公共卫生研究摘要 (2025-08-16)

共收录 61 篇研究文章

1. Determinants of When Community Behavioral Health Clinics Partner With Emergency Response Systems: The Role of Capacity in 911 Referral and Co-response Models.

期刊: The Milbank quarterly 发表日期: 2025-Aug-15 链接: PubMed

摘要

Policy Points Certified community behavioral health clinics (CCBHCs) commonly partner with emergency response systems in mobile crisis response through 911 referral arrangements, wherein behavioral health practitioner-only teams respond to 911 calls, and co-response partnerships, wherein a CCBHC clinician joins a police or emergency medical services team. Both the internal staff capacity of the CCBHC and external police capacity are associated with when CCBHCs partner with emergency response systems in mobile crisis response, although their effects differ by partnership: Co-response is more likely when CCBHCs have greater internal capacity, whereas 911 referral is more common in communities with lower police capacity. Stakeholders seeking to increase CCBHC-emergency response system partnerships may need to apply different strategies depending on the type of arrangement they aim to expand. Individuals with behavioral health disorders are more likely to experience substantial harm from a police encounter, prompting reforms to minimize encounters between police and people experiencing a behavioral health crisis. One strategy involves expanding partnerships between certified community behavioral health clinic (CCBHC) mobile crisis teams and emergency response systems, often through two models: 911 referral, wherein a CCBHC’s behavioral health practitioner-only team responds to 911 calls, and co-response, wherein a CCBHC clinician joins a police or emergency medical services (EMS) team. We examine whether the internal capacity of the CCBHC and external police capacity influence when CCBHCs engage in these partnerships. Using data from the only national survey of CCBHCs, this study applies multivariable logistic regression to assess whether CCBHC staff capacity and police capacity are associated with CCBHC-emergency response system partnerships in mobile crisis, controlling for organizational characteristics of the CCBHC and demographic and socioeconomic features of its service area. One-third (33.0%, 95% confidence interval [CI], 26.0-40.0) of CCBHCs report a 911 referral partnership, and nearly half (48.5%, 95% CI 41.1-55.9) report a co-response arrangement. While police capacity is not significantly associated with co-response, a one standard deviation increase in police capacity corresponds to an 11.0-percentage-point (95% CI -19.5 to -2.5) decrease in the predicted probability of a 911 referral partnership. CCBHC capacity is not associated with 911 referral arrangements, but CCBHCs in the top tertile of CCBHC capacity are 19.2 (95% CI 4.3-34.2) percentage points more likely to report a co-response partnership. The internal capacity of CCBHCs and external police capacity are associated with when CCBHCs partner with emergency response systems in mobile crisis. Because a robust behavioral health crisis system likely requires multiple response models with varying police involvement, stakeholders may need different strategies depending on the type of partnership they aim to expand.

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2. Implementation of Clinical Practice Guidelines to Prevent Cervical Cancer: Mixed Methods Study.

期刊: JMIR cancer 发表日期: 2025-Aug-15 链接: PubMed

摘要

Cervical cancer is a common cause of death among women globally, particularly in Africa. Each year, an average of 7093 women in Nigeria die from cervical cancer. Clinical practice guidelines developed by the Society of Obstetrics and Gynecology of Nigeria (SOGON) aim to prevent cervical cancer. However, the extent of their adoption among gynecologists remains unclear. This study aimed to assess Nigerian gynecologists’ awareness, understanding, and incorporation of the SOGON clinical practice guidelines for cervical cancer prevention in their clinical practices. A convergent parallel mixed methods design was used. Quantitative data were collected via a web-based and in-person survey distributed to gynecologists attending the 57th SOGON Annual General Meeting in Kano, Nigeria (November 2023). A total of 105 gynecologists completed the survey (response rate: 80%). Key informant interviews (n=12) were conducted to provide qualitative insights. Quantitative data were analyzed using descriptive and inferential statistics, including logistic regression (P<.05). Thematic analysis was applied to qualitative data. Among the 105 respondents (mean age 50, SD 8.3 y and mean postresidency practice 12, SD 9.4 y), 98 (93.3%) reported awareness of the SOGON guidelines, and 74 (70.5%) endorsed their importance for cervical cancer prevention. However, only 58.1% (61/105) of the respondents reported integrating the guidelines into routine clinical practice. Barriers to implementation included limited training (71/105, 67.6%), resource constraints (64/105, 60.9%), and lack of institutional support (57/105, 54.3%). Qualitative data reinforced the need for more tailored guidelines for high-risk populations and rural settings. In addition, 70.5% (74/105) of the respondents advocated for a participatory guideline review process to ensure relevance and feasibility. While awareness of the SOGON guidelines is high, their integration into clinical practice remains suboptimal due to systemic barriers. Strengthening training programs, improving access to resources, and enhancing institutional support are critical to increasing guideline adoption and advancing cervical cancer prevention efforts in Nigeria.

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3. Optimizing and Testing an Individualized and Adaptive Physical Activity Digital Health Intervention: Protocol for a Control Optimization Trial Embedded Within a Randomized Controlled Trial.

期刊: JMIR research protocols 发表日期: 2025-Aug-15 链接: PubMed

摘要

While effective physical activity (PA) interventions exist, interventions often work only for some individuals or only for a limited time. Thus, there is a need for digital health interventions that account for dynamic, idiosyncratic PA determinants to support each person’s PA. We hypothesize that supporting individuals with their personal PA goals requires a personalized intervention that both supports each person in forming daily habits of walking more and develops personalized knowledge, skills, and practices regarding engaging in exercise routines. We operationalized these adaptive features via a digital health intervention called YourMove that uses a control systems approach to support personalized habit formation and a self-experimentation approach to develop personalized knowledge, skills, and practices. The primary aim is to evaluate differences in minutes of moderate to vigorous PA (MVPA) per week at 12 months comparing our personalized intervention, called YourMove, with an active control that is similar but without personalization of the intervention components and mimics best-in-class digital health worksite wellness programs. The YourMove study is a 12-month randomized controlled trial that involves 386 inactive adults aged 25 to 80 years. All participants receive (1) a Fitbit Versa smartwatch and corresponding smartphone app; (2) weekly PA goal suggestions and feedback, behavior change strategies, and reminders via SMS text messaging; and (3) up to US $50 in incentives for reaching daily step goals. Participants randomized to the active control group, modeled after worksite wellness programs, receive all the elements described in addition to a static daily step goal and static point rewards. Participants randomized to the intervention group receive (1) a habit formation element with daily personalized step goals and personalized point rewards generated through a control optimization trial approach and (2) a knowledge, skill, and practice development element featuring a self-guided self-experimentation tool that helps individuals find strategies to improve MVPA. The primary outcome is objectively assessed weekly minutes of MVPA via an ActiGraph monitor. Recruitment began in October 2022 and concluded in August 2024. Data collection will conclude in August 2025, with results expected by early 2026. We hypothesize that the intervention group will show greater improvement in MVPA than the active control group at 12 months. If the hypothesis is supported, this will provide compelling evidence to suggest that personalized and perpetually adaptive support can enhance PA more effectively than intervention elements commonly used in digital health worksite wellness programs. If the trial is successful, the results will provide justification to explore both the control optimization trial approach and self-experimentation approach for other complex, idiosyncratic, and dynamic behaviors such as weight management, smoking, or substance abuse. ClinicalTrials.gov NCT05598996; https://clinicaltrials.gov/study/NCT05598996. DERR1-10.2196/70599.

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4. The Impact of a Mobile Money-Based Intervention on Maternal and Neonatal Health Outcomes in Madagascar: Cluster-Randomized Controlled Trial.

