公共卫生研究摘要 (2025-08-09)
共收录 54 篇研究文章
1. Epidemiologic, Clinical, and Radiologic Study of Cerebral Amyloid Angiopathy-Related Inflammation in Northern Ireland.
期刊: Neurology 发表日期: 2025-Sep-09 链接: PubMed
摘要
Cerebral amyloid angiopathy-related inflammation (CAAri) can present with acute or subacute encephalopathy, focal neurologic deficits, or seizures. In a population study, we describe epidemiologic, clinical, and radiologic features of patients with CAAri. Using multiple sources, a cohort of patients diagnosed with CAAri in Northern Ireland was recruited over 12 years. Standardized incidence and prevalence data, clinical presentation, radiologic findings, treatment, and outcome were recorded. Twenty-five patients (12 women, 13 men) presented with CAAri (mean age 69.8 (SD 9.7) years). The age-standardized incidence of CAAri was 0.128 (95% CI 0.078-0.179)/100,000/y, and the point prevalence of CAAri was 0.904 (0.461-1.346)/100,000. Patients presented with subacute cognitive decline or behavioral change, focal deficits, headache, seizures, and falls. MRI contrast enhancement occurred in 5 of 17 (29%), and 19 of 25 (76%) had over 50 cerebral microbleeds. Nineteen patients (76%) were treated with steroid therapy ± other immunotherapies. Neuroimaging improvement occurred in most patients, but 7 patients (28%) had clinical progression. The median survival was 81 (95% CI 43.5-118.5) months. CAAri is rare and has a broad spectrum of presentations. Most patients with CAAri survive more than 6 years. Further research is required to identify the most appropriate immunotherapy regimen for patients with CAAri.
2. Associations of Longitudinal Changes in Blood Biomarkers of Dementia With the Proportion of Genetically Inferred African Ancestry.
期刊: Neurology 发表日期: 2025-Sep-09 链接: PubMed
摘要
African American individuals have a higher risk of Alzheimer disease (AD) and related dementia (ADRD) than non-Hispanic White individuals. Some cross-sectional studies with self-reported race and ethnicity have reported racial differences in circulating ADRD biomarkers, including phosphorylated tau181 (p-Tau181), glial fibrillary acidic protein (GFAP), and neurofilament light (NfL). We aimed to examine the associations of genetically inferred African ancestry proportion with the longitudinal changes in these biomarkers and to evaluate the associations of previously identified ADRD-related genetic factors in European cohorts with these biomarkers in an African American cohort. This study used longitudinal data from the Family and Community Health Study, which was initiated in 1996, recruited and followed 889 African American families residing in Georgia and Iowa. Circulating p-Tau181, GFAP, and NfL were measured in serum samples collected in 2008 (wave 5) and 2019 (wave 8). Closely related individuals, genetically inferred to be third-degree relatives or closer, were excluded. Genetic ancestry proportions were inferred using the ADMIXTURE analysis. Multivariable regression analyses were performed to test the associations of African ancestry proportion with cross-sectional biomarker levels and their longitudinal changes over 11 years. We also tested the associations of selected genetic variants, polygenic scores, and APOE ε4 status with these biomarkers. Our cross-sectional sample included 573 participants (mean age = 55.1 years; 69% female), whereas our longitudinal sample included 225 (57.2 years; 80% female). African ancestry proportion was not associated with cross-sectional biomarker levels but was inversely associated with the longitudinal change in p-Tau181 (β = -14.50 pg/mL, p = 0.02). The significant inverse association was robust to adjustment for age, sex, APOE ε4, socioeconomic status, physical activity, smoking, subjective cognitive decline, and various cardiovascular risk factors and comorbidities. Finally, genetic factors associated with AD and biomarkers in European cohorts were not associated with the 3 biomarkers in our African American cohort. We found suggestive evidence that a higher African ancestry proportion is associated with an attenuated increase in the blood p-Tau181 level over time. More research is needed to characterize the longitudinal dynamics of ADRD biomarkers across ancestry and the driving biological or sociocultural factors.
3. Posttreatment toxicity following single-fraction versus multifraction hypofractionated stereotactic radiosurgery for larger meningiomas.
期刊: Journal of neurosurgery 发表日期: 2025-Aug-08 链接: PubMed
摘要
Stereotactic radiosurgery (SRS) has been used to manage patients with intracranial meningioma with contraindications to resection. Limitations to SRS traditionally include tumors > 3 cm due to the risk of posttreatment toxicity. Hypofractionated SRS (hSRS) has been proposed as an alternative for tumors exceeding volume constraints for single-fraction SRS, although how hypofractionation affects the volume versus toxicity relationship has not been reported. Thus, the authors conducted a single-institution retrospective analysis of the medical records of patients receiving single-fraction SRS or multifraction hSRS for large (> 2 cm) meningiomas to assess the effect of hypofractionation on the likelihood of posttreatment toxicity. Patients were identified using the Wake Forest University Department of Radiation Oncology prospectively administered Gamma Knife database. Patients were included if they had single-fraction SRS or multifraction hSRS for a diagnosis of meningioma that was > 2 cm. Analysis was limited to tumor volumes between 2.7 and 49.3 cm3, the overlapping range shared by those undergoing hSRS or SRS. Electronic medical records were used to determine patient and tumor characteristics and clinical outcomes. A total of 121 SRS cases with a median dose of 12 Gy and 51 hSRS cases with a median dose of 20 Gy with tumor volumes between 2.7 and 49.3 cm3 were identified and included in the analysis. The probabilities of freedom from local failure at 1, 3, and 5 years were 87.0%, 79.0%, and 63.6%, respectively, for patients receiving single-fraction SRS and 96.0%, 91.0%, and 91.0%, respectively, for patients receiving multifraction hSRS. The probabilities of overall survival at 1, 3, and 5 years were 97.5%, 79.7%, and 72.6%, respectively, for patients receiving single-fraction SRS and 85.5%, 80.9%, and 76.4%, respectively, for patients receiving multifraction hSRS. Eighteen (14.9%) of 121 patients receiving single-fraction SRS experienced Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2 toxicity, and 12 (23.5%) of 51 patients receiving multifraction hSRS experienced CTCAE grade ≥ 2 toxicity. When controlling for tumor volume, despite higher treatment doses in the hSRS group relative to the SRS group, posttreatment toxicity was not significantly different between the groups, and freedom from local failure was improved in the hSRS group. For patients with larger meningiomas, multifraction hSRS may help to limit the risk of posttreatment edema and toxicity, while maintaining acceptable freedom from local failure.
4. Variation of demographic and socioeconomic factors associated with pediatric traumatic brain injury: a geospatial analysis.
期刊: Journal of neurosurgery. Pediatrics 发表日期: 2025-Aug-08 链接: PubMed
摘要
Traumatic brain injury (TBI) is a leading cause of mortality and morbidity among children in the United States, with nearly a half million pediatric TBI-related emergency visits annually. The authors aimed to investigate geospatial disparities in pediatric TBI across ZIP Code Tabulation Areas (ZCTAs) and to assess the association of neighborhood sociodemographic factors with pediatric TBI incidence rate and outcomes. A retrospective cross-sectional study was conducted to examine the electronic medical records of pediatric patients treated at a level I pediatric trauma center between June 2016 and June 2023. Data were linked with ZCTA-level socioeconomic indicators from the American Community Survey 5-year estimates. Neighborhood-level social disadvantage, including the Social Deprivation Index (SDI), median household income, housing characteristics, and health coverage patterns, was assessed. Pediatric TBI incidence rates were calculated using spatial Bayesian smoothing techniques. Global Moran’s I test was used to assess spatial autocorrelation, while the local indicators of spatial association test was used to identify TBI hot spots and cold spots. Incidence rate ratios (IRRs) were derived using zero-inflated negative binomial regression. Injury severity (via the Injury Severity Score [ISS]), hospital length of stay (LOS), discharge disposition, and mortality were examined. Among 2809 patients (median age 6 years [IQR 1-12 years], 36.4% female), 47 ZCTAs were identified as hot spots and 143 as cold spots. Compared with cold spots, hot spot ZCTAs had a higher child population density, greater proportions of renter-occupied housing units, lower median household incomes, shorter mean travel times to work, higher rates of public health insurance coverage, and higher SDI scores (all p < 0.001). In multivariable regression, higher vacant housing units (IRR 1.032, 95% CI 1.014-1.051; p < 0.001), lower proportions of individuals working from home (IRR 0.941, 95% CI 0.921-0.963; p < 0.001), lower private health insurance coverage (IRR 0.979, 95% CI 0.969-0.990; p < 0.001), and higher poverty (IRR 1.073, 95% CI 1.047-1.110; p < 0.001) were associated with increased TBI incidence rates. Compared with other areas, patients from hot spots had a lower median ISS (5 vs 6, p < 0.001) and fewer prolonged hospital LOS events (25.1% vs 32.0%, p < 0.001), but no significant differences in discharge disposition or mortality (both p > 0.05). In this cross-sectional study, pediatric TBI rates clustered disproportionately in socioeconomically disadvantaged areas. These findings underscore the need for targeted, neighborhood-level prevention strategies and policies addressing social determinants to mitigate the rising burden of pediatric TBI.
5. Pocket Parent-Child Interaction Therapy (PCIT) Online for Young Children With Disruptive Behaviors: Open Trial.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-08 链接: PubMed
摘要
Parent-Child Interaction Therapy (PCIT) is an evidence-based treatment for child disruptive behavior problems, but access barriers historically limit its reach. This study examined the reach, effectiveness, adoption, and implementation of Pocket PCIT Online, a self-directed web-based adaptation of PCIT. In an open trial, 1480 caregivers accessed the free 4-week Pocket PCIT Online intervention. Measures of child behavior, parenting stress, and family conflict were collected pre- and postintervention. Reach, effectiveness, adoption, and implementation were assessed using an implementation science framework. Significant improvements were observed across all outcome measures for intervention completers (n=204). Caregivers reported increased positive child behaviors (Cohen’s d=0.87) and decreased parenting distress (Cohen’s d=-0.3) following completion of Pocket PCIT Online. Of note, approximately 35.8% (73/204) of caregivers reported clinically significant improvements in their children’s frequency of disruptive behaviors. However, only 16.5% (204/1234) of participants completed postintervention measures. Caregivers completed Pocket PCIT Online at a significantly higher rate prior to the COVID-19 national emergency (21/74, 28%) than during or after the onset of COVID-19 (183/1158, 15.8%). While Pocket PCIT Online demonstrates potential as a low-cost, accessible, and scalable public health intervention for child disruptive behaviors, strategies to enhance retention and broaden reach to historically underserved populations are needed.
6. The Burden and Risk Factors of Gastric Cancer in Eastern Asia From 1990 to 2021: Longitudinal Observational Study of the Global Burden of Disease Study 2021.
