antecedentes familiares de urticaria (ORa: 8.15; p < 0.001) como factores asociados con la HFT. Este estudio indica que aproximadamente el 4% de los adultos encuestados presentan síntomas tras el consumo de FT, y señala al asma, la dermatitis atópica y los antecedentes familiares de urticaria como factores significativamente asociados con la HFT.
47. Civic participation among young people in Chile: an association analysis in times of COVID-19.
期刊: Revista da Escola de Enfermagem da U S P 发表日期: 2025 链接: PubMed
摘要
To analyze the association between sociodemographic and socio-health factors on the civic participation of young people in Chile. A cross-sectional study using the Tenth National Youth Survey. Descriptive statistics and models were used to examine associations between sociodemographic, socio-health, social participation, and sociopolitical variables in Chile. Female sex and education levels indicated greater political participation. Being single, not being heads of household, being happy, having a positive outlook on their future, being satisfied with their finances, health, leisure time, having time available to spend with friends and family, and the country’s characteristic democracy showed significant associations. No identification with specific political sectors, interest in political matters, and self-identification as not actively participating in politics had significant associations. Young people are essential for building future citizenship. Their unique characteristics must be strengthened through effective citizen participation strategies, mediated by education that fosters awareness of their own value as individuals who impact public policy.
48. Addressing the Urgency for Healthy Aging in Sri Lanka: Policy Dialogues.
期刊: WHO South-East Asia journal of public health 发表日期: 2025-Jan-01 链接: PubMed
摘要
One in every four Sri Lankans will be an older person by the year 2041 with an increasing share of the very old elderly. The share of the population aged 65 years and above is projected to rise leading to an increase of the old age dependency ratio with female preponderance. With this demographic transition, and epidemiological profile dominated by noncommunicable disease, the health system warrants major changes to meet new demands. Policy dialogue on healthy aging was initiated with the aim of providing impactful support to build better and resilient primary healthcare-centered health system. The dialogue contributed to improve evidence-based decision-making, which entails creating the platforms supporting pathways between key stakeholders. Key issues to explore through policy dialogue were framed from the available evidence and desk reviews, that included examining policy-related literature and considered the ongoing primary healthcare reorientation in Sri Lanka. The methodology adopted for dialogue on healthy aging enriched by a comprehensive context review led to focused technical dialogues that aided the construction of a conceptual model to be considered within the current overall health structure being reoriented.
49. High Prevalence of Self-reported Experience of Violence among School-going Adolescents in Bhutan: A Secondary Analysis of Nationally Representative Global School-based Student Health Survey.
期刊: WHO South-East Asia journal of public health 发表日期: 2025-Jan-01 链接: PubMed
摘要
Although Bhutan has recently advanced beyond response to preventive services for violence against women and children, there is limited data on adolescent violence to inform policy and interventions, highlighting the need for studies like the 2016 Global School-based Health Survey (GSHS). We have analyzed the Global School-based Student Health Survey-2016, Bhutan, to assess the burden and pattern of violence among school-going adolescents (13-17 years). Two-stage cluster sampling was done; fifty schools were selected based on probability proportional to enrollment size from where classes 7 to 11 were selected using systematic sampling. Of the 5808 students, 3255 (56.0%) were female and 3184 (54.8%) were day scholars. Overall, 3528 (60.7%) experienced at least one form of violence, and 2305 (57.7%) had more than one form. Involved in physical fights (39.8%), physically attacks (38.5%), bullied (26.3%), and experienced sexual violence (7.1%) were reported in descending order. The prevalence of bullying and sexual violence did not significantly differ between boys and girls. Adolescents who were younger and have reported suicidal tendency (adjusted prevalence ratios [aPR]: 1.81, 95% CI: 0.54-2.13), using tobacco (aPR: 1.72, 95% CI: 1.44-2.05), using alcohol (aPR: 1.61, 95% CI: 1.36-1.91), boarding students (aPR: 1.50, 95% CI: 1.33-1.69), reporting stress (aPR: 1.43, 95% CI: 1.15-1.78), poor social support (aPR: 1.32, 95% CI: 1.13-1.53), male (aPR: 1.28, 95% CI: 1.13-1.46), and poor parental understanding of the problem (aPR: 1.13, 95% CI: 1.00-1.26) experienced higher prevalence of any violence. A higher prevalence of violence among younger and boarding students calls for focused interventions.