期刊: JMIR public health and surveillance 发表日期: 2025-Aug-15 链接: PubMed

摘要

Financial barriers to accessing obstetric care persist in many low-resource settings. With increasing use of mobile phones, mobile money services appear as a promising tool to address this concern. Maternal health care is particularly suitable for a savings program using mobile money due to the predictable timing and costs of delivery. The mobile money-based Mobile Maternal Health Wallet (MMHW) intervention aimed to ease the burden of out-of-pocket expenses related to maternal health care by providing an accessible savings tool. This study aimed to assess the impact of the MMHW on maternal and neonatal health outcomes. We used a stratified cluster-randomized trial to assess the impact of the MMHW on maternal and neonatal health outcomes in the Analamanga region of Madagascar. All 63 eligible public sector primary care health facilities (Centres de Santé de Base [CSBs]) within 6 strata were randomized to either receive the intervention or not. We estimated intention-to-treat effects and contamination-adjusted effects following an instrumental variable approach. The primary outcomes included (1) delivery at a health facility, (2) antenatal care visits, and (3) total health care expenditure. Between March 2022 and December 2022, a total of 6483 women who had been pregnant between July 2020 and December 2021 were surveyed. Among women in catchment areas of treated CSBs, 38.79% (1297/3344) had heard of the MMHW, and 37.42% (485/1296) of them registered for the tool. There was considerable variation in uptake across treated CSBs. Descriptively, women in the catchment areas of treated CSBs were more likely to deliver in a facility and had more antenatal care visits and higher total health expenditures compared to women in control CSB catchment areas in the intention-to-treat and contamination-adjusted analyses. However, none of the effects were statistically significant. While this study did not identify a statistically significant impact, the estimated contamination-adjusted effects suggest that the MMHW has potential to improve access to maternal care for women who are receptive to such a mobile money-based savings tool. Estimated population-level effects were much smaller, and this study was underpowered to detect such effects due to lower-than-anticipated uptake of the intervention. German Clinical Trials Register DRKS00014928; https://www.drks.de/search/de/trial/DRKS00014928. RR2-10.1186/s13063-021-05694-8.

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5. "It's Still Exposure Just in a Slightly Different Way" - Understanding the Contribution of Simulation to Developing Physical Therapist Skills in Ireland: An Interpretive Description Study.

期刊: Physical therapy 发表日期: 2025-Aug-15 链接: PubMed

摘要

Simulation-based education (SBE) is increasingly used in physical therapist training to address growing student numbers and clinical placement shortages. However, clinical educators’ perspectives on the role of SBE in preparing students for practice remain unexplored. The objective of this study was to explore physical therapy clinical educators’ perspectives on academic-based SBE, particularly how it can equip students for clinical placement and whether it should contribute to practice education hours. Qualitative interpretive description methodology using semi-structured interviews was used. Five hospital sites across the island of Ireland engaged in physical therapist practice education. This study involved 8 physical therapist practice educators and tutors with 6 to 15 years of experience, supervising 2 to 50 students annually. Individual semi-structured interviews were conducted exploring participants’ perspectives on SBE’s role in clinical education, lasting 40 to 60 minutes each. Thematic analysis identified patterns in clinical educators’ perceptions of SBE’s educational value and contribution to practice preparation. Simulation supported the transition to practice by: (1) priming for clinical environments; (2) enhancing feedback literacy in the workplace; and (3) tackling complexity of clinical practice. Specific clinical skills including documentation, basic safety, manual handling, subjective assessment, and understanding the multidisciplinary team’s role were recognized as appropriate for instruction through SBE. Participants reported activities spent in SBE should count toward clinical hours and highlighted that processing feedback during SBE established a foundation for feedback practices in the workplace. Engaging simulated patients in scenarios informed by real patient experiences was proposed as a way of managing complex patient encounters. SBE provides a means to scaffold the learning of essential clinical skills before practice placement and contributes to clinical education, though more research is needed to determine the proportion. Future research should examine simulated interventions to boost feedback literacy and readiness for clinical settings. Involving patients and the public in the design of SBE curricula is crucial for relevant and beneficial learning outcomes.

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6. Toward an Understanding of the Lack of Transmission of Facts About Human Papillomavirus: Qualitative Case Study.

期刊: JMIR cancer 发表日期: 2025-Aug-15 链接: PubMed

摘要

Human papillomavirus (HPV) is the primary cause of cervical cancer, a largely preventable disease. Although extensive information about HPV is available and could help women prevent infection, a widespread lack of knowledge transmission hinders many women in Saudi Arabia from taking necessary preventive steps. Previous studies have reported low levels of HPV awareness among women in Saudi Arabia, highlighting the importance of understanding the barriers to effective information dissemination. Identifying the factors that influence the transmission of HPV-related knowledge is essential for designing targeted and impactful public health interventions. This study aimed to explore the factors that either block or facilitate the transmission of HPV-related facts among women in Saudi Arabia, using the HPV facts transmission model as a theoretical framework. A qualitative case study design was used, involving semistructured interviews with 20 women in Saudi Arabia aged 23 to 42 years. Participants were recruited using convenience and snowball sampling. The data were analyzed using pattern matching to assess how participant responses aligned with 11 predefined propositions from the HPV facts transmission model, which integrates individual and social influences on health information-seeking behavior. Of the 11 propositions, 8 (73%) were supported by the data. Five were individual-level factors (personal need to learn, stigma, language barriers, technology use, and individual qualities), while 3 were social-level factors (social promotion, social support, and cultural norms). These factors were classified as barriers, resources, or both, depending on their influence on women’s intention to seek HPV-related knowledge. For instance, personal motivation, curiosity, and digital access facilitated knowledge acquisition, while stigma, limited Arabic-language resources, and conservative social norms served as major deterrents. Three propositions (social structure, suppression structure, and interaction or collaboration) did not align with participant experiences and were excluded from the final model. Understanding these barriers and resources is essential for developing targeted interventions to improve HPV knowledge dissemination. Strategies should include culturally appropriate awareness campaigns, accessible Arabic-language educational materials, and the integration of digital tools to encourage confidential learning. Addressing stigma through community engagement and structured education programs can further enhance HPV fact transmission, ultimately supporting informed decision-making and preventive health behaviors among women in Saudi Arabia.

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7. Knowledge, Attitudes, and Behaviors Related to Dementia Prevention and Caregiving Among Korean Americans (the KIMCHI Project): Pre- and Posttest Evaluation Study.