期刊: JMIR cancer 发表日期: 2025-Aug-08 链接: PubMed
摘要
Eastern Asia has historically had the highest global incidence and mortality rates of gastric cancer (GC) while substantial disparities exist between countries. The overall burden of GC remains insufficiently explored. Using the Global Burden of Disease Study 2021, this research aims to estimate the burden and risk factors of GC in Eastern Asia from 1990 to 2021. Incidence, age-standardized incidence rate (ASIR), deaths, age-standardized mortality rate (ASMR), disability-adjusted life years, age-standardized disability-adjusted life year rate (ASDR), and risk factor burdens for GC were analyzed in Eastern Asia from 1990 to 2021. Joinpoint analysis determined average annual percent change (AAPC) and annual percent change, while age-period-cohort analysis assessed temporal trends. The Bayesian age-period-cohort model projected GC burden from 2021 to 2035. All analyses used R software (version 4.4.1; R Foundation for Statistical Computing). In 2021, Eastern Asia reported 748,235 new GC cases and 527,054 deaths, accounting for 60.8% (748,235/1,230,232) of new cases and 55.2% (527,054/954,373) of deaths reported globally. From 1990 to 2021, South Korea showed the largest declines in ASIR, ASMR, and ASDR, with ASMR decreasing from 55.4 per 100,000 to 13.3 per 100,000 (AAPC -4.5, 95% CI -4.8 to -4.3). ASIR, ASMR, and ASDR also showed a downward trend in Japan and China, with an AAPC of -3.0 (95% CI -3.2 to -2.8) for ASMR in Japan and -2.4 (95% CI -2.6 to -2.3) in China. The GC burden of North Korea was basically stable, with an AAPC of ASMR of -0.8 (95% CI -0.8 to -0.8). Mongolia showed a slight decline, with an AAPC of ASMR of -1.4 (95% CI -1.7 to -1.0), and the burden of GC was the highest. High-sodium diets and smoking were the main risk factors for disability-adjusted life years of GC in 2021. Smoking contributed to a decline in ASDR as the sociodemographic index increased. Projections suggest continued ASDR reductions across Eastern Asia from 2022 to 2035, though Mongolia will maintain the highest burden. Despite a decrease from 1990 to 2021, GC remains a significant public health issue in Eastern Asia. Addressing it necessitates prioritizing primary and secondary prevention, including reducing risk factors and enhancing early screening.
7. Patient Perspectives on Open-Door Policies in Psychiatry: Mixed Methods Study.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-08 链接: PubMed
摘要
Open-door policies in psychiatric wards are increasingly recommended as a means to reduce coercion and enhance patient autonomy. However, evidence that integrates patient perspectives on ward openness and related safety measures remains limited. Traditional qualitative approaches often lack the breadth to fully capture the complexity of these views. We hypothesized that patients would prefer open-door treatment and hold a critical view of locked-ward environments, emphasizing autonomy and dignity in care. This study aims to systematically explore psychiatric patients’ perspectives on open-door versus locked-ward treatment, identifying key themes and quantifying preferences within a large clinical sample. A hybrid questionnaire survey was conducted in September 2023 at the University Psychiatric Clinics (UPK) Basel. The survey examined psychiatric service usage and integrated key factors from a meta-review, including ward relationships, environment, autonomy, legal status, coercion, care entitlement, and expectations at admission and discharge. The final sample comprised 604 patients (response rate 19.1%) drawn from an initial pool of 3212 former inpatients. A text mining approach using latent Dirichlet allocation, a Bayesian topic modeling technique, was applied to analyze open-ended responses and identify latent thematic structures. The majority of respondents (347/544, 63.8%) rated open-door treatment as “very important” (10 out of 10 on a Likert scale). In contrast, only 21.0% (127/552) of participants were willing to accept voluntary treatment in locked wards, with 70.4% (425/552) explicitly rejecting this option. Logistic regression indicated that younger patients were significantly more likely to accept locked ward treatment (β=-.18, P=.04), while patients diagnosed with mood disorders (ICD-10 [International Statistical Classification of Diseases and Related Health Problems, Tenth Revision] F3) showed a trend toward lower acceptance (β=-.42, P=.08). Gender and other diagnoses were not significant predictors. Latent Dirichlet allocation identified 5 key topics within patient narratives, which hierarchical clustering grouped into 2 overarching themes: Restriction and Institutionalization, characterized by terms indicating confinement, loss of control, and social isolation; and Autonomy and Self-Determination, which emphasizes patients’ desire for freedom, control over daily life, and access to nature and outdoor spaces. This study provides robust evidence that psychiatric patients overwhelmingly prioritize open-door policies, linking them to enhanced autonomy, trust, and therapeutic engagement. The thematic analysis highlights the psychological and social costs of locked wards and the critical need for flexible, patient-centered care models. Younger age and diagnostic category influence willingness to accept locked settings, suggesting the need for tailored approaches. Institutions aiming to implement open-door policies should consider these preferences alongside adequate staffing, therapeutic programming, and environmental modifications to foster autonomy while maintaining safety. Integrating patient perspectives in policy design may enhance treatment satisfaction and clinical outcomes.
8. Effects of Information Length and Implementation Intentions on Adherence to Weight Management Strategies: Experimental Study.
期刊: JMIR mHealth and uHealth 发表日期: 2025-Aug-08 链接: PubMed
摘要
Adherence to weight management strategies may be undermined where lengthy strategy explanations limit engagement and understanding, weakening intervention efficacy. By contrast, implementation intentions have been shown to promote adherence across various health behaviors. This study aimed to investigate the impact of explanation length and implementation intentions on adherence to brief weight management strategies. Participants (N=200) with a BMI above 25 and an interest in losing weight were recruited from a commercial digital weight management service provider. Participants received information about 1 of 4 weight management strategies on a smartphone app in either a brief or detailed format and were asked to plan their use of the strategy with implementation intentions or were given tips on strategy use. Participants received daily prompts over a 2-week period to report whether they used their assigned strategy. Proposed moderators (need for cognition and planning skills) were measured at baseline. Strategy adherence was greater with brief information (mean 74%, SD 23%) compared with detailed information (mean 69%, SD 23%); however, this small effect size (Cohen d=0.24) was not statistically significant (P=.13). There was no moderation by need for cognition (P=.25). Adherence did not differ significantly between implementation intentions (mean 71%, SD 27%) and tips (mean 72%, SD 21%; P=.73); however, there was moderation by planning skills (P=.04). As predicted, adherence was greater with implementation intentions compared with tips among those with poorer planning skills. Shorter explanation length and implementation intentions (in poorer planners) may enhance adherence to brief weight management strategies, and further investigation is required to confirm these effects.
9. Investigating the Effects of a High-Load Resistance Training Program on Bone Health in Wheelchair Users (the BoneWheel Study): Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Aug-08 链接: PubMed
摘要
Low mechanical loading of the bones of wheelchair users leads to low bone mineral density (BMD) and increased risk of bone fractures and associated complications. High-load resistance training of the upper body is one way to achieve mechanical loading of the lumbar spine and the hip bones. In addition, maintaining good nutritional status with key nutrients for bone remodeling, that is, vitamin D and calcium, is important for bone accrual. This study aims to investigate the effect of 24 weeks of high-load resistance training combined with nutritional optimization on lumbar spine BMD. Secondary objectives are to investigate the effects of the intervention on (1) bone and physical health parameters, such as bone turnover blood markers, nutritional status, body composition, and maximal muscular strength, as well as (2) exercise motivation and mental health. In this randomized controlled trial, we aimed to include 60 wheelchair users with nonprogressive impairments. Participants were randomly allocated to 24 weeks of either (1) high-load resistance training and nutrition optimization or (2) nutrition optimization only, stratified by sex and sport activity status. The training program consisted of 3 weekly sessions comprising 6 exercises periodized in low-, moderate-, and high-load phases. The nutritional optimization aimed to ensure sufficient intake of protein, vitamin D, and calcium. BMD and body composition; maximal muscular strength; and nutritional, physical, and mental health status were assessed at baseline, midpoint, and postintervention visits. Furthermore, follow-up assessments of a subgroup were conducted at 6 to 18 months after the intervention. This protocol was approved by the Regional Committee for Medical and Health Research Ethics South-East, Norway. Recruitment occurred between November 2022 and 2023. A total of 68 wheelchair users were screened for eligibility, of whom 45 (66%) were enrolled and allocated to one of the study groups (n=24, 53% training group; n=21, 47% control group). At the midpoint and postintervention visits, 36 (n=17, 47% and n=19, 53%, respectively) and 33 (n=14, 42% and n=19, 58%, respectively) participants were assessed, respectively. Analysis of the data collected at the screening visit commenced in spring 2024, while analyses of data collected at the baseline and retest visits began in autumn 2024. Publication of the results of this study is expected by the end of 2025. This protocol presents the first randomized controlled trial of a high-load resistance training intervention in wheelchair users, focusing on bone, physical, and mental health. The results will contribute to new knowledge in exercise science for this population and generate novel hypotheses for future studies.
10. A Digital Tool for Assessing Well-Being at the Workplace and in Personal Life: Development and Validation of the Quan Well-Being Index.
期刊: JMIR formative research 发表日期: 2025-Aug-08 链接: PubMed
摘要
Quan is a workplace well-being digital platform that supports employees, teams, and organizations in measuring, understanding, and improving their well-being. It is important to develop a validated measurement instrument that enables users to assess and track their well-being over time. Currently, no digital measurement instrument comprehensively evaluates well-being across both personal and professional domains. We detail the development and validation of the Quan Well-being Index, a new digital self-report measure for assessing well-being in personal life and at the workplace. We performed 3 studies. The first study involved the conceptualization of 6 initial factors, the generation of 51 items, and the steps of face and content validity. In the second study, revised items were presented to a UK sample. In the third study, an independent UK sample completed the final assessment along with a battery of well-being and personality questionnaires. A subsample of participants from the third study retook the assessment approximately 2 weeks after initial completion. In the first study, after face and content validity processes, the number of items was reduced to 45. In the second study, exploratory factor analysis on data from 1020 participants (age: mean 43.06, SD 12.98 years; 525 female participants) identified a 4-factor solution with 35 items (Kaiser-Meyer-Olkin value=0.98; Bartlett test: χ2990=37063.54; P<.001), accounting for 64% of variance. The 4 factors were thrive and connect in personal life, thrive and connect at work, mental health, and physical health. In the third study, confirmatory factor analysis on data from 966 participants (age: mean 44.4, SD 12.52 years; 480 female participants) tested 4 structural models. A hierarchical model (model 1) where the general factor influenced the 4 group factors demonstrated the best fit (χ2521=3467.00; Bentler comparative fit index=0.906; Tucker-Lewis index=0.892; root mean square error of approximation=0.077; standardized root mean square residual=0.048; ΔAkaike information criterion=0.0; ΔBayesian information criterion=0.0). Internal reliability was high across subscales (Cronbach α=.88-.93; McDonald ω total=0.89-0.94; Guttman λ6=0.86-0.92). Convergent validity was demonstrated by strong correlations with the Warwick-Edinburgh Mental Well-being Scale (r=0.45-0.85; P<.001) and Flourishing-at-Work Scale (r=0.80-0.84; P<.001). Divergent validity was supported through weak or negative correlations with Big Five Personality Inventory traits (eg, neuroticism: r=-0.29; P<.001). Test-retest reliability assessed in a subset of 275 participants (age: mean 52.12, SD 9.56 years; 170 female participants) over a 2-week interval was strong to very strong across factors (r=0.74-0.81; P<.001). The Quan Well-being Index provides a comprehensive assessment of well-being at the workplace and in personal life, and is anticipated to be a valuable digital tool, enabling individuals, teams, and organizations to gain insights, monitor progress, and implement appropriate interventions for a healthier workforce.
11. Optimizing Cardiovascular Risk Management in Primary Care Using a Personalized eCoach Solution Enhanced by an Artificial Intelligence-Driven Clinical Prediction Model: Protocol from the Coronary Artery Disease Risk Estimation and Early Detection Consortium.
