公共卫生研究摘要 (2025-08-13)
共收录 50 篇研究文章
1. Identifying Substance Use and High-Risk Sexual Behavior Among Sexual and Gender Minority Youth by Using Mobile Phone Data: Development and Validation Study.
期刊: Online journal of public health informatics 发表日期: 2025-Aug-12 链接: PubMed
摘要
Sexual and gender minority (SGM) individuals are at heightened risk for substance use and sexually transmitted infections than their non-SGM peers. Collecting mobile phone usage data passively may open new opportunities for personalizing interventions, as behavioral risks could be identified without user input. This study aimed to determine (1) whether passively sensed mobile phone data can be used to identify substance use and sexual risk behaviors for sexually transmitted infection (STI) and HIV transmission among young SGM who have sex with men, (2) which outcomes can be predicted with a high level of accuracy, and (3) which passive data sources are most predictive of these outcomes. We developed a mobile phone app to collect participants’ messaging, location, and app use data and trained a machine learning model to predict risk behaviors for STI and HIV transmission. We used Scikit-learn to train logistic regression and gradient boosting classification models with simple linear model specification to predict participants’ substance use and sexual behaviors (ie, condomless anal sex, number of sexual partners, and methamphetamine use), which were validated using self-report questionnaires. F1-scores were used to quantify prediction accuracy of the model using different data sources (and combinations of these sources) for prediction. Differences between text, location, app use, and Linguistic Inquiry and Word Count (LIWC) domains by outcome were investigated using independent t tests where associations were considered significant at P<.05. Among participants (n=82) who identified as SGM, were sexually active, and reported recent substance use, our model was highly predictive of methamphetamine use and having ≥6 sexual partners (F1-scores as high as 0.83 and 0.69, respectively). The model was less predictive of condomless anal sex (highest F1-score 0.38). Overall, text-based features were found to be most predictive, but app use and location data improved predictive accuracy, particularly for detecting ≥6 sexual partners. Methamphetamine use was significantly associated with dating app use (P=.01) and use of sex-related words (P=.002). Having ≥6 sex partners was associated with dating app use (0.02), use of sex-related words (P=.001), and traveling a further distance from home (P=.03), on average, compared to participants with fewer sex partners. Methamphetamine users were more likely to use social (P=.002) and affect words (P=.003) and less likely to use drive-related words (P=.02). People having 6 or more partners were more likely to use social, affect words, and cognitive process-related words (P=.003 and .004 respectively). Our results show that passively collected mobile phone data may be useful in detecting sexual risk behaviors. Expanding data collection may improve the results further, as certain behaviors, such as injection drug use, were quite rare in the study sample. These models may be used to personalize STI and HIV prevention as well as substance use harm reduction interventions.
2. Authors' Reply: Equity-Centered Optimization of Virtual Cancer Survivorship CareEquity-Centered Optimization of Virtual Cancer Survivorship Care.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-12 链接: PubMed
摘要
3. Opportunities and Challenges for an Organizational Digital Public Health Strategy in a Provincial Public Health Program in Canada: Qualitative Description of Practitioner Perspectives.
期刊: JMIR public health and surveillance 发表日期: 2025-Aug-12 链接: PubMed
摘要
The digital transformation of health services accelerated during the pandemic. While “digital health” strategies were created, they paid minimal attention to public health services like health promotion, disease surveillance, emergency preparedness, and health protection. This study aimed to inform a digital public health (DPH) strategy at the British Columbia Centre for Disease Control (BCCDC) and explored public health practitioners’ perspectives on challenges and opportunities of integrating digital technologies into public health functions within the organization. In this qualitative description, we conducted 18 focus groups (FGs) between January and June 2023, drawing practitioners from 9 organizational subunits of the BCCDC including population and public health, environmental health, clinical services, vaccine-preventable diseases, communications, knowledge translation, data analytics, and Indigenous health (2 FGs per subunit). Discussions explored practitioners’ application of digital technologies in their public health work, focusing on challenges encountered during implementation (current state FGs) and perceived opportunities (future state FGs). Sessions were audio-recorded, and detailed field notes were taken. Thematic analysis was conducted, comparing perspectives across groups using constant comparative techniques. We identified 3 themes. First, “bridging existing inequities-an opportunity and a challenge contingent on public trust” described participants’ excitement about opportunities for DPH to disrupt historical inequities if centered on trust and reconciliation, while recognizing current digital transformation efforts risk exacerbating existing inequities with the digital divide. Second, “a sense of disconnect between “digital” and “public health” functions” described perceptions of DPH as being out of scope of core public health duties, requiring new competencies and navigation of complex organizational policies for which support is suboptimal. Third, “balancing the need for responsive DPH with necessary reactivity” highlighted practitioners’ yearnings for a proactive DPH strategy rather than current issue-based reactive approaches. Participants suggest that a centralized systematic program can help achieve this goal. A cohesive, systematic, and proactive organizational strategy for DPH is critical to enable equity-focused digital transformation. Such a strategy can bridge perceived disconnects between digital and public health functions through organizational supports like competency development and streamlined policies that can better support public health practitioners to integrate digital technologies into their work.
4. Triclocarban Disrupts Hepatic Lipid Homeostasis and Promotes Endoplasmic Reticulum Stress in Mice: A Multiomics Investigation.
期刊: Chemical research in toxicology 发表日期: 2025-Aug-12 链接: PubMed
摘要
Triclocarban (TCC) is an antiseptic ingredient incorporated into many skin-contact hygiene products, raising public health concerns for its frequent detection in the general population. As the central metabolic organ, the liver plays a key role in lipid synthesis and metabolism; however, the in vivo effects of TCC on hepatic lipid homeostasis remain largely unclear. Herein, a percutaneous TCC exposure model was established based on human-relevant concentrations. An integrated multiomics approach, including hepatic transcriptomics and lipidomics, was applied to explore TCC effects on the liver. We discovered that continuous dermal absorption of TCC significantly disturbed hepatic lipid profiles, as manifested by the decrease in energy storage lipid triacylglycerol (TG) and its synthetic precursor diacylglycerol (DG). Integrated analysis of transcriptomics and targeted validation revealed that TG reduction could result from the decline in lipogenesis, acceleration of fatty acid β-oxidation, and elevated secretion of very-low-density lipoproteins (VLDLs). Cell membrane homeostasis was also disrupted through altering hepatocellular phosphatidylcholine (PC) and phosphatidylethanolamine (PE) levels, which may be related to the activation of endoplasmic reticulum (ER) stress, resulting in the promotion of hepatocyte apoptosis. Together, this work provides novel insights into the causal relationship between TCC exposure and the hepatic metabolic homeostasis.
5. How Healthy and Unhealthy Lifestyle Behaviors Affect Cognitive Function-Evidence From Older Adults in Chinese Communities: Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Aug-12 链接: PubMed
摘要
Many lifestyle behaviors-including smoking, alcohol consumption, and engagement in physical activity and social activity-have been identified as potential determinants of the risk of cognitive impairment. Understanding how those lifestyle behavior patterns in older adults affect cognitive function is crucial for developing targeted interventions. This study examined the lifestyle behavior patterns of Chinese community-dwelling older adults and their associations with cognitive impairment. A cross-sectional study was conducted with 2060 community-dwelling older adults in Beijing, China. Latent class analysis identified distinct lifestyle behavior patterns based on unhealthy lifestyle behaviors (smoking and alcohol consumption) and healthy behaviors (physical activity and social activity). Cognitive function was evaluated using the Mini-Mental State Examination. Multiple logistic regression was conducted to examine the associations between lifestyle behavior patterns and cognitive impairment. Three distinct lifestyle behavior patterns emerged: (1) high control-high engagement (685/2060, 33.3%), (2) high control-low engagement (1210/2060, 58.7%), and (3) low control-low engagement (165/2060, 8.0%). The high control-high engagement group, characterized by non-smoking, low-to-moderate alcohol consumption, and frequent engagement in physical and social activities, exhibited the lowest risk of cognitive impairment. In contrast, participants in the high control-low engagement group (OR 1.852, 95% CI 1.314-2.655) and low control-low engagement group (OR 2.905, 95% CI 1.670-5.001) exhibited significantly higher risks. Subgroup analyses revealed that males and hypertensive individuals within the high control-low engagement group were at an even greater risk. Our findings revealed that both avoiding harmful behaviors and actively engaging in health-promoting activities are important for cognitive health in older adults. Based on the results, we propose adopting a dual-pathway intervention model in policy making, simultaneously optimizing risk behaviors management and healthy behaviors promotion mechanisms.
6. The Impact of Social Stress and Healthy Lifestyle on the Mortality of Chinese Older Adults: Prospective Cohort Study.
期刊: JMIR aging 发表日期: 2025-Aug-12 链接: PubMed
摘要
With social progress, social stress (SS) has become a key factor affecting health. Unhealthy lifestyles may exacerbate these effects. However, the relationship between SS, lifestyle, and older adults’ mortality rate still needs to be studied. This study aimed to explore the relationship between SS and all-cause mortality in Chinese older adults, as well as the influence of healthy lifestyle factors. Three groups of SS were defined through latent class analysis: low, medium, and high. We created a healthy lifestyle index based on smoking, alcohol consumption, physical activity, and diet. Multivariable Cox proportional hazards models, interaction analyses, and mediation analyses were conducted. The Chinese Longitudinal Healthy Longevity Survey (CLHLS) datasets included participants from 806 cities and counties across 23 provinces in China from 1998 to 2018. In this study, participants were recruited from 4 waves of the CLHLS (2005, 2008, 2011, and 2014). Finally, 19,236 participants were included in this study, of which 6891 (35.8%) had low SS, 11,662 (60.6%) had medium SS, and 683 (3.6%) had high SS. In the fully adjusted model, the hazard ratio (HR) for medium SS was 1.16 (95% CI 1.11-1.20; P<.001), and for high SS, it was 1.28 (95% CI 1.18-1.40; P<.001) compared to the low SS group. For individuals aged ≥80 years, the medium SS group had a 28% (HR 1.28, 95% CI 1.22-1.34; P<.001) increased mortality risk, and the high SS group had a 38% (HR 1.38, 95%CI 1.26-1.52; P<.001) increased risk compared to the low SS group. Approximately 7% of the association between SS and mortality was mediated through the healthy lifestyle. Under different SS, the lower the healthy lifestyle score, the higher the risk of mortality. SS was an independent predictor of all-cause mortality in Chinese older adults. The healthy lifestyle mediated this effect to some extent. Unhealthy lifestyle behaviors were associated with a higher risk of mortality at all SS levels.
7. Tetrabromobisphenol A Induces Neurotoxicity in Adult Zebrafish: Insights from the Gut Microbiota-Bile Acid-Brain Axis.
