公共卫生研究摘要 (2025-08-08)
共收录 58 篇研究文章
1. The Longitudinal Association Between Chronic Back Pain and Cognitive Decline in Older Adults With Mediation Analysis: An Analysis of Four Population-Based Databases.
期刊: European journal of pain (London, England) 发表日期: 2025-Sep 链接: PubMed
摘要
While studies suggest chronic back pain (CBP) may heighten accelerated cognitive decline risk in older adults, no multinational research has comprehensively examined this significant public health concern alongside healthy lifestyles’ potential impact. Data from 18,558 individuals across 17 countries (China, England, Europe, USA) were extracted from four databases (2010-2023; median follow-up: 8.4 years). Associations between CBP and memory-related diseases (MDs), cognitive function performance metrics (e.g., numeracy, orientation, immediate word recall, delayed word recall memory, and an overall cognitive score combining these elements), and subjective cognitive decline (SCD) were analysed using linear mixed-effects models and conducting mediation analysis through Structural Equation Modelling, adjusting for confounders. CBP significantly elevated MD and SCD risks in the USA (MDs: OR 1.03 to 1.47; SCD: OR 1.03 to 1.04) and Europe (MDs: HR 1.18 to 2.15; SCD: HR 1.01 to 1.03). Pooled meta-analyses confirmed significant but weak associations: MDs (OR = 1.35, 95% CI 1.03 to 1.68), delayed recall (β = -0.05, 95% CI -0.09 to -0.02), and SCD (HR = 1.02, 95% CI 1.00 to 1.03). Mediation analyses identified alcohol intake as exacerbating cognitive decline, while smoking cessation, physical activity, and sleep (7-9 h) reduced risks in older adults with CBP. CBP heightens accelerated cognitive decline risks in older adults, mediated by modifiable lifestyle factors. These findings emphasise cognitive monitoring and tailored lifestyle interventions, particularly smoking cessation, activity promotion, and sleep optimisation in older adults with CBP. Multidimensional approaches integrating physical and behavioural strategies are critical to mitigating cognitive impairment in this population. CBP increases the risk of cognitive decline in older adults, underscoring the importance of preventing cognitive decline in this population. Public health initiatives should prioritise interventions that target CBP management and lifestyle modifications to mitigate the risk of pain and cognitive decline.
2. Tracing SARS-CoV-2 clusters across local scales using genomic data.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Aug-12 链接: PubMed
摘要
A quantitative understanding of local transmission dynamics is essential for designing effective prevention strategies. In this study, we developed a computational workflow to identify viral introductions and trace locally circulating clusters. We analyzed over 26,000 SARS-CoV-2 genomes and their associated metadata, collected between January and October 2021, to explore introduction and local dispersal patterns in Greater Houston, a major metropolitan area known for its demographic diversity. Our analysis identified more than 1,000 independent introduction events, resulting in clusters of varying sizes. The majority of introductions originated from domestic sources, while international introductions occurred earlier and were associated with larger cluster sizes. An analysis of locally circulating clusters revealed age-structured transmission dynamics. Geographic reconstruction of cluster spread identified Harris County as the primary viral source for surrounding areas. The outbreak in the source population was characterized by 1) a smaller proportion of new cases associated with external viral imports and 2) longer persistence times of circulating lineages. Overall, our high-resolution spatiotemporal reconstruction of the epidemic provides essential insights into the local-scale transmission landscape, supporting outbreak-specific, regional response strategies and public health planning.
3. Crosswalk Analysis of Existing Nurse Practitioner Populations and Emergency Nurse Practitioner Competencies: An Executive Summary.
期刊: Advanced emergency nursing journal 发表日期: 2025-Aug-08 链接: PubMed
摘要
As the number of nurse practitioners working in emergency care (ENP) has grown over the past decade, the alignment of ENP knowledge, skills, and abilities with those of the NP populations has not been fully explored. To identify overlapping themes among the emergency nurse practitioner (ENP) specialty and the eight nurse practitioner population foci’s knowledge, skills, and abilities, national leaders and expert faculty collaborated on a crosswalk analysis of NP competencies, certification examination content and procedures. This project revealed that the ENP specialty competencies, certification exam blueprint items, and procedures are not entirely subsumed within an existing nurse practitioner population focus.
4. The Latent Membrane Protein 1 (LMP1): Biological Functions and Molecular Mechanisms.
期刊: Current topics in microbiology and immunology 发表日期: 2025-Aug-08 链接: PubMed
摘要
Nearly two decades after the discovery of Epstein-Barr virus (EBV), the latent membrane protein 1 (LMP1) was identified and recognized as the primary transforming gene product of the virus. LMP1 is expressed in most EBV-associated lymphoproliferative diseases and malignancies, where it plays a central role in pathogenesis. Over 40 years of research have established LMP1 as a potent driver of cellular transformation and survival, deregulating key signaling pathways, cellular metabolism, and transcription while simultaneously subverting programmed cell death mechanisms. Beyond its role in transformation and immortalization, LMP1 exerts multifaceted biological activities supporting tumorigenesis, including immune modulation, regulation of the tumor microenvironment, and promotion of migration and invasive tumor growth. Functioning as a constitutively active receptor that mimics co-stimulatory CD40 receptor signals in B-lymphocytes, LMP1 recruits cellular signaling molecules associated with tumor necrosis factor receptors (TNFRs), such as TNFR-associated factors (TRAFs) and the TNFR-associated death domain protein (TRADD). It triggers phosphorylation, ubiquitination, and SUMOylation events in the target cell to activate NF-κB, mitogen-activated protein kinase (MAPK), phosphatidylinositol 3-kinase (PI3K), interferon regulatory factor (IRF), and STAT pathways. This review provides an updated and comprehensive overview of the biological and molecular functions of LMP1, highlighting its role as a critical interface in virus-host interactions and its potential as a therapeutic target.
5. ChatGPT-4's Level of Dermatological Knowledge Based on Board Examination Review Questions and Bloom's Taxonomy.
期刊: JMIR dermatology 发表日期: 2025-Aug-07 链接: PubMed
摘要
Our study demonstrated the ability of ChatGPT-4 to answer 77.5% of all sampled text-based board review type questions correctly. Questions requiring the recall of factual information were answered correctly most often, with slight decreases in correctness as higher-order thinking requirements increased. Improvements to ChatGPT’s visual diagnostics capabilities will be required before it can be used reliably for clinical decision-making and visual diagnostics.
6. Associations of Violence Against Women With Comorbid Symptoms of Depression and Anxiety Among Left-Behind Women in Rural China: Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Aug-07 链接: PubMed
摘要
Violence against women (VAW) is a major public health and human rights concern with profound mental health consequences. However, the association between specific VAW forms and mental health, particularly among left-behind women in rural China, remains unclear. This study aimed to identify the associations of VAW with depression, anxiety, and comorbid symptoms and to explore the potential roles of resilience and social support. The cross-sectional survey was conducted in Y City, Henan Province, China, in July 2023. A multistage stratified random sampling method was used to recruit left-behind women, resulting in a final sample of 1503 participants. Data on participants and their VAW were collected through a face-to-face questionnaire survey. The forms of VAW assessed were nonpartner violence (NPV) and intimate partner violence (IPV; including remote IPV). Depressive symptoms were evaluated using the 10-item Center for Epidemiological Studies Depression Scale, while anxiety symptoms were assessed with the Generalized Anxiety Disorder-7. The comorbid symptoms of depression and anxiety (CDA) were ascertained as the simultaneous presence of depressive and anxiety symptoms. A multivariable logistic regression model was used to estimate the odds ratio and 95% CIs. A 4-way decomposition analysis was conducted to test the mediation roles and interactions of resilience and social support between VAW and mental health outcomes. Population attributable fractions and pathway-specific population attributable fractions were calculated to estimate the burden of mental health outcomes attributable to VAW. Lifetime VAW (adjusted odds ratio [aOR] 1.84, 95% CI 1.32-2.54) was associated with an increased risk of CDA. Women who were exposed to lifetime IPV (aOR 1.84, 95% CI 1.32-2.56), remote IPV (aOR 2.79, 95% CI 1.60-4.74), and NPV (aOR 2.63, 95% CI 1.58-4.26) had an increased likelihood of reporting CDA. Similar associations could also be found for depressive symptoms and anxiety symptoms. In the 4-way decomposition analysis for VAW and CDA, mediation effects of low resilience and social support were statistically significant (P<.05), whereas none of the interactions reached significance (P>.05). The pure mediation proportion was 28.2% for the low resilience and 18.6% for the social support between VAW and CDA. A total of 20.8% of CDA cases, 15.1% of depressive symptoms cases, and 22.7% of anxiety symptoms cases were attributable to VAW. Among these, low resilience accounted for 7.2% and low social support accounted for 4.7% of CDA cases as mediators. Lifetime VAW, including IPV (and remote IPV) and NPV, shows significant associations with CDA and depressive and anxiety symptoms among rural left-behind women in China. The associations are partly mediated by low resilience and social support. Targeted strategies, including efforts to reduce violence against rural left-behind women, enhance their resilience and strengthen their social support networks, are urgently needed.
7. Predictors of Persistent Pain After Hysterectomy for Chronic Pelvic Pain: A Systematic Review.
期刊: Obstetrics and gynecology 发表日期: 2025-Aug-07 链接: PubMed
摘要
To systematically review predictors associated with persistent pain after hysterectomy performed for individuals with chronic pelvic pain. PubMed and EMBASE were queried from inception to July 2, 2024, searching for human subject studies investigating hysterectomy performed for chronic pelvic pain. Double independent screening for studies of chronic pelvic pain was performed by members of the Systematic Review Group of the Society of Gynecologic Surgeons. We included longitudinal observational studies (prospective or retrospective) and randomized controlled trials (RCTs). Data were extracted with risk-of-bias assessment with the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Extractions were reviewed by a second researcher. We conducted restricted maximum-likelihood meta-analyses of effect sizes as feasible. One RCT and six cohort studies met the inclusion criteria. The overall quality of the studies was fair to good. The incidence of persistent pelvic pain after hysterectomy ranged widely, from 12% to 68%. Younger age was associated with increased likelihood of persistent pain after hysterectomy (summary odds ratio [OR] 1.39, 95% CI, 1.11-1.75; five studies, N=11,165). Ovarian conservation was not significantly associated with persistent pain (OR 2.04, 95% CI, 0.67-6.18; three studies). Endometriosis was variably associated with persistent pain, with two studies finding an association (summary OR 1.18, 95% CI, 1.06-1.31), whereas two other studies found that stage III or greater endometriosis was not associated with persistent pain (summary OR 0.99, 95% CI, 0.45-2.21). Multiple predictors of interest were evaluated by single studies, limiting the ability to draw aggregate conclusions. High proportions of patients undergoing hysterectomy for chronic pelvic pain experience persistent postoperative pain. Although there is heterogeneity among study design and clinical factors examined and some associations should be interpreted with caution, persistent pelvic pain was associated with younger age at the time of hysterectomy. PROSPERO, CRD42024530836.
8. User Experiences Among Patients and Health Care Professionals Who Participated in a Randomized Controlled Trial of E-nergEYEze, a Vision-Specific eHealth Intervention to Reduce Fatigue in Adults With Visual Impairment: Mixed Methods Study.