期刊: JMIR aging 发表日期: 2025-Aug-15 链接: PubMed

摘要

Many Korean American older adults have limited English proficiency, have low socioeconomic status, and are immigrants. The availability and accessibility of linguistic and culturally appropriate dementia-related health care and caregiving resources for this population are limited. This is concerning given that Korean American older adults are a rapidly growing population, and Alzheimer disease and related dementias (ADRD) represent a significant public health issue. We aimed to assess changes in pre- and posttest knowledge, attitudes, and behaviors regarding ADRD prevention and caregiving among participants in the Koreans Invested in Making Caregivers’ Health Important (KIMCHI) before and after their participation in KIMCHI workshop presentations. A community engagement dissemination project, KIMCHI, was developed by academic and community partners to culturally and linguistically tailor selected evidence-based research from the Patient-Centered Outcomes Research Institute for Korean American older adults, caregivers, and other stakeholders. Dissemination activities were conducted in-person (as workshops) and on digital platforms. Through partnerships with 1 academic institution and 2 community organizations that serve Korean Americans, 211 participants participated in the KIMCHI in-person workshop presentations, and 134 participants participated asynchronously online (via fact sheets on the project website, YouTube videos, and other social media, such as Facebook and X [formerly known as Twitter]). Pre- and postparticipation tests on knowledge, attitudes, and behaviors for ADRD and caregiving were conducted with workshop participants. We administered satisfaction surveys to all participants (workshop and online) and conducted two-tailed paired-sample 2-tailed t tests to assess mean changes in the pre- and postparticipation tests. Among the workshop participants (N=211), most (114/204, 55.9%) were older adults (mean age 69, SD 12.1 y; range 24-90 y), female (n=148, 70.1%), and foreign-born (n=203, 96.2%). Many reported having limited English proficiency (167/211, 79.1%). Significant changes were observed in posttest ADRD knowledge (mean 11.51, SD 2.64), attitudes (mean 7.13, SD 2.83), and behaviors (mean 8.88, SD 2.72) compared to pretest scores (knowledge: mean 10.34, SD 2.67; t210=1.17; P<.001; attitudes: mean 6.33, SD 2.44; t210=0.8; P<.001; and behaviors: mean 8.11, SD 2.68; t210=0.76; P<.001). Workshop participants reported high satisfaction (196/209, 93.8%) with KIMCHI, with the workshop presentations being perceived as culturally relevant and applicable (196/209, 93.8%). Most workshop participants expressed interest in learning more about ADRD-related health topics (186/209, 89%). Similarly, the online participants (N=134) expressed high satisfaction (115/134, 85.8%) and agreed that the topics and content were culturally relevant and applicable (116/133, 87.2%) and learned new information (110/134, 82.1%). The findings indicate that KIMCHI may have a positive impact on improving ADRD knowledge, attitudes, and behaviors among Korean Americans. Academic-community collaborations should continue to culturally tailor the programs and studies to help ensure greater representation of Korean Americans in research and community engagement projects.

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8. Web-Based Video Intervention and Associated Factors for the Uptake of the Catch-Up Human Papillomavirus Vaccination in Japan: Randomized Controlled Trial.

期刊: Journal of medical Internet research 发表日期: 2025-Aug-15 链接: PubMed

摘要

In Japan, the human papillomavirus (HPV) vaccination rate has dropped to nearly zero since the suspension of proactive government recommendations in 2013. Following the termination of vaccination suspension in 2021 and subsequent proactive vaccination recommendation in 2022, it is crucial to promote catch-up vaccinations for those who missed their initial opportunity. This study aims to evaluate the effect of video-based informational intervention and explore factors associated with the uptake of catch-up HPV vaccinations among unvaccinated young adult women in Japan. In this randomized, parallel, single-blinded, internet-based trial, we recruited women aged 18-26 years unvaccinated for HPV through a web-based research panel. The participants were randomly assigned (1:1) to receive either an educational leaflet containing information on the HPV vaccine and a short narrative video (intervention) or the leaflet alone (control). The primary outcome was the difference in proportion between both groups regarding the uptake of the free catch-up vaccinations at the follow-up survey after 3 months. No deviations from the registered protocol occurred during the study. We enrolled 4065 women in the trial and randomly assigned them to either the intervention (2274 women) or the control (2331 women) group. Of these, we excluded 2595 women (63.8%) who did not respond to the follow-up survey, resulting in 1017 and 993 women in the intervention and control groups, respectively, for the final analysis. At the 3-month follow-up, 11.3% (228/2010) of the participants received at least one catch-up vaccine dose. The intervention and control groups had 10.5% (107/1017) and 12.2% (121/993) uptake, respectively. The difference in proportions between both groups was -1.7% (95% CI -4.5 to 1.2%; P=.26), and the adjusted difference was -1.6% (95% CI -4.3 to 1%; P=.23). In the subgroup analysis, the intervention group had a lower proportion of catch-up vaccination among sexually experienced women who had previous sexual intercourse experience (difference in proportion -5%, 95% CI -10% to -1%; P=.03) and those who had undergone a Pap test within the past 2 years (difference in proportion -11%, 95% CI -20% to -1%; P=.03). In addition, in the overall sample, factors positively associated with catch-up vaccination included higher educational background (difference in proportion: 7%, 95% CI 4%-10%; P<.001) and having undergone a Pap test within the past 2 years (difference in proportion 5%, 95% CI 0%-9%, P=.06). Our study demonstrated that video-based interventions did not have a substantial impact on the uptake of catch-up HPV vaccinations among young adults. However, our subgroup analyses suggested that the effectiveness of interventions may vary depending on individual characteristics. It is therefore desirable to explore and tailor more effective strategies based on the background and needs of specific populations in real-world settings.

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9. Willingness to Pay for the COVID-19 Vaccine and Its Correlates in Bangladesh: Cross-Sectional Study.

期刊: JMIRx med 发表日期: 2025-Aug-15 链接: PubMed

摘要

The Government of Bangladesh offers COVID-19 vaccines at no cost; however, sustaining this free vaccination program for a large population poses significant challenges. Thus, assessing the willingness to pay (WTP) for the COVID-19 vaccine is essential for understanding potential pricing strategies, subsidy requirements, and vaccine demand. This study aimed to assess the prevalence of WTP for the COVID-19 vaccine and its correlates. A cross-sectional design was used to collect data from 1497 respondents through web-based platform and face-to-face interviews. Multivariable logistic regression was used to analyze the correlates of the WTP. The results showed that 772 of 1497 (51.6%) participants were willing to pay for the COVID-19 vaccine, with a median of 300 BDT (IQR 150-500 BDT; a currency exchange rate of 1 BDT=US $0.008 is applicable). The WTP was significantly higher among individuals with a graduate degree (adjusted odds ratio [aOR] 1.98, 95% CI 1.14-3.45) or master’s and MPhil or PhD-level education (aOR 1.93, 95% CI 1.07-3.48) and those with higher knowledge about the vaccine (aOR 1.09, 95% CI 1.02-1.15), positive behavioral practices (aOR 1.11, 95% CI 1.06-1.17), stronger subjective norms regarding COVID-19 vaccine (aOR 1.25, 95% CI 1.08-1.46), and higher anticipated regret of getting infected with COVID-19 (aOR 1.17, 95% CI 1.04-1.32). Conversely, WTP was lower among participants with negative attitudes toward vaccines (aOR 0.91, 95% CI 0.88-0.95) and high perceived behavioral control regarding COVID-19 vaccination (aOR 0.86, 95% CI 0.76-0.96; P=.006). With nearly half of the respondents unwilling to pay, this study highlights the need to improve vaccine-related knowledge and enhance income-based affordability to increase WTP. Health promotion efforts should focus on disseminating knowledge about vaccines and addressing negative perceptions. Additionally, a subsidized program for low-income groups can help mitigate financial barriers and promote equitable access to vaccines.

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10. The Effectiveness of Online Exercise on Physical Activity, Motor Function, and Mental Health: Systematic Review and Meta-Analysis.