期刊: Environmental science & technology 发表日期: 2025-Aug-12 链接: PubMed
摘要
Tetrabromobisphenol A (TBBPA), a widely used brominated flame retardant, has been reported to have neurotoxicity and risks in inducing obesity. However, the underlying mechanisms remain incompletely understood, especially with respect to diet-induced susceptibility. In this study, we systematically investigated the neurotoxic effects of environmentally relevant TBBPA exposure in adult zebrafish under both normal-diet (ND) and high-fat-diet (HFD) conditions. Behavioral assessment and histopathology revealed that TBBPA induced pronounced anxiety-like behaviors and neuronal damage, with the HFD markedly augmenting these effects. Integrated multiomics analysis demonstrated that TBBPA exposure alters gut microbial composition, leading to substantial dysbiosis and a profound reduction of glycodeoxycholic acid (GDCA), a key secondary bile acid mediating gut-brain communication. Additionally, TBBPA induces mitochondrial dysfunction and activates inflammasome-mediated neuroinflammatory pathways in the brain. Notably, dietary GDCA supplementation effectively rescued TBBPA-induced behavioral deficits, mitochondrial dysfunction, and neuroinflammation. To our knowledge, this study is the first to delineate a diet-dependent gut microbiota-bile acid-brain axis as a critical mediator of TBBPA-induced neurotoxicity, highlighting the significance of bile acid metabolism and the diet factor in maintaining neurophysiological homeostasis. These findings reveal a novel mechanism underlying brominated flame retardant neurotoxicity, providing new insights into environmental health risk assessment of other environmental pollutants.
8. Beyond a Diagnosis: A Qualitative Study of Women's Experiences of Painful Sexual Intercourse.
期刊: The Clinical journal of pain 发表日期: 2025-Aug-12 链接: PubMed
摘要
We aimed to explore the diverse aspects of sexual pain experiences among affected women. We conducted an interpretive description qualitative study and collected data using one-to-one semi-structured interviews. Participants were purposefully recruited for one-on-one semi-structured online interviews. Two independent reviewers analyzed the transcripts, and coding was finalized through consensus. The study consisted of 31 women who self-identified as experiencing sexual pain with a mean age of 29 (Sd.=9.72) years and a mean pain duration of 53 (Sd.=41.93) months. We identified six main themes, including experience of living with pain, beliefs, behavior, search for help, treatments, and expectations. This study revealed that sexual pain often begins with the first sexual encounter and may persist, deeply affecting personal and marital well-being. Pain was linked to factors such as trauma and biological dysfunctions. Participants employed various coping strategies and sought multiple treatments, though outcomes and satisfaction levels varied. Key facilitators of effective treatment were professional support and access to information, while significant barriers included shame and financial constraints. Satisfaction with healthcare largely depended on receiving a diagnosis, with future outlooks varying from hopelessness to optimism.
9. Ways of working in Aboriginal and Torres Strait Islander Community Controlled Health Organisations: describing a conceptual model of comprehensive primary healthcare characteristics.
期刊: Australian and New Zealand journal of public health 发表日期: 2025-Aug-11 链接: PubMed
摘要
This research sought to describe a conceptual model of Aboriginal and Torres Strait Islander Community Controlled Health Organisation (ATSICCHO) primary health care, and the fundamental role ATSICCHOs exercise in addressing critical service gaps needed to achieve equitable outcomes for Aboriginal and Torres Strait Islander peoples. ATSICCHO representatives governed the research process. A sequential mixed-method approach for articulating the ATSICCHO model drew upon scoping review evidence, case study evidence, and expert consultations. Culture is central to ATSICCHO service delivery and entwined within nine discrete characteristics: self-determination and empowerment, community control and community participation, culturally appropriate and skilled workforce, holistic health care, accessible health services, flexible and responsive approach to care, relationship building and advocacy, comprehensive health promotion and continuous quality improvement. Aboriginal and Torres Strait Islander governance, leadership and workforce are common enablers, and challenges often relate to funding, workforce recruitment and building relationships with multiple partners. ATSICCHOs exemplify culturally-centred, comprehensive and accessible primary health care and empower Aboriginal and Torres Strait Islander people. This model can guide the expansion of the ATSICCHO sector and offer comprehensive primary health care insights to the broader Australian health system.
10. Serum perfluoroalkyl and polyfluoroalkyl substances and the risk of kidney function decline: Unraveling the mediating role of iron status.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Aug-11 链接: PubMed
摘要
The effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) on kidney function across physiological conditions remain inconclusive, and previous research has not assessed the potential mediating effect of iron status. We aimed to examine the relationships between PFAS exposure and kidney function in various demographic groups, as well as to evaluate the potential mediating role of iron status. This study included 7369 Chinese adults aged 18 years or older from the China Health and Nutrition Survey (CHNS). Estimated glomerular filtration rate (eGFR) levels were used to reflect the efficiency of kidney function. Generalized linear models and weighted quantile sum regression models indicated negative associations between PFAS and eGFR levels, with PFNA and PFHxS emerging as the dominant contributors. Subgroup analysis revealed that the adverse effects of PFAS on eGFR levels were more pronounced in the males, young and middle age, non-hypertension, and non-diabetes subgroups. Further mediation analyses demonstrated that iron status (ferritin, transferrin, and hemoglobin) partially mediated these associations, with mediation proportions ranging from 8.89 % to 60.84 %. Our study established PFNA and PFHxS as critical nephrotoxic PFAS in China while pioneering the identification of iron status as a novel mechanistic mediator between PFAS exposure and kidney dysfunction, advancing mechanistic understanding of environmental nephrotoxicity.
11. Synergistic effects of PM2.5 components and ozone exposure on lung function in young adults: A cohort study in Shandong, China.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Aug-11 链接: PubMed
摘要
Exposure to fine particulate matter (PM2.5) components and ozone (O3) is associated with reduced lung function. This study aimed to examine the interaction effects of PM2.5 components and O3 on lung function in young adults. A cohort study involving 1697 participants was conducted in Shandong Province, China from September 2019 to November 2020. Pollutant data were obtained from the China High Air Pollutants (CHAP) dataset and the Tracking Air Pollution in China (TAP) dataset. Forced Vital Capacity (FVC), first-second forceful expiratory volume (FEV1.0), peak expiratory flow rate (PEF) and 50 % forceful expiratory flow rate (FEF50 %) were used as lung function indices. A linear mixed-effects model was employed to evaluate the impact of PM2.5 components and its interaction effects with O3 on lung function. Each 1 μg/m³ increase in black carbon (BC) concentration was significantly associated with 0.4027 L/s decrease in PEF (95 % confidence interval (CI): 0.2420 L/s, 0.5634 L/s). Increases in other PM2.5 components were also associated with various reduced lung function indices. Notably, the interaction term for BC and O3 was significantly associated with reduced PEF (-0.0243, 95 % CI: -0.0472, -0.0014). Synergistic effects between PM2.5 components [organic matter (OM), nitrate (NO3-)] and O3 adversely impacted lung function. A more proactive policy should be adopted to address the synergistic effects of air pollution.
12. Bisphenol AF exposure induced synaptic plasticity and neurobehavioral impairments via triggering the ROS-mediated PERK-eIF2α-ATF4 signaling pathway in adolescent mice.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Aug-11 链接: PubMed
摘要
Bisphenol AF (BPAF), a fluorinated homolog of BPA, has been produced as a replacement for BPA. However, the consequences and mechanisms of adolescent exposure to BPAF in terms of neurobehavioral injury remain unclear. In this study, using an in vivo model, we found that BPAF is able to cross the blood-brain barrier (BBB) and lead to anxiety- and depression-like behaviors and cognitive dysfunction in adolescent mice. Furthermore, exposure of adolescent mice to BPAF induced a reduction in the number of pyramidal neurons, as well as a decrease in dendritic complexity and dendritic spine density in the hippocampus. In addition, BPAF exposure inhibits the CREB-BDNF pathway and activates the PERK-eIF2α-ATF4 axis in the prefrontal cortex and hippocampus of adolescent mice. The SH-SY5Y cell culture experiments showed that inhibition of the PERK-eIF2α-ATF4 axis attenuated BPAF-induced downregulation of the CREB-BDNF pathway. NAC, a scavenger of ROS, markedly suppressed the expression levels of the PERK-eIF2α-ATF4 axis and restored the expression levels of CREB-BDNF proteins in both mouse brain and SH-SY5Y cells. NAC also prevented hippocampal synaptic damage. Unsurprisingly, behavioral results showed that NAC obviously attenuated BPAF-induced anxiety- and depression-like behaviors and cognitive dysfunction in adolescent mice. In conclusion, these findings suggest that exposure to BPAF during adolescence leads to neurobehavioral impairments through the activation of the ROS-mediated PERK-eIF2α-ATF4 axis, which in turn inhibits the CREB-BDNF pathway and compromises synaptic plasticity.
13. Occupational Risk Factors for Kidney Disease: A Comprehensive Review.
期刊: Journal of Korean medical science 发表日期: 2025-Aug-11 链接: PubMed
摘要
Chronic kidney disease (CKD) is a major global health concern, with traditional risk factors such as diabetes and hypertension well established. However, emerging evidence suggests that occupational exposures could play a significant role in CKD development. This review comprehensively summarizes the current evidence concerning occupational risk factors contributing to kidney disease, including exposure to heavy metals (lead, cadmium, mercury, chromium), organic solvents (trichloroethylene, methanol, ethylene glycol), heat stress, and job-related stress factors (occupational stress, long working hours, shift work). Epidemiological studies indicate that nephrotoxic agents contribute to renal dysfunction through oxidative stress, mitochondrial damage, and impaired ion transport. Industries such as manufacturing, agriculture, and mining pose particularly high risks due to hazardous exposures. While strong evidence links nephrotoxic metals and solvents to early renal dysfunction, the long-term effects of chronic low-dose exposure remain unclear. Additionally, heat stress-related CKD, particularly Meso-American nephropathy, highlights the growing concern of climate-related occupational risks. Job-related stress factors, including long working hours and shift work, may further accelerate CKD progression through stress-induced hypertension and metabolic disturbances. Given the substantial public health implications, preventive strategies should focus on reducing workplace exposures, implementing heat stress management programs, and addressing the impact of job-related stress factors.