期刊: JMIR research protocols 发表日期: 2025-Aug-08 链接: PubMed
摘要
Atherosclerotic cardiovascular disease poses a heavy burden on the population’s health and health care costs. Identifying apparently healthy individuals at risk of developing cardiovascular diseases using clinical prediction models raises awareness, facilitates shared decision-making, and supports tailored management of disease prevention. In the CARRIER project, a personalized cardiovascular risk management (CVRM) eCoach approach is cocreated, in which identified individuals receive education, guidance, and monitoring to prevent atherosclerotic cardiovascular disease through existing interventions. In this approach, an artificial intelligence-driven clinical prediction model calculates the 10-year risk for atherosclerotic cardiovascular disease, which supports informed decision-making. This study aims to assess the effectiveness of our CVRM eCoach approach through a 10-year risk calculation of atherosclerotic cardiovascular disease, including risk factors contributing to this risk. This pretest-posttest interventional study provides the CVRM eCoach approach for 6 months to 100 apparently healthy individuals eligible for CVRM. The CVRM eCoach approach is a multicomponent eHealth solution, including a clinical prediction under intervention model that not only calculates the 10-year risk of cardiovascular disease through conventional risk factors (smoking, blood pressure, and lipid profile) and individual characteristics (age, gender, socioeconomic status, physical activity, and diet) but also calculates how the risk changes after hypothetical lifestyle or medical interventions. The CVRM eCoach approach includes features that encourage behavior change. Most of these features include goal setting, decision cards to help decide on an intervention, intervention monitoring, remote communication, and education, all accessible from one dashboard. A practice nurse or physician consults the individuals after risk calculation with the clinical prediction model and uses behavior change features, such as the decision cards, to support shared decision-making. Data are primarily collected via the eCoach, after which the 10-year risk for atherosclerotic cardiovascular disease and its components are analyzed using paired-sample analyses. Recruitment began in March 2024 and will continue until 100 participants have been recruited, which is expected in 2025. We anticipate that our CVRM eCoach approach will be valuable in the primary prevention setting. During the crucial initial first months of habit formation, factors such as education, regular check-ups via the eCoach, and clear risk communication could support individuals in sustaining their medical or lifestyle interventions. We hypothesize that there will be a slight to moderate reduction in the 10-year risk of atherosclerotic cardiovascular disease, which over time will lead to significant health improvements on a larger scale. CCMO NL84584.096.23; https://onderzoekmetmensen.nl/nl/trial/56578.
12. The prevalence and risk factors of posttraumatic stress disorder following road traffic accidents in China: A meta-analysis.
期刊: Traffic injury prevention 发表日期: 2025-Aug-08 链接: PubMed
摘要
While the prevalence of posttraumatic stress disorder (PTSD) after road traffic accidents (RTA) has been widely studied, there is a gap in research in the context of China. Therefore, this study aimed to provide a pooled estimation of PTSD prevalence after RTA based on Chinese data and compare it to existing international prevalence. A systematic literature search of English and Chinese databases was performed from their inception dates to December 31, 2024. Chinese patients admitted to a hospital or emergency department after RTA, and without traumatic brain injury following RTA or without PTSD before RTA were included, regardless of type of RTA and whether fracture was sustained. Subgroup analyses were performed on the basis on demographics, assessment methods, income, and comorbidity. The inclusion criteria were met by 21 studies. The pooled prevalence of acute stress disorder (ASD) and PTSD was 30% (95% CI, 22%-37%) and 27% (95% CI,22%-32%), respectively, which is higher than the global prevalence of 16% ASD and 22% PTSD. The transition rate of ASD to PTSD was 77% (95% CI, 63%-91%). Females, older adults, and those with lower income had a higher prevalence of PTSD. In addition, the prevalence of PTSD increased with age. Older survivors with comorbidities including anxiety, depression, complication (such as pain, hemorrhagic shock, hypoxemia), diabetes, and hypertension were more likely to suffer from PTSD than older survivors without those comorbidities. PTSD after RTA is common, with more than one in four RTA survivors reporting PTSD. Pooled prevalence was higher than that of meta-analysis that had no restrictions on world region.
13. Optimizing and Automating Aggregation and Visualization of COVID-19 Data in Metro Manila, Philippines Through the Use of a Free Dashboard Software: A Case Study.
期刊: Journal of public health management and practice : JPHMP 发表日期: 2025-Aug-08 链接: PubMed
摘要
In response to an increased demand for data, staff from the Regional Epidemiology and Surveillance Unit of the Department of Health Metro Manila developed an internal dashboard to automate the aggregation and visualization of COVID-19 data from multiple sources, thereby decreasing the time taken to complete the process by approximately 35 minutes, or more than half the duration of the original workflow. Time, financial, and human resource constraints were overcome with staff commitment and communication, and the approach was scaled to develop dashboards for other surveillance systems. Dashboards are useful for aggregation and visualization of data at the subnational level, but they are not replacements for critical review and effective communication of data. Further studies on dashboard development will help establish a framework and promote a new standard for public health organizations at the subnational level.
14. Reporting Digital Health Implementations Based on the iCHECK-DH Guidelines and Checklist: Development of an Interactive Toolkit.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-08 链接: PubMed
摘要
Despite their potential, many digital health implementations fail to scale beyond pilot stages due to reporting challenges, stakeholder disengagement, and policy barriers. To improve documentation and knowledge sharing, the iCHECK-DH (Guidelines and Checklist for the Reporting on Digital Health Implementations) guidelines have been developed by global experts and implemented by the Journal of Medical Internet Research as the required reporting standard for implementation reports. This study aims to introduce an interactive iCHECK-DH toolkit designed to streamline reporting, facilitate knowledge sharing, and support scalability, demonstrating its practical application through a use case. The iCHECK-DH toolkit was developed through an iterative process informed by best practices for creating user-friendly toolkits. A targeted literature review and analysis of World Health Organization documents were conducted to identify best practices in toolkit design. A multidisciplinary team designed the toolkit using the Fillout platform (Restly, Inc) for its intuitive interface. A total of 9 international experts in digital health and implementation science were recruited through purposive sampling. They provided qualitative feedback through semistructured interviews and open-ended comments on the draft toolkit. Discussions focused on content relevance, usability, and alignment with the iCHECK-DH framework. Feedback was thematically analyzed and key suggestions were incorporated iteratively into subsequent versions of the toolkit. It underwent pilot testing, with a real-world Family Planning Stock Management System in Sri Lanka serving as the use case. The findings further refined the toolkit’s practicality and informed final improvements. The interactive toolkit successfully translated the iCHECK-DH guidelines into a structured digital health implementations reporting tool, refining navigation, terminology, and usability based on qualitative feedback from the expert panel. It features 4 main sections, including a step-by-step checklist aligned with the 20 items of the iCHECK-DH framework, contextual explanations and examples for each item, a self-assessment function to track progress, and automatic compilation of a downloadable PDF report. Pilot testing showed that the toolkit enabled comprehensive documentation of all 9 domains and 20 checklist items from the iCHECK-DH framework. It confirmed its practicality and effectiveness, leading to targeted improvements. Time to complete the toolkit was 40 minutes (final version) after usability refinements. The iCHECK-DH toolkit complements the iCHECK-DH guidelines, enhances their functionality, and demonstrates their usability through a practical use case. It provides a structured approach to digital health reporting, supporting scalability and knowledge sharing in real-world implementations.
15. Improving Affective Associations With Physical Activity via a Message-Based mHealth Intervention (WalkToJoy): Proof-of-Concept Study.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-08 链接: PubMed
摘要
Traditional mobile health interventions for physical activity (PA) primarily rely on reflective self-regulatory processes, often neglecting the role of affective associations in sustaining long-term engagement. The WalkToJoy intervention addresses this gap by applying the affective-reflective theory to enhance intrinsic motivation for PA among adults aged ≥40 years through affective message framing, evaluative conditioning, and belief updating. This proof-of-concept study evaluated the feasibility of the message-based WalkToJoy intervention package and examined the impact of its 3 components-walking suggestion prompts, salience messages, and planning prompts-on affective and behavioral outcomes related to walking. We conducted a fully remote, 6-week full factorial experiment with an embedded microrandomized trial (MRT) involving 49 adults aged ≥40 years. Statistical analyses, including paired t tests and generalized estimating equations, assessed pretest-posttest changes and the effects of smile-inducing walking suggestion prompts with short animated images (GIF images), salience messages, and planning prompts on weekly affective measures and daily step counts. In addition, MRT analyses evaluated the proximal effects of these components. Poststudy interviews were thematically analyzed to contextualize participants’ experiences and engagement with the intervention. Significant pretest-posttest improvements were observed across affective outcomes on a 7-point Likert scale-affective attitudes improved by 0.547 points (P<.001), affective valuations improved by 0.718 points (P<.001), affective reflection improved by 0.692 points (P<.001), and anticipated affect improved by 0.692 points (P<.001). While the average daily steps showed a nonsignificant pretest-posttest increase of 80 steps (P=.79), further analysis revealed an increase of 506 steps (P=.07) when comparing baseline to the average of weeks 4 to 6. Among the intervention components, GIF prompts significantly increased anticipated affect by 0.345 points (P=.046) and average daily step count by 1834 steps (P=.05) compared to identical text-only prompts. However, MRT analysis found no significant increase in 4-hour step counts following the walking suggestion prompts (P=.55), which was explained by qualitative findings suggesting that participants interpreted messages as flexible day-long reminders rather than immediate calls to action. Salience and planning prompts did not yield substantial quantitative effects but were positively received by participants for promoting mindfulness and personalized engagement. The WalkToJoy intervention is a feasible and promising approach for improving affective associations with walking. Walking suggestion prompts were particularly effective in boosting engagement and mitigating message fatigue, highlighting the potential of affect-driven interventions to enhance PA motivation and adherence.
16. Exergame-Based Behavior Change Interventions for Promoting Physical Activity: Systematic Review and Meta-Analysis of Randomized Controlled Studies.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-08 链接: PubMed
摘要
Physical inactivity is defined to be an activity level insufficient to meet recommendations. Exergame, which refers to a combination of exercise and video games, has the potential to promote physical activity (PA). Behavior change techniques (BCTs), the minimal, replicable components of an intervention, are widely used to identify components used in health behavior promotion. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to examine the overall effects of exergame-based interventions for promoting PA and their influencing factors. BCTs were also identified and discussed in this review. We searched for relevant RCTs across 6 databases from their inception to March 21, 2024. Meta-analyses using random-effects models assessed the effects on PA, moderate to vigorous physical activity (MVPA), light physical activity, moderate physical activity, vigorous physical activity, sedentary time, step count, and BMI. Subgroup analyses of PA were conducted to explore the influencing factors of exergame-based behavior change interventions. Review Manager software (version 5.3; Cochrane Collaboration) and Stata software (version 16; StataCorp) were used to analyze data. A total of 20 RCTs targeting populations with various medical conditions (aged between 7.5 and 79 years; 1073/2211, 48.5% female) were included in this review, with sample sizes ranging from 16 to 1112. Exergame-based behavior change interventions significantly increased PA (standard mean difference [SMD] 0.19, 95% CI 0.05-0.33), MVPA (SMD 0.48, 95% CI 0.12-0.85), and step counts (SMD 0.54, 95% CI 0.13-0.94). Furthermore, subgroup analyses showed that intervention implementer (research assistants vs other implementers), game console (Microsoft Xbox vs Sony PlayStation vs Nintendo Wii), game participation type (individual game vs nonindividual game), measurement method (subjective vs objective), and the number of BCTs (n<7 vs 7≤n<10 vs n≥10) used significantly influenced the effectiveness of these interventions. The most frequently used BCTs included “1.4 action planning” (n=15), “1.1 goal setting” (n=13), “12.5 adding objects to the environment” (n=13), “2.3 self-monitoring of behavior” (n=11), and “4.1 instruction on how to perform the behavior” (n=11). Our review has demonstrated that exergame-based interventions are effective in promoting PA. Future trials are needed to further validate the insights proposed in our studies and assess the long-term effects on PA.