期刊: Journal of medical Internet research 发表日期: 2025-Aug-15 链接: PubMed

摘要

Regular engagement in physical activity and exercise is associated with a multitude of physical and mental health benefits. Hence, it has been widely encouraged as a measure by which to combat somatic and psychological ailments. In view of the technical progress, the aging society and the public life restrictions issued during the COVID-19 pandemic, the delivery of interventions using digital devices has become highly popular. This systematic review and meta-analysis aimed to examine the effects of online exercise programs on physical activity (PA), motor performance, and mental health. Two independent investigators performed a systematic literature search, using PubMed, Cochrane Library, and Google Scholar. Randomized controlled trials assessing the effects of online exercise (OE) versus no exercise or face-to-face exercise (FFE) in healthy adults were included. Effect sizes (standardized mean difference [SMD]) were pooled using robust variance estimation. The quality of the included studies was assessed by 2 independent reviewers applying the PEDro scale, and publication bias was checked by means of funnel plots. To determine the certainty about the evidence, the results were rated by means of the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) criteria. A total of 18 articles with moderate to high methodological quality (7/10 points on the PEDro scale), including a total of 3571 participants, were identified. Visual inspection of funnel plots provided indications of a publication bias for 2 out of 16 outcomes. According to the meta-analysis, OE was superior to no exercise regarding strength (SMD=0.61, 95% CI 0.06 to 1.15, n=5 studies), balance (SMD=0.52, 95% CI 0.06 to 0.99, n=4 studies), endurance (SMD=0.85, 95% CI -0.01 to 1.70, n=5 studies), PA (SMD=0.46, 95% CI 0.05 to 0.87, n=5 studies), depression (SMD=1.08, 95% CI -0.01 to 2.16, n=4 studies), mood or emotion (SMD=0.47, 95% CI 0.05 to 0.90, n=5 studies), mental well-being (SMD=0.79, 95% CI 0.06 to 1.52, n=4 studies), and self-efficacy (SMD=1.1, 95% CI 1.03 to 1.17, n=3 studies). Compared to FFE, OE was noninferior (P>.05) except for gait speed which improved more following FFE (SMD=0.25, 95% CI 0.24 to 0.26, n=2 studies). The certainty about the evidence (GRADE criteria) was low to moderate for all comparisons. OE represents an effective strategy to improve PA, physical function, and mental health in healthy adults and may hence help combat physical inactivity. However, despite the encouraging findings, some limitations need to be tackled before drawing definitive conclusions. These, inter alia, include a small total number of studies and substantial between-trial heterogeneity for some outcomes. Furthermore, as this review focused on healthy adults, future research examining other populations (eg, children and adolescents) is needed.

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11. Screening and Management of Obstructive Sleep Apnea and Daytime Sleepiness Among Professional Drivers in Tunisia: Protocol for a Machine Learning Study.

期刊: JMIR research protocols 发表日期: 2025-Aug-15 链接: PubMed

摘要

Obstructive sleep apnea (OSA) is highly prevalent among professional drivers; however, its true burden in this population remains underexplored and likely underdiagnosed. This study aims to determine the prevalence of OSA and excessive daytime sleepiness (EDS) and identify their risk factors among a large representative sample of professional drivers in Tunisia. We will also evaluate the risk of accidents associated with OSA and EDS before and after the treatment. This will be a population-based and prospective study of about 3000 professional drivers. Participants will receive a structured questionnaire to evaluate five main outcomes: the likelihood of OSA, EDS, drowsy driving, related sleepiness near misses and accidents, as well as work productivity. Validated self-report measures will be used to evaluate these outcomes. Participants suspected of having OSA or EDS will undergo sleep laboratory investigations, including a sleep study. Participants who have moderate-to-severe OSA will be recommended continuous positive airway pressure (CPAP) treatment. After one year of follow-up, all participants will be re-evaluated with self-report questionnaires. For those treated with CPAP, they will undergo the Maintenance of Wakefulness Test (MWT). We will evaluate several widely used machine learning models in medical diagnosis that are known for their high accuracy, including random forests, extreme gradient boosting, and deep neural networks, to predict the probability of OSA and its association with road traffic accidents. A total of 127 male drivers participated in the study, with a mean age of 39.22 (SD 8.62) years. Most participants (76/127, 60.3%) had completed secondary education, 54.3% (69/127) were smokers, and the median BMI was 25.6 kg/m2. A medical history was reported by 20.5% (26/127) of patients. The median driver experience was 8 (IQR 4.0-15.0) years. Among the drivers, 49 (39.5%) were working night shifts, and 30 (23.6%) were in hazardous materials transportation. Machinery (41.3%) was the most common mode of transportation, followed by trucks (34.9%), and light vehicles (22.2%). Notably, 11 drowsiness accidents were avoided. The overall score of presenteeism was 12.25 out of 100, whereas absenteeism was 1.74 out of 100. The overall daily activity impairment and productivity loss were 11.46 out of 100 and 12.76 out of 100, respectively. Overall, 30 (23.62%) cases were identified with either a pathological Epworth Sleepiness Scale or a positive Berlin score. Our preliminary findings revealed that a significant proportion of drivers were at a high risk of OSA. Our results will pave the way for the creation of a clinical screening instrument that can identify sleep-wake disturbances in professional drivers. This is likely to have a significant impact on the legal regulations concerning driving fitness and road safety.

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12. Clinical Characteristics and 1-Year Response in Rheumatic Mexican Patients Using JAK Inhibitors: Data From BIOBADAMEX.

期刊: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 发表日期: 2025-Aug-15 链接: PubMed

摘要

We aim to evaluate the clinical features, first-year treatment response, and frequency of adverse events in Mexican patients receiving Janus kinase inhibitor (JAK-i) using data from the Mexican Adverse Events Registry (BIOBADAMEX). We included all BIOBADAMEX patients from 2022 to 2024 and described the sociodemographic, clinical, treatment characteristics and adverse events of the approved JAK-i in Mexico: tofacitinib, baricitinib, and upadacitinib. We assessed the JAK-i efficacy comparing baseline and the 1-year response mean disease activity scores. A total of 222 patients were included, 39.6% received tofacitinib, 47.3% baricitinib, and 13.1% upadacitinib. The most common diagnosis was rheumatoid arthritis (77%). Sixty-eight percent of patients had comorbidities, 6% had prior history of malignancy, and 57% previously used a biologic. Mean age at JAK-i initiation was 49.6 (±13.9) years with an overall latency period of 9.4 years. DAS28 (Disease Activity Score in 28 joints) reduced from 4.7 (±1.2) at baseline to 2.99 (±1.2) in the first year (p = 0.001), and Bath Ankylosing Spondylitis Disease Activity Index from 4.8 (±3.9) to 2 (±1.5). JAK-i withdrawal was 29%; nonmedical reasons were the main motive. Sixty-five adverse events were reported; all were nonsevere with only 1 case of herpes zoster and no reports of malignancy or thrombosis. Differences in clinical and treatment characteristics between JAK-i were found. Our study showed older age for JAK-i initiation, a lower overall latency period, and lower use of prior biologic disease-modifying antirheumatic drug when compared with existing data in the literature. The main motive for JAK-i withdrawal was nonmedical reasons. Adverse events were nonsevere; interestingly, there was only 1 case of herpes zoster and no reports of malignancy or thrombosis.

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13. Design and initial findings of a natural history study of anal HPV and associated lesions among young adult women in Costa Rica.

期刊: International journal of cancer 发表日期: 2025-Aug-15 链接: PubMed

摘要

Anal cancer is caused by HPV, and its incidence has increased globally over the last five decades. We conducted an anal HPV natural history study nested in the Costa Rica HPV Vaccine Trial (CVT) to quantitatively describe the natural history and clinical outcomes of anal HPV in HIV-negative women. CVT was a randomized clinical trial of the bivalent HPV vaccine, and an anal substudy included women selected based on a priori criteria to enrich for anal disease. For women in the anal substudy, anal samples were collected for cytology and determination of HPV16/18/45 for up to four annual visits. Women were referred for high-resolution anoscopy (HRA) based on abnormal anal cytology or anal HPV16/18/45 positivity. We describe the analytic cohort for this study according to inclusion criteria and factors associated with referral criteria for HRA during study follow-up. 9,416 women, 1,178 were included in the anal substudy (age-range = 23-35-years): 93 had prevalent anal HPV16, 236 had cervical HPV16, 364 had an anal high-risk HPV infection other than 16, 295 had anal low-risk HPV, and 227 were included as anal HPV-negative controls; 352 women were included because of a CIN3+ in study follow-up. From 3,033 study visits over a median of 70 months follow-up, 71 (6%) women were referred to HRA. This anal study nested within the CVT infrastructure and enriched for anal disease provides a unique setting to address research questions related to the natural history of anal HPV infections and associated lesions in women without HIV.