期刊: JMIR formative research 发表日期: 2025-Aug-07 链接: PubMed
摘要
Fatigue is a common symptom occurring in individuals with visual impairment (VI). Feeling fatigued has a strong impact on an individual’s well-being, with profound consequences. Cognitive and emotional functioning, social roles, and participation are negatively affected in severely fatigued individuals with VI. Therefore, we developed E-nergEYEze, a blended vision-specific eHealth intervention based on cognitive behavioral therapy and self-management to reduce fatigue severity in adults with VI. We aimed to report the experience of patients and professionals with E-nergEYEze. To complement cost-effectiveness outcomes, the user experiences from both perspectives were considered relevant for a better understanding of the intervention uptake. E-nergEYEze was studied in a randomized controlled trial. User experiences of participants with VI and severe fatigue (51/98, 52%; median age 58.0, IQR 53.0-65.0 years; female participants: 32/51, 63%), who were randomized to the intervention group, and professionals (n=11), who provided blended support, were evaluated. The Dutch Mental Health Care Thermometer questionnaire and a therapist evaluation were used and analyzed using mixed methods. A focus group meeting with social workers (4/7, 57%), a computer trainer (1/7, 14%), and psychologists (2/7, 29%) was held for more in-depth information. The eHealth platform provided data on user engagement from both perspectives. E-nergEYEze was completed by 63% (32/51) of patients for more than 80% of the module steps. Overall, results on user engagement showed that a median 89% (IQR 45%-100%) of all assigned module steps were completed, with all modules being completed by at least 50% (37/51) of the patients. Completion of the intervention was related to the presence of digital proficiency; having the appropriate expectations; content that matches personal preferences and life context; and the absence of impeding personal circumstances, mental health issues, or other concurrent rehabilitation programs. The intervention was given a median grade of 7.0 out of 10.0 (IQR 6.0-8.0), and 87% (39/45) of the patients reported that they would recommend E-nergEYEze to others. However, improvements in the frequency and quality of guidance were considered highly relevant. Professionals reported that E-nergEYEze required patients’ self-efficacy, motivation, and digital skills; therefore, preselection was seen as essential. Professionals’ affinity with eHealth was considered important to provide appropriate remote support. eHealth provides treatment opportunities for individuals with VI for which guidance is considered highly relevant. During participation in E-nergEYEze, patients were engaged, internalized personally relevant topics, and made use of the benefits of eHealth. More attention to the suitability of patients and training of professionals for providing remote support is considered essential. These user experiences underlined the potential of E-nergEYEze to reduce fatigue severity in adults with VI and provided valuable insights to learn from and optimize E-nergEYEze. International Clinical Trials Registry Platform (ICTRP) NL7764; https://tinyurl.com/32b3xt74.
9. What Matters Most to Veterans When Deciding to Use Technology for Health: Cross-Sectional Analysis of a National Survey.
期刊: JMIR formative research 发表日期: 2025-Aug-07 链接: PubMed
摘要
There is an increasingly diverse range of mobile apps and digital health devices available to help patients manage their health. Despite evidence for the effectiveness of such technologies, their potential has not been fully realized because adoption remains low. Such limited uptake can have direct implications for the intended benefits of these technologies. This study aimed to understand what matters most to US military veterans when deciding whether to use digital health technologies (DHTs) such as mobile health apps or devices to manage their health and compare these factors between veterans with and without prevalent chronic physical and mental health conditions. We conducted a cross-sectional analysis of survey data collected from a national sample of veterans who receive care from the Veterans Health Administration (VHA), which was predominantly gathered as part of the last wave of a larger longitudinal data collection effort. Among respondents (n=857), 86.7% (736/849) reported currently using or having previously used ≥1 devices to manage their health, and 78.4% (639/815) also reported using either VHA or non-VHA health apps. Considerations most frequently endorsed as “very important” by veterans when deciding whether to use DHTs included receiving secure messages from their health care team about DHTs, knowing data from DHTs would be used to inform their care, and receiving recommendations from providers to use DHTs. Conversely, considerations most frequently endorsed as “not at all important” included seeing information about DHTs on social media, having community support to use DHTs, and receiving encouragement from peers to use DHTs. Considerations did not significantly differ between veterans with or without prevalent chronic health conditions; however, a greater proportion of veterans with prevalent mental health conditions reported the following considerations to be “very important:” seeing information about DHTs on social media, having community support to use DHTs, having other veterans encourage DHT use, and having help from family, friends, or other important people to use DHTs. Understanding what matters most to patients when they are deciding to adopt a technology for their health can, and should, inform implementation strategies and other approaches to enhance health-related technology use. Our results suggest that, for veterans, recommendations from health care team members and knowing that the data from DHTs will be used in clinical care are more important than information from social media, community sources, or peers when deciding to use DHTs, although perceptions of importance regarding the latter may differ among patients with different conditions. Our findings suggest that communication from health care team members to patients, perhaps either in-person or electronically, could help encourage DHT adoption and use.
10. Health Care Workers' Experience With a Psychological Self-Monitoring App During the COVID-19 Pandemic: Mixed Methods Study.
期刊: JMIR mHealth and uHealth 发表日期: 2025-Aug-07 链接: PubMed
摘要
Health care workers (HCWs) are at risk of experiencing psychological distress, particularly during the COVID-19 pandemic. Psychological self-monitoring apps may contribute to reducing symptoms of depression, anxiety, and trauma exposure by enhancing emotional self-awareness. This study focused on how a basic psychological self-monitoring app was experienced by HCWs during the COVID-19 pandemic in Quebec by exploring users’ experience and factors contributing to their adherence. This study aimed to explore HCWs’ experiences with a psychological self-monitoring app, including if their satisfaction with the app, their perception of its contribution to self-awareness, and their experience of distress influenced their adherence to the app. HCWs in Quebec were invited to respond weekly to questions about their well-being via a mobile app. A convergent mixed methods design was used. Sample data (N=424) were collected from the app, a postparticipation questionnaire was administered, and 30 semistructured interviews were conducted. Correlations and hierarchical multiple regression models were conducted to examine possible factors influencing participants’ adherence, and a thematic analysis was used to further explore their experience. Over a 12-week-period, mean adherence to the psychological self-monitoring app was 74.5% (SD 29.4%) and mean satisfaction was 80% (SD 20%). Most participants perceived that the app contributed moderately (165/418, 39.5%) or a lot (140/418, 33.5%) to enhancing their self-awareness. The significant regression model (F5,401=6.59; P<.001) suggested that around 7.6% of adherence variation could be explained by satisfaction (β=.16; t401=3.14; P=.002) and the app’s perceived contribution to self-awareness (β=.15; t401=2.88; P=.004). Biological sex (369/419, 88.1% female and 50/419, 11.9% male), age (mean 40.8, SD 9.9 y), and the experience of psychological distress at least once in 12 weeks (228/420, 54.3%) were not statistically significant predictors of adherence. Emergent themes from the 30 interviews highlighted participants’ experiences. Psychological self-monitoring was seen as an introspective practice, with reports of enhanced self-awareness and self-care practices. Interviewees generally considered the app as practical, but it did not suit everyone’s preferences. Potential app enhancements were provided by the participants. A simple psychological self-monitoring app could be an interesting tool for HCWs who wish to improve their self-awareness and prevent psychological distress, particularly in health crises such as pandemics.
11. A Work-Based, Fully Remote, and Peer-Supported Exercise Snack Behavior Change Intervention (MOV'D): Protocol for a Randomized Controlled Pilot Trial.
期刊: JMIR research protocols 发表日期: 2025-Aug-07 链接: PubMed
摘要
Prolonged sitting and lack of moderate to vigorous physical activity represent 2 independent risk factors for myriad poor health outcomes. The negative effects of prolonged sitting can be ameliorated with as little as 2 minutes of large muscle movement. Further, cardiovascular benefits from moderate to vigorous activity can be accumulated throughout the day in short bouts rather than require continuous long bouts. Taken together, “exercise snacks” provide a way to both interrupt prolonged sitting and accumulate moderate to vigorous physical activity during a sedentary workday. This protocol describes the feasibility and acceptability pilot of MOV’D (Move Often Every Day)-a fully remote, peer-supported behavioral intervention to interrupt prolonged bouts of sitting at work with exercise snack breaks. The MOV’D pilot study aims to recruit approximately 60-80 participants who work full-time in a sedentary occupation. Participants were randomly assigned either to the Fitbit Control or the MOV’D experimental group in a randomized 2-group design. The pilot study had a 4-week active intervention and a 4-week follow-up with assessments at baseline, 4 weeks, and 8 weeks. The Fitbit control group received a Fitbit to self-monitor their physical activity prior to receiving the intervention material at the end of the study. In addition to Fitbit, the MOV’D intervention features included a private social support group chat seeded with daily experimenter prompts, weekly 5-minute behavior change technique videos, daily self-monitoring, and daily exercise snack suggestion videos. Study enrollment began in March 2022 and concluded in June 2022. Data collection concluded in October 2022. We enrolled 70 participants, and 68 participants completed all the study assessments. This protocol integrates findings from education, behavioral sciences, sedentary behavior, and exercise physiology to promote building an exercise snack habit at work: taking short intense exercise breaks to break up prolonged sitting. The results from this pilot study will show the feasibility and acceptability of the MOV’D intervention. ClinicalTrials.gov CT05360485; https://clinicaltrials.gov/study/NCT05360485.
12. Use of Naltrexone for Patients With Stimulant Use Disorder in Malaysia: Protocol for a Retrospective Cohort Study.
期刊: JMIR research protocols 发表日期: 2025-Aug-07 链接: PubMed
摘要
Naltrexone is an opioid receptor antagonist. Naltrexone is used to block the euphoric and sedative effects of drugs such as heroin, codeine, and morphine. The medication helps to bind and block opioid receptors to decrease opioid cravings. In Malaysia, naltrexone has been used for maintenance treatments for heroin and alcohol since 1996. However, since 2011, naltrexone has been used as an off-label stimulant use disorder (StUD) treatment to achieve abstinence. This study aims to determine the abstinence among StUD and non-StUD patients treated and without naltrexone. We will conduct a retrospective cohort study on the effect of naltrexone or treatment as usual (TAU) by examining the data for both StUD and non-StUD patients. We will use patients’ clinical records from the hospital registry. All adult patients (aged 18-65 years) diagnosed with StUD or other substance use disorders who were treated with naltrexone and standard care from January 1, 2011, to December 31, 2023, will be screened. All StUD and non-StUD patients who were offered the naltrexone treatment or TAU at the beginning of treatment will be recruited. All data will be extracted using a standardized data extraction form. Descriptive analysis will be performed to describe the distribution of patient characteristics, sociodemographic profiles, and percentages of abstinence and treatment retention. We will conduct univariable analysis to determine the association of stimulant abstinence and treatment retention between naltrexone and TAU among both StUD and non-StUD patients. All significant independent variables will be further analyzed using a cross-sectional time series method for categorical variables. Recruitment began in July 2025. Data analysis will begin after completing data collection, planned for January 2026. The expected main outcome of this study is to observe the significant associations of stimulant use abstinence and treatment retention between TAU and naltrexone among StUD and non-StUD patients. The findings from this study may provide preliminary evidence regarding the use of naltrexone in treating StUD. Currently, there is no specific medication to treat amphetamine or methamphetamine use disorder. The effect of naltrexone with psychosocial interventions for StUD is unclear. Public health approaches recognize the multifaceted nature of substance misuse and focus on addressing the myriad individual, environmental, and social factors that contribute to StUD. PRR1-10.2196/64101.
13. Erratum In: "Collecting Data Is Just the First Step: The Importance of Training Providers for Patient Encounters".
期刊: American journal of public health 发表日期: 2025-Aug-07 链接: PubMed
摘要
14. Gender Affirmation Research Is Not Gender Ideology Extremism, It Is Science.
期刊: American journal of public health 发表日期: 2025-Aug-07 链接: PubMed
摘要
15. Discrimination and Sleep Health Among Transgender Women of Color in New York City: Cross-Sectional and Longitudinal Associations From the TURNNT Cohort Study.