17. Effects of a Theory- and Evidence-Based, Motivational Interviewing-Oriented Artificial Intelligence Digital Assistant on Vaccine Attitudes: A Randomized Controlled Trial.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-08 链接: PubMed
摘要
Attitude-targeted interventions are important approaches for promoting vaccination. Educational approaches alone cannot effectively cultivate positive vaccine attitudes. Artificial intelligence (AI)-driven chatbots and motivational interviewing (MI) techniques show high promise in improving vaccine attitudes and facilitating readiness for vaccination. This study aimed to evaluate the effectiveness of a theory and evidence-based, MI-oriented AI digital assistant in improving COVID-19 vaccine attitudes among adults in Hong Kong. This 2 parallel-armed randomized controlled trial was conducted from October 2022 to June 2024. Hong Kong adults (N=177) who were vaccine-hesitant were randomly assigned into 2 study groups. The intervention group (n=91) interacted with the AI digital assistant over 5 weeks, including receiving a web-based education program comprising 5 educational modules and communicating with an AI-driven chatbot equipped with MI techniques. The control group (n=86) received WhatsApp (Meta) messages directing them to government websites for COVID-19 vaccine information and knowledge, with the same dosage as the intervention group. Primary outcomes included vaccine hesitancy. Secondary outcomes included vaccine readiness, confidence, trust in government, and health literacy. Outcomes were measured at baseline, postintervention, 3-month, and 6-month follow-up. Focus group interviews were conducted postintervention. Intervention effects were analyzed using the generalized estimating equation model. Interview data were content analyzed. Decreases in vaccine hesitancy were observed while no statistically significant time-by-group interaction effects were found. The intervention showed significant time-by-group interaction effects on vaccine readiness (P=.04), confidence (P=.02), and trust in government (P=.04). Significant between-group differences with medium effect sizes were identified for vaccine readiness (Cohen d=0.52) and trust in government (Cohen d=0.54) postintervention, respectively. Increases in vaccine-related health literacy were observed, and a significant time effect was found (P=.01). In total, three categories were summarized from interview data: (1) improved vaccine literacy, confidence, and trust in government; (2) hesitancy varied while readiness improved; and (3) facilitators, barriers, and recommendations of modifications on the intervention. The intervention indicated promising yet significant effects on vaccine readiness while the effects on vaccine hesitancy require further confirmation. The qualitative findings; however, further consolidate the significant effects on participants’ attitudes toward vaccines. The findings provide novel evidence to encourage the adoption and refinement of a MI-oriented AI digital assistant in vaccine promotion.
18. STate Activation and Response (STAR): An Evidence-Based, Practice-Informed Approach to Public Health System Improvement.
期刊: Journal of public health management and practice : JPHMP 发表日期: 2025-Aug-08 链接: PubMed
摘要
This article summarizes the development and refinement of the STate Activation and Response (STAR) technical assistance program. STAR is an evidence-based, practice-informed approach to supporting state and territorial health departments with developing, implementing, and evaluating chronic disease prevention and health promotion programs. The National Association of Chronic Disease Directors developed the first version of this program during 2008 and has iteratively updated the program based on organizational effectiveness literature, evidence-based public health practice, and state and territorial health department feedback. The current version of STAR was implemented during 2019; through the end of 2023, 15 states, and 1 territory participated in the program using the revised framework. This new iteration of STAR has been well-received by state and territorial health department participants, who have reported improvements to public health infrastructure and operations, workforce training and wellbeing, application of evidence-based practice and communication, and commitment to a shared mission.
19. Meme Exposure on Social Media Associated with More Positive E-Cigarette Perceptions and Greater Usage Among Youth.
期刊: Journal of health communication 发表日期: 2025-Aug-08 链接: PubMed
摘要
Internet memes, viral and mutable messages online, have been used by individuals and organizations to disseminate health messages. Specifically, both companies and public health organizations have used memes to influence e-cigarette behaviors. How does exposure to e-cigarette memes on social media shape related perceptions and behaviors among youth? This study extracted data from restricted-use file of Wave 7 (2022-2023) of the Population Assessment of Tobacco and Health (PATH) study, a nationally representative study that collected information about tobacco use and associated health behaviors among adults (≥18 years) and youth (12-17 years) in the United States. Our analyses investigated the association between youth participants’ exposure to various sources of memes related to e-cigarette use and their e-cigarette-related expectancies, perceptions, use, and cessation, while controlling for parental and youth factors. Exposure to memes posted by friends and celebrities were all associated with lower perceived harmfulness, higher descriptive norms, more positive injunctive norms of using e-cigarettes, and more ease for purchasing e-cigarettes (ps<.05). For youth who do not use e-cigarettes, exposure to e-cigarette memes was associated with higher susceptibility of using e-cigarettes (ps<.01). Additionally, exposure to memes posted by friends was also associated with lower e-cigarette quit intentions. E-cigarette memes may influence youth’s perceptions about e-cigarettes and contribute to initiation among youth. Future research is needed for identifying strategies in using Internet memes for e-cigarette prevention and health campaigns.
20. A mixed methods evaluation of Total Worker Health® training transfer in México.
期刊: Journal of occupational and environmental medicine 发表日期: 2025-Aug-08 链接: PubMed
摘要
This study evaluated training transfer after a Total Worker Health (TWH) training with Mexican safety engineers and occupational medicine physicians and residents. We used a mixed methods analysis to assess responses pre- and post-training and 3-months after. Nearly three quarters (73%) of participants applied a TWH concept from the course into their work. Over half (52%) of participants worked to change the way they applied the TWH approach, examples included broadened awareness of what health means at work and the need for workforce engagement. While changes in TWH practices occurred, gaps remained. The TWH training facilitated behavior changes, particularly in leadership for TWH practices. Factors supporting skill transfer included a national-level TWH-type program, positive mindsets, and willingness to implement change. Additional training is needed to address specific skills in TWH risk assessment and controls.
21. Rapid Detection of Carbapenemase-Producing Enterobacterales Using a Luminescent Whole-Cell Biosensor.
期刊: ACS infectious diseases 发表日期: 2025-Aug-08 链接: PubMed
摘要
Carbapenemase-producing Enterobacterales (CPE) pose an urgent global health threat due to their ability to inactivate carbapenems, a group of last-resort antibiotics. Infections caused by these pathogens are associated with poor patient outcomes, high mortality rates, and added burden to infection prevention and control programs, making early detection vital to ensure optimal antimicrobial therapy and appropriate implementation of infection control practices. In this study, we report the application of a luminescent whole-cell biosensor for the rapid detection of CPE. This biosensor provides positive test results within 2.5 h, inclusive of setup time, and has been validated with a panel of laboratory and clinical isolates producing a diverse range of carbapenemases (KPC, NDM, IMP, VIM, and OXA-48-like). The assay identified 81/83 CPE isolates tested with a sensitivity of 97.5%, including strains producing weak OXA-48-like carbapenemases, which are sometimes missed by currently used detection methods. The assay also demonstrated a specificity of 100%, with all non-CPE clinical isolates testing negative under the optimized assay conditions. Due to the rapid time-to-positivity, minimal setup requirements, and high sensitivity, this test could serve as an attractive alternative to CPE detection methods currently employed by clinical microbiology laboratories and could also facilitate CPE screening in other settings (e.g., environmental and agricultural).
22. Applications of Ballistocardiogram in the Diagnosis of Coronary Heart Disease: Systematic Review.
期刊: JMIR cardio 发表日期: 2025-Aug-08 链接: PubMed
摘要
Coronary heart disease (CHD) continues to account for a substantial proportion of deaths worldwide. Ballistocardiogram (BCG), a noncontact, noninvasive technique for monitoring cardiac activity, has gained increasing attention for its potential role in various medical applications, particularly in CHD. This review comprehensively explores the applications of BCG in the diagnostic evaluation of CHD. The aim of this systematic review is to evaluate the clinical applications and diagnostic capabilities of BCG in CHD, with the ultimate goal of enhancing the precision of CHD management and optimizing therapeutic decision-making pathways. A literature search was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines to identify studies evaluating the use of BCG in CHD. The initial search identified 500 studies. Based on titles, abstracts, and keywords, 266 studies were selected for further review. Following further exclusion of non-English articles, animal studies, and review articles, 38 eligible studies were included in the final analysis. Among the 38 studies, 22 focused on the application of BCG in acute coronary syndrome. These studies explored various aspects, including BCG waveforms in patients with acute myocardial infarction, the diagnosis of acute coronary syndrome, and the relationship between age and the rate of abnormal BCG waveforms. The remaining studies covered the effects of drugs, emotions, exercise, and other variables on BCG recordings in patients with CHD. Sample sizes varied significantly across the studies, 36 studies explicitly reported sample sizes, encompassing a total of 9479 participants with individual study sizes ranging from 1 to 903 cases. Notably, 13 studies enrolled fewer than 50 participants, raising concerns about potential selection bias and reduced reliability of the findings. Overall, while BCG demonstrates significant potential in the diagnosis and prevention of CHD, several limitations remain. Variability in study design, sample size, and outcome measures poses challenges to the generalizability of findings. Nevertheless, the capability of BCG to reflect cardiac function and assist in the detection of CHD remains valuable. With continued research and technological advancement, BCG has the potential to transform current approaches to CHD diagnosis and management, ultimately improving patient outcomes and quality of life.
23. Development of a Sham Smartphone App for Opioid Use Disorder: Acceptability and Suitability Study.
期刊: JMIR formative research 发表日期: 2025-Aug-08 链接: PubMed
摘要
Despite having evidence-based medication for opioid use disorder (OUD), dropout is one of the most common issues noted with this treatment. Prescription digital therapeutics, which are app-based interventions prescribed by a health care professional, have the potential to increase adherence to medication for OUD and retention while overcoming treatment barriers, including provider capacity and patient access. Using a sham app as a control condition for a randomized clinical trial is an innovative method to establish the true efficacy of these apps. This study included the development and testing of a sham smartphone app for OUD. After the sham app was developed, participants were enrolled in a 4-week trial examining the use and suitability of the sham app as a control condition. Criteria for determining suitability included (1) participants believing the sham app is an active intervention and (2) participants experiencing no clinical improvements in depression severity or quality of life after using the sham app. Self-reported depression severity and quality of life were captured before and after using the sham app. A user satisfaction survey and semistructured interviews were conducted at the end of the study. Quantitative analyses included paired 2-tailed t tests. The semistructured interviews were conducted with 20 of the 21 participants, and these interviews were analyzed using rapid qualitative analysis. Overall, 21 participants (meanage 42.0, SD 6.4 years; female: n=9, 43% and male: n=12, 57%) were enrolled. The average number of app log-ins was 17.8 (SD 10.6; range 1-41). There were 2 participants who only logged in 1 time, and 15 (71%) participants completed the goal of logging in an average of 3 times per week. No significant differences were found in depression severity (P=.50) or quality of life (quality of life: P=.42, physical health: P=.58, psychological health: P=.07, environmental health: P=.44, and social relationships: P=.86) after using the sham app. Of the 20 participants who completed the semistructured interview, 19 (95%) believed that they were using an active intervention. The user satisfaction survey revealed high overall satisfaction with the sham app with a score of 91%. Qualitative analyses revealed several recurring themes, including perceived value and impact, potential for behavior change, use patterns and engagement, perspective and usability, and perceptions of authenticity. Our sham app met our a priori criteria for suitability as a sham app. No clinical improvements from baseline were observed at the end of the study period, and all but 1 participant believed that they were using an active intervention. Demonstrating that this sham app is suitable as a control condition elevates the rigor of randomized clinical trials and ensures the efficacy of prescription digital therapeutics.
24. Ecological Roles and Shared Microbes Differentiate the Plastisphere from Natural Particle-Associated Microbiomes in Urban Rivers.
期刊: Environmental science & technology 发表日期: 2025-Aug-08 链接: PubMed
摘要
The “plastisphere,” comprising microbes associated with microplastics (MPs), may have substantial ecological impacts on riverine ecosystems. However, little is known about how the microbiomes associated with anthropogenic MPs compare with those associated with natural particles (NPs) in urban rivers with varying MP pollution levels. We therefore conducted a comparative analysis of the metagenomes associated with MPs and NPs (100-5000 μm) and river water (RW) across 10 urban river systems. Although we found similarities in taxonomic and functional compositions between the microbiomes associated with MPs and NPs, the plastisphere exhibited distinct associations with specialized taxa and life-history strategies. These unique traits enhanced the potential of the plastisphere for complex carbohydrate and plastic degradation, nitrate and nitric oxide reduction, and antibiotic resistance and virulence compared with the NP or RW microbiomes. Furthermore, MPs supported the sharing of unique microbes with the surrounding RW; these shared microbes possessed enhanced horizontal gene transfer capabilities and potentially could disperse traits of the plastisphere into the broader RW microbiomes. This study highlights the distinct ecological roles and shared microbes of the plastisphere, indicating that MP pollution may substantially and uniquely impact the function and health of riverine ecosystems.