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14. Impact of Drought and Virus Infection on Plant Traits, Virus Transmission Rate and Aphid Feeding Behavior.

期刊: Phytopathology 发表日期: 2025-Aug-15 链接: PubMed

摘要

Climate change is projected to increase the intensity and frequency of drought in several regions, potentially impacting aphid-virus-plant relationships. Here, we investigated the combined effects of water regime and virus infection on plant traits, virus transmission, and aphid feeding behaviour. Two factorial experiments were established that combined (i) four virus treatments: single infection with cucumber mosaic virus, CMV (non-persistent), single infection with cucurbit aphid-borne yellows virus CABYV (persistent), double infection and mock control, with (ii) five water regimes on melon cv. Bazan (exp. 1) or two water regimes on melon cv. Piel de Sapo (exp. 2). Virus and drought reduced plant dry weight, number of leaves, and leaf area. In exp. 1, drought reduced symptom severity on CMV-infected plants. Severe drought did not affect CMV inoculation rate, but transient, moderate water stress reduced the transmission rate of CABYV. In exp. 2 drought and virus infection altered the feeding behavior of A. gossypii. On well-watered but not on droughted plants, both CABYV and double infection with CABYV and CMV reduced passive phloem sap ingestion (E2 waveform), critical for transmission of persistent viruses, in comparison to mock-inoculated controls. On droughted plants, aphids produced shorter intracellular punctures (waveform pd), associated with transmission of non-persistent viruses. However, pd duration was not reduced for aphids that fed on droughted plants infected with CMV or with both CMV and CABYV. Despite the significant impact of drought on the plant phenotype, drought combined with virus infection had no impact on aphid feeding behavior related to virus transmission.

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15. Comparative Clinical Characteristics and Outcomes of Candida (Candidozyma) auris vs. Non-C. auris Candidemia in Non-neutropenic Patients in South India.

期刊: Mycopathologia 发表日期: 2025-Aug-15 链接: PubMed

摘要

Invasive candidiasis is a serious healthcare associated infection with a high mortality rate. Emergence of the multi-drug-resistant species Candida (Candidozyma) auris over the past two decades poses further challenges. We aimed to study the epidemiology, clinical profile and outcomes of non-neutropenic adults with C. auris candidemia in comparison with candidemia due to other species. We conducted a retrospective study of all non-neutropenic adult patients admitted to our tertiary care centre with blood culture proven candidemia between January 2019 and September 2024. We retrospectively collected their clinical data and investigation records via hospital’s electronic records and document management systems. Out of a total of 372 candidemia episodes, 85 (22.8%) were caused by C. auris, which was the second most common species after C.tropicalis. The incidence of candidemia overall as well as C. auris candidemia increased during the SARS-COV2 pandemic. In comparison to other species, C. auris candidemia was associated with prolonged hospital stay, prior antifungal exposure, a lower SOFA score and was common in patients on ECMO. Candida endocarditis was associated with persistent candidemia and long, tunnelled lines. C. auris showed 100% resistance to fluconazole and very low rate of susceptibility to amphotericin B: only echinocandins were reliably effective. A negative beta-D glucan (BDG) value was seen in a quarter of patients with both C. auris as well as with other species. Overall survival at 28 days was only 40%. Advanced age and a high SOFA score were associated with higher mortality. C. auris was associated with a lower mortality overall but was not associated with higher mortality in a multi-variate analysis. Multi-drug-resistant Candida (Candidozyma) auris has emerged as a major nosocomial pathogen in Indian ICUs since the SARS-COV-2 pandemic, especially later in the course of hospital stay and with prior antifungal exposure. A negative BDG result alone cannot be used for withholding or discontinuing antifungals. Echinocandins are the empiric antifungals of choice for candidemia in view of the current epidemiology and resistance profile.

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16. Prospective validation of an artificial intelligence assessment in a cohort of applicants seeking financial compensation for asbestosis (PROSBEST).

期刊: European radiology experimental 发表日期: 2025-Aug-15 链接: PubMed

摘要

Asbestosis, a rare pneumoconiosis marked by diffuse pulmonary fibrosis, arises from prolonged asbestos exposure. Its diagnosis, guided by the Helsinki criteria, relies on exposure history, clinical findings, radiology, and lung function. However, interobserver variability complicates diagnoses and financial compensation. This study prospectively validated the sensitivity of an AI-driven assessment for asbestosis compensation in the Netherlands. Secondary objectives included evaluating specificity, accuracy, predictive values, area under the curve of the receiver operating characteristic (ROC-AUC), area under the precision-recall curve (PR-AUC), and interobserver variability. Between September 2020 and July 2022, 92 adult compensation applicants were assessed using both AI models and pulmonologists’ reviews based on Dutch Health Council criteria. The AI model assigned an asbestosis probability score: negative (< 35), uncertain (35-66), or positive (≥ 66). Uncertain cases underwent additional reviews for a final determination. The AI assessment demonstrated sensitivity of 0.86 (95% confidence interval: 0.77-0.95), specificity of 0.85 (0.76-0.97), accuracy of 0.87 (0.79-0.93), ROC-AUC of 0.92 (0.84-0.97), and PR-AUC of 0.95 (0.89-0.99). Despite strong metrics, the sensitivity target of 98% was unmet. Pulmonologist reviews showed moderate to substantial interobserver variability. The AI-driven approach demonstrated robust accuracy but insufficient sensitivity for validation. Addressing interobserver variability and incorporating objective fibrosis measurements could enhance future reliability in clinical and compensation settings. The AI-driven assessment for financial compensation of asbestosis showed adequate accuracy but did not meet the required sensitivity for validation. We prospectively assessed the sensitivity of an AI-driven assessment procedure for financial compensation of asbestosis. The AI-driven asbestosis probability score underperformed across all metrics compared to internal testing. The AI-driven assessment procedure achieved a sensitivity of 0.86 (95% confidence interval: 0.77-0.95). It did not meet the predefined sensitivity target.

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17. Outcomes of ventriculoperitoneal shunt surgery for hydrocephalus in children in low- and middle-income countries: a systematic review.

期刊: Journal of neurosurgery. Pediatrics 发表日期: 2025-Aug-15 链接: PubMed

摘要

Improving outcomes for pediatric patients with hydrocephalus in low- and middle-income countries (LMICs) requires research on ventriculoperitoneal shunt (VPS) complications and outcomes that may be comparable to studies conducted in high-income countries (HICs). The authors aimed to address this gap by conducting a systematic review to analyze VPS complications and outcomes among pediatric patients in LMICs. This review adhered to PRISMA guidelines and the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) quality assessment. The authors screened English-language publications on pediatric VPS surgeries in LMICs, excluding studies from HICs and adult populations (> 18 years), using 6 databases: PubMed/Medline, Embase, Cochrane Library, Web of Science, Global Index Medicus, and Google Scholar. The search was completed on August 31, 2023. Data extraction included patient demographics, diagnosis, management, complications, and outcomes. Descriptive analyses were performed using Google Spreadsheets and R. A total of 590 studies were included, revealing trends in VPS utilization across 6 continents. Among 25,950 patients, the majority were aged 0-5 years (13,044/15,008, 86.9%), with a slight male predominance (11,043/19,971, 55.3%). Key complications included infections (mainly involving Staphylococcus spp.), shunt failure, and obstruction. Outcomes were reported for 7185 patients, representing 27.7% of the total cohort. Favorable outcomes were observed in 68.1% (4893 patients) and unfavorable outcomes in 13.1% (938 patients), and the overall mortality rate was 18.8% (1354 patients). This review provides a comprehensive profile of VPS complications and outcomes in pediatric patients in LMICs. Despite a predominance of observational studies, these findings offer critical insights that may inform health policy and practice in LMICs. Future research should prioritize longitudinal studies to explore long-term outcomes, develop cost-effective approaches to reduce complications, and foster international collaborations to strengthen global neurosurgical capacity.