期刊: American journal of public health 发表日期: 2025-Aug-07 链接: PubMed
摘要
Objectives. To determine whether discrimination is associated with sleep health among transgender women of color. Methods. We included 269 participants from the Trying to Understand Relationships, Networks, and Neighborhoods Among Transgender Women of Color (TURNNT) Cohort Study in New York City in a cross-sectional analysis and 179 in a longitudinal analysis of the association between discrimination and sleep duration, quality, and latency. Results. Median sleep duration was 6 hours per night, with 65% of participants reporting poor sleep in the past month. Nearly two thirds experienced moderate or high levels of discrimination. Cross sectionally, high discrimination was associated with a 14% greater risk of poor sleep quality relative to low discrimination (prevalence ratio [PR] = 1.14). Longitudinally, high discrimination was associated with a 15% higher risk of poor sleep (PR = 1.15) and an average of 43 minutes less per night. Conclusions. Transgender women of color generally do not receive an adequate amount of sleep, and that sleep is often of poor quality. Those who experience higher rates of discrimination are particularly vulnerable to poor sleep health. Public Health Implications. Effort should be focused on reducing antitransgender discrimination and developing interventions to mitigate the negative impact of discrimination on sleep health among transgender populations. (Am J Public Health. Published online ahead of print August 7, 2025:e1-e10. https://doi.org/10.2105/AJPH.2025.308208).
16. The Lifecycle of Electronic Health Record Data in HIV-Related Big Data Studies: Qualitative Study of Bias Instances and Potential Opportunities for Minimization.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-07 链接: PubMed
摘要
Electronic health record (EHR) data are widely used in public health research, including in HIV-related studies, but are limited by potential bias due to incomplete and inaccurate information, lack of generalizability, and lack of representativeness. This study explores how workflow processes among HIV health care providers (HCPs), data scientists, and state health department professionals may potentially introduce or minimize bias within EHR data. One focus group with 3 health department professionals working in HIV surveillance and 16 in-depth interviews (ie, 5 people with HIV, 5 HCPs, 5 data scientists, and 1 health department professional providing retention-in-care services) were conducted with participants purposively sampled in South Carolina from August 2023 to April 2024. All interviews were transcribed verbatim and analyzed using a constructivist grounded theory approach, where transcripts were first coded and then focused, axial, and theoretically coded. The EHR data lifecycle originates with people with HIV and HCPs in the clinical setting. Data scientists then curate EHR data and health department professionals manage and use the data for surveillance and policy decision-making. Throughout this lifecycle, the three primary stakeholders (ie, HCPs, data scientists, and health department professionals) identified challenges with EHR processes and provided their recommendations and accommodations in addressing the related challenges. HCPs reported the influence of socio-structural biases on their inquiry, interpretation, and documentation of social determinants of health (SDOH) information of people living with HIV, the influence of which is proposed to be mitigated through people living with HIV access to their EHRs. Data scientists identified limited data availability and representativeness as biasing the data they manage. Health department professionals face challenges with delayed and incomplete data, which may be addressed statistically but require consideration of the data’s limitations. Overall, bias within the EHR data lifecycle persists because workflows are not intentionally structured to minimize bias and there is a diffusion of responsibility for data quality between the various stakeholders. From the perspective of various stakeholders, this study describes the EHR data lifecycle and its associated challenges as well as stakeholders’ accommodations and recommendations for mitigating and eliminating bias in EHR data. Based upon these findings, studies reliant on EHR data should adequately consider its challenges and limitations. Throughout the EHR data lifecycle, bias could be reduced through an inclusive, supportive health care environment, people living with HIV verification of SDOH information, the customization of data collection systems, and EHR data inspection for completeness, accuracy, and timeliness. Future research is needed to further identify instances where bias is introduced and how it can best be mitigated and eliminated across the EHR data lifecycle. Systematic changes are necessary to reduce instances of bias between data workflows and stakeholders.
17. Understanding Home Health Agencies' Perspectives Toward Telehealth Use Among Home Health Stakeholders in the Post-COVID-19 Era: Qualitative Interview Study.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-07 链接: PubMed
摘要
In the United States, the COVID-19 pandemic accelerated the adoption of telehealth in home health care (HHC), but its sustainability remains uncertain. Despite telehealth’s potential benefits, including improved patient monitoring and expanded access, the lack of reimbursement and regulatory constraints may limit widespread adoption. Understanding how home health agencies (HHAs) perceive these challenges is critical for shaping future telehealth policy. To examine HHA stakeholders’ perspectives on the adoption, implementation, and sustainability of telehealth in the postpandemic era, with particular attention to operational benefits, financial and regulatory barriers, and the impact of new Centers for Medicare & Medicaid Services (CMS) billing codes (G-codes) for telehealth documentation. Qualitative study using semistructured interviews conducted between February and December 2024. The study followed the Practical Implementation Sustainability Model (PRISM) framework for data collection and analysis. Participants were recruited from HHAs and home health policy organizations across the United States, representing a range of agency types and geographic regions. A purposive and snowball sampling strategy was used to recruit 14 stakeholders, including HHA leaders, HHC clinicians, and policy experts. Interviews were transcribed and analyzed thematically using both deductive codes from the PRISM framework and inductive codes to capture emergent themes. Participants described their experiences with telehealth in HHC, including its operational feasibility, clinical utility, financial impact, and response to new CMS G-codes introduced in July 2023 for telehealth documentation. Primary topics of focus included stakeholders’ perceptions of telehealth’s benefits, barriers, and future viability in HHC. Stakeholders identified 4 key themes: (1) telehealth offers operational efficiencies (eg, increased patient touchpoints and workforce support) and clinical benefits (eg, improved patient monitoring and potential reduction in rehospitalizations); (2) the lack of CMS reimbursement makes telehealth adoption financially unsustainable for many HHAs; (3) specific HHAs, particularly those integrated with health systems or serving high-risk patient populations, may derive sufficient benefits to continue telehealth use despite financial constraints; and (4) current regulatory policies, including new CMS G-codes, increase administrative burden without providing financial incentives and discouraging telehealth adoption. While stakeholders recognize the benefits of telehealth in HHC, financial and regulatory challenges pose substantial barriers to its sustainability. Policymakers must weigh the advantages of telehealth reimbursement and regulatory support against concerns about wasteful care.
18. Machine Learning-Based Analysis of Lifestyle Risk Factors for Atherosclerotic Cardiovascular Disease: Retrospective Case-Control Study.
期刊: JMIR medical informatics 发表日期: 2025-Aug-07 链接: PubMed
摘要
The risk of developing atherosclerotic cardiovascular disease (ASCVD) varies among individuals and is related to a variety of lifestyle factors in addition to the presence of chronic diseases. We aimed to assess the predictive accuracy of machine learning (ML) models incorporating lifestyle risk behaviors for ASCVD risk using the Korean nationwide database. Using data from the Korea National Health and Nutrition Examination Survey, 5 ML algorithms were used for the prediction of high ASCVD risk: logistic regression (LR), support vector machine, random forest, extreme gradient boosting, and light gradient boosting models. ASCVD risk was assessed using the pooled cohort equations, with a high-risk threshold of ≥7.5% over 10 years. Among the 8573 participants aged 40-79 years, propensity score matching (PSM) was used to adjust for demographic confounders. We divided the dataset into a training and a test dataset in an 8:2 ratio. We also used bootstrapping to train the ML model with the area under the receiver operating characteristics curve score. Shapley additive explanations were used to identify the models’ important variables in assessing high ASCVD risks. In sensitivity analysis, we additionally performed binary LR analysis, in which the ML model’s results were consistent with the conventional statistical model. Of the 8573 participants, 41.7% (n=3578) had high ASCVD risk. Before PSM, age and sex differed significantly between groups. PSM (1:1) yielded 1976 patients with balanced demographics. After PSM, the high ASCVD risk group had higher alcohol or tobacco use, lower omega-3 intake, higher BMI, less physical activity, and spent less time sitting. In 5 ML models, the extreme gradient boosting model showed the highest area under the receiver operating characteristics curve, indicating superior overall discrimination between high and low ASCVD risk groups. However, the light gradient boosting model demonstrated better performance in accuracy, recall, and F1-score. Variable importance analysis using Shapley additive explanations identified smoking and age as the strongest predictors, while BMI, sodium or omega-3 intake, and low-density lipoprotein cholesterol also had significant variables. Sensitivity analysis using multivariable LR analysis also confirmed these findings, showing that smoking, BMI, and low-density lipoprotein cholesterol increased ASCVD risk, whereas omega-3 intake and physical activity were associated with lower risk. Analyzing lifestyle behavioral factors in ASCVD risk with an ML model improves the predictive performance compared to traditional models. Personalized prevention strategies tailored to an individual’s lifestyle can effectively reduce ASCVD risk.
19. Feasibility of a Digital Coaching Program for Improving Mental Well-Being and Emotional Intelligence: Pragmatic Retrospective Cohort Study.
期刊: JMIR formative research 发表日期: 2025-Aug-07 链接: PubMed
摘要
Within the past decade, digital coaching programs (DCPs) have emerged as an evidence-based modality to improve mental well-being and emotional intelligence (EI), although there is limited evidence in real-world contexts. This pragmatic retrospective cohort study aims to determine the preliminary effectiveness of a DCP in improving mental well-being and EI within a real-world context. We hypothesized that there would be a significant increase in mental well-being and EI. This study included 588 people who voluntarily enrolled in an 8-week, blended care DCP offered through their employers from October 2021 to August 2024. The DCP included routine check-ins and consultations with certified coaches. Participants completed the World Health Organization-Five Well-Being Index (WHO-5) at baseline and then weekly until the end of the program, as well as the Brief Emotional Intelligence Scale-10 (BEIS-10) at baseline and the end of the program. Multivariable linear mixed models examined changes in WHO-5 (biweekly) and BEIS-10 (pre-post) scores, adjusting for age, gender, program engagement, and program completion. Multivariable logistic regression models evaluated correlates of clinically meaningful improvements on the WHO-5 (ie, at least a 10-point improvement). We calculated a reliable change index (RCI) for the BEIS-10 and the proportion of participants meeting the RCI criterion from baseline to end of treatment. In multivariate linear mixed models adjusting for demographics and program characteristics, we observed a significant increase in WHO-5 scores (baseline x¯=45.6; week 8 x¯=66.3; Cohen’s d=1.98; P<.001). Over half of the sample (55.4%) experienced a clinically meaningful improvement on the WHO-5. Multivariable logistic regression found that higher engagement was associated with an increased odds of a clinically meaningful improvement on the WHO-5 (adjusted odds ratio [aOR] 1.002, 95% CI 1.001-1.003), while program noncompletion (aOR 0.27, 95% CI 0.15-0.50) and higher baseline well-being (aOR 0.91, 95% CI 0.89-0.92) were associated with reduced odds. BEIS-10 scores also significantly increased from baseline to the end of the program after adjusting for relevant correlates (baseline x¯=37.6; week 8 x¯=41.2; Cohen’s d=1.32; P<.001). The estimated RCI on the BEIS-10 was approximately 5, with 19.7% experiencing a meaningful improvement. These results demonstrate that DCPs can be a viable option for individuals looking to improve their mental well-being. Additional efforts should focus on establishing reliable change metrics for EI measures. Studies using hybrid effectiveness-implementation trial designs are now needed to further evaluate the real-world effectiveness of this program.