25. A Self-Powered pH Sensing Method Based on a Triboelectric Nanogenerator: An Innovative Application in Marine Ranch Water Quality Monitoring.
期刊: Langmuir : the ACS journal of surfaces and colloids 发表日期: 2025-Aug-08 链接: PubMed
摘要
To achieve intelligent aquaculture and ensure environmental health, water quality monitoring is indispensable in marine ranching. However, the energy supply for widely deployed sensors remains a critical challenge. Self-powered sensing technology is one of the core solutions to address this bottleneck. In this research, a capsule-structured, solid-solid/solid-liquid mixed-mode triboelectric nanogenerator (TENG) is proposed, which addresses the limitations of the existing TENG technology in marine environments. The proposed TENG collects wind and wave energy by coupling solid-solid contact electrification with the bilayer effect at the solid-liquid interface under complex marine conditions. A theoretical model of triboelectric energy conversion and solid-liquid pH sensing is developed. Additionally, the TENG self-powered sensing structure is optimized to improve its performance for pH monitoring under a range of conditions in marine ranches. The experimental results demonstrate that the capsule-type dual-mode TENG (CD-TENG) achieves an open-circuit voltage of 50 V and a short-circuit current of 25 μA under optimal conditions. The peak power density of 0.35 W/m2 enables sustained operation of low-power microelectronics, which is beneficial for real-time water quality monitoring in marine ranching.
26. Integrating Planetary Health Into Residencies: A Vital Step for Medical Education.
期刊: Academic medicine : journal of the Association of American Medical Colleges 发表日期: 2025-Aug-08 链接: PubMed
摘要
The escalating climate crisis necessitates that health care and medical education adapt to the increasing health impacts of extreme weather events, rising temperatures, and shifting ecosystems. Patients and medical trainees are already confronting the health consequences of climate change, pollution, and environmental degradation, while health care systems grapple with effects on service delivery. These environmental challenges underscore the need for health care and medical education that is resilient and proactive in addressing emerging threats.Planetary health is a field inclusive of the effects of climate change and environmental degradation on human health and the broader systems that sustain life. Many U.S. medical schools have begun integrating planetary health into their curricula. However, without deliberate and scaffolded inclusion of planetary health education throughout graduate medical education, trainees may lack the ability to translate environmental determinants of health into actionable clinical strategies that improve patient outcomes and health care system resilience, as graduate medical education plays a pivotal role in shaping physicians’ practice patterns. The Accreditation Council for Graduate Medical Education (ACGME), which sets the standard for routine graduate medical education, has the opportunity to help prepare trainees to meet societal needs and equip them for the challenges they will encounter in their medical practice.Incorporating planetary health into the Common Program Requirements would establish a training standard for planetary health, now widely recognized as fundamental to human health. Existing ACGME priorities, such as health equity, quality improvement, systems-based practice, and interdisciplinary collaboration, align with planetary health approaches. The ACGME’s endorsement of planetary health education would ensure all residents acquire the skills and knowledge necessary to address the health consequences of climate change and are prepared to practice sustainable health care, thus fostering a health care workforce capable of meeting the needs of patients and delivering resilient, sustainable, and equitable care.
27. A Qualitative Study to Investigate the Nutrition Perspectives and Experiences of Veterans with Chronic Kidney Disease.
期刊: Clinical journal of the American Society of Nephrology : CJASN 发表日期: 2025-Aug-08 链接: PubMed
摘要
Chronic kidney disease (CKD) affects susceptible populations at higher rates than the general public. Dietary adherence, quality, and behaviors play a crucial role in CKD and chronic disease management. However, individuals with CKD, including Veterans and those with mission-driven occupations and cultures, face unique challenges navigating dietary recommendations and kidney-health promoting diets. Understanding factors such as military or occupational experiences, comorbidities, and dietary barriers, may lead to developing effective, patient-centered dietary interventions. We conducted a qualitative descriptive study and semi-structured interviews with 32 Veterans with CKD (stages 3b-5; including dialysis), mean age of 71 years, 54% White/Caucasian, and 16% women, receiving care at the Veterans Affairs (VA) Eastern Colorado Health Care System, from June 2023 to July of 2024. Interview constructs included healthy eating, CKD management, food preferences and decision making. We conducted thematic analyses using an inductive approach to understand participants’ perspectives and experiences. Three overarching domains emerged: (1) Moments that Matter, shaping dietary behaviors by themes such as health crises, diagnoses, and the perceived mortal consequences of food choices; (2) Chronic Disease Perceptions, Management, and Adaptation, capturing the burden of rigid dietary restrictions, conflicting recommendations, and dichotomies between strict rules versus flexible healthy diet principles; and (3) Contextual Factors that Influence Health, Nutrition, and Adaptation, highlighting the impact of social support, military culture, and environmental influences on food behaviors. Veterans’ experiences with CKD nutrition and management are shaped by pivotal health events, rigid dietary frameworks, military-influenced eating habits, and other social-emotional contextual factors. Nutrition and healthcare approaches should focus on personalized, flexible approaches and leveraging existing VA-based principles that emphasize patient-centered care and experience. These include supporting individuals by acknowledging urgency in dietary decision-making, capitalizing on key moments for intervention, and increasing awareness of nutrition’s role in health without reinforcing restrictive, unsustainable dietary patterns.
28. Perceptions of Child-Adult Relationship Enhancement (CARE) Training Usefulness for Educational, Behavioral, and Allied Health Professionals: Attitudes Toward Evidence-Based Practices.
期刊: Journal of clinical psychology in medical settings 发表日期: 2025-Aug-08 链接: PubMed
摘要
Child-Adult Relationship Enhancement (CARE) is an evidence-informed approach to promote positive child-adult relationships in youth with behavior problems or traumatic stress. Implementing CARE in community settings may extend accessibility to evidence-based practices (EBP) for children in underserved areas. The present study examined health professionals’ perceptions of CARE. Participants were 277 professionals from a statewide training initiative including early childhood educators (n = 178), allied health professionals (n = 48; speech, occupational, physical therapists), and behavioral health clinicians (n = 51) completing CARE training. Participants completed the Evidence-Based Practice Attitude Scale (Aarons (2004) Mental Health Services Research 6:61-74) (pre-training). Post-training, participants completed two scales created for this study which assessed participants perceptions of the training experience. Structural equation modeling evaluated differences in health professionals’ perceptions of CARE and EBP. CARE was the most well received by allied health professionals, who reported greater favorability of EBP relative to behavioral health clinicians (0.12, 95% CI [.04, .24]). Additionally, results indicated greater favorability of EBP-mediated perceived usefulness (0.17, 95% CI [.07, .31]). CARE is a well-received training for professionals working with youth. Interprofessional training may enhance developmental and behavioral outcomes for youth, and our findings suggest particular receptivity to CARE by allied health professionals and implicate EBP favorability as a key driver.
29. Analysis of Perfluoroalkyl Substances (PFASs) in Settled Dust by Liquid Chromatography with Tandem Mass Spectrometry: Method Validation and Application to Vietnamese House and Road Dusts.
期刊: Bulletin of environmental contamination and toxicology 发表日期: 2025-Aug-08 链接: PubMed
摘要
Information about perfluoroalkyl substances (PFASs) like perfluoroalkyl carboxylic acids (PFCAs) and sulfonates (PFSs) in settled dust from emerging and developing countries is still limited, partly due to the lack of efficient analytical methods. In this study, a reliable, simple, and cost-effective analytical procedure was developed and validated to determine 12 PFCAs and 4 PFSs in dust samples. The samples were ultrasonicated with methanol, followed by a dispersive sorbent clean-up step with graphitized carbon and quantification by liquid chromatography with tandem mass spectrometry (LC-MS/MS) method. The analytical method exhibited adequate recovery (80-120% for native standards and 50-130% for labeled standards), precision (relative standard deviations < 25%), and detection limits (0.010-0.10 ng/g). The validated method was applied to analyze PFAS concentrations in settled dusts collected from Hanoi, Vietnam. PFASs were frequently detected in the Vietnamese dust samples at relatively low concentrations (median 4.15, max 27.4 ng/g).
30. An Evaluation of the Prevalence and Efficacy of Gender Affirmative Vocal Therapy in Poland.
期刊: Archives of sexual behavior 发表日期: 2025-Aug-08 链接: PubMed
摘要
The voice is one of the most important factors influencing gender and cultural identity. Voice problems and disabilities are common in the transgender community. This preliminary research investigates the prevalence of voice problems in transgender people who have completed or are in the process of completing gender reassignment in Poland. The aim was to describe the scope of challenges faced by the transgender community and to assess whether gender affirmative vocal therapy improves outcomes during gender transition. A questionnaire was distributed through secure social media forums to gather anonymized data. The questionnaire explored demographic details, self-perception, societal perception, and voice quality perception. Out of 200 responses, 21 confirmed participating in gender affirmative vocal therapy. Ten elements of voice quality perception were significantly improved in the gender affirmative vocal therapy group compared to controls (p < 0.033). The study showed a significant impact of societal and self-perception on voice quality perception. It is crucial for health and well-being that people who undergo gender reassignment have access to gender affirmative vocal therapy.
31. Cannabis sensitization and allergy in cannabis industry workers, recreational cannabis users, and non-users.
期刊: Journal of occupational and environmental medicine 发表日期: 2025-Aug-08 链接: PubMed
摘要
To evaluate respiratory and allergic health symptoms and sensitization to cannabis in cannabis workers while controlling for recreational cannabis use. We compared allergic and respiratory symptoms, lung function, and airway inflammation among cannabis workers (n = 42) and recreational cannabis users (n = 20) and non-users (n = 20) with no occupational exposure. In multivariable regressions adjusted for recreational cannabis use, cannabis workers trended toward increased airway inflammation and decreased pulmonary function when compared to non-workers. Compared to non-workers, cannabis workers exhibited increased odds of cannabis sensitization on skin prick test (OR: 9.5, 95% CI 1.38 to 193; P = 0.05) and reported a higher prevalence of allergic symptoms (OR: 3.7, 95% CI 0.91,16.9; P = 0.07). Our findings suggest that occupational exposures contribute to the respiratory and allergic effects seen in cannabis workers, regardless of recreational cannabis use.
32. More Than a Symptom Count: Measuring Functioning in Alcohol Use Disorder With the Life Stress Interview.
期刊: Journal of studies on alcohol and drugs 发表日期: 2025-Aug-08 链接: PubMed
摘要
The alcohol field has increasingly recognized that functioning plays a key role in the clinical course of alcohol use disorder (AUD). However, there remains a need for comprehensive instruments that capture functioning in this population. This study examined the utility of the UCLA Life Stress Interview Chronic Stress Assessment (LSI)-a functional domains-based assessment widely used in mood disorder research-as a tool to measure functioning in key life domains in AUD. We: (1) compare LSI scores between individuals with and without current AUD; and (2) examine whether LSI scores are associated with recent alcohol use and AUD symptomology. This secondary case-control study included 38 adults with AUD and 35 age- and biological sex-matched controls. The LSI was used to assess functioning in interpersonal, occupational, personal health, and family health domains over the prior 6-months. The Timeline Followback was used to assess recent alcohol use, and the Structured Clinical Interview for DSM-5 was used to assess AUD symptomology. Individuals with AUD exhibited significantly poorer interpersonal, occupational, and personal health functioning, compared to controls. Among individuals with AUD, worse interpersonal, occupational, and personal health functioning correlated with a higher number of AUD symptoms, and both interpersonal and occupational functioning also correlated with greater recent alcohol use. This secondary study provides preliminary support for the LSI as a tool to assess functioning in AUD, offering an unbiased, addiction-independent evaluation of functioning across key domains. Future work should replicate results in larger samples, conduct formal psychometric evaluation, and examine the effects of biological, demographic, and clinical factors.