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18. Parents' Perspectives on the Use of Virtual Reality in Pediatric Chronic Pain Management: Qualitative Study.

期刊: Journal of medical Internet research 发表日期: 2025-Aug-15 链接: PubMed

摘要

Virtual reality (VR) technology holds significant potential for chronic pain management in children and adolescents by providing an alternative and complementary approach to traditional methods of alleviating pain and improving quality of life. Parents play an important role in the successful adoption of VR technologies for children, influencing how children accept, use, and benefit from it. However, little is known about parents’ views on integrating VR technology into pediatric and adolescent chronic pain management. This study aimed to better our understanding of parents’ perspectives regarding the integration of VR technology into pediatric and adolescent chronic pain management-including barriers, facilitators, and recommendations for future VR technologies. Semistructured interviews were conducted with parents of children with chronic pain between March and November 2024. Key aspects of the discussion centered on the acceptability, barriers, and enablers of integrating VR technology into pediatric and adolescent chronic pain management. Interviews were audio-recorded, transcribed, and analyzed through inductive thematic analysis. We conducted 12 interviews. We identified four broad themes from the interview data: (1) views toward integrating VR technology into chronic pain management (perceived benefits, distraction, and redirection); (2) barriers to using VR technology for chronic pain management (accessibility, complexity, discomfort, and symptom exacerbation); (3) facilitators of integrating VR technology into chronic pain management (addressing financial barriers, integrating VR technology into clinical care, establishing evidence of effectiveness and showcasing positive patient experiences); and (4) recommendations for program content and features (relaxation and mindfulness, physical activity, customization, and social connection). Our findings underscore the perceived benefits of integrating VR technology into pediatric and adolescent chronic pain management to enhance physical, social, and mental health and well-being. However, there are several potential challenges that need to be addressed to improve the accessibility of VR technology for use in pediatric and adolescent chronic pain management. Our findings yielded several practical suggestions to guide the development of effective and equitable VR technology for chronic pain management in children and adolescents.

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19. Combined regional anesthetic techniques enhance postoperative recovery after cardiac surgery: a randomized controlled trial.

期刊: Postgraduate medical journal 发表日期: 2025-Aug-15 链接: PubMed

摘要

Regional anesthetic techniques are applied in cardiac surgery to improve postoperative pain and accelerate recovery. Pecto-intercostal fascial block (PIFB) combined with rectus sheath block (RSB) has been proved to provide ideal analgesia for cardiac surgery, but the effects of combing regional anesthetic techniques on postoperative recovery are uncertain. This is a prospective and randomized controlled trial at Fuwai Hospital from 1 June 2024 to 3 July 2024. Eighty patients undergoing elective cardiac surgery via cardiopulmonary bypass were randomized at a 1:1 ratio to be allocated in the intervention group (PIFB combined with RSB) or control group (without regional blocks). The primary outcome was the global score of the 15-item quality of recovery (QoR-15) questionnaire at 24 h after surgery. Secondary outcomes included QoR-15 at 72 h, postoperative pain scores, time to extubation, length of stay, medical expenses in hospital and postoperative morbidities. The QoR-15 global score at 24 h after cardiac surgery was 122.35 ± 6.71 in the intervention group vs 115.30 ± 5.90 in the control group (P < .001). The proportion of patients experiencing better quality of recovery (Qor-15 ≥ 118) was higher in the intervention group (77.5% vs 55%, P = .033). Postoperative pain scores were 1.90 ± 0.18 in the intervention group compared to 2.95 ± 0.99 in the control group (P = .027) at 24 h. Time to extubation was earlier in the intervention group (274.40 ± 98.36 vs 741.28 ± 93.82 min, P < .001). There were no statistically differences in Qor-15 at 72 h and other recovery outcomes. The administration of PIFB combined with RSB could improve quality of recovery and relieve postoperative pain for patients following cardiac surgery. Key message What is already known on this topic Previous studies have demonstrated that ultrasound-guided nerve blocks effectively reduce postoperative pain in cardiac surgery patients. However, whether these techniques further enhance overall postoperative recovery remained unclear. What this study adds This trial revealed that ultrasound-guided nerve blocks improved postoperative QoR-15 scores, and combined regional techniques further improved recovery without compromising analgesia. How this study might affect research, practice, or policy The findings support applying combined nerve blocks into enhanced recovery protocols for cardiac surgery, offering evidence to optimize postoperative analgesia strategies.

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20. Digital Informed Consent/Assent in Clinical Trials Among Pregnant Women, Minors, and Adults: Multicountry Cross-Sectional Evaluation of Comprehension and Satisfaction.

期刊: JMIR human factors 发表日期: 2025-Aug-15 链接: PubMed

摘要

Informed consent (IC) is a cornerstone of ethical clinical research, yet comprehension gaps persist. The i-CONSENT guidelines aim to improve IC materials by enhancing clarity, accessibility, and tailoring them to the needs of diverse populations. This study evaluates the effectiveness of electronic IC (eIC) materials developed under these guidelines for 3 target populations-minors, pregnant women, and adults-across Spain, the United Kingdom, and Romania. The primary aim of this study is to assess participants’ comprehension of and satisfaction with eIC materials tailored to their specific needs. The secondary objectives are to identify demographic predictors of comprehension, evaluate the cross-cultural applicability of materials, and explore format preferences. A cross-sectional study was conducted with 1757 participants (620 minors, 312 pregnant women, and 825 adults), who reviewed eIC materials through a digital platform offering layered web content, narrative videos, printable documents, and infographics. Materials were co-designed using participatory methods, including design thinking sessions with minors and pregnant women, and online surveys with adults. Comprehension was assessed using an adapted version of the Quality of the Informed Consent questionnaire. Objective comprehension (part A) was categorized as low (<70%), moderate (70%-80%), adequate (80%-90%), or high (≥90%). Subjective comprehension (part B) was measured using a 5-point Likert scale. Satisfaction was evaluated through Likert scales and usability questions, with scores ≥80% considered acceptable. Multivariable regression models were applied to identify predictors of comprehension. Objective comprehension exceeded 80% across all groups: minors (mean 83.3, SD 13.5), pregnant women (mean 82.2, SD 11.0), and adults (mean 84.8, SD 10.8). Women/girls outperformed men/boys (β=+.16 to +.36). Generation X adults scored higher than millennials (β=+.26, P<.001), while prior trial participation was associated with lower comprehension scores (β=-.47 to -1.77). Among minors, compared with participants from Spain with no previous clinical trial experience, comprehension was significantly lower in Spain (P=.03), Romania (P<.001), and the United Kingdom (P<.001). Format preferences varied: 382 out of 620 (61.6%) minors and 152 out of 312 (48.7%) pregnant women preferred videos, whereas 452 out of 825 (54.8%) adults favored text (P<.001). Satisfaction rates surpassed 90% in all groups (minors, 604/620, 97.4%; pregnant women, 303/312, 97.1%; and adults, 804/825, 97.5%), with 777 out of 825 (94.2%) adults also indicating that the materials facilitated understanding. While translated materials maintained high efficacy across countries, comprehension scores in Romania were lower among participants with lower educational levels (β=-1.05, P=.001). Materials cocreated in Spain were effective across countries but yielded higher comprehension within the original target population. eIC materials developed following the i-CONSENT guidelines achieved high levels of comprehension and satisfaction across diverse populations, demonstrating scalability for multinational trials. Cocreation and multimodal design effectively addressed participant preferences; however, cultural adaptation remained crucial for optimizing outcomes. The negative impact of prior trial participation highlights the need for tailored engagement strategies for returning participants. Future research should explore regional disparities, evaluate interventions for overconfident returning participants, and validate these tools across broader cultural contexts.