20. Improving Explainability and Integrability of Medical AI to Promote Health Care Professional Acceptance and Use: Mixed Systematic Review.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-07 链接: PubMed
摘要
The integration of artificial intelligence (AI) in health care has significant potential, yet its acceptance by health care professionals (HCPs) is essential for successful implementation. Understanding HCPs’ perspectives on the explainability and integrability of medical AI is crucial, as these factors influence their willingness to adopt and effectively use such technologies. This study aims to improve the acceptance and use of medical AI. From a user perspective, it explores HCPs’ understanding of the explainability and integrability of medical AI. We performed a mixed systematic review by conducting a comprehensive search in the PubMed, Web of Science, Scopus, IEEE Xplore, and ACM Digital Library and arXiv databases for studies published between 2014 and 2024. Studies concerning an explanation or the integrability of medical AI were included. Study quality was assessed using the Joanna Briggs Institute critical appraisal checklist and Mixed Methods Appraisal Tool, with only medium- or high-quality studies included. Qualitative data were analyzed via thematic analysis, while quantitative findings were synthesized narratively. Out of 11,888 records initially retrieved, 22 (0.19%) studies met the inclusion criteria. All selected studies were published from 2020 onward, reflecting the recency and relevance of the topic. The majority (18/22, 82%) originated from high-income countries, and most (17/22, 77%) adopted qualitative methodologies, with the remainder (5/22, 23%) using quantitative or mixed method approaches. From the included studies, a conceptual framework was developed that delineates HCPs’ perceptions of explainability and integrability. Regarding explainability, HCPs predominantly emphasized postprocessing explanations, particularly aspects of local explainability such as feature relevance and case-specific outputs. Visual tools that enhance the explainability of AI decisions (eg, heat maps and feature attribution) were frequently mentioned as important enablers of trust and acceptance. For integrability, key concerns included workflow adaptation, system compatibility with electronic health records, and overall ease of use. These aspects were consistently identified as primary conditions for real-world adoption. To foster wider adoption of AI in clinical settings, future system designs must center on the needs of HCPs. Enhancing post hoc explainability and ensuring seamless integration into existing workflows are critical to building trust and promoting sustained use. The proposed conceptual framework can serve as a practical guide for developers, researchers, and policy makers in aligning AI solutions with frontline user expectations. PROSPERO CRD420250652253; https://www.crd.york.ac.uk/PROSPERO/view/CRD420250652253.
21. Cold atmospheric plasma-activated liquid inhibits peritoneal metastasis in drug-resistant ovarian cancer by targeting the epithelial-mesenchymal transition.
期刊: Clinical & experimental metastasis 发表日期: 2025-Aug-07 链接: PubMed
摘要
Ovarian cancer remains a significant challenge in oncology due to its aggressive nature, late-stage diagnosis, and high rates of chemoresistance, particularly to platinum-based therapies like cisplatin. The epithelial-mesenchymal transition (EMT) is a key driver of ovarian cancer metastasis and drug resistance, highlighting the need for novel therapeutic strategies. Cold atmospheric plasma (CAP) and plasma-activated liquids (PAL), including plasma-activated medium (PAM) and saline (PAS), have emerged as promising anticancer agents, generating reactive oxygen and nitrogen species (RONS) that selectively target cancer cells. This study investigates the potential of PAL to inhibit the invasion and metastasis of cisplatin-resistant ovarian cancer cells and explores its synergistic effects with cisplatin. In vitro, PAM reduced proliferation, migration, and invasion of cisplatin-resistant ovarian cancer cells (A2780/DDP and SKOV3/DDP) while downregulating EMT-related proteins (N-cadherin, β-catenin, vimentin). H2O2 in PAM inhibit the PI3K/AKT/GSK3β pathway, promoting degradation of EMT regulators Snail, Slug, and β-catenin. Combining PAM with cisplatin enhanced therapeutic efficacy, reducing cell viability and metastatic potential. In vivo studies using an orthotopic mouse model further confirmed that PAS combined with low-dose cisplatin effectively suppressed tumor growth and metastasis with minimal side effects. These findings underscore the potential of PAL as an adjuvant therapy for cisplatin-resistant ovarian cancer, offering a novel approach to overcome drug resistance and inhibit metastasis. Future research should focus on optimizing treatment protocols and elucidating the molecular mechanisms underlying the synergistic effects of PAL and cisplatin.
22. Assessing Surgical Innovation. ALPPS: An IDEAL Example of Disruptive Innovation.
期刊: Annals of surgery 发表日期: 2025-Aug-07 链接: PubMed
摘要
To assess the impact of the IDEAL (Innovation, Development, Exploration, Assessment and Long-term) paradigm on the development of ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) in comparison to the evaluation of two other revolutionary innovations: laparoscopic cholecystectomy (LC) and robotic surgery. The assessment and development of disruptive procedures often follow a chaotic and unstructured approach. The IDEAL paradigm has offered a sequential 5-stage process to assess controversial surgical strategies like ALPPS, which was introduced in 2012 to expand liver surgery for primarily non-resectable disease. By October 2024, the international ALPPS registry collected 1349 cases from 146 centers in 46 countries. Early reports unveiled an alarming morbidity and peri-operative mortality. Accumulating cases in the registry and a consensus conference enabled to reduce the initial 90-day mortality rates>15% to<5% in high-volume centers. Meta-analyses, long-term follow-up and a RCT were available through the growing data in the registry. In comparison, the development of LC was similarly marked by technical advances and a registry to highlight safety (especially bile duct injuries). A small multi- center RCT (as well as a larger one later) supported an unstoppable wave of rapid adoption by patients and surgeons. Robotic surgery is currently going through close scrutinization by many stakeholders in view of the massive promotion by the industry, but a compelling registry is still missing. ALPPS has now reached a high-level of evaluation with clear guidelines for use thanks to international collaborations and the IDEAL paradigm. This may serve as template for future evaluations of surgical innovations.
23. Low-Risk Cesarean Delivery Rates by County of Birth in the United States.
期刊: Obstetrics and gynecology 发表日期: 2025-Aug-07 链接: PubMed
摘要
Healthy People 2030 aims to decrease low-risk cesarean delivery rates to 23.6% in the United States. In 2023, the national rate was 26.6%, though rates vary widely by state and hospital. This suggests a need for localized geographic estimates to identify places with higher burden. We modeled 2023 low-risk cesarean delivery rates by county of birth using birth certificate data and hierarchical Bayesian models that spatially smooth unstable estimates. We found considerable variation in rates, with county rates ranging from 5.8% to 53.4%. Counties in the West had lower rates than those in the Midwest, South, and Northeast. County rates increased with urbanicity. Only 47.7% (985) of counties had rates meeting the Healthy People 2030 target.
24. Cost Effectiveness of the Reverse Sequence Algorithm Compared With the Traditional Algorithm for Syphilis Screening Among Pregnant Women.
期刊: Obstetrics and gynecology 发表日期: 2025-Aug-07 链接: PubMed
摘要
The traditional syphilis screening algorithm, which involves a nontreponemal assay followed by confirmatory treponemal testing, has been challenged by an alternative approach known as the reverse sequence algorithm. The latter reverses the order of the tests and incorporates a second treponemal test for discordant results. Although the reverse sequence may offer operational advantages, there is a need for formal cost-effectiveness analyses to compare these two syphilis screening alternatives. We conducted cost-effectiveness analyses from the health care sector perspective to compare the reverse sequence with the traditional algorithm. We employed a decision tree for pregnant women in prenatal care that included the possibility of congenital syphilis outcomes. A simulated a cohort of 10,000 people was screened over 1 year to estimate total costs and quality-adjusted life-years (QALYs) under each algorithm. We estimated incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were performed to identify influential parameters affecting the ICERs and to conduct scenario analyses. During prenatal care, the reverse sequence detected four more cases, overtreated 185 more individuals, and prevented 0.42 more congenital syphilis cases (ICER $463,735/QALY gained), when compared with the traditional algorithm. Sensitivity analyses revealed that syphilis prevalence had the greatest effect on the ICER. To achieve ICERs below $50,000/QALY gained, syphilis prevalence would need to exceed 6% during prenatal care. Our analysis indicates that, under likely parameter values, the reverse sequence algorithm is equally effective but more costly than the traditional algorithm and therefore not cost effective. Although treponemal test automation may offer potential savings in laboratory costs, these are outweighed by overtreatment costs.
25. Developing an Equitable Machine Learning-Based Music Intervention for Older Adults At Risk for Alzheimer Disease: Protocol for Algorithm Development and Validation.
期刊: JMIR research protocols 发表日期: 2025-Aug-07 链接: PubMed
摘要
Given the high prevalence and cost of Alzheimer disease (AD), it is crucial to develop equitable interventions to address lifestyle factors associated with AD incidence (eg, depression). While lifestyle interventions show promise for reducing cognitive decline, culturally sensitive interventions are needed to ensure acceptability and engagement. Given the increased risk for AD and health care barriers among rural-residing older adults, tailoring interventions to align with rural culture and distinct needs is important to improve accessibility and adherence. This protocol aims to develop an intelligent recommendation system capable of identifying the optimal therapeutic music components to elicit engagement and resonate with diverse rural-residing older adults at risk for AD. Aim 1 is to develop culturally inclusive user personas for rural-residing older adults to understand their goals and challenges for music-based digital health intervention. Aim 2 is to develop knowledge embedding-based machine learning (ML) models that use music metadata and survey response data to identify optimal therapeutic music components for enhancing engagement and emotional resonance for depression among rural-residing older adults at risk for AD. Aim 3 is to assess acceptability for personalized therapeutic music sessions and ML-based music recommendations with a separate sample. Participants (N=1200) will be aged 55 years or older and residing in the United States. In phase 1, participants (n=1000) will receive 5 randomized songs and complete a survey to understand the sentiment, cultural relevance, and perceived benefit for each song. Brief, researcher-created Likert surveys will be used. In phase 2, survey data will be used to develop ML algorithms in collaboration with the University of Massachusetts Amherst Center for Data Science and Artificial Intelligence. These ML models will be integrated into the digital music intervention and tested with a separate sample of 200 participants. Similar to phase 1, participants will be provided with sets of songs generated by the recommendation system based on the target goal (ie, to reduce depression). The recommendation accuracy of the ML algorithm will be assessed using multiple performance metrics, including root-mean-square error and normalized discounted cumulative gain as well as the mean acceptability score with a goal of 85% user acceptability. Participant recruitment is complete for phases 1 and 2 as of June 2025. Data analysis for the results of aims 1, 2, and 3 are underway and results are expected to be published in the fall of 2025. This protocol seeks to use ML to improve the equitability and accessibility of a digital lifestyle intervention for AD. DERR1-10.2196/73711.
26. Alzheimer's Disease-Associated Amyloid Beta Precursor Protein Prevents Aging Stress-Induced Mitophagy and Fumarate Depletion to Improve Anti-Tumor Immunity.
期刊: Cancer research 发表日期: 2025-Aug-07 链接: PubMed
摘要
Alzheimer’s disease (AD) patients have a decreased incidence of cancer., with a cross-sectional analysis of a nationwide sample of adults finding 21-fold higher odds of cancer diagnosis in non-AD compared to AD patients. Here, we demonstrated that mitochondrial localization of AD-associated amyloid-β precursor protein (APP) and its cleavage product amyloid-β 40, but not mutant APP that lacks a mitochondrial localization signal, inhibits lipid stress-mediated hyperactive mitophagy in aging T-cells, improving their anti-tumor functions. Growth of melanoma xenograft or carcinogen-induced oral cancer models was highly reduced in AD mice. Additionally, adoptive cell transfer (ACT)-based immunotherapy using aging T cells isolated from AD mice suppressed tumor growth. The metabolic signature of stress-dependent mitophagy in T cells showed fumarate depletion, which was linked to decreased succination of Parkin and enhanced mitochondrial damage. Mechanistically, APP interaction with TOMM complex at the outer mitochondrial membrane attenuated trafficking of ceramide synthase CerS6 to mitochondria in aging AD T-cells, preventing ceramide-dependent mitophagy. Thus, APP restored mitochondrial fumarate metabolism and Parkin succination, improving anti-tumor functions of AD T cells in vitro and in vivo. Exogenous fumarate supplementation or healthy AD mitochondria transfer functionally mimicked the AD/APP phenotype in aging T-cells, enhancing their anti-tumor activity to control tumor growth. Moreover, T cells isolated from aging donors showed elevated mitophagy with fumarate depletion, which was restored in T cells isolated from age-matched AD patients. Together, these findings show that AD protects T cells against ceramide-dependent mitophagy and fumarate depletion to enhance anti-tumor functions.