33. Subjective Performance Expectations From and Demographic and Categorical Differences in the Acceptance of Virtual Reality or AI Technologies in Rehabilitation Programs: Cross-Sectional Questionnaire Survey With Rehabilitation Patients.
期刊: Journal of participatory medicine 发表日期: 2025-Aug-08 链接: PubMed
摘要
More than a few concepts have been presented in rehabilitation clinics that implement aspects of modern IT in the arrangement of augmented reality or virtual rehabilitation aiming to enhance cognitive or motor learning and rehabilitation motivation. Despite their scientific success, it is currently unknown whether rehabilitants will accept rehabilitation concepts that integrate modern ITs. This study aims to investigate the subjective performance expectations of rehabilitation patients regarding the application of virtual reality (VR) or artificial intelligence technologies across various therapeutic fields, and to identify demographic and categorical differences in acceptance to inform the development and implementation of VR-based rehabilitation programs. In total, 111 rehabilitation patients were surveyed about their subjective performance expectations of VR in 15 therapeutic fields with a questionnaire. The distribution of the responses was evaluated using box plots. The relationship between the subjective performance expectations for the 15 therapeutic fields was analyzed using the Spearman ρ coefficient, while the Mann-Whitney U test was used to compare subjective performance expectations between age groups and between genders. For all 15 therapeutic fields, the median of the subjective performance expectations was between 2 and 3, while therapeutic fields in the categories “activity/movement,” “competence in daily life/communication,” and “education” tended to be rated higher than therapeutic fields in the categories “relaxation/passive measures” and “advisory/conversation.” A significant rank correlation was observed for 103 out of 105 pairwise comparisons of the therapeutic fields, with distinct patterns of effects sizes within the chosen categories. There was no significant difference in the evaluation between rehabilitants of employable age and those aged 68 years or older. Male rehabilitation patients reported greater subjective expectations for virtual rehabilitation than female patients, but there was only a significant difference with small effect sizes for 3 of the 15 therapeutic fields. The general trend is that patients can imagine taking part in VR in rehabilitation activities involving active movement (physiotherapy, sports and exercise therapy, and occupational therapy) and health education. The results of the survey show that there is also a high level of support for the therapeutic field advisory/conversation. Current circumstances have led to substantial use of virtual offerings in practice. The limited data available may have encouraged the professional development of VR systems and their widespread use in medical rehabilitation follow-up in the home setting.
34. A Qualitative Study Defining Physician System Citizens: Expanding the Physician Role.
期刊: Academic medicine : journal of the Association of American Medical Colleges 发表日期: 2025-Aug-07 链接: PubMed
摘要
The role of 21st-century physicians must change to meet the needs of evolving health care systems, including meeting societal needs by ensuring equitable distribution of resources, improving health care systems inclusivity and care delivery safety, and providing value-based care. The authors define the characteristics and behaviors of physicians who are currently meeting those needs, termed physician system citizens (PSCs). This study explored and defined the personal characteristics and behaviors of PSCs and the environmental factors that facilitate system citizenship. The authors used the concept of positive deviance, a method to identify individuals in a community with uncommon but successful behaviors, to identify faculty physicians from a consortium of 5 U.S. academic institutions and their associated health care delivery systems considered to be exemplary PSCs. From April to June 2022, semistructured, open-ended interviews were performed with each physician and 1 to 2 of their interprofessional colleagues to explore the characteristics they demonstrate within clinical practice. Content thematic analysis was performed on interview data to identify patterns, with final themes triangulated across the research team. Twenty-one interviews of 9 exemplar PSCs, 6 of their interprofessional colleagues, and 6 resident physicians who worked with the physician were performed. Four main themes were identified: (1) PSCs’ personal characteristics are in alignment with existing core physician competencies, in particular superb communication and teaming skills; (2) PSCs’ behaviors exhibit the presence of systems thinking; (3) PSCs’ behaviors exhibit exceptional emotional intelligence; and (4) mentors were the key learning environment factor in PSC development. These findings provide novel insights into the knowledge, skills, and attitudes required by 21st-century PSCs. More traditional physician-based competencies remain critical for physician development. However, systems thinking and emotional intelligence emerged as meta-competencies that highlight a broader scope and responsibility for physicians to embrace in health care delivery.
35. The Environmental and Human Health Impact of Virtual General Surgery Residency Interviews With an In-Person Second Look.
期刊: Academic medicine : journal of the Association of American Medical Colleges 发表日期: 2025-Aug-07 链接: PubMed
摘要
Health care contributes to climate change through several mechanisms, including potentially avoidable travel. A major change in academic medicine during the COVID-19 pandemic was the transition to virtual interviews and resultant reduced environmental impact. However, as travel restrictions have lifted, programs have explored interview styles incorporating both virtual and in-person aspects. This study estimated the net carbon emissions from a single general surgery residency program that offered virtual interviews paired with an optional in-person second-look event and quantified the potential human health impact of this hybrid interview model compared with the in-person interview model. This cross-sectional study of the 2022 to 2023 application cycle for Rush University Medical Center’s general surgery residency program invited all interviewed applicants to participate in an optional second look. Interviewees’ travel distance and most likely mode of transportation were estimated using the address provided in their application. Environmental impact was measured as metric tons of carbon dioxide equivalents (MTCO2e) and human health impact as disability-adjusted life-years (DALYs). Thirty-one of 111 interviewed applicants (27.9%) attended an in-person second look. Travel for the second look generated an estimated 6.79 MTCO2e (95% CI, 4.06-9.52 MTCO2e). This program avoided an estimated 27.61 MTCO2e and saved 2.8923 DALYs during 1 interview cycle. If the emissions avoided at a single program through a hybrid interview style are extrapolated to all U.S. general surgery residency programs, a hybrid interview style potentially reduces emissions by 5,001 MTCO2e annually, the equivalent of removing nearly 1,200 passenger vehicles from the road for a year, and saves more than 500 years of full health each interview cycle. This hybrid interview model reduces health care’s contribution to climate change and the associated negative effects on public health while still allowing candidates critical in-person interaction.
36. The State of Funding for Applied Epidemiology-Results From the 2024 Epidemiology Capacity Assessment.
期刊: Journal of public health management and practice : JPHMP 发表日期: 2025-Aug-05 链接: PubMed
摘要
The applied epidemiology workforce in state health departments relies heavily on federal funding sources and personnel will be lost with the end of pandemic funding. In Spring 2024, the Council of State and Territorial Epidemiologists conducted its 8th Epidemiology Capacity Assessment in state and territorial health departments to understand the epidemiology workforce, including describing the funding sources for epidemiology personnel and activities. The assessment was distributed electronically via Qualtrics to the State and Territorial Epidemiologists in the 50 states, District of Columbia and the 8 US territories and freely associated states. Data collection took place between January and April 2024. The assessment had 42 questions, including a mix of numeric entry, matrix tables and open-ended questions. The results were analyzed using R Studio software and Excel 2008, including descriptive statistics, statistical significance tests, and cross-tabulations to explore data at the national level and by state size and region. Qualitative results were tabulated and coded for salient themes. Major gaps in the workforce remain across program areas and cyclical, prescriptive funding limits epidemiologists’ ability to respond to the unique needs of their communities. There is a need to diversify funding streams through engagement with state government and academic institutions. Health departments need flexible, diverse funding to be able to effectively respond to both current and future health threats.
37. Metal-organic framework-enhanced Electrochemiluminescence of pyrene-based ligands for sensitive CEA detection.
期刊: Bioelectrochemistry (Amsterdam, Netherlands) 发表日期: 2025-Aug-05 链接: PubMed
摘要
The early and sensitive detection of cancer, a malignant disease posing significant threats to human health, is of strategic importance for disease prevention and control. This study employed 1,3,6,8-tetra(4-carboxyphenyl)pyrene (H4TBAPy), a fluorophore exhibiting aggregation-caused quenching (ACQ), to construct a zinc-based metal-organic framework (Zn-TBAPy) serving as an energy donor platform. Polydopamine-coated ZIF-67 (ZIF-67@PDA) was employed as the energy acceptor to construct an electrochemiluminescence (ECL) immunosensor for sensitive carcinoembryonic antigen (CEA) detection. The advantages of ECL immunosensor are primarily manifested in the following three aspects: (1) Zn-TBAPy not only mitigates ACQ caused by polycyclic aromatic hydrocarbon π-π stacking but also enhances chromophore loading capacity and specific surface area. Relative to aggregate systems, the Zn-TBAPy exhibits a 2.5-fold enhancement in ECL signal intensity. (2) ZIF-67@PDA exhibits favorable broad-spectrum absorption characteristics and excellent quenching efficiency; as well as demonstrates superior biocompatibility for immunosensor construction. (3) The immunosensor was constructed through an electrochemiluminescence resonance energy transfer (ECL-RET) mechanism, yielding markedly improved sensitivity; the developed sensor demonstrated a linear detection range from100 fg·mL-1 to 80 ng·mL-1with LOD) of 0.275 pg·mL-1. In conclusion, this study provides a valuable research strategy for the construction of immunosensors based on novel luminophore materials.
38. Building Capacity in Public Health: Effects of the Pacific Public Health Fellowship Program in the US-Affiliated Islands.
期刊: Journal of public health management and practice : JPHMP 发表日期: 2025-Aug-05 链接: PubMed
摘要
Public health agencies require a competent, well-trained workforce to protect health and meet the specific needs of the communities served. In the US-Affiliated Pacific Islands (USAPI), geographic and educational barriers, and limited availability of culturally and linguistically appropriate training programs are unique challenges that contribute to public health workforce shortages. The Pacific Public Health Fellowship Program (PPHFP) was introduced through a partnership between the Centers for Diseases Control and Prevention and the Pacific Island Health Officers Association. It was designed to address barriers to public health workforce development and capacity in USAPI. Established in 2019, PPHFP is a 2-year, full-time training program designed for USAPI residents who are recent college graduates with interests in pursuing careers in public health. The program includes a competency-based training curriculum and field-based projects at participating host sites to address local public health challenges. PPHFP has expanded from 2 fellows in 2021 to 43 fellows in 2024, with each USAPI having hosted fellows. All 2021-2023 cohort respondents to the PPHFP exit survey have reported satisfaction with the program, increased knowledge and skills in public health, and readiness to enter the public health workforce. In addition, respondents reported that they have contributed to public health workforce capacity at their local host sites. In total, 16 of 17 graduates from these cohorts have been employed or continued their education in the public health field. PPHFP is a successful approach to addressing unique public health workforce challenges in USAPI through recruitment, training, and placement of residents at local host sites. This fellowship program can serve as a model for enhancing public health workforce capacity in other regions and globally.
39. The Effect of Sex, Race/Ethnicity, and Neighborhood Socioeconomic Disadvantage on Total Hip Arthroplasty Utilization: A Multicenter Cohort Study.