50. Oral Health Survey in Rural and Urban Population from Central India.
期刊: WHO South-East Asia journal of public health 发表日期: 2025-Jan-01 链接: PubMed
摘要
Public health authorities and decision-makers need the tools, capacity, and information necessary for assessing health needs, choosing intervention strategies, and drafting policy guidelines. Inadequate information about the oral health of populations leads to ineffective policies. A total of 47,837 randomly selected individuals participated in the study: 19,760 from urban regions and 28,077 from rural regions. The study population was the World Health Organization-specified index age groups of 5, 12, 35-44, and 60 years and above, which was modified for the Indian population. Information was collected for demographic details, behavioral practices, available infrastructure, workforce, and public dental services provided in each district. Oral examinations were conducted at individual households for dental caries, periodontal disease, malocclusion, dental fluorosis, and oromucosal lesions. Risk factors for oral diseases were identified using regression analysis. A high prevalence of oral disease, extremely low utilization of dental care services, and a high dental prosthetic need were noted in the study population. Early childhood caries was noted among 46.9% and 53.6% of 5-year-old children in the urban and rural regions, respectively. The prevalence of dental fluorosis among 12-year-old rural and urban children was at 9.2% and 8.8%, respectively. Periodontal predicaments were noted among 50%, 75%, and 86% of the population in the target age groups of 12, 35-44, and 60 years and above, respectively. Malocclusion was noted among 20% and 25% of the study population in the 12 and 35-44 years’ age group, respectively. The prevalence of complete edentulism among older adults was observed in 13% and 11.5% of populations in the rural and urban regions, respectively. This study provides comprehensive oral health data for target age groups and aids in improved planning and management of public oral health services in a state in Central India.
51. Prevalence and Social Determinants of Multiple Long-term Conditions among Adults of Odisha, India: A Population-based Cross-sectional Study.
期刊: WHO South-East Asia journal of public health 发表日期: 2025-Jan-01 链接: PubMed
摘要
Multiple long-term conditions (MLTCs) defined as the co-occurrence of ≥2 chronic conditions are rising in low- and middle-income countries such as India. MLTCs can require continued medical support, investigations, and medications calling for health system strengthening. This highlights the need for assessing the burden of MLTC in the community. We estimated the prevalence of MLTCs and assessed their social determinants in Odisha, India. A cross-sectional study was conducted in two villages of Khordha district, Odisha, employing a systematic random sampling method. We recruited 530 adults aged ≥18 years between March and June 2023. Prevalence was presented as frequency and proportion, along with a 95% confidence interval (CI) as a measure of uncertainty. The relationship between MLTCs (≥2 conditions out of 28 assessed chronic conditions) and various sociodemographic traits - such as age, gender, education, and employment elicited using a validated Multimorbidity Assessment Questionnaire for Primary Care tool was examined through a multivariable logistic regression model. Results were expressed as adjusted odds ratios (AOR) with 95% CI. The overall prevalence of MLTCs was 29.21% (95% CI: 25.4-33.32). Individuals aged 60 years or older (AOR: 23.56 [95% CI: 7.55-73.53]), compared to those aged 18-30 years, and those residing in rural areas (AOR: 3.18 [95% CI: 1.70-5.92]), compared to their urban counterparts, were more likely to have MLTCs. Almost one-third of the adults had MLTCs that suggest an immediate need to develop, strengthen, and promote healthcare services for chronic conditions in the community that is accessible and cost-effective.
52. Early Childhood Media Exposure and Associated Factors in Khon Kaen Province, Thailand.
期刊: WHO South-East Asia journal of public health 发表日期: 2025-Jan-01 链接: PubMed
摘要
This study aimed to estimate the prevalence of electronic media exposure among 18-month-old children and to identify associated factors in Khon Kaen Province. This was a descriptive cross-sectional study. Data were collected from 247 caregiver-child pairs visiting the primary care unit for their children’s 18-month vaccination, using a structured questionnaire, between February and July 2021. The primary outcome was electronic media exposure, which was defined as the child’s engagement with or exposure to electronic devices, including mobile phones and television. Descriptive statistics and Poisson regression with robust standard errors were applied to directly estimate crude and adjusted prevalence ratios (aPR). The study found that 52.2% of mothers were using electronic media to assist in child-rearing. Statistically significant characteristics of electronic media use in children at 18 months were identified (P < 0.05) include primary caregivers with marital status divorced/separated (aPR = 0.50, 95% confidence interval [CI] = 0.27-0.91, P = 0.023), primary caregivers unemployed (aPR = 1.30, 95% CI = 1.01-1.69, P = 0.046), and 2-4 family members in family (aPR = 1.39, 95% CI = 1.02-1.90, P = 0.036). This study’s findings can guide the promotion, prevention, and care of early childhood regarding electronic media use.