27. Improving Alzheimer's disease immunotherapy.
期刊: Science (New York, N.Y.) 发表日期: 2025-Aug-07 链接: PubMed
摘要
A modified antibody targeting amyloid-β reduces adverse events and increases efficacy in a mouse model.
28. Losing protection.
期刊: Science (New York, N.Y.) 发表日期: 2025-Aug-07 链接: PubMed
摘要
The United States helped beat back malaria in Guinea. Now, the disease is set to soar.
29. The CueR-regulated transporters CopA and CusFABC coordinate copper detoxification in Vibrio parahaemolyticus.
期刊: Virulence 发表日期: 2025-Aug-07 链接: PubMed
摘要
Vibrio parahaemolyticus is a zoonotic pathogen that poses a serious threat to shrimp aquaculture and public health worldwide. Copper (Cu) serves as a catalytic cofactor and structural element in bacteria, but is toxic in excess. Herein, we report that the CueR-regulated transporters CopA and CusFABC coordinate Cu detoxification in V. parahaemolyticus. Through RNA sequencing, we show that most genes in the CueR and Fur regulons are significantly upregulated during V. parahaemolyticus response to external Cu. Quantitative real-time PCR (qRT-PCR) showed that copA and cusA are strongly induced by Cu. Growth curve analyses and spot dilution assay revealed that CopA and CusFABC protect V. parahaemolyticus against Cu-induced bactericidal effects. Inductively coupled plasma-mass spectrometry revealed that CopA and CusFABC are involved in maintaining Cu and Fe homoeostasis. Additionally, CopA promotes V. parahaemolyticus resistance to pyrithione. In a competitive-infection assay, the copA and cusFABC double mutant, but not the single mutants, was significantly attenuated in colonization of the zebrafish intestine. Lastly, qRT-PCR, RNA sequencing, β-galactosidase activity, and AIDmut-Seq analyses revealed that CueR can bind to the promoters of copA and cusFABC, and positively regulate their expression. Collectively, V. parahaemolyticus utilizes the CueR-regulated transporters CopA and CusFABC to coordinate Cu detoxification and colonization of the zebrafish intestine.
30. Co-adsorption and Co-removal of Cu(II), Ciprofloxacin, and Norfloxacin from Water by a Modified Three-Component Covalent Organic Framework.
期刊: Langmuir : the ACS journal of surfaces and colloids 发表日期: 2025-Aug-07 链接: PubMed
摘要
Organic pollutants and heavy metal ions (HMIs) are widely present in water systems. They often coexist in the environment and form more complex forms of pollution through complexation, thereby posing a serious threat to human health and the ecological environment. We successfully synthesized a three-component covalent organic framework (TpBD-SO3H/OH) and functionalized it through the introduction of diethylenetriaminepentaacetic acid (DTPA). Eventually, a covalent organic framework material with dual DTPA/sulfonic acid functionalities (TpBD-SO3H/OH-DTPA) was obtained. Subsequently, this material was applied to the co-adsorption and removal of ciprofloxacin (CIP), norfloxacin (NOR), and Cu(II). The experimental results demonstrated that the maximum adsorption capacities of TpBD-SO3H/OH-DTPA for CIP, NOR, and Cu(II) were 424.5, 392.4, and 513.7 mg g-1, respectively. In addition, we systematically carried out adsorption experiments and characterization analyses, and based on density functional theory (DFT), theoretical calculations were conducted on the minimum repeating unit of TpBD-SO3H/OH-DTPA and its possible adsorption configurations. The influence of the addition sequence of pollutants on the adsorption behavior was deeply explored, thereby verifying the specific adsorption mechanism of pollutants on the surface of the adsorbent. TpBD-SO3H/OH-DTPA can maintain stable adsorption performance under different environmental factors and can maintain the stability of the adsorption effect after five adsorption-desorption cycles. This study provides useful insights into the co-adsorption behavior of a modified covalent organic framework.
31. PFAS in Rural U.S. Well Water: Using Participatory Science to Identify and Communicate Results to Address Risks.
期刊: Environmental science & technology 发表日期: 2025-Aug-07 链接: PubMed
摘要
Drinking water contributes 1.2-61% of perfluoroalkyl and polyfluoroalkyl substances (PFAS) exposure, but little information is available on PFAS in private wells serving 17% of the U.S. population. Well users (n = 271) from four U.S. states collected tap water samples for analysis of 25 PFAS. Participants received results report comparing their water to PFAS health guidelines and recommending water filters when guidelines were exceeded. Follow-up surveys asked respondents what actions they took in response. To identify potential PFAS sources, we computed distances from households to PFAS sources recorded in EPA’s PFAS Analytic Tools and other public databases and used spatial regression models to analyze relationships between these sources and water quality. PFAS were found in 15% of wells in the area with no known sources, some above a health guideline, and 53-88% of wells at sites with known sources. Total PFAS concentrations were significantly higher in wells closer to PFAS production facilities, Superfund sites, spill sites, and federal facilities. When recommended, 49% installed filters, while none did where water met the guidelines. Our study sheds insight into geographic variation in PFAS in private wells, the influence of potential PFAS sources on well water quality, and private well user decision-making in response to PFAS water quality information.
32. The experience of misgendering among transgender and gender diverse people.
期刊: The American journal of orthopsychiatry 发表日期: 2025-Aug-07 链接: PubMed
摘要
Misgendering is a common and distressing experience for many transgender (trans) and gender diverse people. Although existing research (e.g., McLemore, 2015, 2018) suggests that being misgendered is negatively associated with mental health, the empirical literature on misgendering is currently nascent. In the present study, we examined how trans and gender diverse people experienced and negotiated being misgendered. Guided by a constructivist grounded theory framework with a critical-ideological lens (Cresswell, 2007; Ponterotto, 2005), we conducted and analyzed 14 semistructured interviews using a constant comparative approach, including internal and external auditing and member check interviews. Participants’ experiences of misgendering were influenced by several contextual factors, both temporary and long-standing, and in both personal and environmental spheres. Participants described and differentiated the experiences and effects of misgendering from accidental to intentional. Participants also described the decision-making process and response possibilities subsequent to misgendering-which could be influenced both by their initial reaction to being misgendered and by contextual factors-and could then correct or not correct the misgendering. Depending on how they reacted and responded, experiences of misgendering had short- and long-term consequences for many participants. Thematic results were integrated into a model of the experience of negotiating being misgendered. Participants’ experiences indicate that misgendering is a significant minority stressor and highlight ways in which others can support trans and gender diverse individuals in navigating this experience to minimize the negative impact on well-being. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
33. Association Between Meaningful Activities and Frailty in Community-Dwelling Older Adults in Rural Japan: A Cross-Sectional Study.
期刊: Occupational therapy in health care 发表日期: 2025-Aug-07 链接: PubMed
摘要
This cross-sectional study investigates the relationship between meaningful activities and frailty, including pre-frailty, among older adults in rural Japan. Data from 1,018 participants aged 65 years or older were analyzed using multinomial logistic regression. Among the entire sample, the presence of meaningful activities was significantly associated with lower odds of both pre-frailty and frailty. Additionally, both higher performance and satisfaction with meaningful activities were associated with reduced odds of frailty-related outcomes. These findings underscore the role of meaningful activities in promoting healthy aging. Tailored occupational therapy interventions enhancing engagement in meaningful activities may help prevent frailty, particularly in rural settings.
34. Occupational Therapy Dosing: A Cohort Study of Frequency Recommendations in an Acute Care Pediatric Hospital Setting.
期刊: Occupational therapy in health care 发表日期: 2025-Aug-07 链接: PubMed
摘要
This retrospective chart review of inpatient occupational therapy patients from a pediatric acute care hospital examined occupational therapy dosing and the association between demographic and diagnoses variables and service recommendations. Having multiple diagnoses was associated with weekly/biweekly occupational therapy recommendations (OR = 2.59; 95% CI, 1.65-4.05) verses one diagnosis. Patients with visual issues had 33% decreased odds of receiving higher frequency recommendations (OR = 0.67; 95% CI, 0.49-0.99). Consistent occupational therapy services were recommended with multiple therapy diagnoses. This study provides additional information to occupational therapy providers to consider when making dosing recommendations.
35. Immunization Coverage and Barriers among Hajj and Umrah Pilgrims: Insights into Vaccine Uptake and Compliance.
期刊: Journal of epidemiology and global health 发表日期: 2025-Aug-07 链接: PubMed
摘要
36. Early Employment Outcomes in Autistic and Non-autistic Youth: Challenges and Opportunities.
期刊: Journal of autism and developmental disorders 发表日期: 2025-Aug-07 链接: PubMed
摘要
Autistic youth often encounter significant barriers in securing employment, including difficulties with job acquisition, limited workplace support, and reduced access to structured employment services. This study examined early employment experiences in cognitively able autistic and non-autistic youth, with a focus on job characteristics and the associated factors of employment status. Participants included 99 individuals (51 autistic, 48 non-autistic) aged 18-23. Open-ended responses were coded to characterize first job experiences, including job setting, duration, hours worked, support received, sector, and job acquisition method. Group differences were assessed using chi-square tests. Logistic regression was used to examine the predictors of employment outcomes, including IQ, executive functioning, adaptive functioning, and education level. Results revealed notable differences between groups, with 67% of autistic participants having had a first work experience compared to 86% of non-autistic participants. When unpaid experiences (such as WorkAbility/internships) were excluded, this gap widened to 50% versus 78%. Autistic participants were significantly less likely to obtain jobs through competitive hiring and were more likely to work in sales/retail-related roles, whereas non-autistic participants exhibited greater job diversity and career-oriented positions. Personal connections were critical to job acquisition for autistic individuals, although structured employment programs were also a key pathway. Executive functioning difficulties were significantly associated with lower employment likelihood. Early employment disparities persist among autistic youth, particularly in access to competitive and career-track jobs. Interventions that support executive functioning, expand structured employment options, and leverage family and social networks may enhance employment success during the transition to adulthood.
37. The goitrous sponge-bearer in Francesco Bianchi Ferrari's Pala delle Tre Croci (c. 1495).
期刊: Journal of endocrinological investigation 发表日期: 2025-Aug-07 链接: PubMed
摘要
38. Indoor radon exposure and health risks in a community proximal to gold mine tailings in Gauteng Province, South Africa: a cross-sectional study.
期刊: Environmental geochemistry and health 发表日期: 2025-Aug-07 链接: PubMed
摘要
Exposure to indoor radon presents a significant risk for lung cancer and is also suspected to be associated with other health issues such as chronic obstructive pulmonary diseases (COPD) and leukemia. This study examined the association between indoor radon exposure and self-reported cases of lung cancer, COPD, and leukemia among individuals living in close proximity to gold mine tailings, a known source of high radon levels. A cross-sectional study was carried out among residents living near or further away from gold mine tailings in Gauteng, South Africa. A total of 331 residents took part in an interviewer-administered questionnaire survey on socio-demographic characteristics, smoking habits, occupational exposures, adverse health problems, and other factors related to lung cancer, COPD, and leukemia. Subsequently, their homes were tested for indoor radon concentration on the lowest livable floor over a two-hour period from June to July 2023 using AlphaE radon monitors. Logistic regression was employed to calculate odds ratios (OR) for lung cancer, COPD, and leukemia based on indoor radon exposure, dwelling location, smoking habits, and occupational exposures. The study found significantly higher indoor radon levels in the exposed group (103.30 ± 94.91 Bq/m3) compared to the control group (65.19 ± 47.83 Bq/m3). The results indicated an association between lung cancer and residing near gold mine tailings, while indoor radon exposure was linked to leukemia. However, no association was found between indoor radon exposure and COPD. In regions impacted by gold mine tailings, it is crucial to implement efficient indoor radon mitigation measures and promote public consciousness about the health hazards linked to indoor radon exposure. There is a need to motivate affected residents to adopt proactive steps to lower indoor radon concentrations, including enhancing ventilation practices.