14. Supply-Side Impact of Supporting Obstetrically Underserved Areas: A Nationwide Cross-Sectional Study.
期刊: Journal of Korean medical science 发表日期: 2025-Aug-11 链接: PubMed
摘要
There is limited evidence on the effectiveness of financial incentives in improving the shortage of obstetrics/gynecology (OB/GYN) specialists in underserved areas. This study aimed to examine whether the financial incentives for OB/GYN clinics were associated with improved availability of OB/GYN specialists in obstetrically underserved areas (OUA) and potentially obstetrically underserved areas (POUA) in South Korea. A cross-sectional study design was employed to observe all cities (n = 240) in South Korea for a period of 10 years (2011-2020). The cities were divided into intervention groups (cities designated as OUA and POUA) and control groups (all other rural districts). A two-way fixed-effects linear regression was used to explore the policy’s association with the number of specialists at the city level. The availability of OB/GYN specialists was evaluated based on the number of total/full-time/part-time OB/GYN specialists and facilities with full-time OB/GYN specialists per 1,000 females of reproductive age. The exposures considered were grant incentives for facility and equipment costs, human resources, and additional reimbursement rates for deliveries. A total of 240 South Korean cities were identified as analytic samples from 2011 to 2020 (2,400 city-year observations). The number of total OB/GYN specialists decreased (-3.390 per 1,000 females of reproductive age; P < 0.001) in cities designated as OUA and POUA (intervention group) after the introduction of combined financial incentives (grant and additional reimbursement since 2016). Results showed that the number of full-time OB/GYN specialists increased (0.083 per 1,000 females of reproductive age; P = 0.007). However, that of part-time OB/GYN specialists decreased (-3.473 per 1,000 females of reproductive age; P < 0.001). The number of facilities with full-time OB/GYN specialists also increased (5.775 per 100,000 females of reproductive age; P = 0.036). This cross-sectional study revealed that financial incentives, including grants and reimbursement rates, were insufficient to improve the availability of OB/GYN specialists in underserved areas of South Korea. Therefore, multidimensional financial and nonfinancial approaches are required to ensure a stable supply of specialists at vulnerable sites.
15. Epidemiology of Candidemia in Children and Neonates in Korea, 2009-2018: A Multi-Center Study.
期刊: Journal of Korean medical science 发表日期: 2025-Aug-11 链接: PubMed
摘要
Invasive candidal infection is a serious health threat to high-risk pediatric populations. Data on pediatric epidemiology of candidemia in Korea are limited. A retrospective chart review was performed for patients aged 0-18 years who were diagnosed with candidemia from 2009 to 2018 in tertiary hospitals. Patients were divided into two groups; a neonatal group of babies with postnatal age 28 days or younger or any patients hospitalized in neonatal intensive care unit and a pediatric group of the rest of patients. Only the first candidemia episode for each patient was included. Candida species, antifungal sensitivity, underlying condition, and outcomes were investigated. A total of 228 patients with candidemia were identified from five hospitals. Of them, 87 and 141 were assigned into the neonatal group and the pediatric group, respectively. The most common underlying condition was prematurity (88.5%) in the neonatal group and hematology-oncology diseases (49.6%) in the pediatric group. Non- albicans Candida spp. (65.4%) was more common than C. albicans. C. parapsilosis was the most commonly identified species (35.1%), followed by C. albicans (34.6%), C. tropicalis (9.6%), C. glabrata (9.6%), and C. krusei (2.2%) in all patients. C. parapsilosis was the most common pathogen in the neonatal group, while C. albicans was the most common pathogen in the pediatric group. Results of antifungal sensitivity to fluconazole were available for 160 patients. About 11.2% of isolates were either intermediate or resistant to fluconazole (10.0% for non-albicans, 1.2% for C. albicans) (P = 0.036). Overall mortality within 30 days after candidemia was 25.4%. Candidemia caused by non-albicans Candida was more common in pediatric patients during the study period. Resistance to antifungal agents was noted. Monitoring for epidemiologic change is warranted.
16. Trends in Epidemiology, Clinical Characteristics, and Outcomes of Infective Endocarditis: A 16-Year Nationwide Cohort Study in Korea.
期刊: Journal of Korean medical science 发表日期: 2025-Aug-11 链接: PubMed
摘要
Infective endocarditis (IE) is a life-threatening disease, the profile of which varies across countries. This nationwide cohort study aimed to assess the epidemiology, clinical characteristics, and outcomes of IE. Patients diagnosed with IE between 2003 and 2018 were included in this study based on data from the National Health Insurance System of South Korea. The patients’ baseline characteristics, treatment modalities, and survival outcomes were analyzed. The incidence and in-hospital mortality rates were calculated and adjusted for age. A total of 8,487 IE cases were included: 6,617 (78.0%), 1,678 (19.8%), and 192 (2.3%) cases of native valve IE, prosthetic valve IE, and cardiac device-related IE (CDRIE), respectively. The incidence rate (per 1,000,000) of IE increased from 7.24 in 2003 to 17.47 in 2018. Furthermore, the in-hospital mortality rate for IE (per 1,000,000 person-years) increased from 0.59 in 2003 to 2.76 in 2018. The proportions of prosthetic valve IE and CDRIE cases increased over time, whereas that of native valve IE cases decreased. The number of surgeries for IE showed a consistent upward trend, with a notable increase occurring from 2014 onward. IE is a health burden with an increasing incidence and high mortality rates. Understanding the epidemiology and characteristics of IE is crucial to establish future treatment strategies.
17. Impact of Clostridium difficile Infection on Chemotherapy in Patients With Primary Ovarian Cancer.
期刊: Journal of Korean medical science 发表日期: 2025-Aug-11 链接: PubMed
摘要
To investigate the impact of Clostridium difficile infection (CDI) on chemotherapy in patients with primary ovarian cancer. This retrospective study included patients with primary ovarian cancer diagnosed with CDI at the National Cancer Center, Korea, between January 2014 and December 2023. Patients with gastrointestinal symptoms and positive C. difficile stool tests were included. The primary objective was to assess the impact of CDI on chemotherapy, and the secondary objective was to evaluate other clinical outcomes and risk factors associated with CDI. A total of 111 CDI episodes were identified in 90 patients, with 17 patients experiencing recurrent CDI. Among initial CDI episodes, 51.1% occurred during the first or second cycle of adjuvant chemotherapy after cytoreductive surgery. Adjuvant chemotherapy cycles were delayed in 81.1% of cases, with a median delay of 13 days. Additionally, 7.8% of patients discontinued chemotherapy, and CDI-related mortality was 2.2%. Severe or fulminant CDI was associated with higher rates of intensive care unit admission, bowel surgery, or death (38.9% vs. 4.2%; P < 0.001). Septic shock (odds ratio [OR], 8.40; 95% confidence interval [CI], 1.54-45.74; P = 0.014) and prolonged post-CDI antibiotic treatment (OR, 1.08; 95% CI, 1.01-1.15; P = 0.016) were linked to severe outcomes. CDI can cause chemotherapy delays and severe adverse outcomes, such as septic shock or death. Early identification of CDI and a multidisciplinary approach are essential to minimize CDI-related complications in patients with ovarian cancer. Further research is needed to develop preventive strategies and evaluate the long-term impact of CDI on cancer prognosis.
18. Interdisciplinary Development and Fine-Tuning of CARDIO a LLM for Cardiovascular Health Education in HIV Care: A Tutorial.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-11 链接: PubMed
摘要
The integration of Artificial Intelligence in healthcare presents as a significant opportunity to revolutionize patient care. In the United States, an estimated 129 million people have at least one chronic illness, with 42% having two or more. Despite being largely preventable, the prevalence of chronic illness is expected to rise and impose significant economic burdens and financial toxicity on healthcare consumers. We leveraged an interdisciplinary team encompassing nursing, public health, and computer science to optimize health through prevention education for cardiovascular and metabolic comorbidities in persons living with HIV. In this tutorial, we describe the iterative, data-based development and evaluation of an intersectionality-informed large language model designed to support patient teaching in this population. First, we curated data by scraping publicly available, authoritative, evidence-based sources to capture a comprehensive dataset, supplemented by publicly available HIV forum content. Second, we benchmarked candidate large language models and generated a fine-tuning dataset using GPT-4 through multi-turn question-answer conversations, employing standardized metrics to assess baseline model performance. Third, we iteratively refined the selected model via Low-Rank Adaptation and reinforcement learning, integrating quantitative metrics with qualitative expert evaluations. Pre-existing LLM models demonstrated poor n-gram agreement, dissonance from model answers (Accuracy 4.16, Readability 4.63, Professionalism 4.58), and difficult readability (Kincaid 8.54, Jargon 4.44). After prompt adjustments and fine-tuning, preliminary results demonstrate the potential of a customized LLaMA-based LLM to provide personalized, culturally salient patient education. We present a data-based, step-by-step tutorial for interdisciplinary development of CARDIO, a specialized LLM, for cardiovascular health education in HIV care. Through comprehensive data curation and scraping, systematic benchmarking, and a dual-stage fine-tuning pipeline, CARDIO’s performance improved markedly (Accuracy 5.0, Readability 4.98, Professionalism 4.98, Kincaid 7.17, Jargon 2.92). Although patient pilot testing remains forthcoming, our results demonstrate that targeted data curation, rigorous benchmarking, and iterative fine-tuning have provided a robust evaluation of the model’s potential. By building an LLM tailored to cardiovascular health promotion and patient education, this work lays the foundation for innovative AI-driven strategies to manage comorbid conditions in people living with HIV.
19. Parents' experiences of pediatric hematopoietic stem cell transplantation: A systematic review and meta-synthesis.
期刊: Journal of pediatric nursing 发表日期: 2025-Aug-11 链接: PubMed
摘要
Hematopoietic stem cell transplantation (HSCT) is a life-saving treatment for various pediatric conditions, including malignancies and genetic disorders but imposes significant burdens on families, especially parents. This study synthesized and analyzed existing evidence on parents’ experiences of pediatric HSCT to provide a comprehensive understanding of their challenges and needs. This study utilized a systematic review with a meta-synthesis approach. The search was conducted across five databases-PubMed, Scopus, CINAHL, Web of Science, and Embase-without time restrictions to identify relevant articles published in reputable online scientific journals. Inclusion criteria encompassed qualitative studies and the qualitative components of mixed-methods studies exploring parents’ experiences with their child’s HSCT, published in peer-reviewed journals and written in English. The review included 24 qualitative studies and one mixed-methods study. Through thematic synthesis, five main themes emerged: “caregiver burden”, “support systems”, “family dynamics”, “coping strategies”, and “positive outcomes”. Our findings provide meaningful insights into the multifaceted challenges and growth opportunities faced by the parents of children undergoing HSCT. They emphasize the necessity of holistic, family-centered care models that reduce caregiver burden, enhance support systems, promote healthy family dynamics, and foster effective coping strategies. This study emphasizes the importance of healthcare providers and policymakers in supporting parents of children undergoing pediatric HSCT. It calls for family-centered care that meets parents’ emotional, psychological, and practical needs, and urges policymakers to support family-focused care models through mental health services, financial aid, and flexible care to reduce stress and improve outcomes.
20. Large-scale fate tendency of lufenuron during cabbage cultivation: new insights into dietary risk and models comparison.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Aug-11 链接: PubMed
摘要
Elucidating the environmental fate and exposure risk of lufenuron is crucial to ensure food safety and protect human health. In this study, we developed a rapid and sensitive analytical method for tracing lufenuron in cabbages using ultra-high-performance liquid chromatography-tandem mass spectrometry. The occurrence, pharmacokinetic dissipation, and concentration variation of lufenuron were characterized by primary concentrations (0.009-0.420 mg/kg), half-lives (0.3 d-11.7 d), and final magnitude (<LOQ-0.320 mg/kg). A probabilistic model was introduced to assess dietary risks and presented a comprehensive picture of the risk at multi-probabilities. The chronic dietary risk (ADI%) of lufenuron were 1.074-5.609 % from the 50th to the 99.9th percentile. This was compared with deterministic models, which yielded ADI% values ranging from 0.177 % to 0.500 %, both of which were acceptable. The exposure risks of rural females aged 4-6 years were significantly higher than those of the other groups (P < 0.05), which should be taken seriously with the increasing requirement of lufenuron in actual agricultural production.