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21. Patient preferences and perceived barriers to follow-up care in a pharmacy-based colorectal cancer screening program: a national survey.

期刊: Cancer causes & control : CCC 发表日期: 2025-Aug-15 链接: PubMed

摘要

Fecal immunochemical tests (FIT) are recommended for routine colorectal cancer (CRC) screening because they are cost-effective, non-invasive, and convenient. Pharmacy-based CRC screening using FIT kits could be effective to improve screening rates, particularly in medically underserved communities. However, data on follow-up procedures and barriers after positive FIT results in this context remain sparse. We conducted a national survey of 1,045 US adults aged 45-75 to assess preferences for follow-up care in a pharmacy-based CRC screening program we call PharmFIT™ and identify perceived barriers to follow-up colonoscopy after positive FIT results. We evaluated patient preferences and barriers using descriptive statistics. We used multinomial logistic regressions to identify correlates of patient preferences for follow-up and multiple logistic regressions to identify correlates of perceived psychosocial and structural barriers to follow-up colonoscopy. Participants showed a strong preference for digital communication for negative FIT results and reminders, but favored direct, interpersonal communication from healthcare providers for positive results and follow-up. Psychosocial barriers, such as fear of colonoscopy or cancer diagnosis, were more prevalent than structural barriers like cost and transportation. Older adults, those with a regular healthcare provider, and higher-income individuals were less likely to report barriers, while non-white and Medicaid patients showed lower preferences for automated notifications. PharmFIT should use tailored, multimodal communication strategies to address patient preferences and include strategies, like patient navigation, to address potential barriers to follow-up colonoscopy. This study reinforces the potential of pharmacy-based CRC screening programs to increase screening access and opportunities, particularly in medically underserved communities.

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22. The Impact of Sedentary Behavior and Physical Activity on Bone Health: A Narrative Review from the Rehabilitation Working Group of the International Osteoporosis Foundation.

期刊: Calcified tissue international 发表日期: 2025-Aug-15 链接: PubMed

摘要

Physical activity (PA) and sedentary behavior (SB) are two key lifestyle factors with profound implications for bone health across the lifespan. While PA is recognized for its positive effects on bone mineral density (BMD) and fracture prevention, emerging evidence highlights the detrimental consequences of prolonged sedentary time, independent of PA levels. This review synthesizes current knowledge on the impact of PA and SB on bone health outcomes, focusing on BMD and fracture risk in children, adolescents, adults, and older populations. A selection of epidemiological studies, systematic reviews, and meta-analyses was analyzed to explore the associations between movement behaviors and bone health indicators across different life stages. Particular attention was given to studies objectively measuring SB and PA and to the substitution effects of sedentary time with light or moderate-to-vigorous PA. In children and adolescents, higher levels of SB are associated with lower BMD, particularly at weight-bearing sites, while participation in weight-bearing and impact-loading PA positively influences bone mass accrual. In adults and older individuals, regular PA, including moderate-to-vigorous intensity weight-bearing PA and resistance training activities, is consistently linked to greater BMD and reduced fracture risk. Conversely, high sedentary time is associated with lower BMD and increased fracture incidence, particularly among frail or pre-frail individuals. Importantly, replacing sedentary time with even light-intensity PA yields measurable benefits for bone health, particularly among older adults and postmenopausal women, and may contribute to a reduced risk of fractures, although evidence remains limited. Promoting PA while minimizing SB should be central to clinical practice and public health policies aimed at maximizing and preserving skeletal health and preventing osteoporotic fractures, across the lifespan. Early intervention, continuous promotion across life stages, and adherence to WHO guidelines offer an effective, evidence-based framework for lifelong bone health maintenance.

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23. Differentiating Lung From Chest Wall Mechanics Is Difficult Without Esophageal Manometry in Children With Acute Respiratory Distress Syndrome.

期刊: Critical care medicine 发表日期: 2025-Aug-15 链接: PubMed

摘要

Pediatric acute respiratory distress syndrome (PARDS) guidelines recommend limiting airway plateau pressure (Pplat) to 28 cm H2O, allowing for higher limits when chest wall compliance (CCW) is poor since less of the pressure is transmitted to lung (transpulmonary pressure). Transpulmonary pressure depends on Pplat and the ratio of lung elastance to respiratory system elastance (EL/ERS). EL/ERS measurement requires esophageal manometry, although it is not routinely available. We sought to determine if routinely available clinical data could reliably predict EL/ERS or changes in EL/ERS, to understand when Pplat greater than 28 cm H2O could be acceptable. Secondary analysis of randomized controlled trial with esophageal manometry monitoring. Quaternary PICU. Mechanically ventilated children with PARDS. None. Two hundred seven patients and 750 patient days were included. Using the first day per patient, median EL/ERS was 0.83 (interquartile range, 0.72-0.87), with a weak negative correlation with respiratory system compliance (CRS) (r = -0.26; p < 0.001). CRS was strongly correlated with lung compliance (Cl) (r = 0.94; p < 0.001) and moderately correlated with CCW (r = 0.53; p < 0.001). Multivariable analysis identified that higher CRS, younger age and peripheral neuromuscular disease were associated with higher CCW, while higher CRS was the only variable independently associated with higher Cl (all p < 0.01). When trying to predict high (> 0.9) or low (< 0.7) EL/ERS, CRS was the only variable retaining an independent association: lower CRS (CRS × 10 [mL/cm H2O/kg × 1/10]) with high EL/ERS (odds ratio [OR], 0.70; 95% CI, 0.54-0.86; p = 0.002; area under the receiver operating characteristic curve [AUC], 0.73) and higher CRS (CRS × 10 [mL/cm H2O/kg × 1/10]) with low EL/ERS (OR, 1.14; 95% CI, 1.02-1.28; p = 0.017; AUC, 0.60). Change in EL/ERS from day to day was not predictable. In PARDS, CRS is more strongly tied to Cl than CCW. While EL/ERS is not easily predictable from clinical variables, when CRS is low, EL/ERS is generally high. Therefore, increasing Pplat above the suggested thresholds when CRS is impaired may be inappropriate without measuring esophageal pressure.

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24. Validity and Reliability of the New Innovation Culture Scale© for Use in Healthcare Settings.