39. Ambient Noise in the Operating Theater: A Bibliometric Analysis of Studies Examining Its Effects on Physiological, Psychological, and Performance of Health Professionals.
期刊: Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses 发表日期: 2025-Aug-06 链接: PubMed
摘要
To present a bibliometric analysis of scientific studies examining the effects of noise, specifically, to review publications, authors, journals, and research institutions and to outline thematic developments in this area. This retrospective and descriptive study was conducted using a bibliometric analysis approach. The study population comprised 238 publications from the Web of Science Core Collection database, focusing on noise in operating room environments with keywords in titles, abstracts, or main texts. Based on inclusion and exclusion criteria, a sample of 64 publications was selected. These records were downloaded in BibTeX format as of August 21, 2024, excluding studies added to the database after this date. Data analysis was performed using R Studio software. The earliest study on the effects of operating room noise on health care professionals was published in 1993. Of the total publications, 62.5% were published within the past 4 years. The most frequent journals were “Anaesthesia,” “Surgical Endoscopy and Other Interventional Techniques,” and “World Journal of Surgery.” The country with the highest output was the United States. Keywords such as “noise,” “operating room,” “music,” “communication,” and “stress” were most commonly used. Additionally, interest in noise and music topics peaked in 2021. There has been a notable increase in studies on the impact of operating room noise on health care professionals, with a concentration of research in 2021. Most studies originated from developed countries like the United States, the United Kingdom, and Germany. This trend reflects a growing global awareness of the importance of occupational safety and health for health care workers.
40. Characteristics and causes of recurrent ischemic events in minor ischemic stroke and TIA in the READAPT study.
期刊: Journal of the neurological sciences 发表日期: 2025-Aug-05 链接: PubMed
摘要
Understanding the causes of recurrent ischemic events in patients with minor stroke or high-risk TIA is crucial to understand unmet needs in secondary prevention. This study examines the characteristics and causes of recurrences after non-cardioembolic minor stroke/high-risk TIA in patients treated with the best medical care. This subgroup analysis from a prospective real-world study (READAPT, NCT05476081) included patients with non-cardioembolic minor ischemic stroke (NIHSS ≤5) or TIA (ABCD2 score ≥ 4), receiving short-term DAPT. We described the etiologic distribution according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) classification of the index and of the recurrent event. We analyzed baseline characteristics of patients with and without a 90-day ischemic recurrence to identify factors linked to recurrence. Out of 1641 patients, 56 (3.4 %) had a recurrent ischemic event (35 strokes and 21 TIAs). The cause of recurrences was undetermined in 21 (37.5 %), small vessel occlusion in 18 (32.1 %), large artery atherosclerosis in 11 (19.6 %), other determined in 3 (5.4 %), and cardioembolism in 3 (5.4 %). The etiologic distribution of recurrent events differed from that of the corresponding index events (p = 0.002). Non-compliance to DAPT was more prevalent in patients with recurrences compared with those without (8.9 % vs 3.7 %, p = 0.048). Patients with recurrences after a minor stroke or high-risk TIA have a different etiologic distribution compared with their index events. Additionally, a lower compliance to DAPT was observed in those with recurrences, suggesting that adherence to DAPT should be encouraged to optimize the outcome of patients.
41. Treatment Patterns and Outcomes of Patients With Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer in Tanzania.
期刊: JCO global oncology 发表日期: 2025-Aug 链接: PubMed
摘要
Human epidermal growth factor receptor 2 (HER2)-positive breast cancer (HER2+BC) is linked to poorer outcomes. Trastuzumab is the standard treatment, but its high cost limits access in resource-limited settings. This study evaluated the treatment patterns and survival outcomes of patients with HER2 BC in Tanzania. A retrospective hospital-based study was conducted between January 2018 and May 2021 at two prominent public tertiary hospitals in Tanzania. The primary outcome was the 5-year overall survival (OS) rate. Independent variables included demographics, clinical characteristics, and treatment patterns. Survival analysis was conducted using the Kaplan-Meier method. The log-rank test was used in univariate analysis, whereas multivariate Cox regression was used in multivariate analysis. A total of 169 patients with nonmetastatic HER2+BC were included, with a median age of 50 years. Most patients were estrogen receptor-positive (50.3%) and diagnosed with stage III BC (58.6%). About 70.4% of patients received trastuzumab, whereas neoadjuvant chemotherapy was administered to 24.3%, and 95.9% underwent mastectomy. Trastuzumab was primarily used in the adjuvant setting rather than the neoadjuvant setting and was more accessible to patients with higher socioeconomic status. The 5-year OS was 65%, with a median survival of 72 months. Trastuzumab reduced the mortality risk by 74%. Extended therapy with trastuzumab benefited patients with hormone receptor-negative HER2+BC more than those who were hormone receptor-positive. Advanced-stage disease increased mortality risk, whereas postmenopausal status and nonsmoking were associated with lower mortality. A higher Eastern Cooperative Oncology Group score (>1) was associated with an increased mortality risk. Trastuzumab significantly improves OS in resource-limited settings, particularly in patients with hormone receptor-negative HER2+BC. There are disparities in access to trastuzumab in Tanzania.
42. Automated Extraction of Imaging and Pathology Data From Diverse Prostate Cancer Electronic Records.
期刊: JCO clinical cancer informatics 发表日期: 2025-Aug 链接: PubMed
摘要
To develop and validate an algorithm to extract clinically relevant data elements for prostate cancer (PCa) from prostate biopsy reports and magnetic resonance imaging (MRI) reports. MRI reports and biopsy pathology reports were extracted from a cohort of 1,360,866 patients with PCa in the VA Cancer Registry System or the VA Corporate Data Warehouse, with 155,570 patients having the relevant reports for inclusion. We hand-annotated a sample of these reports, which were used to develop a rule-based natural language processing (NLP) algorithm for extracting Gleason score, positive cores, and total cores taken during biopsy from biopsy pathology reports and Prostate Imaging Reporting and Data System (PI-RADS) score, prostate-specific antigen (PSA) density, prostate volume, and prostate dimensions from MRI reports. Our algorithm was validated on a set of 250 biopsy reports and 250 MRI reports representing 378 patients at 78 VA centers with procedures between 2004 and 2024. Our algorithm performed well across all data elements, demonstrating high F1 scores: Gleason (96.9), PI-RADS (93.7), PSA density (99.5), prostate volume (95.7), and prostate dimensions (93.2), with the percentage of positive cores being greater than or less than 34% (88.4). Error analysis demonstrated that items missed by our algorithm were often explained by unusual or vague wording within the notes or especially complex language. We developed an NLP algorithm and validated that it successfully captures salient information about data elements of interest in PCa research. Reliable extraction of these key data elements will have numerous uses for downstream research in this field.
43. Barriers to surveillance and control of re-emergence of the Chagas disease vector Triatoma infestans in Arequipa, Peru.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Aug 链接: PubMed
摘要
Vector control is usually designed as a top-down system with limited capacity to respond to the unique characteristics of each epidemiological setting, or to adjust to routine stressors that challenge ongoing programs, such as resource limitations and competing priorities. Here, we investigated barriers in Chagas disease vector surveillance and control systems in Arequipa, Peru. We conducted in-depth interviews and a focus group with key stakeholders (n = 32) at different levels of the health system and community. For interviews, we used process maps to illustrate the workflow for passive and active surveillance. Additionally, we held a focus group with vector control specialists to present the findings from the interviews and discuss the results. We identified barriers at each step of the process, including systemic, operational, financial, and policy limitations. For passive surveillance, community participation was limited by practical challenges in capturing the insect and uncertainty about the pathways to report it. Systemic barriers were related to the use of a data system that did not meet the needs for recording and managing data on vector control activities. At the policy level, the establishment of quotas on the number of houses staff are required to inspect ignores important determinants for infestation and lacks an appropriate sampling design. We discuss the impact of the reported barriers to effective conduction of surveillance and control activities and the initiatives and strategies that have been designed and assessed to bridge these gaps in order to collaboratively design a more resilient health system.
44. Cake, Checkups, and Captain Starlight: Evaluating the Cherbourg Third Birthday Party Health Initiative for Children in Rural Australia.
期刊: The Australian journal of rural health 发表日期: 2025-Aug 链接: PubMed
摘要
Aboriginal and Torres Strait Islander children, particularly those in remote Australia, face disproportionately higher rates of preventable health conditions and disability. Early intervention is considered particularly important for this demographic, but previous attempts have had limited success. In response to a need identified by the Cherbourg Health Service, Starlight Children’s Foundation Australia (Starlight) partnered with them to host a unique “third birthday party” event in Cherbourg, Queensland. The event aimed to provide health checks and a culturally sensitive, positive healthcare experience for three-year-old children and the Cherbourg community, incorporating key health service providers and Starlight “Captains” to facilitate the health checks and activities/games. To evaluate the third birthday party health initiative, the main outcome measures were the strengths and future considerations and improvements of the event. The quantitative and qualitative data highlighted the event’s success in promoting an effective and positive community-led healthcare experience by employing a unique, prevention-focused methodology, with benefits extending from the community to health staff and students. Overall, the Cherbourg third birthday party serves as a model for culturally appropriate early health interventions in Australia, offering valuable insights to enhance healthcare promotion, access, and engagement for Indigenous children and communities.
45. SAIGE II: The Role of Staphylococcus aureus in Skin Barrier Dysfunction and the Development and Severity of Atopic Dermatitis in Young Children.
期刊: Journal of drugs in dermatology : JDD 发表日期: 2025-Aug-01 链接: PubMed
摘要
Atopic dermatitis (AD) is a chronic inflammatory skin condition that often manifests in infancy or early childhood, with significant impacts on quality of life and potential persistence into adulthood. S. aureus colonization and a complex interplay of immunological, genetic, and environmental (SAIGE) factors are key contributors to AD pathogenesis. In pediatric patients, the S. aureus colonization induces pruritus, barrier dysfunction, and inflammation, making AD management particularly challenging. A panel of 7 pediatric dermatology experts employed a modified Delphi process, including a face-to-face meeting and online follow-up, to evaluate current evidence and formulate consensus recommendations for managing pediatric AD. The panel identified 6 consensus statements emphasizing S. aureus as a critical contributor to pruritus, skin barrier dysfunction, and AD exacerbation, reinforcing the need for effective, early skincare strategies. Recommendations include mitigating SAIGE factors, particularly S. aureus, through the proactive use of ceramide-containing skincare from birth in high-risk infants to delay and potentially prevent AD onset. The consensus panel highlighted S. aureus as the most critical SAIGE factor in pediatric AD pathogenesis, driving the itch-scratch-inflammation cycle and contributing to disease exacerbation. Consensus recommendations underscore the role of early, targeted skincare in pediatric AD management to reduce S. aureus impact on the skin barrier and support the need for clinician education on SAIGE factors and therapeutic strategies that mitigate AD progression and severity.