21. Sex-specific DNA methylation changes in placental thyroid hormone regulatory genes following prenatal exposure to flame retardants.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Aug-11 链接: PubMed
摘要
Prenatal exposure to organophosphate esters (OPEs) and polybrominated diphenyl ethers (PBDEs) has been linked to disrupted fetal thyroid hormone (TH), though the underlying mechanisms remain unclear. Based on the S-MBCS cohort, we analyzed OPE metabolite concentrations in maternal urine during early pregnancy and PBDE levels in cord plasma. Methylation of five TH regulatory genes, namely deiodinase type 3 (DIO3), solute carrier family 16 member 2 (SLC16A2), solute carrier organic anion transporter family member 1C1 (SLCO1C1), thyrotropin-releasing hormone (TRH), and transthyretin (TTR), was quantified in the placenta. We investigated the associations between prenatal exposure to PBDEs and OPEs and DNA methylation of placental TH-related genes, using samples from 240 and 327 mother-newborn pairs, respectively. We further examined sex-specific differences in these associations and assessed whether the observed epigenetic alterations mediated the relationship between exposures and TH disruption. Mediation analyses were conducted in a subset of mother-newborn pairs with available TH measurements in cord plasma. BDE-47 and ΣPBDE showed sex-specific relationships with DIO3 and SLC16A2 methylation, with a significant positive association in females and a non-significant inverse association in males. Both BDE-47 and ΣPBDEs were linked to SLCO1C1 hypermethylation. OPE metabolites were positively associated with DIO3 and TTR methylation, predominantly in females. Mediation analyses suggested that SLCO1C1 hypermethylation mediated 6.5-7.0 % of the association between ΣPBDE exposure and reduced free triiodothyronine. These findings highlight sex-specific epigenetic changes in placental TH-related genes in relation to PBDE and OPE exposure, providing novel insights into fetal thyroid disruption pathways.
22. Occupational disparities in common cancer screening participation among workers: a nationwide cross-sectional study in Japan.
期刊: Journal of occupational health 发表日期: 2025-Aug-09 链接: PubMed
摘要
Cancer screening is crucial for early detection and improved health outcomes. Limited evidence exists on the association between occupational class and cancer screening participation in Japan. Therefore, we aimed to examine screening participation rates and disparities among active workers across different occupational classes. This cross-sectional study analyzed data from a nationwide web-based survey conducted in Japan (September-November, 2023). Eligible participants included current workers aged 40-64 years for colorectal, lung, and stomach cancer screenings (n=7,038), 40-64 years for breast cancer screening (n=2,929), and 30-64 years for cervical cancer screening (n=4,252). Cancer screening participation rates across occupational classes (upper non-manual, lower non-manual, and manual workers) were compared using the chi-square test. Poisson regression with robust variance was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for non-participation, adjusted for sex, age, educational attainment, household income, and workplace scale. Upper non-manual workers served as the reference group. Manual workers consistently had lower cancer screening participation rates. Compared to upper non-manual workers, manual workers exhibited significantly higher PRs for non-participation in colorectal (PR=1.12, 95% CI: 1.04-1.22), lung (PR=1.22, 95% CI: 1.12-1.34), stomach (PR=1.14, 95% CI: 1.05-1.23), and cervical cancer screenings (PR=1.16, 95% CI: 1.02-1.33). The disparities were particularly pronounced among male workers. Manual workers had lower cancer screening participation rates, particularly for colorectal, lung, stomach, and cervical cancer. Targeted interventions are needed to improve screening, particularly among manual workers, and reduce occupational disparities in cancer prevention and outcomes.
23. Low-density lipoprotein cholesterol and cardiovascular risk in the absence of calcifications on computed tomography: the Western Denmark Heart Registry.
期刊: European heart journal 发表日期: 2025-Aug-09 链接: PubMed
摘要
Coronary atherosclerosis tends to be non-calcified at early stages, questioning the implications of a coronary artery calcification score of zero (CAC = 0) at younger ages. This study investigates whether elevated low-density lipoprotein cholesterol (LDL-C) is associated with the presence of non-calcified plaques and future cardiovascular events in individuals with CAC = 0 across different ages. This cohort study from the Western Denmark Heart Registry included symptomatic individuals undergoing coronary computed tomography angiography (CCTA) from 2008-2021, with a 7.1-year median follow-up time. Outcomes included adjusted odds ratios (aOR) for non-calcified plaque on CCTA and adjusted hazard ratios (aHR) for coronary heart disease (CHD).The study included 23 777 individuals with CAC = 0. Median age was 54 (Q1-Q3 47-61) years, and 61% were women. The prevalence of non-calcified plaques was 11%. Per 1 mmol/L higher LDL-C, the overall aOR for non-calcified plaques was 1.21 [95% confidence interval (CI) 1.16-1.27]; corresponding values were 1.39 (1.23-1.56) at age ≤45, 1.22 (1.14-1.31) at age 46-60, and 1.11 (1.02-1.21) at age >60. During follow-up, 299 (1%) had a CHD event. Per 1 mmol/L higher LDL-C, the overall aHR was 1.28 (1.13-1.46) for CHD; corresponding values were 1.37 (1.04-1.82) at age ≤45, 1.24 (1.04-1.49) at age 46-60, and 1.26 (1.00-1.60) at age >60. In symptomatic individuals with CAC = 0, elevated LDL-C is associated with higher risk of non-calcified plaque and with higher relative risk of future CHD events, most pronounced at age ≤45 years. This indicates that LDL-C control over a long-time horizon remains important in younger individuals despite CAC = 0.
24. Response to Letter to the Editor: "Rethinking Biological Aging in Stroke: Nonlinear Thresholds, Patient Vulnerabilities, and Model Constraints".
期刊: QJM : monthly journal of the Association of Physicians 发表日期: 2025-Aug-08 链接: PubMed
摘要
25. Associations between dietary mineral intake and rheumatoid arthritis: evidence from UK biobank and NHANES.
期刊: Rheumatology (Oxford, England) 发表日期: 2025-Aug-08 链接: PubMed
摘要
The relationship between dietary mineral intakes and the risk of rheumatoid arthritis (RA) remains limited. This study aims to investigate the associations between dietary mineral intakes with RA. We evaluated the association between dietary mineral intakes and RA in 123 940 adults age 40-70 years. The observation period extended from April 2009 to December 2019, encompassing individuals who had no prior diagnoses of RA. This study selected common minerals from the UK Biobank and NHANES datasets for analysis, including calcium, iron, potassium, magnesium, zinc, phosphorus, copper, sodium, and selenium. Cox proportional hazard models were performed to assess the association between dietary mineral intakes and RA in UK Biobank. Additionally, we validated the observed associations in NHANES to confirm the robustness. After a median follow-up period of 8.07 years, a total of 123 940 participants were included in this study. The high intakes of iron (HR = 0.804, 95% CI 0.687-0.940) and magnesium (HR = 0.823, 95% CI 0.704-0.962) were associated with a reduced risk of RA. Intakes of phosphorus (HRMiddle = 0.827, 95% CI 0.707-0.966, HRHigh = 0.794, 95% CI 0.679-0.928) and copper (HRMiddle = 0.819, 95% CI 0.702-0.955, HRHigh = 0.763, 95% CI 0.652-0.893) were inversely associated with risk of RA. Similar results were observed in NHANES, particularly iron, magnesium, phosphorus, and copper. This study supported that dietary mineral intakes were inversely associated with RA, particularly dietary iron, magnesium, phosphorus, and copper.
26. Execution of School Feeding Programs in Latin America during the Covid-19 Pandemic from the Perspective of the Human Right to Adequate Food and Nutrition (HRAFN): A Scoping Review.
期刊: Nutrition reviews 发表日期: 2025-Aug-08 链接: PubMed
摘要
The COVID-19 pandemic impacted several sectors, including school feeding policies in Latin America, and harmed, above all, school-age children and adolescents, since schools closed and classes were interrupted. The aim of this review was to analyze the execution of school feeding programs (SFPs) in Latin America in the context of the COVID-19 pandemic from the perspective of the Human Right to Adequate Food and Nutrition (HRAFN). We undertook a scoping review of articles and official documents in the databases Embase, FSTA, LILACS, PubMed, SciELO, Scopus, and Web of Science, and in official websites and websites of government agencies of Latin American countries. A descriptive synthesis of the data was performed from the perspective of the HRAFN, analyzing whether the availability, accessibility, adequacy, and stability dimensions were guaranteed. A total of 191 texts were located. From these, 107 were selected, including 20 articles and 87 documents. It was found that 3 of the 20 Latin American countries did not maintain SFPs during the pandemic (2020-2022): Cuba, Haiti, and Nicaragua. Most countries adapted the provision of school feeding to include food baskets, cash transfers, ready meals, or meals prepared at the educational institutions. Regarding accessibility, 45% of the countries served the same beneficiaries who were previously part of the program, while 30% reduced accessibility to only a portion of the public. As for adequacy, 55% of the countries did not specify whether fresh food was provided. Concerning the stability dimension, no texts presented information about the guarantee of the measures carried out regularly during the pandemic. The dimensions of the HRAFN were not fully contemplated during the emergency period, and, therefore, there were several violations of the rights of students who were beneficiaries of SFPs.
27. Does Selection Bias Explain Observed Associations Between Respiratory Viral Co-Detection and Illness Severity?
期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 发表日期: 2025-Aug-08 链接: PubMed
摘要
28. Reporting of tobacco use and health outcomes among transgender and gender expansive people in gender-affirming hormone therapy research: 1980-2024.
期刊: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 发表日期: 2025-Aug-08 链接: PubMed
摘要
Transgender/gender expansive (TGE) people, who use tobacco at high rates, are frequently advised not to use tobacco during gender-affirming hormone therapy (GAHT) due to increased risk of negative health events. However, there is no summary of studies reporting risk of negative health events for TGE people with versus without tobacco use during GAHT. This systematic review assesses what is known about tobacco use and health outcomes in studies of TGE people pursuing GAHT. Searches were conducted in PubMed, Embase, PsycInfo, Google Scholar, and Mednar. The protocol was registered in Prospero (CRD42023416390). 107 studies published from 1980-2024 mentioned tobacco and GAHT for TGE patients. Most studies focused on adults (80.4%). Patient samples were feminine/transfeminine (29.9%), masculine/transmasculine (26.2%) or “both”/combinations (43.0%). Most studies (96.3%) reported smoking prevalence, ranging from 4.2% to 73.0%. Forty-three studies (40.2%) explored patient outcomes as they related to GAHT and tobacco use, but significantly increased risk of adverse health events for TGE people receiving GAHT with tobacco use relative to no tobacco use were found in only five studies (4.7%). Tobacco cessation was not mentioned in 79.4% of studies, and no studies reported offering cessation assistance. Identifying whether TGE people pursuing GAHT experience unique or exacerbated outcomes based on whether and what type of tobacco they use is critical for TGE-focused clinicians and researchers. This systematic review found few studies that identified empirical associations between tobacco use and GAHT-related health outcomes. Accurate tobacco assessment is essential to discern associations with GAHT-related outcomes.