期刊: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews 发表日期: 2025-Aug-01 链接: PubMed
摘要
Disparities in the management of hip osteoarthritis (OA) exist across sex, race/ethnicity, and socioeconomic status, but their combined effect on total hip arthroplasty (THA) utilization remains unclear. This study evaluates differences in presentation, nonsurgical treatments, and THA rates across two academic centers. Patients with primary hip OA seen in 2002 at two tertiary academic centers were included. Demographics, Kellgren-Lawrence grade, Charlson Comorbidity Index (CCI), and nonsurgical treatments were collected. Socioeconomic status was assessed using the social deprivation index, stratified into quartiles (Q4 = most deprived). Chi square, analysis of variance, and t-tests compared demographics and utilization rates. A multivariable model analyzed factors influencing THA likelihood. Among 456 patients, 328 were recommended for THA for primary hip OA, 63% were female, 6% were Asian, 6% Black, 23% other, 3% unknown, 54% White, and 8% Hispanic. Female patients were older (70.3 ± 8.6 vs. 68.1 ± 9.7 years, P = 0.03). Hispanic patients were younger (62.2 ± 12.1 vs. 70.1 ± 8.7 years, P = 0.0020) with lower CCI (2.20 ± 1.52 vs. 2.93 ± 1.49 vs. 3.28 ± 1.69 P = 0.027). Social deprivation index Q4 patients had greater physical therapy utilization (Q4 79% vs. Q1 62%, P = 0.006). Overall, 79% of patients who were offered THA underwent surgery, with multivariate analysis revealing lower likelihood among females, Black, Asian, and Hispanic patients with higher CCI (P < 0.001), whereas socioeconomically disadvantaged patients were more likely to undergo THA (P < 0.05). Although THA utilization was high, disparities in presentation age, nonsurgical treatments, and comorbidities suggest differing challenges across populations. Future research should explore drivers of these disparities. IV retrospective cohort.
40. Risk Score Model of Aging-Related Genes for Bladder Cancer and Its Application in Clinical Prognosis.
期刊: JCO clinical cancer informatics 发表日期: 2025-Aug 链接: PubMed
摘要
Bladder cancer (BLCA) ranks as the tenth most common malignancy worldwide, with rising incidence and mortality rates. Owing to its molecular and clinical heterogeneity, BLCA is associated with high rates of recurrence and metastasis after surgery, contributing to a poor 5-year survival rate. There is a pressing need for highly sensitive and specific molecular biomarkers to enable early identification of high-risk patients, guide clinical management, and improve patient outcomes. This study aimed to develop a prognostic model on the basis of aging-related genes (ARGs) to evaluate survival outcomes and immunotherapy responsiveness in patients with BLCA, and to further explore its relevance to the tumor immune microenvironment and drug sensitivity. Transcriptomic and clinical data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus were used to construct a 12-gene ARG-based prognostic signature through LASSO and Cox regression analyses. Patients were stratified into high-risk and low-risk groups according to the median risk score. Kaplan-Meier survival curves, receiver operating characteristic analyses, and nomograms were used to assess the predictive value of the model. Univariate and multivariate Cox regression analyses were conducted to determine its prognostic independence. Twelve ARGs were identified. Patients in the low-risk group exhibited significantly better overall survival (P < .0001). In the TCGA cohort, the model yielded AUC values ranging from 0.772 to 0.794 across 1-5 years. Cox regression confirmed the ARG score as an independent prognostic indicator. External validation using the GSE32894 data set supported its clinical reliability. The ARG signature was also associated with immune cell infiltration and predicted chemosensitivity. The ARG-based risk score independently predicts clinical prognosis in BLCA and correlates with immune microenvironment characteristics, offering potential value in guiding personalized treatment strategies.
41. Building Maternal Health Capacity: Impact of the Maternal Health Learning and Innovation Center.
期刊: Journal of public health management and practice : JPHMP 发表日期: 2025-Aug-01 链接: PubMed
摘要
To address the maternal health crisis, Health Resources and Services Administration funded the Maternal Health Learning and Innovation Center (MHLIC) in 2019 to provide capacity-building assistance (CBA) to maternal health practitioners nationally. To measure whether and how MHLIC’s capacity-building efforts increased maternal health practitioners’ confidence in their team’s capacity to address maternal health. Mixed methods evaluation, including a retrospective post-test survey and semi-structured focus group interview among 9 state Maternal Health Innovation (MHI) awardee teams funded for 5 years. MHLIC served 9 state MHI teams initially, growing to 35 states nationally by 2024. From May-June 2024, 23 staff from 9 teams participated in the survey and these same staff and other teammates (n = 32) participated in a focus group interview. MHLIC’s CBA is multi-pronged, offering learning opportunities to help awardees gain and strengthen the skills, knowledge, and tools they need to implement innovations that reduce severe maternal morbidity and mortality. Learning opportunities included coaching, technical assistance, tailored consultation, training, peer learning, learning institutes, and national symposia. The survey outcome was confidence in their team’s ability to address 22 maternal health, engagement, and policy items before and after engaging with MHLIC. The focus group’s main outcomes were evidence of improved maternal health capacity and the contribution of MHLIC’s CBA. There were statistically significant moderate increases in teams’ reported confidence on every item from before to after engaging with MHLIC. All changes were roughly 0.5 points or higher on the 4-point scale. Interview evidence of improved capacity with support from MHLIC included equity, community engagement, implicit bias, data use and dissemination, strategic planning, and sustainability. MHLIC’s CBA increased teams’ maternal health capacity, enabling teams to achieve their MHI goals while laying a foundation for advancing maternal health beyond the scope of the program.
42. Predictors of Conversion Total Hip Arthroplasty After Surgically Managed Acetabulum Fractures: A Prognostic Factor Systematic Review and Meta-Analysis.
期刊: JBJS reviews 发表日期: 2025-Aug-01 链接: PubMed
摘要
Operative management of acetabular fractures can be complicated by the development of symptomatic post-traumatic arthritis, which may necessitate conversion total hip arthroplasty (THA). There is increased interest in treatment with THA for acute management, but optimal patient selection depends on identifying those at risk of later symptomatic post-traumatic arthritis requiring conversion THA. We systematically reviewed prognostic factors associated with conversion THA in adult patients with operatively managed acetabulum fractures. We searched MEDLINE and EMBASE from inception to September 27, 2024. Screening, data extraction, risk of bias assessment, and evidence grading were completed in duplicate. Data were pooled using a random-effects model to produce summary odds ratios (ORs), hazard ratios (HRs), and mean differences, with 95% confidence intervals (CIs). Risk of bias was assessed using the Quality in Prognosis Studies tool. Certainty of evidence was evaluated using the Grade of Recommendation, Assessment, Development, and Evaluation framework. A total of 3,054 citations were screened, and 38 studies (6,931 fractures) met inclusion criteria. Eight factors were associated with conversion THA in unadjusted analyses: acetabular impaction (OR 2.08, 95% CI 1.60-2.70, moderate certainty), femoral head impaction (OR 2.70, 95% CI 1.80-4.06, moderate certainty), dislocation (OR 2.20, 95% CI 1.51-3.19, moderate certainty), nonanatomic reduction on radiography (OR 2.36, 95% CI 1.58-3.51, moderate certainty), nonanatomic reduction on computed tomography (OR 3.46, 95% CI 1.25-9.57, moderate certainty), associated fracture type (OR 1.76, 95% CI 1.29-2.41, moderate certainty), female sex (OR 1.48, 95% CI 1.15-1.88, moderate certainty), and posterior wall involvement (OR 1.82, 95% CI 1.18-2.80, moderate certainty). In multivariable analyses, age (adjusted OR 1.04, 95% CI 1.02-1.06, high certainty; adjusted HR 1.04, 95% CI 1.03-1.05, high certainty) and femoral head impaction (adjusted HR 3.19, 95% CI 1.16-8.75, moderate certainty) were associated with conversion THA. The weighted proportion of patients requiring THA conversion was 17.6% (95% CI 15.2%-20.4%, low certainty). Older age and femoral head impaction were the only factors associated with conversion to THA in univariable and multivariable analyses. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
43. Trends in Labor After Cesarean Delivery Access in the US.
期刊: JAMA network open 发表日期: 2025-Aug-01 链接: PubMed
摘要
This cross-sectional study examines county-level trends in labor after cesarean delivery access across the US from 2016 to 2021.
44. Source of Alcohol Among Adults in the United States: Differences in the Use of Home Delivery and On-Premises and Off-Premises Alcohol Outlets.
期刊: Journal of public health management and practice : JPHMP 发表日期: 2025-Jul-31 链接: PubMed
摘要
While many states have expanded alcohol delivery policies, data are limited on where US adults obtain alcohol, often not specifying alcohol delivery. This study assessed sources of how adults obtained their alcohol, by sociodemographic characteristics and drinking patterns. Among the 2200 adult respondents to the 2024 SummerStyles survey who drink, 4 logistic regressions were used to assess adjusted odds ratios between sociodemographic characteristics and how respondents obtained their alcohol during the past 30 days. Respondents could select more than 1 source, if applicable. Obtaining alcohol from off-premises outlets was most common (73.9%), followed by on-premises outlets (49.9%); 2.4% reported using delivery. Compared to adults who did not binge drink, binge drinking was associated with almost twice the odds of using alcohol delivery. This study underscores the usefulness of further research to assess the effects of alcohol policy changes that modify access to alcohol on excessive drinking and alcohol-related harms.
45. Development and computer-assisted validation of a radio frequency identification system for tracking individual chicken visits to functional areas.
期刊: Poultry science 发表日期: 2025-Jul-31 链接: PubMed
摘要
Understanding how laying hens interact with functional resources-such as drinkers, feeders, perches, nest boxes, and wintergardens-is essential for meeting their physiological needs and enabling species-specific behaviors. This knowledge is crucial for poultry welfare assessments and precision livestock management. However, traditional ethological data collection methods, including direct observation and manual video analysis, are labor-intensive, prone to observer bias, and impractical for individual-level tracking. To overcome these challenges, we developed and validated an RFID-based system for automated, non-invasive tracking of individual hens’ visits to key resources, using an established ArUco-based video annotation system as the reference standard. For validation, twenty-one laying hens were fitted with RFID leg bands and 3D-ArUco markers and monitored over five days in a mobile barn setup equipped with ultra-high-frequency RFID antennas. Alignment between data from the RFID and 3D-ArUco systems allowed calculation of performance metrics such as the F1-score-defined as the harmonic mean of precision and sensitivity-for visit durations and event detections (i.e., entries and exits), and the coefficient of determination (r²) for visit counts. Wintergarden showed the highest performance (84 % F1-score, 93 % r²). Metal perch achieved F1-scores of 79 % and 86 % for access and leaving events. Nest boxes showed intermediate performance (78 % F1-score, 77 % r²), while drinkers and feeders were lower (64 % F1-score each; r² values of 69 % and 49 %). These findings confirm RFID’s potential for tracking visits to wintergardens, perches, and nest boxes-demonstrating sufficient performance for practical use, though further optimization through antenna positioning remains possible. For feeders and drinkers, however, accurate tracking remains challenging, and complementary technologies may be required, as rapid movements reduce tag dwell time, overcrowding causes signal interference, and open areas increase misreads from nearby surrounding movement. This study highlights RFID’s value for behavioral research at the individual level in poultry and supports research-driven innovation in housing equipment design. It also demonstrates how a computer-assisted approach can facilitate validation across diverse behavioral contexts.
46. Contamination of perfusion fluid and its impact on kidney transplantation: an observational study from a single Brazilian center.
期刊: Jornal brasileiro de nefrologia 发表日期: 2025 链接: PubMed
摘要
Infections represent a major cause of morbidity and mortality in kidney transplant recipients. Preservation fluid (PF) contamination is considered a potential infectious source; however, its clinical relevance remains controversial. To evaluate whether PF contamination acts as a source of early post-transplant infections (within 30 days) and its association with acute rejection, graft loss, and mortality within 90 days. This was a retrospective, observational, and descriptive study based on medical records of patients aged ≥18 years who underwent kidney transplantation between January 2021 and December 2023. Collected variables included demographic, clinical, and post-transplant outcome data. Among 246 recipients with available PF culture data, 27.6% (68/246) presented with PF contamination. Gram-positive cocci accounted for 64.7% of isolates, Gram-negative bacilli, for 35.3%, and fungi, for 2.9%. Coagulase-negative staphylococci (CoNS) were the most frequent isolate (36.8%). Microbiological concordance between PF isolates and pathogens responsible for early infection were observed in 13.23% (9/68) of cases, with Klebsiella pneumoniae being the predominant pathogen (66.6%). Although the infection rate was higher among patients with positive PF cultures (72%) compared to those with negative cultures (64%), this difference was not statistically significant (p = 0.2992). No significant associations were found with mortality (p = 1.000), graft loss (p = 0.8199), or acute rejection (p = 0.5635). PF contamination was frequent and may contribute to early post-transplant infections, reinforcing the importance of microbiological surveillance and preventive strategies.