53. Comparative analysis of Egypt's malaria elimination strategies and implementation science: Pathways to achieve malaria-free status for other African countries.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Malaria elimination is a critical public health goal, particularly in Africa, where the disease disproportionately affects vulnerable populations. Egypt’s success in achieving World Health Organization (WHO) malaria-free certification on October 20, 2024, through an evidence-based malaria elimination program, offers a valuable model for replication. Our study is identified as an implementation study, evaluating the evidence-based interventions deployed, the implementation strategy tested, and its outcomes to provide insights for scaling similar programs across Africa. A RE-AIM-informed lens was applied to better articulate how contextual factors, intervention reach, effectiveness, adoption, implementation, and maintenance influenced observed outcomes. We adopted a retrospective implementation science approach to analyze Egypt’s malaria elimination program. The implementation strategy focused on high-priority malaria-endemic regions, targeting vulnerable groups such as children under five and pregnant women. Interventions included vector control measures, such as insecticide-treated nets (ITNs), indoor residual spraying (IRS), antimalarial treatment protocols, and public health education campaigns. Key implementation strategies included workforce training, multilevel stakeholder engagement, integrated data-driven decision-making, and community mobilization. Our study evaluated key implementation outcomes, including fidelity, feasibility, acceptability (measured using a custom-designed tool assessing stakeholder and community perceptions of the interventions), and adaptability alongside health outcomes such as incidence reduction, treatment coverage, and community awareness. Economic evaluations and process analyses provided additional insights into cost-effectiveness and operational efficiency. The implementation strategy targeted malaria-endemic regions, achieving a 92% recruitment rate, focusing on vulnerable groups such as children under five (37%) and pregnant women (12%). 78% of the recipient population adhered to preventive measures like insecticide-treated nets (ITNs). The program reduced malaria incidence by 96% over 15 years and achieved a 94% reduction in Anopheles mosquito density. Active surveillance led to the detection of 98% of cases within 48 hours of symptom onset, while treatment coverage reached 91%. Community awareness of malaria prevention increased to 84% by the program’s conclusion. Economic evaluations revealed a cost per disability-adjusted life year (DALY) averted of $24, with an estimated $1.5 billion saved in healthcare costs and productivity losses over 15 years. Sub-group analyses highlighted higher adherence rates in urban areas (89%) compared to rural areas (73%) and significant reductions in malaria-related complications among pregnant women (78%). Implementation outcomes included high fidelity (93%) to planned strategies, high feasibility across urban and rural contexts, and successful adaptability to emerging challenges such as insecticide resistance and funding fluctuations. Routine monitoring systems, continuous feedback loops, and responsive adaptation mechanisms were central to achieving these outcomes. Acceptability scores averaged 87% across stakeholders, reflecting strong alignment with community values, trust in health authorities, and perceived relevance of interventions. Egypt’s malaria elimination strategies exemplify the effective integration of implementation science into public health programs. Key success factors included community engagement, robust surveillance systems, and cost-effective resource allocation. The intentional use of implementation strategies and documented outcomes demonstrate alignment with the RE-AIM framework, reinforcing the program’s relevance for broader application. Future efforts should emphasize tailored interventions, capacity building, transparent assessment of acceptability, and sustainable funding mechanisms to replicate Egypt’s success.