29. Trajectory of Efficacy and Safety Across Ulotaront Dose Levels in Schizophrenia: A Systematic Review and Dose-Response Meta-Analysis.
期刊: The international journal of neuropsychopharmacology 发表日期: 2025-Aug-08 链接: PubMed
摘要
Ulotaront is an experimental antipsychotic for schizophrenia, but its optimal dose is unclear. This study aimed to evaluate dose-response relationships for efficacy and safety in people with schizophrenia. A systematic review of four databases (until January 22, 2025; INPLASY202510091) identified randomized clinical trials assessing ulotaront. Outcomes included efficacy, measured by changes in the Positive and Negative Syndrome Scale (PANSS) total score (primary outcome), positive and negative subdomains, and the Clinical Global Impression Scale-Severity (CGI-S), and safety, assessed by all-cause dropout (co-primary outcome, dropout due to adverse event, serious, non-serious, and specific adverse events. We employed one-stage dose-response meta-analysis (random-effects model) calculating standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Analysis of three randomized clinical trials (n=1,144) indicated that the 100 mg dose of ulotaront provided the greatest improvement in PANSS total score (SMD = -0.23 [95% CI: -0.43, -0.02]), PANSS positive symptom score (-0.30 [-0.70, 0.10]), and PANSS negative symptom score (-0.28 [-0.48, -0.08]). However, CGI-S scores did not exhibit a clear dose-response relationship. Regarding safety, all-cause dropout (RR at 100mg =1.10 [95% CI: 0.57, 2.12]), adverse event-related dropout, serious, non-serious, and most specific adverse events showed no significant dose-response relationship. The risk of anxiety-related adverse events was significantly higher than placebo at 50 mg and 75 mg doses (RR at 75mg =2.06 [95% CI: 1.11, 3.80]). Ulotaront 100 mg appears greatest efficacy with favorable safety for acute schizophrenia. However, effect sizes were small, and higher ulotaront doses should be tested.
30. Empowering Emergency Responders to Treat on Scene Alleviates Hospital Strain During Disaster Events.
期刊: Journal of burn care & research : official publication of the American Burn Association 发表日期: 2025-Aug-08 链接: PubMed
摘要
Disasters often lead to increased generator use, resulting in carbon monoxide poisonings (COP) and burn injuries that can overwhelm regional burn centers. Following Hurricane Ida, EMS providers in southeastern Louisiana were empowered to treat minor COP and burn injuries on scene without hospital transport. This study evaluated the impact of that policy. Using EMS and Louisiana Emergency Response Network (LERN) data, we analyzed EMS calls from three periods surrounding Hurricane Ida’s landfall on August 29, 2021: PRE-IDA (07/08-08/25), MID-IDA (08/26-09/08), and POST-IDA (09/09-10/31). We tracked call volumes, transport rates, and EMS turnaround times. Weekly calls were compared using Kruskal-Wallis tests and negative binomial regression; transport rates were assessed using Chi-squared tests. EMS received 1607 COP or burn-related calls during the study period. PRE-IDA, EMS averaged 15.3 calls/day (89% COP), with transport rates of 98% for COP and 61% for burns; turnaround time averaged 63 ± 36 minutes. MID-IDA saw a rise to 20.9 calls/day (84% COP), with transport rates of 78% for COP and 73% for burns; turnaround was 64 ± 31 minutes. POST-IDA, calls declined to 10.6/day, with 97% of COP and 61% of burns transported; turnaround was 69 ± 49 minutes. No repeat EMS calls were made by patients treated on scene. The study observed a significant increase in CO-related EMS dispatches during MID-IDA, with a concurrent decrease in hospital transports, indicating successful on-scene care. EMS turnaround times remained stable across all periods. These findings highlight effective collaboration between EMS and burn centers during disaster response.
31. Early pregnancy maternal hemoglobin and the risk of neonatal congenital heart disease: insights from a case-control study, Guangdong, China.
期刊: Postgraduate medical journal 发表日期: 2025-Aug-08 链接: PubMed
摘要
The association between maternal hemoglobin in the first trimester (1st TRI) and the risk of neonatal congenital heart disease (CHD) remains unclear. A case-control study was conducted involving 102 CHD neonates and 408 controls. Iron-deficiency anemia in the first trimester (1st TRI) was characterized by a hemoglobin level below 110 mg/L, in the absence of hemoglobinopathies such as thalassemias and sickle cell anemia like thalassemia or sickle cell anemia. We utilized logistic regression models to assess the association between maternal hemoglobin/iron-deficiency anemia in 1st TRI and the risk of neonatal CHD. Neonate born to mothers with iron-deficiency anemia in 1st TRI increased risks of CHD and patent ductus arteriosus compared to those in neonates born to mothers without anemia in 1st TRI (OR = 3.544, 95%CI = 1.428, 8.795; OR = 6.990, 95%CI = 1.248, 39.157, respectively). Pregnant women in the lowest hemoglobin quartile (Q1) in 1st TRI had a significantly higher risk compared to Q4 (OR = 5.365, 95% CI: 2.232-12.896). There was a dose-response relationship between lower maternal hemoglobin in 1st TRI and the increased risk of neonate CHD (P for trend < .001). The probabilities of neonates developing CHD increased as the maternal hemoglobin concentrations in 1st TRI decreased (rs = -0.614, 95% CI: -0.673, -0.555, P < .05). Maternal iron-deficiency anemia in 1st TRI increased the risk of CHD in neonates. Maternal hemoglobin in 1st TRI may be a practical risk marker of neonatal CHD. Key message What is already known on this topic-Previous studies have suggested that maternal anemia may influence fetal development, but the association between first-trimester maternal hemoglobin levels and the risk of neonatal CHD has remained unclear. What this study adds-This study demonstrates that maternal iron-deficiency anemia in the first trimester is significantly associated with an increased risk of neonatal CHD, particularly PDA, and that lower maternal hemoglobin levels are positively associated with higher CHD risk. How this study might affect research, practice or policy-These findings highlight the importance of early screening and management of maternal iron-deficiency anemia, suggesting that maternal hemoglobin in the first trimester could serve as a potential risk marker for neonatal CHD, informing prenatal care strategies and public health policies.
32. Surgical indicators for obstetrics and family planning in routine health information systems: a landscape analysis.
期刊: Health policy and planning 发表日期: 2025-Aug-08 链接: PubMed
摘要
Strengthening use of high-quality data for surgical obstetrics and family planning is important for improving maternal and perinatal health outcomes. Routine health information systems (RHIS) represent an important data source for indicator tracking. This landscape analysis aims to describe and compare surgical obstetric and family planning indicators put forth by global multi-stakeholder groups and those that are currently captured in RHIS in nine low- and middle-income countries. The analysis focused on five indicator topics: 1. caesarean delivery, 2. peripartum hysterectomy, 3. female genital fistula care, 4. insertion/removal of long-acting reversible contraception and male/female sterilization, and 5. the general surgical context. We examined 12 indicator lists developed by multi-stakeholder groups and RHIS documentation from the Democratic Republic of Congo, Guinea, India, Madagascar, Mali, Mozambique, Nigeria, Rwanda, and Senegal. 29 multi-stakeholder and 104 country indicators (119 unique indicators) met our inclusion criteria, typically capturing service provision or service readiness. Indicators on post-surgical outcomes or complications were rarer. The reviewed multi-stakeholder lists did not include indicators on peripartum hysterectomy. At the country level, not all RHIS included fistula care or peripartum hysterectomy indicators and there were marked differences with regards to what indicators were included and the relative distribution of indicators across the indicator topics. Only 14 (48%) of the multi-stakeholder indicators were included in countries’ RHIS, with just two being tracked by all nine countries (caesarean deliveries and family planning users by modern method of contraception). There was a lack of standardized indicators for surgical obstetrics and family planning, and we noted typical RHIS challenges such as indicator profusion, duplication, vague indicator definitions, and measurement of composite or difficult-to-quantify concepts. Our findings suggest that there are opportunities to standardize and streamline prioritized measurement of surgical obstetric and family planning data for tracking with the ultimate aim of improving health services.
33. Evolving strategies for early diagnosis, proactive prevention and treatment of CKD.
期刊: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 发表日期: 2025-Aug-08 链接: PubMed
摘要
Chronic kidney disease (CKD) is among the fastest growing global causes of death, forecasted to become the 3rd cause of death in Western Europe and Japan by 2050. By contrast, mortality from cardiovascular disease is decreasing. Cardiovascular medicine is focused on identifying people at high risk and intervening to prevent cardiovascular events. The focus of kidney medicine has evolved over time. Last century the focus was on treating kidney failure by kidney replacement therapy (KRT). However, KRT outcomes are suboptimal. Life expectancy is up to 44 (women on dialysis) to 22 years (women with functioning kidney grafts) shorter on KRT than in the general population. The 21st century has witnessed an explosion of highly effective kidney protective drugs that may both prevent and slow the progression of CKD while addressing the full cardiovascular-kidney-metabolic (CKM) syndrome spectrum, i.e. also improving cardiovascular and metabolic outcomes. However, these advances have met a barrier: 20th century concepts on whom to test for CKD, which focus on assessing albuminuria just in people with diabetes mellitus. This outdated concept limits early diagnosis and treatment in up to 80% of people who eventually develop kidney failure. Clinical trials suggest that starting kidney protective therapy because CKD was diagnosed based on albuminuria, when glomerular filtration rate is normal, may delay the need for KRT for up to nearly 3 decades, meaning that many older subjects would not require KRT. To improve outcomes, the next two steps in kidney medicine should involve the widespread adoption of the ABCDE (Albuminuria, Blood pressure, Cholesterol, Diabetes and Estimated glomerular filtration rate) approach for early detection and treatment of CKM risk, followed by developing the concept of pre-CKD that may guide pharmacological interventions targeted to prevent CKD, on top of healthy lifestyle measures for all he population, not just for those at risk.
34. Radiation dose to the eye lens and the shielding efficacy of a protective eye mask in patients with Hodgkin lymphoma undergoing repeated CT examinations.