46. Hospital-Based Methadone and Buprenorphine Initiation Practices by Addiction Consult Services.
期刊: JAMA network open 发表日期: 2025-Aug-01 链接: PubMed
摘要
The emergence of fentanyl and other high-potency synthetic opioids (HPSOs) has not only been underlying overdose deaths, but has complicated initiation of methadone and buprenorphine for opioid use disorder (OUD) treatment, including in the hospital. In response, clinicians with addiction expertise have developed novel initiation practices, yet no studies have characterized initiation practices nationally. To assess the use of novel hospital-based practices for initiating methadone and buprenorphine. This cross-sectional survey study of directors of hospital-based addiction consult services (ACS) associated with addiction medicine and addiction psychiatry fellowships in hospitals in the US was conducted using a REDcap anonymous survey from October 2023 to April 2024. Predefined methadone and buprenorphine initiation practices. Standard methadone initiation was defined as 40 mg oral maximum on day 1 with up-titration of 5 to 10 mg every 3 days. Rapid methadone initiation was defined as any initiation regimen more rapid than standard. Buprenorphine initiation practices included low dose, high dose, traditional, and rescue. The primary outcome was the proportion of ACS directors using predefined methadone and buprenorphine initiation practices. Perceived impact of the drug supply on methadone and buprenorphine initiation was assessed through a 5-point Likert scale ranging from strongly disagree to strongly agree. Typical selection of buprenorphine initiation practices was assessed using 7 case-based scenarios intended to represent common hospital scenarios. Among 80 consult services, 58 directors (72.5%; median [IQR] age, 41 [38-50] years; 27 of 57 [47.3%] women) completed surveys, one of which was partially completed. Of 57 ACS directors, specialties included addiction medicine (41 respondents [71.9%]), addiction psychiatry (11 respondents [19.3%]), general or consult liaison psychiatry (11 respondents [19.3%]), and toxicology (2 respondents [3.5%]). Among those who reported initiating methadone (47 of 58 respondents [81.0%]), 33 (70.2%) agreed that HPSOs changed their methadone initiation practices. Of 46 respondents, 40 (87.0%) reported rapid initiation of methadone, and of those, 26 (65.0%) reported using rapid initiation for more than 50% of initiations. Full-agonist opioids were used by 31 of 46 ACS directors (67.4%) to treat withdrawal during methadone initiation. Of 58 respondents, 54 (93.1%) agreed that HPSOs changed their buprenorphine initiation practices. All 58 ACS directors reported that their initiation practices offered buprenorphine initiation, including 53 of 57 (92.9%) offering low dose, 50 of 57 (87.7%) offering traditional, 43 of 57 (75.4%) offering high dose , and 20 of 57 (35.1%) offering rescue. For 7 clinical cases provided, low-dose initiation was the most commonly endorsed method of buprenorphine initiation, except in the case of a person presenting in significant withdrawal 2 days after last fentanyl use. The findings of this survey study of hospital-based academic ACS directors suggest that methadone and buprenorphine initiation has adapted to a shifting opioid supply, often outpacing research and changes in clinical guidelines.
47. Non-Partisan Proposal for Reforming Physician Payment System and Preserving Telehealth Services.
期刊: Pain physician 发表日期: 2025-Jul 链接: PubMed
摘要
Physician payments have declined significantly due to budget neutrality rules and reimbursement cuts. Since 2001, Medicare payments to physicians have dropped by 33% when adjusted for inflation. These reductions have been compounded by 2% annual sequestration cuts introduced after the Affordable Care Act (ACA), which continues through 2032. Despite their long-term impact, sequestration cuts receive little public attention.Congress has historically delayed or softened these cuts. However, in 2025, a bill that would have adjusted payment rates was removed from the continuing resolution, resulting in continued reductions. Meanwhile, insurance premiums have risen nearly 400%, highlighting the disparity between healthcare costs and physician compensation.Ironically, while physicians face significant payment cuts, the Centers for Medicare & Medicaid Services (CMS) proposed on January 10, 2025, a 4.3% payment increase for Medicare Advantage plans-totaling $21 billion in 2026 and an estimated $210 billion over the following decade starting in calendar year 2026. This proposal comes amid ongoing concerns about Medicare Advantage overpayments, estimated at nearly $100 billion annually, and additional funding through annual premiums of $198 from all Medicare beneficiaries, amounting to roughly $13 billion per year.In response, the American Society of Interventional Pain Physicians (ASIPP) submitted a nonpartisan reform proposal advocating for telehealth protections and elimination of sequester cuts-measures that have received strong bipartisan support in Congress. Both the House of Representatives and the Senate voted to pass a reconciliation bill-nicknamed the “Big Beautiful Bill”, which has been signed into law by the President recently. It proposes an $8.9 billion investment in the Medicare Physician Fee Schedule, with a 2.25% update in 2026. The proposal does not address the budget neutrality provision, growing practice costs, inflationary pressures, or ongoing sequestration and pay-as-you-go (PAYGO) cuts. It also fails to resolve issues with the Medicare Access and CHIP Reauthorization Act (MACRA), particularly within the Merit-Based Incentive Payment System (MIPS). On November 1, 2024, CMS finalized a 2.8% cut to physician payments-an estimated $20 billion-while also eliminating telehealth services. These cuts continue to threaten physician sustainability and patient access to care.
48. Diagnostic accuracy evaluation of a point-of-care antigen test for SARS-CoV-2 and influenza in UK primary care (RAPTOR-C19).
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
To evaluate the diagnostic accuracy of the Roche SARS-CoV-2 & Flu A/B Rapid Antigen Test at the point of care. Prospective diagnostic accuracy study. 17 primary care practices in England. 500 individuals with symptoms consistent with possible SARS-CoV-2 or influenza infection identified upon presentation to primary care or via medical note review. Sensitivity, specificity and predictive values, compared to a laboratory reference standard of real-time reverse transcription PCR, using samples collected using a combined nasal and oropharyngeal swab. Of 481 participants with available index and reference test results, 5.6% (27/481) were reference standard-positive for SARS-CoV-2, 11.4% (55/481) for Influenza A and 1.9% (9/481) for Influenza B. The sensitivity of the antigen test to detect SARS-CoV-2 was 70.4% (19/27, 95% CI 49.6-86.2%) and specificity was 99.3% (451/454, 95%CI 98.1-99.9%). For Influenza A, sensitivity was 29.1% (16/55, 95% CI 17.6-42.9%) and specificity 98.6% (420/426, 97.0-99.5%), and for Influenza B, sensitivity was 22.2% (2/9, 2.8-60.0%) and specificity 98.1% (463/472, 96.4-99.1%). In a primary care population of symptomatic individuals, the assay was highly specific and had moderate sensitivity to detect SARS-CoV-2, but did not detect the majority of influenza infections. ISRCTN14226970.
49. Trends in adverse perinatal outcomes and associated hospitalisations, emergency department presentations, and healthcare costs from birth to early childhood in the Northern Territory, Australia: A two-decade population-based study.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Adverse perinatal outcomes, including preterm birth (PTB), small-for-gestational-age (SGA), and low birthweight (LBW), impact childhood health and impose substantial burdens. This retrospective cohort study included all births in the Northern Territory, Australia, from July 1, 2000, to June 30, 2016, examining trends in these outcomes and related hospitalisations, emergency department (ED) presentations, and healthcare costs through June 30, 2021. Births were linked to hospitalisation, ED, and cost-weight data. Cost, adjusted to June 2024 Australian Dollars (AUD), includes both direct medical and non-medical components. A Generalized Additive Model with a gamma distribution and log link was used to identify cost drivers. A total of 31,183 and 42,174 births were linked to hospitalisations and ED records, respectively. The incidence of PTB increased from 8.1% to 8.7%, while SGA declined from 15.2% to 11.3%. The mean number of hospitalisations by age five increased for children with PTB (1.3 ± 0.7 to 6.9 ± 6.0), and SGA (1.2 ± 0.6 to 8.1 ± 15.1), despite a decline in length of stay. ED presentations also increased for children with PTB (1.3 ± 0.5 to 11.5 ± 10.7), SGA (2.2 ± 1.9 to 12.2 ± 11.5), and LBW (1.2 ± 0.2 to 10.9 ± 8.7). Median five-year hospitalisations cost was AUD 23,848 (IQR: 11,858-44,475) for children with PTB and SGA, compared with AUD 8,668 (IQR: 4,365-17,855) for term non-SGA children. ED cost was AUD 3,108 (IQR: 1,609-7,520) versus AUD 2,058 (IQR: 1,032-4,057), respectively. Costs increased over time for SGA and LBW but declined slightly for PTB. Higher costs than the national average were observed among Indigenous children, those from remote areas, and those with prolonged hospital stays. The healthcare burden associated with adverse perinatal has increased in recent cohorts, particularly among vulnerable groups. Future studies should quantify these burdens across population subgroups to better inform policy.
50. Measurement and evolution of government attention to the health industry in China based on the BERTopic model.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
This paper aims to measure the government’s attention to the health industry accurately, which is crucial for understanding policy directions and resource allocation strategies. Addressing the limitations of traditional word frequency methods, such as restricted word segmentation and ambiguous terms, the BERTopic (Bidirectional Encoder Representations from Transformers Topic Modeling) is applied to measure government attention at the sentence level. Rule matching in an ambiguous dictionary, which is expanded by utilizing the word2vec model, is to achieve accurate identification of unclassified topics. This approach reveals policy concerns at the semantic level. The BERTopic model is a more precise instrument for evaluating the health industry’s attention. Furthermore, significant regional differences are detected. Attention in the Northeast has declined, remained stable in the Central and Western regions, and continuously increased in the Eastern region. The main areas of government attention in the health industry are sports and fitness, environmental governance, medical services, and healthy older individuals’ care. The mode of medical care in healthy retirement has evolved to a combination of medical care and health preservation. It is recommended that the balanced development of the health industry across regions be promoted based on specific local conditions. Efforts should also be made to enhance the efficiency of medical services, optimize the allocation mechanism for medical resources, establish a systematic medical treatment plan, and encourage the comprehensive and coordinated development of the health industry.
51. Designing and evaluation of the effect of community-based intervention on breast self-examination among reproductive-aged women in Ethiopia: A Cluster Randomized Controlled Trial.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Though early intervention saves many lives worldwide, breast cancer remains a leading cause of cancer among women in Ethiopia. This study, therefore, aimed to evaluate community-based interventions promoting breast self-examination using the Health Belief Model. A cluster randomized controlled trial followed by a cross-sectional study lasting six months was used to evaluate the effectiveness of the community-based educational intervention on breast self-examination among reproductive-aged women in Ethiopia. A total of 810 participants were randomly assigned in a 1:1 ratio and assessed at baseline, three months, and six months post-intervention. A general linear model for repeated measures was used to examine the mean differences in study variables across time points. Non-parametric tests (Cochran’s Q) were employed to analyze dichotomous variables related to breast self-examination practices. Path analysis was conducted to examine the interactions among the constructs of the Health Belief Model. A total of 810 reproductive-aged women participated in the study, yielding a 100% response rate at baseline. The mean age of participants was 33.2 ± 7.7 years in the intervention group and 33.5 ± 8.1 years in the control group. The proportion of women performing breast self-examinations increased from 33.3% at baseline to 59.9% at the end of the intervention. And the Comprehensive knowledge about breast self-examination rose from 11.7% to 69.1% over the same period. Perceived susceptibility, perceived severity, knowledge, and health motivations had a statistically significant mean difference between the intervention and control groups (p < 0.0001). We registered PACTR database (https://pactr.samrc.ac.za/): “PACTR201802002902886”. The study found that there is a strong interplay between the likelihood of performing breast self-examination and perceived susceptibility, perceived severity, knowledge, and health motivations. Field specialists should figure out the problem related to perception and awareness through intensive health promotion interventions. Registered in the Pan African Clinical Trial Registry (www.pactr.org) database, and the unique identification number for the registry is PACTR201802002902886.