47. Assessment of change and persistence of youth psychosocial status reported by youth and their guardians during the COVID-19 pandemic: A MyHEARTSMAP study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The pediatric mental health crisis pre-dated the COVID 19 pandemic with rates of mental health visits to pediatric emergency departments steadily increasing for the last decade. The COVID-19 pandemic has profoundly impacted children and adolescents and understanding the trajectory of their psychosocial status is important for appropriate resource allocation and policy planning. MyHEARTSMAP is a digital self-assessment mental health evaluation that examines four major psychosocial domains: psychiatry, social, function, and youth health. Children and adolescents throughout British Columbia, and their guardians, completed the baseline assessment between August 2020 and July 2021 (51.8% completed by guardian only, 40.2% youth and guardians, 7.9% youth only). Both children and their guardians repeated the MyHEARTSMAP evaluation three-months after their baseline. Patient demographics and psychosocial concerns were statistically described and compared between baseline and follow-up. A logistic regression model assessed the influence of baseline scores and demographic factors on follow-up severity. 241 of 424 participants (56.8%) completed both the baseline and three-month follow-up. The majority of participants reported no change overtime across the psychosocial domains. Both improvement and decline occurred in each domain, with a greater proportion of psychosocial states improving rather than worsening, for all domains. Higher severity of psychosocial concerns reported at baseline indicated a greater likelihood of psychosocial concerns at 3-month follow-up for psychiatric, social and function concerns. Demographic, pandemic, and support service variables were not associated with psychosocial trajectories. The severity of youth mental health concerns in British Columbia remained consistent through three-month follow up, despite the changing nature of the COVID-19 pandemic during this period. Greater persistence of psychosocial concerns with increased severity highlights the need for early intervention to prevent worsening mental health. Community support is needed for youth experiencing mental health concerns to address mild psychosocial concerns before presentation at the emergency department.
48. Modeling the effects of treatment adherence challenges on the transmission dynamics of hepatitis C virus.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Infectious disease modeling is crucial for predicting disease progression over time and helps guide decision makers in public health policy. Hepatitis C virus (HCV) prevalence is still increasing in Zimbabwe, a low-middle-income country (LMIC), despite the availability of effective treatments, and the reasons for this increase are not well understood. Our study employed a mathematical model to explain the impact of poor treatment adherence on HCV transmission dynamics in Zimbabwe. We computed the basic reproduction number ([Formula: see text]), a vital metric of disease spread. Equilibrium states of the model were determined, and their stability was investigated. The study demonstrated that an adherence level exceeding 52% causes the reproduction number to drop below 1, curtailing further spread. Our HCV model indicates that variations in re-susceptibility minimally impact outcomes, suggesting that re-susceptibility can often be excluded in such analyses. Our model unraveled the synergistic impact of simultaneously enhancing the recovery rate of acutely infected individuals and treatment adherence on reducing [Formula: see text]. The study underlines the pressing need for stronger health interventions, including patient education, financial assistance, and rigorous monitoring, to improve treatment adherence. These interventions are paramount in curbing HCV proliferation, particularly in LMICs like Zimbabwe, and can serve as a template for similar settings globally.
49. The promotive effect of ocean literacy on marine conservation behavior: A qualitative study based on Chinese university students.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Ocean literacy plays a crucial role in promoting sustainable marine conservation behaviors, yet its underlying psychological mechanisms among university students remain underexplored, particularly within Asian contexts. This qualitative study aimed to investigate how ocean literacy influences pro-environmental behaviors among Chinese university students through environmental beliefs, values, and perceived responsibility. Semi-structured interviews with 16 university students from four coastal universities in China were conducted and analyzed using thematic analysis with NVivo software. Results indicated that ocean literacy encompasses five interconnected dimensions: scientific knowledge, environmental ethics, behavioral intentions for conservation, policy understanding, and critical thinking. Emotional connectedness and direct experiential engagement emerged as significant factors enhancing students’ environmental awareness and behavioral transformation. The findings also highlighted cultural relevance, social norms, and interactive educational practices as essential elements for translating ocean literacy into tangible conservation actions. Despite participants demonstrating foundational ocean knowledge, limitations in their systemic understanding of complex marine issues were identified, suggesting the need for more comprehensive educational interventions. This study provides empirical insights for optimizing marine education strategies and policy initiatives aimed at enhancing public engagement and achieving sustainable ocean governance.
50. Emergency temporary standards and COVID-19 trends among Oregon farmworkers.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
During the COVID-19 pandemic, migrant and seasonal farmworkers were deemed essential due to their central roles in US agricultural operations. However, employer-provided housing and transportation conditions increased their risks of SARS-CoV-2 exposure, and some states implemented emergency temporary standards (ETSs) at the insistence of farmworker advocates. Despite numerous studies examining the effectiveness of policy interventions (e.g., workplace closures) for mitigating SARS-CoV-2 transmission, limited research has specifically examined the effectiveness of interventions aimed at protecting farmworkers from COVID-19. We used an interrupted time series analysis to estimate how two ETSs and one executive order issued in Oregon impacted COVID-19 trends from March 1, 2020, to February 27, 2021, for the overall population and among agricultural labor groups in Oregon. Our models show that the ETS and executive order, which specifically targeted farmworker housing, transportation, and worksites, did not demonstrate any significant effects on the numbers of COVID-19 cases or associated deaths. However, the other ETS, which targeted all workplaces, was associated with statistically significant decreases in COVID-19 cases among the general population (-142.36214, p-value<0.0001), producers (-1.67128, p-value = 0.0009), hired workers (-2.39413, p-value = 0.0014), unpaid workers (-1.01572, p-value = 0.0003), and migrant workers (-0.60017, p-value = 0.0166). None of the three policy changes were found to have any statistically significant impacts on the numbers of COVID-19-associated deaths. The ETS targeting all workplaces was more effective for reducing COVID-19 transmission than the ETS or executive order specifically targeting farmworkers, indicating that the design, communication, and implementation of ETSs targeting farmworkers should be re-evaluated.
51. Commonalities and distinctions of pediatric patient and family engagement in clinical care, education, and research contexts: Protocol for a scoping review.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Pediatric patient and family engagement is an active and collaborative process, that involves children, adolescents, and family members with lived experience contributing to the design, implementation, and evaluation of healthcare services. Prior studies have highlighted the patient engagement methods and impact in clinical care, education, and research. However, gaps remain in understanding the commonalities and distinctions of engagement approaches, patient/family partner roles, and outcomes in clinical care, education, and research contexts. Further, research examining the nuances of pediatric patient and family engagement within healthcare delivery, education, and research in pediatric institutions is needed to streamline efforts. This scoping review will identify the commonalities of and distinctions between pediatric patient and family engagement in clinical care, education, and research contexts in pediatric healthcare institutions. A scoping review, conducted in collaboration with a team of adolescent, young adult, and family partners, will allow us to systematically map out key concepts, evidence, and knowledge gaps regarding pediatric patient and family engagement in clinical care, education, and research. We will follow the Joanna Briggs Institute framework in the design and conduct of the review and guidance on engaging knowledge users within scoping reviews. The protocol for this scoping review has been registered with the Open Science Framework database (https://osf.io/63qx5). This study will describe the engagement types, approaches, and outcomes of pediatric patient and family engagement employed within clinical care, education, and research settings, highlighting commonalities and distinctions across contexts. In doing so, it will identify potential opportunities for collaboration and resource-sharing based on the context of engagement and provide needed clarity on streamlining pediatric patient and family engagement approaches within pediatric institutional settings. It is anticipated that the results will produce preliminary evidence of relevance to pediatric institutions seeking to consolidate engagement practices across clinical care, education, and research domains.
52. NGP: A Tool to Detect Noncoding RNA-Gene Regulatory Pairs from Transcriptomic Data.
期刊: Methods in molecular biology (Clifton, N.J.) 发表日期: 2025 链接: PubMed
摘要
Noncoding RNAs (ncRNAs) play key roles in cancer initiation, promotion, and progression via regulating the expression of critical genes. Existing methods performed simple bivariate analysis on each pair of ncRNA and gene separately without considering the complex interactions among ncRNAs and genes. We developed a statistically rigorous and computationally efficient software tool to identify essential ncRNA-gene regulatory pairs from transcriptome-wide ncRNA and gene expression data. Here we provide a practical guidance with real data examples on the use of the tool implemented in the R package “NGP.”
53. Malaria, urogenital schistosomiasis and co-infection and nutritional status of school children in Ondo state.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Parasitic infections are a major cause of morbidity and mortality in Nigeria, with malaria and schistosomiasis having the highest burden. This study investigated the prevalence of malaria, urogenital schistosomiasis, and co-infections and their impact on the nutritional status of schoolchildren in two communities in Ondo State. A total of 185 participants from Ipogun and Oke Igbo were screened for malaria and schistosomiasis infection using the ParaHit malaria rapid diagnostic test kit and urine microscopy. Anthropometric measurements were used to assess the nutritional status of the participants. In this study, a higher prevalence of malaria was recorded in Oke Igbo, with 36 individuals (57.1%), compared to 60 individuals (49.2%) in Ipogun. Urogenital schistosomiasis was also more prevalent in Oke Igbo, affecting 18 individuals (28.6%), while only 5 individuals (4.1%) were affected in Ipogun. Co-infection with both diseases was more common in Oke Igbo, with 13 cases (20.6%), compared to 4 cases (3.3%) in Ipogun. However, malnutrition rates were similar between the two communities, with 60 cases (77.9%) in Ipogun and 28 cases (75.5%) in Oke Igbo. Notably, participants with either malaria or urogenital schistosomiasis, as well as those co-infected, exhibited a higher frequency of chronic malnutrition. The likelihood of co-infection was significantly associated with gender and locality, with individuals in Oke Igbo being 0.78 times less likely to be co-infected (P = 0.00; CI = 0.09-0.49), while males were 2.19 times more likely to have co-infections (P = 0.02; CI = 1.13-4.28). This study emphasised the significant health burden posed by malaria and urogenital schistosomiasis co-infections among schoolchildren in Ondo State, highlighting the need for comprehensive health and nutritional interventions to address the challenges associated with these parasitic diseases.
54. Work-related stress and sleep problems among small-scale miners in Ghana: The role of psychological factors.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Sleep problems (SP) are prevalent among small-scale miners, yet little is known about their psychological and occupational determinants. We examined the association between work-related stress (WRS) and SP among small-scale miners in Ghana and explored the mediating roles of anxiety and depression in this association. In this community-based cross-sectional study, data were collected from 664 miners in Obuasi,Ghana. WRS and SP were assessed using the Perceived Stress Scale (PSS-4) and the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0), respectively, while anxiety and depression were measured using the GAD-7 and PHQ-9. Adjusted multivariate regressions and bootstrapped serial mediation models (Hayes’ PROCESS Model 6) evaluated the hypothesized pathways. The mean (SD) age was 28.8 (8.2) years, and 84.3% were males. WRS was significantly associated with SP (B = 0.2964, 95% CI = 0.2398-0.3530), with both direct (42.5%) and indirect (57.5%) effects. Anxiety mediated 38.0% of the total effect, depression 11.4%, and the anxiety-depression pathway 8.1%. The study findings suggest that anxiety and depression serially mediate the WRS-SP link. These results underscore the need to address occupational stressors and incorporate mental health support into workplace policies to improve sleep quality and overall well-being in this vulnerable workforce.