期刊: Radiation protection dosimetry 发表日期: 2025-Aug-08 链接: PubMed
摘要
This study evaluated radiation dose to the eye lens and the shielding efficacy of a radiation-protective eye mask (E-Mask) during repeated chest and abdomen computed tomography (CT) scans. Dose measurements were obtained using an anthropomorphic phantom and an optically stimulated luminescence dosemeter (Model TOPAZ, LANDAUER, USA). A 5-y follow-up scenario for Hodgkin lymphoma was simulated by assuming one scan per quarter, with the single-scan dose multiplied by 20 to represent four scans annually over 5-y. Despite the use of low-dose protocols based on national diagnostic reference levels issued by the Korea Disease Control and Prevention Agency, unshielded cumulative lens doses reached 363.89 mSv (right) and 424.84 mSv (left). Using an E-Mask reduced these doses to 243.96 mSv and 240.13 mSv, corresponding to reductions of 32.96% and 43.48%, respectively. These findings support the use of the E-Mask in radiosensitive populations to reduce lens exposure during long-term CT follow-up.
35. Body mass index and subsequent fracture risk: A meta-analysis to update FRAX®.
期刊: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 发表日期: 2025-Aug-08 链接: PubMed
摘要
The aim of this international meta-analysis was to quantify the predictive value of body mass index (BMI) for incident fracture and relationship of this risk with age, sex, follow-up time and bone mineral density (BMD). 1 667 922 men and women from 32 countries (63 cohorts), followed for a total of 16.0 million person-years were studied. 293 325 had femoral neck BMD measured (2.2 million person-years follow-up). An extended Poisson model in each cohort was used to investigate relationships between WHO-defined BMI categories (Underweight:<18.5 kg/m2; Normal:18.5-24.9 kg/m2; Overweight:25.0-29.9 kg/m2; Obese I:30.0-34.9 kg/m2; Obese II:≥35.0 kg/m2) and risk of incident osteoporotic, major osteoporotic and hip fracture (HF). Inverse-variance weighted β-coefficients were used to merge the cohort-specific results. For the subset with BMD available, in models adjusted for age and follow-up time, the hazard ratio (95%CI) for HF comparing underweight with normal weight was 2.35 (2.10-2.60) in women and for men was 2.45 (1.90-3.17). HF risk was lower in overweight and obese categories compared to normal weight [obese II vs normal: women 0.66 (0.55-0.80); men 0.91 (0.66-1.26). Further adjustment for femoral neck BMD T-score attenuated the increased risk associated with underweight [underweight vs normal: women 1.69 (1.47-1.96); men 1.46 (1.00-2.13)]. In these models, the protective effects of overweight and obesity were attenuated, and in both sexes the direction of association reversed to higher fracture risk in Obese II category [Obese II vs Normal: women 1.24 (0.97-1.58); men 1.70 (1.06-2.75)]. Results were similar for other fracture outcomes. Underweight is a risk factor for fracture in both men and women regardless of adjustment for BMD. However, whilst overweight/obesity appeared protective base models, they became risk factors after additional adjustment for femoral neck BMD, particularly in the Obese II category. This effect in the highest BMI categories was of greater magnitude in men than women. These results will inform the second iteration of FRAX.
36. A Novel Approach for Atrial Fibrillation-related Obstructive Sleep Apnea Detection Using Enhanced Single-Lead ECG Features with Customized Deep Learning Algorithm.
期刊: Sleep 发表日期: 2025-Aug-08 链接: PubMed
摘要
Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are interrelated conditions that substantially increase the risk of cardiovascular complications. However, concurrent detection of these conditions remains a critical unmet need in clinical practice. Current home sleep apnea test (HSAT) devices often fail to detect arrhythmias essential for diagnosing OSA-associated AF due to limited ECG monitoring capabilities, and their integration with continuous positive airway pressure (CPAP) data for treatment optimization remains underutilized. This study introduces SHHDeepNet, an advanced deep learning-based framework designed for the detection of OSA in patients with AF, leveraging enhanced features extracted from single-lead electrocardiogram (ECG) signals. The ECG signals were preprocessed and refined using reconstruction independent component analysis (RICA), which isolates statistically independent features for improved data representation. These features were subsequently classified using the customized SHHDeepNet architecture. SHHDeepNet utilizes advanced signal processing and deep learning techniques to enhance ECG-based detection of AF-associated OSA. The framework was validated using overnight ECG recordings from 101 subjects derived from the Sleep Heart Health Study Visit 1 (SHHS1) database, encompassing 36 prevalent AF (PAF) cases, 25 incident AF (IAF) cases, and 40 OSA cases. Detection performance was evaluated through binary classification (AF AH vs. AF non-AH) and multi-class classification (AF AH, AF non-AH, non-AF AH, and non-AF non-AH). During 5-fold cross-validation (5fold-CV), the framework achieved a binary classification accuracy of 98.22%, sensitivity of 96.8%, specificity of 99%, and an area under the curve (AUC) of 0.9981. For multi-class classification, 5fold-CV yielded 98.36% accuracy, 97.14% sensitivity, 98.77% specificity, and an AUC of 0.9975. Validation using leave-one-subject-out cross-validation (LOSO-CV) achieved a binary classification accuracy of 86.42%, sensitivity of 79.4%, specificity of 90.2%, and an AUC of 0.9372. For multi-class classification under LOSO-CV, the average accuracy, sensitivity, and F1-score were 86.7%, 72.6%, and 0.7224, respectively. External validation was performed on a cohort of 123 subjects from the Osteoporotic Fractures in Men (MrOS) database, comprising 68 cases of PAF and 55 cases of OSA. The proposed method achieved a multi-class classification accuracy of 88.51%, sensitivity of 73.50%, specificity of 91.34%, and an AUC of 0.9363. These findings underscore the significance of simultaneous detection of AF and OSA, providing a more comprehensive evaluation of cardiovascular health. The proposed SHHDeepNet framework offers a promising tool to support clinical decision-making, enhance management strategies, and improve patient outcomes by mitigating the risks associated with these conditions.
37. Women with endometriosis have decreased health-related quality of life until late fertile age: a population-based cohort analysis at ages 31 and 46 years.
期刊: Human reproduction (Oxford, England) 发表日期: 2025-Aug-08 链接: PubMed
摘要
What is the health-related quality of life (HRQoL) at fertile and late fertile age in women with history of endometriosis? Women with endometriosis have lower HRQoL until late fertile age and depression, infertility, pain, and poor general health seem to contribute to this impairment, whereas BMI, education, smoking, parity, current use of contraceptives, and contact to tertiary care have positive association with HRQoL in this population. Women with endometriosis are known to have decreased HRQoL at fertile age, however, studies concerning late fertile age and beyond are lacking. This study utilized Northern Finland Birth Cohort 1966, which is a unique, population-based dataset comprising all expected births in 1966. The present study included data from two collection time points, at ages 31 (fertile age) and 46 years (late fertile age), including both questionnaire and clinical measures. The endometriosis diagnosis was obtained from self-reported questionnaires as well as through a data linkage to the Finnish Institute for Health and Welfare Care Register for Health Care (CRHC) to obtain International Classification of Diseases (ICD) code data from years 1972-2020. Altogether, 419 women with and 3279 women without endometriosis were identified. The diagnosis for endometriosis was based on either CRHC-derived ICD data (n = 298) and/or self-reported history of endometriosis diagnosed by a physician (n = 283). HRQoL was assessed with the 15D instrument, which is a generic, comprehensive, and standardized tool to measure HRQoL. The 15D score and the dimensional level values range from 0 to 1, score 1 indicating full health and 0 indicating death. The questionnaire was completed by 252 women with endometriosis at 31 years and 302 women at age 46 years. The corresponding numbers in the reference group were 2057 and 2626, respectively. Several confounding factors were also considered. In women with endometriosis, HRQoL was lower both at fertile and at late fertile age when compared with women without endometriosis, yet the total score did not reach clinical significance, set as ±0.015 change in HRQoL total score (age 31 years: 0.944 vs 0.951, P = 0.04; age 46 years: 0.916 vs 0.924, P = 0.03). At age 31 years, the 15D single index scores on ‘sleeping’, ‘depression’, and ‘distress’ were impaired in women with endometriosis, whereas ‘sleeping’ was impaired at age 46 years in affected women. The HRQoL decreased both in endometriosis and reference groups over time from age 31 to 46 years. In the non-adjusted analysis, women with endometriosis had their HRQoL score in the lowest quartile as often as the women without endometriosis at 31 or 46 years (OR [95% CI] 1.33 [1.00-1.78]); age 46 years (1.28 [0.98-1.66]). However, when the adjusted risk model took into account BMI, education, and smoking, there was a significant risk for lower HRQoL in endometriosis cases at both time points (age 31 years: OR [95% CI] 1.42 [1.06-1.91]; age 46 years: 1.42 [1.06-1.89]) and at age 31 years when parity and contraceptive use were considered in the model (OR [95% CI] 1.40 [1.03-1.91]). Depression, infertility, pain, and poor general health seemed to contribute to impaired HRQoL. Moreover, in the subgroup analysis, women with self-reported endometriosis had a higher risk for lower HRQoL scores at fertile and late fertile age than women with a hospital-based disease code when compared with reference population. Given the well-known lack of awareness and diagnostic delay in endometriosis, there may be undiagnosed cases of endometriosis among the reference group that may have led to underestimations of the differences between the study groups. Moreover, we were not able to identify the type of intervention during hospitalization in the present dataset. Also, the ethnicity of this study population is rather homogenous and thus may not be generalized in other ethnicities. This is the first population-based data to show women with endometriosis presenting low HRQoL at fertile and even at late fertile age, although with only mild decrease compared to non-endometriosis cases. HRQoL-items like ‘sleeping’, ‘depression’, and ‘distress’ were affected giving the idea that these items should be targeted in patient care, noting that depression, infertility, pain, and poor general health contributed to lower HRQoL. On the other hand, supporting fertility, hormonal treatments and access to tertiary care may offer solutions to improve HRQoL in women suffering from endometriosis. The study has been funded with grants received from the Finnish Society of Obstetrics and Gynaecology (S.V.), University of Oulu (S.V.), Paulo Foundation (S.V.), Gedeon Richter (S.V.), Sigrid Jusélius Foundation (T.T.P.), and Oulu University Hospital (T.T.P., H.-R.R., L.M.-P.). The NFBC1966 31-year follow-up received financial support from the University of Oulu Grant no. 65354, Oulu University Hospital Grant no. 2/97 and 8/97, Ministry of Health and Social Affairs Grant no. 23/251/97, 160/97 and 190/97, the National Institute for Health and Welfare, Helsinki Grant no. 54121 and the Regional Institute of Occupational Health, Oulu, Finland Grant no. 50621 and 54231. The NFBC1966 46-year follow-up received financial support from University of Oulu Grant no. 24000692, Oulu University Hospital Grant no. 24301140 and European Regional Development Fund (ERDF) Grant no. 539/2010 A31592. Authors have no conflict of interest to declare. N/A.
38. The relationship between private import of alcoholic beverages and domestic sales of alcoholic beverages: analyses of Swedish time-series data.