54. Reassessment of public awareness and prevention strategies for HIV and COVID-19 co-infections through epidemic modeling.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
A co-infection model between HIV and COVID-19 that takes into account COVID-19 vaccination and public awareness is discussed in this article. Rigorous analysis of the model is conducted to establish the existence and local stability conditions of the single-infection models. We discover that when the corresponding reproduction number for COVID-19 and HIV exceeds one, the disease continues to exist in both single-infection models. Furthermore, HIV will always be eradicated if its reproduction number is less than one. Nevertheless, this does not apply to the single-infection COVID-19 model. Even when the fundamental reproduction number is less than one, an endemic equilibrium point may exist due to the potential for a backward bifurcation phenomenon. Consequently, in the single-infection COVID-19 model, bistability between the endemic and disease-free equilibrium may arise when the basic reproduction number is less than one. From the co-infection model, we find that the reproduction number of the co-infection model is the maximum value between the reproduction number of HIV and COVID-19. Our numerical continuation experiments on the co-infection model reveal a threshold indicating that both HIV and COVID-19 may coexist within the population. The disease-free equilibrium for both HIV and COVID-19 is stable only if the reproduction numbers are less than one. Additionally, our two-parameter continuation analysis of the bifurcation diagram shows that the condition where both reproduction numbers equal one serves as an organizing center for the dynamic behavior of the co-infection model. An extended version of our model incorporates four different interventions: face mask usage, vaccination, and public awareness for COVID-19, as well as condom use for HIV, formulated as an optimal control problem. The Pontryagin’s Maximum Principle is employed to characterize the optimal control problem, which is solved using a forward-backward iterative method. Numerical investigations of the optimal control model highlight the critical role of a well-designed combination of interventions to achieve optimal reductions in the spread of both HIV and COVID-19.
55. Optimizing ISO standard microbiological techniques for isolating Campylobacter from poultry samples amidst challenges from extended spectrum beta lactamase producing Escherichia coli.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Isolation of zoonotic Campylobacter species has been standardized through the ISO 10272:2017 protocol. However, application of the protocol in a LMIC country failed to isolate Campylobacter due to extended-spectrum beta-lactamase (ESBL) producing Escherichia coli overgrowth during the Campylobacter selective enrichment phase. The aim of the study was to identify the contaminants and explore ways to mitigate them. A set of 25 non-Campylobacter contaminants isolated from chicken cecal samples grown on modified charcoal-cefoperazone-deoxycholate agar (mCCDA) during Campylobacter isolation were included. All isolates were screened for species identification and the presence of selected ESBL producing genes. Minimum inhibitory concentrations of tazobactam were measured using a microbroth dilution technique. The Campylobacter isolation protocol was then modified to inhibit the contaminants by adding the required tazobactam supplement to Preston broth or to mCCDA. All contaminants were found to be E. coli carrying at least one of the ESBL-producing genes blaTEM, blaCTX or blaSHV. The MIC of tazobactam sodium for ESBL-producing E. coli strains grown in Preston broth was at least 128 mg/L. Preston broth supplemented with tazobactam at 128 mg/L inhibited the growth of ESBL-producing E. coli but did not inhibit the growth of C. jejuni or C. coli. Interestingly, mCCDA plates supplemented with tazobactam at a much lower concentration of 4 mg/L could also prevent growth of ESBL-producing E. coli even without broth enrichment, increasing the efficiency of isolation of Campylobacter. Direct inoculation of cecal materials to mCCDA supplemented with tazobactam at 4 mg/L was recommended as the most cost-effective way to conduct Campylobacter surveillance targeting the cecal matrix instead of directly following ISO 10272:2017 protocol.
56. Health insurance non-enrollment among women in Sierra Leone: A cross-sectional analysis of the 2019 Demographic and Health Survey.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Health insurance enrollment is a vital component of universal health coverage and access to essential healthcare services. However, in Sierra Leone, enrollment remains persistently low, posing a major public health challenge. Women of reproductive age (15-49 years) represent a critical population for health insurance enrollment due to their unique healthcare needs, particularly related to reproductive health, pregnancy, and childcare. Despite their importance, women face notable barriers to health insurance enrollment, including financial constraints, gender inequalities, and sociocultural challenges. This study examines the factors associated with health insurance non-enrollment among women aged 15-49 in Sierra Leone. We analysed data from a weighted sample of 15,574 women aged 15-49 years from the 2019 Sierra Leone Demographic and Health Survey. Percentages were used to present the proportion of health insurance non-enrollment among the women. Multivariable binary logistic regression analysis was used to examine the factors associated with health insurance non-enrollment among the women. The proportion of health insurance non-enrollment among the women was 96.02%. Women with higher education were less likely to be uninsured (adjusted odds ratio [aOR]: 0.35, 95% CI: 0.18-0.64) compared to those with no education. Being employed also reduced the odds of being uninsured (aOR: 0.47, 95% CI: 0.36-0.62) compared to women who were employed. Listening to the radio less than once a week was associated with lower odds of being uninsured (aOR: 0.71, 95% CI: 0.53-0.97) compared to women who did not listen to the radio at all. On the other hand, women who reported distance to a health facility as a big problem were more likely to be uninsured (aOR: 2.21, 95% CI: 1.03-4.75) compared to those who did not consider it a problem. Regionally, women living in the Northwestern (aOR: 0.07, 95% CI: 0.03-0.14) and Northern (aOR: 0.28, 95% CI: 0.12-0.66) regions were less likely to be uninsured compared to those residing in the Eastern region. Health insurance non-enrollment was high among women in Sierra Leone. Education, employment, and exposure to listening to the radio were associated with increased health insurance enrollment, highlighting the need to address socioeconomic barriers and leveraging mass media campaigns to educate women on the importance of getting covered by health insurance. Geographic and regional disparities in health insurance enrollment underscore the importance of improving healthcare accessibility and implementing targeted, community-based interventions to promote health insurance uptake. Also, subsiding health insurance subscription fee could increase its enrollment, especially among women from low socioeconomic households.