52. Physical performance in basic functional tests in premenopausal, perimenopausal and post-menopausal women.
期刊: South African journal of sports medicine 发表日期: 2025 链接: PubMed
摘要
Understanding the hormonal fluctuations and changes in the musculoskeletal system during menopause is important for health promotion and improving quality of life. This study aimed to determine the physical ability of sedentary premenopausal, perimenopausal, and post-menopausal women. Female participants between the ages of 37 and 65 years (n=53) were divided into three groups according to menopausal transition guidelines and underwent anthropometric and physical tests. Descriptive and inferential statistics were computed, including post-hoc pairwise comparisons and ANOVA for significance between the three groups (p<0.05). The Bonferroni correction for multiple tests was applied. Results were expressed as mean and standard deviation. Statistically significant differences were observed in weight (0.010) and waist circumference (0.0001) among the three groups. For the timed up-and-go test, premenopausal women performed significantly better than both perimenopausal (p=0.027) and postmenopausal women (p=0.0001). The one-minute push-up test showed a significant reduction in upper body strength from premenopause to postmenopause (p=0.002). The one-minute sit-up test showed significant declines between premenopause and postmenopause (p=0.001) and between perimenopause and postmenopause (p=0.030). The single-leg balance showed significant impairments in postmenopausal women compared to premenopausal women (p≤0.008 for both legs), and the sit-to-stand test revealed significant differences between premenopause and postmenopause (p=0.0001) and perimenopause and postmenopause (p=0.025). Premenopausal women exhibited the highest p-value significance and mean scores in various parameters, followed by the perimenopausal and post-menopausal groups. Physical performance in basic muscle function tests suggests a decline in muscle strength and endurance during the menopausal transition.
53. Psychological outcomes of dengue fever among individuals: A scoping review.
期刊: Journal of education and health promotion 发表日期: 2025 链接: PubMed
摘要
Dengue fever (DF) is recognized as an acute infectious disease primarily characterized by physical symptoms such as headache and joint pain. However, this disease can also have significant psychological outcomes for affected individuals in addition to its physical complications. A scoping review was conducted to comprehensively examine the available studies on the psychological outcomes of DF. This was a scoping review conducted to examine the psychological outcomes of DF. A search was performed across multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar, using a set of keywords related to the psychological outcomes of DF, covering the period from 2000 to 2024. Based on inclusion and exclusion criteria, 14 studies were selected, encompassing case-control, cross-sectional, cohort, descriptive, preventive, and interventional studies. A total of 6479 documents were retrieved, of which 22 met the eligibility criteria, and finally, 14 were included in the review. The findings indicate that the psychological outcomes of DF can be both short-term (such as anxiety and insomnia) and long-term (such as obsessive-compulsive disorders and suicidal tendencies) among people with different spectrums of age. The review revealed that more than half of the patients exhibited anxiety-related symptoms during the acute phase of the illness, with symptom severity decreasing as physical recovery progressed. Additionally, dengue patients demonstrated a significant risk of developing depressive disorders in both the short and long terms. Among children, age and duration of hospitalization were found to be associated with stress, depression, and anxiety. The findings of the present study revealed that various levels of disease prognosis in individuals with dengue infection significantly impact mental health and can lead to psychological disorders such as stress, depression, and anxiety. Therefore, policymakers should develop psychological interventions based on appropriate psychological theories for recovered patients. Additionally, healthcare providers should be aware of mood disorders associated with DF and facilitate timely referrals to mental health services.
54. Association between presence of latrine and unclean child face on the prevalence of active trachoma among children aged 1 to 9 years in low-income setting: A systematic review and meta-analysis.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Trachoma is the leading infectious cause of blindness worldwide, primarily affecting populations in low-income countries with poor sanitation and hygiene conditions. The World Health Organization has set a goal to eliminate trachoma as a public health problem. However, progress towards this goal has been uneven across different regions. This systematic review and meta-analysis aimed to synthesize the available evidence on the association between the presence of latrine facilities and unclean child faces with the prevalence of active trachoma among children aged 1 to 9 years in low-income country settings. The findings from this study can help guide the design of more targeted interventions to reduce the burden of trachoma in vulnerable populations. A total of 2695 articles were searched from PubMed, Hinari, African Online Journals, Google, Google Scholar, Science Direct, and Semantic Scholar and exported to STATA version 17 for analysis. The levels of heterogeneity among studies were assessed using I2 and p-values. The findings of the meta-analysis were presented using a table, graph, and forest plot with a 95% confidence interval. A P-value of less than 0.05 was considered statistically significant. Among 2695 articles searched, 16 of them were selected for meta-analysis. The pooled prevalence of active trachoma was 21.10 (95% CI; 14.18, 28.02). The finding indicated high heterogeneity among the included studies (I2 =99.3%, p<0.0001). There was a statistically significant association between the presence of a latrine (POR=0.10, 95% CI: 0.00, 0.19) and unclean child face (POR=1.30, 95% CI: 1.08, 1.53) and the pooled prevalence of active trachoma among children aged 1 to 9 years in low-income countries. The present study revealed that the pooled prevalence of active trachoma was high as compared to the WHO trachoma eradication goal. The presence of latrine facility and unclean child face were significantly associated with the prevalence of active trachoma among children aged 1 to 9 years in low-income countries. Hence it is recommended to improve access to latrines, promote child facial hygiene, and intensify overall trachoma control in low-income countries.
55. Perception of rural adolescents and parents regarding child marriage: Findings of a community-based cross-sectional study in Bangladesh.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Child marriage is a blazing global issue influenced by gender inequity, poverty, social norms, and insecurity. It has disastrous social, economic, and health-related consequences. Bangladesh ranks among the top ten countries in terms of child marriage, and rural girls are the most vulnerable group to it. Our study aimed to assess and compare the perception of rural adolescents and parents regarding child marriage, as well as focusing on the key factors governing such perception of the participants. This community-based cross-sectional study randomly selected four unions of Dhamrai upazila (Sub-district) under the Dhaka district as study areas. The study recruited 1030 participants (515 adolescents and 515 parents) from 515 rural households using a systematic random sampling method and specific selection criteria. Data enumerators collected data through face-to-face interviews using a pretested semi-structured questionnaire and obtained informed written consent from parents and assent from adolescents. The study assessed perception related to child marriage by 25 statements formulated based on expert opinions. These statements were further organized into four domains- social, economic, psychological, and environmental through thematic analysis. We categorized the perception as “support” and “do not support” child marriage using a scoring system ranging from 0 to 25, based on the responses to 25 statements by a two-level Likert scale. Participants who obtained scores of ≥80% were considered not to support child marriage. The current study revealed that 25.8% of adolescents and 27.0% of parents supported child marriage. Participants lacking formal schooling were 3 times (AOR 3.00; 95% CI 1.27-7.09, p = 0.01) and participants with primary level education were 2.69 times (AOR 2.69; 95% CI 1.27-7.09, p = 0.01) more likely to support child marriage compared to participants with at least higher secondary level of education. Parents and adolescents did not differ significantly (p < 0.05) in total and domain-specific perception scores. However, substantial differences existed in various statements across the domains, and maximum disagreement was found in the environmental domain. Supportive perception toward child marriage still exists in rural Bangladesh, and it is more prevalent among people with less or no formal education. Despite exceptions, both groups had overall similar perceptions regarding child marriage. Exploration of factors favoring support for child marriage and designing educational as well as community-based interventions specific and suitable to adolescents and parents is crucial to improve perception regarding child marriage.
56. Changes in the pulmonary surfactant in patients with mild to moderate COVID-19.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Changes in the pulmonary surfactant have been seen in severe COVID-19, but data on mild to moderate COVID-19 is scarce. The aim of this study was to explore the protein and phospholipid profiles in the small airways in patients with mild to moderate COVID-19. 29 cases with COVID-19 and 17 healthy controls were examined at baseline. 22 cases were re-examined at follow-up after recovery from COVID-19. Airwave oscillometry was performed and the biological material from the respiratory tract lining fluid was collected with the PExA (Particles in Exhaled Air) method. SOMAscan was used for the analysis of proteins, and liquid chromatography with tandem mass spectrometry (LC-MS/MS) for phospholipids. 95 lipid species belonging to 8 lipid classes, and 46 proteins were analysed. Relative amounts of 13 lipid species differed between cases and controls at baseline, and of 24 lipid species at follow-up. At follow-up, the phosphatidylethanolamine class (PE) was significantly lower in cases at than in controls, and a significant decrease in PE, as well as a change in 20 lipid species from baseline to follow-up in cases was seen. The protein profile did not differ between cases and controls either at baseline or follow-up, or between repeated measurements in cases. The observed alterations in the surfactant phospholipids in the RTLF indicate that surfactant homeostasis is affected already in mild to moderate COVID-19, and these changes appear to persist over time.
57. Seroprevalence and risk factors of hantavirus and hepatitis E virus exposure among wildlife farmers in Vietnam.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Wildlife farming is a growing industry, but it poses substantial risks for zoonotic disease transmission, including infections caused by hantaviruses and hepatitis E virus (HEV). This study aimed to determine seroprevalences of these viruses among wildlife farmers and identify associated risk factors. A cross-sectional study was conducted among 210 wildlife farmers in Lao Cai and Dong Nai provinces in Vietnam who raised bats, bamboo rats, civets, and wild boars. Of these, 207 provided serum samples for serological testing for hantavirus and HEV antibodies. Apparent (AP) and true (TP) prevalences were estimated, and multivariable logistic regression was performed to identify risk factors. The AP of hantavirus IgG was 8.7%, 95% confidence interval (CI): 5.4-13.6 (TP: 4.7%, 95% credible interval (CrI): 0.2-11.1). HEV IgG AP was 26.7%, 95%CI: 20.8-33.2 (TP: 27.1%, 95%CrI: 21.3-33.4). Hantavirus IgM testing was also performed due to higher IgG seroprevalence compared to earlier studies, detecting IgM antibodies in 1.9% of samples (95%CI: 0.6-5.2) (TP: 1.7%, 95%CrI: 0.1-4.7). Hantavirus seropositivity was significantly associated with engaging only in wildlife farming, and not participating in other activities such as hunting, trading, slaughtering, processing, guano collection, or consumption (OR = 2.7, 95% CI: 1.1-6.9). HEV seropositivity was significantly associated with men gender (OR = 3.1, 95%CI: 1.4-7.3), older age (OR = 1.03, 95%CI: 1.0-1.1), raw meat consumption (OR = 6.8, 95%CI: 1.6-31.8), residing at higher altitudes (OR = 31.6, 95%CI: 5.5-204.4), and reporting use of protective clothing (OR = 4.0, 95%CI: 1.4-11.2), although their proper use was not assessed. This study highlights behavioural and environmental risk factors associated with wildlife farming and zoonotic pathogens exposure. Public health interventions should focus on biosecurity, proper hygiene practices, and risk communication to reduce the transmission in wildlife farming settings.
58. Interventions to improve cognitive performance in chronic kidney disease: A scoping review.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Cognitive impairment is commonly associated with chronic kidney disease (CKD. A number of intervention approaches have the potential to improve cognitive performance in CKD. Our objective was to characterize interventions studied to improve cognitive performance for adults with CKD across all categories of severity, including kidney failure. Scoping review following JBI methodology. Adults (≥18 years) with CKD or kidney failure. We searched 5 electronic databases for studies published up to April 5, 2024. Eligible sources were primary research studies that investigated any intervention targeting cognition in adults (≥18 years) with CKD or kidney failure. Full-text article screening was performed in duplicate. Characteristics of interventions, populations studied, and outcomes investigated. Descriptive statistics and narrative syntheses. Seventy-one studies were included. Over half (n = 37, 52%) were conducted within the past five years, and most studies (n = 47, 66%) targeted people on maintenance hemodialysis therapy. Just over one-third of studies investigated pharmacological interventions, with much of the pharmacological or medical research focusing on anemia management or dialysis adequacy. Although recent research has expanded in focus, many other purported mechanisms of cognitive dysfunction in CKD remain understudied in interventional research. Exercise training (n = 14) was the most common nonpharmacological approach studied, but few studies have explored other promising nonpharmacological approaches such as cognitive rehabilitation interventions. Abstract screening not performed in duplicate; non-English studies excluded. Research into cognitive interventions for people with kidney disease has primarily focused on the hemodialysis population and investigated erythropoietin stimulating agents, frequent or prolonged dialysis, and exercise, although there has been recent growth of research activity into other interventions. Future research should aim to address a broader range of purported pathophysiological mechanisms of cognitive impairment in CKD, investigate interventions for predialysis and peritoneal dialysis patients, and explore the impacts of established cognitive rehabilitation approaches.