期刊: European journal of public health 发表日期: 2025-Aug-07 链接: PubMed
摘要
Private imports of alcoholic beverages-often referred to as cross-border trade-have long raised concerns in Sweden and other Nordic countries due to their potential impact on national alcohol policies and public health. A key concern is that this trade increases total alcohol consumption and related harms. This study examines the relationship between private alcohol imports and domestic sales in Sweden, with a focus on how cross-border trade influences total alcohol consumption. Using regional and beverage-specific time series data from 2002 to 2023, we applied SARIMA modelling to self-reported import estimates from the Monitor project to assess substitution effects on domestic alcohol sales. Private imports significantly displace domestic alcohol purchases, particularly in southern Sweden across all beverages, though the substitution is partial. For Sweden as a whole, analyses indicate that a 1-litre increase in imports is associated with a 0.456-litre decrease in domestic sales. In central Sweden, only spirits imports show a significant effect (1-litre increase in spirits imports yields a 0.175-litre decrease in domestic sprits sales), while no significant associations are observed in the north. The findings suggest that cross-border trade contributes to higher overall alcohol consumption, especially in border regions. Regional variation underscores the need for differentiated alcohol policy responses. Private imports undermine the effectiveness of domestic alcohol control measures. However, since domestic sales do not influence import levels, policy efforts such as increased excise taxation may reduce total consumption without triggering substantial compensatory imports.
39. Evolution of Shared Care Networks by Race and Ethnicity: Findings from the National Health and Aging Trends Study (NHATS).
期刊: The journals of gerontology. Series B, Psychological sciences and social sciences 发表日期: 2025-Aug-07 链接: PubMed
摘要
The aging population in the United States is increasingly diverse, particularly among community-dwelling individuals with disabilities. Black and Hispanic older adults experience greater reliance on assistance with daily activities (e.g., bathing, shopping, banking) than White adults. Assistance is often provided by multiple caregivers helping with the same tasks (“role-sharing”). We describe patterns of shared care by examining racial and ethnic differences in role-sharing in 2015 and 2022. We use weighted, repeated cross-sectional data from the 2015 and 2022 National Health and Aging Trends Study, focusing on Black, White, and Hispanic community-dwelling care recipients (n = 3,050 in 2015; n = 2,318 in 2022) who receive assistance with household (e.g., shopping), self-care (e.g., bathing, dressing), mobility (e.g., getting around indoors), or medical activities (e.g., medication management) due to health or functioning limitations. Logistic regression models using generalized estimating equations assessed race differences in experiencing role-sharing, adjusting for older adult characteristics and survey year. Role-sharing was most common in the household assistance domain, with approximately 30% of all groups reporting role-sharing in both years. In fully-adjusted models, Hispanic recipients experienced lower odds of role-sharing for household tasks (OR: 0.72, 95% CI: 0.57-0.91) compared to White care recipients. Racial and ethnic differences were not observed in other care domains, and role-sharing prevalence was consistent in 2015 and 2022. Findings underscore the complexity of caregiving networks and inform strategies to improve collaboration and reduce role ambiguity among role-sharing caregivers.
40. Airborne injustice: a preliminary exploration of the associations between pollutants and hospitalizations, sleep, and cognition in children and young adults living with sickle cell disease.
期刊: Journal of pediatric psychology 发表日期: 2025-Aug-07 链接: PubMed
摘要
This study aimed to investigate the role of environmental pollutants, specifically nitrogen dioxide (NO2) and particulate matter (PM10), on children and young adults (CYA) living with sickle cell disease (SCD) in the United Kingdom. Given the heightened vulnerability of this population due to socio-environmental factors, we explored how these pollutants influence hospitalization rates, sleep quality, and cognitive function. Data were analyzed from the London Sleep Asthma Cohort, which included 94 CYA living with SCD at Visit 1, although this full sample was not available for all analyses. Participants’ exposure to NO2 and PM10 was determined using air quality data linked to their residential postcodes. Hospitalizations, sleep quality, and cognitive function were assessed through medical records, caregiver questionnaires, and cognitive testing. Multiple regression analyses were conducted to determine the relationship between pollutant exposure and health outcomes, controlling for age, community deprivation, and asthma diagnosis. The study found that NO2 exposure significantly predicted lifetime hospitalizations for acute chest syndrome (ACS), particularly among participants with asthma. However, despite some trends toward significance, no significant relationships were observed between pollutant exposure and pain-related hospitalizations, sleep quality, or cognitive function. Our preliminary findings suggest that NO2 exposure exacerbates respiratory complications in CYA with SCD, especially in those with asthma. Our results underscore the need for targeted public health interventions to mitigate air pollution in marginalized communities, which could reduce ACS-related hospitalizations and improve health outcomes for vulnerable populations. Further research is recommended to explore the mechanisms linking pollution to SCD complications.
41. Research on the Traceability and Transmission Factors of Salmonella in the Broiler Production Chain: A One Health Perspective.
期刊: FEMS microbiology letters 发表日期: 2025-Aug-06 链接: PubMed
摘要
Salmonella contamination in chicken is a food safety problem that is widely concerned by all countries around the world. Based on the “One Health” concept, this study systematically collected samples from animals, the environment and workers across 5 stages of the broiler production chain (breeding farms, hatcheries, commercial broiler farms, slaughterhouses, retail) in China, to investigate the prevalence of Salmonella. Meanwhile, based on whole genome sequencing and risk assessment technology, combined with MLST, cgMLST traceability analysis was conducted to clarify the critical control points and transmission factors associated with Salmonella contamination. The results showed that the prevalence rate of Salmonella in the broiler production chain was 10.22% (469/4589). The broiler production chain encompassed 11 serotypes of Salmonella, with S.Enteritidis ran through the entire production chain. Fourteen types of ST were detected from 99 representative strains, and the dominant types were ST11, ST198 and ST1543. ST11 covered the samples from animals, environment and workers in all stages of broider production chain, and was further divided into 14 cgST types. Analysis using @RISK software revealed that the Spearman correlation coefficients for slaughterhouses and hatcheries were 0.54 and 0.26, respectively. These research findings are expected to comprehensively guide chicken production and provide effective strategies for preventing and controlling Salmonella contamination in the broiler production chain.
42. Nursing activities and associated workload of nurses in virtual care centres: A multicentre observational study.
期刊: PLOS digital health 发表日期: 2025-Aug 链接: PubMed
摘要
Virtual care centres (VCCs) are novel wards of hospitals and facilitate the provision of remote monitoring and home-based patient care by virtual care nurses. Whereas since the COVID-19 pandemic VCCs have rapidly emerged, there is a lack of insight in virtual care nurses’ work and the associated work load. Therefore, the aim of this study was to identify the nursing activities performed in Virtual Care Centers (VCCs) and assess nurses’ perceived workload associated with these activities. A multicentre descriptive, observational cross-sectional study was performed. Data collection (February - June 2024) involved three steps: establishing a list of nursing activities, defining and quantifying workload using the NASA-Task Load Index and Analytical Hierarchy Process (AHP), and measuring nursing activity-associated workload by a survey involving 19 virtual care nurses across six VCCs in the Netherlands who had been employed in VCCs for at least one year. Eventually, we identified 21 nursing activities categorized into five areas: education and training (n = 2), development and promotion of new care pathways (n = 4), patient contact (n = 4), clinical decision-making (n = 8), and administration (n = 2). The overall workload was predominantly rated as low to medium, with the development of protocols for new digital care pathways being the most demanding activity. Routine nursing activities, such as patient contact and clinical decision-making, resulted in low to very low workload ratings. In conclusion, we found VCC nurses engage in a broad spectrum of conventional and novel nursing tasks, of which we measured their associated workload using a novel approach integrating NASA-TLX and AHP. The highest associated workload suggest the need for task differentiation and/or additional training to support nurses in managing these high-demand tasks. The VCC model may offer a viable alternative for nurses experiencing high workloads in conventional wards, potentially alleviating some pressures on nursing staff in traditional healthcare settings, mostly in the shift from physical to mental demand.
43. Clinical and pathological characteristics and outcomes of small cell neuroendocrine carcinoma of the uterine cervix.
期刊: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 发表日期: 2025-Jul-11 链接: PubMed
摘要
To describe the clinical and pathological characteristics and outcomes of small cell neuroendocrine carcinoma of the uterine cervix at the population level in the United States. The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program was retrospectively queried. The study population included 54,987 patients with cervical cancer from 2004 to 2021. Descriptive analysis was performed based on histology. Histology types included squamous cell carcinoma (n = 38,145, 69.4%), adenocarcinoma (n = 14,333, 26.1%), adenosquamous carcinoma (n = 1,970, 3.6%), and small cell neuroendocrine carcinoma (n = 539, 1.0%). Over the 18-year study period, the incidence rate of small cell neuroendocrine carcinoma increased by 3.2% per year (95% CI 1.2 to 5.7, p = .003). Based on this trajectory, the incidence of small cell neuroendocrine carcinoma is estimated to reach 2.0% by 2035. Small cell neuroendocrine carcinoma was associated with larger cervical tumors (60 mm versus 27-40 mm), a higher lymph node metastasis ratio (25.0% versus 14.3%-15.4%), higher distant metastasis rate even in small tumor (10 mm, 10.3% versus 0.5-2.6%; and 20 mm, 14.8% versus 3.9-5.3%), and stage IV disease (40.1% versus 11.9%-15.2%) than other histologies (p < .001). Among distant metastasis cases, small cell neuroendocrine carcinoma was more likely to spread to the liver (36.1% versus 14.3%-15.4%) or bone (28.8% versus 17.3%-19.1%) and to involve multiple distant organ metastases (≥2 organs: 37.3% vs 27.8%-30.2%; and ≥3 organs: 18.1% vs 9.2%-10.1%) compared with other histologies (p < .001). Across stages I to IV, small cell neuroendocrine carcinoma had lower 5-year overall survival rates than other histologies: stage I, 58.0% versus 82.5% to 91.3%; stage II, 38.4% versus 60.7% to 64.6%; stage III, 31.3% versus 49.5% to 51.4%; and stage IV, 8.1% versus 18.2% (p < .05). Early-death rates within two months from diagnosis of small cell neuroendocrine carcinoma were substantially higher than other histologies (9.0% vs 2.2%, p < .001). This population-based assessment suggests that, although rare, the incidence of small cell neuroendocrine carcinoma of the uterine cervix is gradually increasing in the United States. Multiple distant organ metastases, especially to the liver and bone, and poor survival outcomes characterize small cell neuroendocrine carcinoma of the uterine cervix.
44. Demystifying the commercial determinants of health in antimicrobial resistance through complex system dynamics.
期刊: Health promotion international 发表日期: 2025-Jul-01 链接: PubMed
摘要
Antimicrobial resistance (AMR) poses a significant threat to public health. The commercial determinants of health (CDoH) play a key role in shaping the development and growth of AMR. It is important to recognise these commercial factors and situate them within the complex system which describes the emergence and transmission of AMR, so that we can begin to evaluate their impact. There are several feedback loops in the AMR system that prevent a linear ‘cause and effect’ solution presenting itself to policymakers. These factors are all complexly interdependent and a solution requires recognition of this complexity. We take it for granted that one solution alone cannot tackle the issue of the growing threat of AMR. For this reason, we propose the use of complex system dynamics to visualize key interdependencies within the system. By building on existing systems maps of AMR, we propose to explore and highlight the relationships between the CDoH and AMR in order to demonstrate how commercial factors have consequences for and knock-on effects on other elements (and potential policy suggestions) within the system. In short, the proposed systems map is a tool that can be used to (i) represent some of the ways that commercial factors impact on AMR and (ii) visually simplify the complexity of the issue at hand. We provide a map that could act as a starting point to demonstrate our argument and act as a baseline to be developed going forward in collaboration with other research and non-research actors within the system.