57. Methodology of community-based venous blood specimen collection for the harmonized diagnostic assessment of dementia for the Longitudinal Aging Study in India (LASI-DAD): Wave 2.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The prevalence of dementia is on the rise, with 60% of dementia cases existing in low- and middle-income countries. In India, the prevalence was reported to be 7.4%. Since the pathophysiology of dementia is multifactorial, the Harmonized Longitudinal Aging Study in India for the Diagnostic Assessment of Dementia (LASI-DAD) collected data to capture multiple domains, including venous blood specimens (VBS). VBS collection and assays help ascertain the overall health status of an individual, understand disease pathogenesis, and diagnose diseases. In community settings, blood assays also help identify disease trends. However, community VBS collections can often be challenging. Sample quality can be impaired due to individual, environmental, geographical, and pre-analytical processing factors. Therefore, standardization of the process is imperative to ensure biomarker data of high accuracy. LASI-DAD developed a systematic sample collection, shipment, processing, and storage protocol. Multiple checkpoints were in place to monitor sample quality in real time. A phlebotomist was trained from each participating state for specimen collection. All samples were centrally tested for analytes. The overall response rate for blood collection was 71.5%. We collected 17 mL of VBS from 3,252 respondents, who consented to participate. Blood samples were tested for routine analytes, and those specific to Alzheimer’s Disease (AD) and AD-related dementias (ADRD). Data was reviewed fortnightly. The median cold chain temperature was 6.2°C and hemolysis was seen in 6.7% of the samples. LASI-DAD standardized and implemented VBS collection while overcoming the challenges faced due to India’s diverse socio-demographic, geographical, and environmental conditions. This methodology can serve as a robust tool for VBS handling and ensuring high sample quality for future community-based studies.
58. How can health systems sustain lessons drawn from emergency contexts? Evidence from Colombia.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The Covid-19 pandemic demanded rapid adaptation to health systems internationally, but little is known about the sustained value of the approaches to learning adopted. How does ongoing environmental turbulence influence the lessons drawn from health system responses to pandemics? To address this question, we engage with, and further develop, Levitt and March’s highly cited perspective on experiential learning by analyzing Colombian healthcare professionals’ experiences gathered during semi-structured interviews. Interviews included representatives of national government, service providers, administrative staff, clinicians, including physicians and nurses, professional associations, and academics. Aspects from the macro, meso, and micro contexts associated with the sustainability of organizational learning were identified. At the macro level, reform efforts seem to overlook lessons learned from the pandemic and divert the attention of key actors. At the meso level, leadership uses success stories to motivate teams, but financial challenges and absence of formal evaluations hinder the sustainability of innovations. At the micro level, there is a diminished workforce capacity, some concerns about virtual professional training and difficulties to address mental health issues is difficult due to stoic professional identities, unrelenting tempo of medical work, and institutional encouragement. This study extends Levitt and March’s organizational learning framework to include environmental turbulence as a factor influencing learning. It highlights that a turbulent context simultaneously triggers learning processes while being a precursor to the interpretation of experiences. The research concludes there are additional moderating variables for organizational learning like human resource capacities, political cycles, and infrastructure continuity, which relate to professional pressures to “turn the page” on the pandemic, the patchy resourcing of new initiatives at the organizational level, and the distraction of health reform.