45. Frameworks for process evaluations of diabetes self-management programs: a systematic review.
期刊: Health promotion international 发表日期: 2025-Jul-01 链接: PubMed
摘要
This systematic review investigates the utilization and reporting of frameworks to guide process evaluations (PE) of diabetes self-management programmes (DSMPs). Constituting a subset of articles from a previously published systematic review, seven studies, comprising nine articles, met the inclusion criteria. The different approaches to manage diabetes were reflected in the study’s characteristics and types of interventions. The quality of reporting differed even with the inclusion of evaluation frameworks, which affected the evidence’s transferability and comparability. All studies cited their frameworks; yet, only a few gave thorough explanations and used the frameworks consistently throughout their research. A critical appraisal for reporting quality revealed a need for standardized guidelines to assess the thoroughness of framework utilization. Implications for practice include adopting a checklist of indicators to enhance reporting quality and encouraging uniformity in PE methodologies.
46. Physical activity in urban green spaces: a systematic review of participatory approaches.
期刊: Health promotion international 发表日期: 2025-Jul-01 链接: PubMed
摘要
Urban green spaces (UGSs) are most effective in promoting physical activity (PA) when they are designed to align with the needs of the communities they serve, and participatory approaches address this need by capturing local knowledge and driving meaningful action. This systematic review aims to synthesize evidence on how participatory approaches address PA in UGS, analyzing variations in their context, process, output, outcome, and impact. A systematic search was conducted in Scopus, Web of Science, PubMed, and ScienceDirect for literature from January 2000 to January 2025. Studies were included if they employed participatory approaches for assessing or promoting PA in UGS. Data extraction followed the comparison of the participatory processes framework, and study quality was assessed using the Mixed Methods Appraisal Tool 2018. Of 1926 records, 13 studies met the inclusion criteria. The results show that most approaches were researcher-led and operated at the local and regional levels. Despite being labeled participatory, several studies had a limited degree of participation, focusing mostly on (co-)data collection. Most studies had also limited spatial, social, and temporal reach, often confined to the study area and participant group. However, some approaches successfully increased PA in UGS and demonstrated positive social and individual benefits, with (co-)design and citizen science projects standing out for their strong participation and broader social impacts. Future studies and interventions should involve participants throughout all stages, establish clear participatory frameworks, enhance scalability, and incorporate strategies for long-term sustainability to optimize outcomes.
47. Using a Farm Safety Checklist to Assess Learner Performance Following a Safety Education Training.
期刊: Journal of agricultural safety and health 发表日期: 2025-Jan-29 链接: PubMed
摘要
Percent agreement score showed moderate acceptability in preparing participants to complete the SFS application. Using self-directed learning to guide the training provided evidence for successful SFS application completion. Researchers plan to modify the self-directed learning approach to increase future SFS training success rates. This study evaluates the use of Self-Directed Learning (SDL) and Performance-Based Assessment (PBA) to improve the accuracy of adult educators’ completion of the Safe Farm Steward (SFS) application. PBA is a form of assessment commonly utilized in youth education, but there is limited evidence of its implementation among adults. Through implementing SDL, the researchers introduced a farm safety model to extension agents, agriculture teachers, and college professors to improve their performance assessment. The cohort attended a three-day professional development training followed by farm visitations; the training and visitations employed materials that incorporated SDL techniques. This study’s findings indicate that the professional development training was moderately acceptable in preparing the cohort to accurately complete the SFS application. Though the cohort did not meet the expected score on each individual construct, the overall PBA demonstrated moderate acceptability compared to the expected score. The researchers highlight gaps in professional development where recommendations for improvement could be made.
48. Social and Individual Influences on ATV and UTV Operating Practices of Young Adult Agricultural Workers.
期刊: Journal of agricultural safety and health 发表日期: 2025-Jan-29 链接: PubMed
摘要
Over 50% of the young adult agricultural workers surveyed reported never wearing a helmet, seatbelt, or hearing protection when operating an ATV or UTV. Young adult agricultural workers’ mean ATV and UTV safety scores ranged from 1 to 4.44 on a scale of 1 to 5. Gender, supervisor influence, and risk-taking behaviors significantly influenced young agricultural workers ATV and UTV safety scores. ATV and UTV crashes are a leading cause of agricultural-related injury and death in the United States. Young adult agricultural workers (under the age of 25) contribute substantially to the agricultural workforce and often utilize ATVs and UTVs in their work. However, it is unknown if they have adopted recommended safe operating behaviors that could reduce the potential for injury or death. As such, we evaluated young adult agricultural workers’ reported ATV and UTV operating practices and safety influences. Agricultural students from four Midwestern colleges and universities responded to an online survey about ATV and UTV operating behaviors, social influences (supervisor, peer, and parental risk-taking behaviors), and individual risk-taking orientation and tendencies. An ATV/UTV safety score was calculated from participants’ responses, and linear regression methods were used to examine associations between scores and other aspects of risk-taking. Out of 193 respondents, a large proportion of participants reported never wearing hearing protection (68.6%), a seatbelt (59.2%), or a helmet (58.1%) while operating an ATV or UTV. The analysis identified gender (p < 0.001), global risk-taking (p = 0.001), risk-taking orientation at work (p = 0.012), and supervisor influence (p = 0.015) as significant factors influencing young adult agricultural workers’ safety scores. The findings suggest that gender, individual risk-taking tendencies, and supervisor influence play crucial roles in safety behavior, indicating that risk management initiatives for young adult agricultural workers should not only focus on individual behavior change but also consider the broader social and workplace influences on safety.
49. An Intervention to Reduce Occupational Health Risk from Antibiotic Resistant Pathogens Among Dairy Farm Workers.
期刊: Journal of agricultural safety and health 发表日期: 2025-Jan-29 链接: PubMed
摘要
This intervention utilized the Health Belief Model and Theory of Planned Behavior to address the knowledge and social barriers that increase dairy farm workers’ risk to antimicrobial-resistant infections. Dairy farm workers gained a significant increase in knowledge of the 8 desired outcomes, related to occupational health skills that reduce risks, from our intervention. Limited time was a major barrier as to why dairy farm workers felt like they could not make behavioral changes that would reduce their occupational health risk. Dairy farmworkers showed a strong likelihood of making workplace health-related behavioral changes, but their intention to change was weaker in areas of personal antibiotic stewardship. This study focused on developing and evaluating an educational intervention designed to mitigate occupational health risks associated with pathogens and antibiotic-resistant bacteria among dairy farm workers. Data collected from farms and workers as part of a larger umbrella project that focused on dairy farm antibiotic use for cows and calves were used to inform elements of the Health Belief Model and the Theory of Planned Behavior, leading to eight intervention outcomes. The intervention targeted increased knowledge and promoted behavioral changes related to worker and workplace hygiene best practices, PPE use, biosecurity, and personal antibiotic stewardship. Educational materials included instructional videos, fact sheets in English and Spanish, and supplementary printed material, including illustrated take-home points, content summaries, and posters. The intervention was conducted with 32 workers from five dairy farms, using pre- and post-intervention assessments to measure knowledge gains and behavioral intentions. Results demonstrated statistically significant increases in knowledge across all targeted outcomes (p-value ≤ .001), with most participants showing a high willingness and likelihood to implement recommended behaviors related to their workplace exposures and best practices. However, participants indicated a greater reluctance to change around issues of personal antibiotic stewardship. Time constraints were the most significant and most consistent barrier to behavior change. The study highlights the importance of ongoing research and refinement of intervention strategies to address barriers and enhance protective practices among often underserved farmworkers in agriculture. These intervention strategies contribute to improved occupational health outcomes with benefits to public health by reducing the spread of antibiotic-resistant infections to the broader population.
50. Feasibility and acceptability of the Fit2Thrive mHealth physical activity promotion intervention components in breast cancer survivors.
期刊: Translational behavioral medicine 发表日期: 2025-Jan-16 链接: PubMed
摘要
Most breast cancer survivors (BCS) are insufficiently active. mHealth moderate-to-vigorous physical activity (MVPA) interventions for BCS are highly scalable, but the feasibility and acceptability of specific intervention components are unknown. The purpose of this study is to examine the feasibility and acceptability of the Fit2Thrive MVPA promotion intervention components. Using Multiphase Optimization Strategy methodology, inactive BCS [n = 269; Mage = 52.5; (SD ± 9.9)] received a core intervention (Fitbit + Fit2Thrive smartphone app) and were randomly assigned to receive zero to five components for 12 weeks: (i) support calls; (ii) deluxe app; (iii) text messages, (iv) online gym; and (v) Buddy. Feasibility was measured through study accrual, retention, and adherence rates. Acceptability was measured via post-program evaluations. Enrollment rates were high; 419 BCS expressed interest in the study, 348 (83%) passed screening, and 269 (77%) were randomized; 98% (n = 264) received the intervention. Retention was 94% at 12 weeks. Fitbits were worn on 93% of study days. Most reported using the app ≥5 days/week (67%), enjoyed using the Fitbit (79%), and were satisfied with their study experience (88%) and the Fit2Thrive app design (79%). Component adherence rates and acceptability varied by intervention component. Component-specific effects on MVPA goal adherence and overall acceptability ratings were significant for telephone support calls. Findings indicate Fit2Thrive’s feasibility and acceptability were high overall but may vary by component. Future work should refine and test components to maximize participant engagement, efficacy, and scalability. The Clinical Trials Registration NCT03131440. This study examined the feasibility and acceptability of Fit2Thrive, a technology-based intervention to promote physical activity among breast cancer survivors (BCS). Regular physical activity can improve health and quality of life for BCS, but many do not meet recommended activity levels. Fit2Thrive offers a scalable strategy to guide BCS in increasing their activity level. Results showed Fit2Thrive was generally well-received by participants. The core components, including a mobile app and Fitbit, were motivating and easy to use. However, when additional intervention features were tested, engagement varied. Telephone support calls were one additional feature rated as particularly helpful, with participants who received these calls showing better adherence to physical activity goals. Participant factors, including age, body mass index (BMI), and education, influenced how participants engaged with the intervention. Older participants, those with lower BMI, and those with higher education were more likely to use the app and meet physical activity goals. Overall, the core Fit2Thrive intervention was highly feasible and acceptable, and the findings suggest that highly automated interventions may be successful. The study supports the potential of Fit2Thrive to improve physical activity and health outcomes for BCS and could be adapted for other survivor groups.