期刊: The Journal of nursing administration 发表日期: 2025-Aug-15 链接: PubMed

摘要

To assess the psychometric properties of the new 10-item Innovation Culture Scale©. American healthcare is expensive with poor health outcomes as the norm. Nurses can disrupt this paradigm through innovation; however, innovation cannot flourish without a supportive organizational culture. There is a lack of scales to measure innovation culture within healthcare settings, thus supporting improvements in quality of care. A Northeastern health system provided a convenience sample of 5658 nurses, physicians, and allied health professionals. Scale responses were obtained digitally. Item correlations, scree plot, and confirmatory factory analysis examined the scale’s internal structure and assessed model fit. Two hundred sixteen participants completed the scale. Item correlations were positive and significant (P < 0.001). Scree plot confirmed a single factor structure. Several indices supported an acceptable model fit (comparative fit index = 0.935, Tucker-Lewis index = 0.916, standardized root mean square residual = 0.05), although root mean square error of approximation (0.119) was poor. Cronbach’s α was 0.94. The Innovation Culture Scale is a valid and reliable measure to assess innovation culture in healthcare settings.

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25. Pediatric-Onset Polyarteritis Nodosa and Deficiency of Adenosine Deaminase 2: Clinical Overlap and Divergence.

期刊: Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases 发表日期: 2025-Aug-15 链接: PubMed

摘要

To compare the clinical features and disease severity of classic polyarteritis nodosa (PAN) with its monogenic form, deficiency of adenosine deaminase 2 (DADA2), in pediatric patients, in order to distinguish overlapping vasculitic phenotypes. This cross-sectional study included 36 pediatric patients with PAN-like vasculitis, comprising 22 with classic PAN (14 systemic, 8 cutaneous) and 14 with DADA2, followed up at our tertiary referral pediatric rheumatology department between August 2016 and February 2025. Demographic features, clinical manifestations, treatment choices, and outcomes were compared between the groups. DADA2 patients had significantly earlier symptom onset (median 4 vs. 11 years, p = 0.002) and higher rates of parental consanguinity (p < 0.001) compared with systemic PAN (sPAN) patients. The most common clinical features in sPAN were constitutional symptoms (100%), followed by cutaneous (78.6%), musculoskeletal (57.1%), and renal involvement (57.1%). Growth retardation (14.3% vs. 57.1%, p = 0.018) and livedo racemosa (7.1% vs. 50%, p = 0.012) were more common in DADA2, whereas fatigue (92.9% vs. 35.7%, p = 0.002), renal involvement (57.1% vs. 0%, p < 0.011), diastolic hypertension (78.6% vs. 7.1%, p < 0.001), and purpura (35.7% vs. 0%, p = 0.014) predominated in PAN. Neurological manifestations were observed in 4 PAN patients (2 peripheral, 2 central) and 1 DADA2 patient with ischemic stroke. Biologic therapy was required in 4 PAN patients, whereas 11 of 14 DADA2 patients were treated with anti-tumor necrosis factor agents. Anti-TNF therapy remains the mainstay of treatment in DADA2 and is effective in preventing disease progression. In contrast, classic sPAN may require escalation to biologic agents in refractory cases or when neurologic or end-organ involvement is present.

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26. ACSS2 coupled with KAT7 regulates histone β-hydroxybutyrylation to enhance transcription.

期刊: Science advances 发表日期: 2025-Aug-15 链接: PubMed

摘要

Histone lysine β-hydroxybutyrylation (Kbhb) is an epigenetic mark linking ketone metabolism to transcription. However, the molecular mechanism by which β-hydroxybutyrate is converted to β-hydroxybutyryl-coenzyme A (BHB-CoA), the cofactor for Kbhb, remains unknown. Here, we report that acetyl-CoA synthetase short-chain family member 2 (ACSS2) coupled with lysine acetyltransferase 7 (KAT7) modulates β-hydroxybutyrylation on lysine 9 of histone H3 (H3K9bhb) to promote transcription. We show that KAT7 serves as a β-hydroxybutyryltransferase and preferably catalyzes histone Kbhb, especially H3K9bhb, in 1171 identified Kbhb substrates. ACSS2 is a BHB-CoA synthetase. This enzyme can sense cellular β-hydroxybutyrate and translocate into the nucleus, where it binds to and colocalizes with KAT7 at specific locus of chromatin. The ACSS2-generated BHB-CoA can fuel KAT7 for histone H3K9bhb. We demonstrate that the β-hydroxybutyrate drives the ACSS2-KAT7-H3K9bhb axis to promote epigenetic regulation and tumor cell growth. Our study not only identifies the founding member of BHB-CoA ligase but also reveals the mechanism underlying KAT7-catalyzed histone Kbhb using ACSS2-generated BHB-CoA.

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27. Development of a Novel Cardiac Arrest Ventilation Rate Metronome: A Human Factors and Implementation Science Mixed-Methods Approach.

期刊: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies 发表日期: 2025-Aug-15 链接: PubMed

摘要

Excessive ventilation adversely affects cardiopulmonary resuscitation (CPR) hemodynamics and outcomes. Pediatric providers rarely achieve guideline-recommended CPR ventilation rates. We aimed to use human factors engineering to design a metronome to improve compliance with recommended CPR ventilation rates. We hypothesized that in usability testing, our novel metronome would achieve: 1) a System Usability Scale (SUS) score greater than 68 and 2) greater than 70% of CPR epochs with ventilation rates within target range, which would be sufficient to support a pilot trial in our PICU. Prospective single-center mixed-methods study. Seventy-five-bed academic PICU. Multidisciplinary clinicians. None. We elicited clinician feedback on the proposed ventilation rate metronome with a survey. Participatory design sessions determined optimal metronome components. During high-fidelity simulation usability testing, we collected qualitative and quantitative measures reflecting participant feedback and performance. Average ventilation rates were calculated during 30-second epochs of CPR, with average rates ± 2 breaths/min (bpm) from the target considered to be within goal range. Among 107 survey respondents, perceptions of appropriateness, acceptability, and feasibility of the ventilation rate metronome were favorable. The final prototype used a bell sound for high saliency in noisy environments and a scrolling timed vertical bar, with pre-set options for three guideline-recommended CPR ventilation rates (infants: 30 bpm, children 1-17 yr old: 20 bpm, adults: 10 bpm). In usability testing (three groups, 34 clinicians), median SUS was 92.5 of 100 (interquartile range, 89.4-93.1), with 0 attributable errors. Overall, 34 of 36 (94% [95% CI, 81-99%]) epochs of simulated CPR with metronome use had ventilation rates ± 2 bpm from the target rate. Utilizing human factors engineering and implementation science, we successfully designed a novel ventilation rate metronome. When deployed during high-fidelity cardiac arrest simulations, metronome use had high usability scores and resulted in excellent compliance with recommended ventilation rates.

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28. A Cost-Effectiveness Analysis of the Switch to 20-Valent Pneumococcal Conjugate Vaccine from Lower-Valent Pneumococcal Conjugate Vaccines in the French Pediatric Population.

期刊: Infectious diseases and therapy 发表日期: 2025-Aug-15 链接: PubMed

摘要

The pneumococcal conjugate vaccine (PCV) with valency of 20 (PCV20) was approved for pediatric use by the European Commission in 2024. However, PCV20 is not yet implemented into the French infant National Immunization Program (NIP). In this cost-effectiveness analysis, we compared PCV20 under a 3 + 1 schedule to the current standard of care (13-valent PCV [PCV13]) or 15-valent PCV (PCV15), both under a 2 + 1 schedule, for infant vaccination in France. The study adopted a multiple-cohort population-level model under the French Collective perspective over a 10-year time horizon. Inputs were sourced from published and unpublished studies conducted in the French population, where available. Clinical outcomes included disease cases (i.e., invasive pneumococcal disease [IPD], inpatient pneumonia, and otitis media [OM]) and deaths. Incremental cost-effectiveness ratios were calculated on the basis of estimated costs and quality-adjusted life years (QALY) for PCV20 3 + 1 versus PCV15 2 + 1 and PCV13 2 + 1 in separate pairwise comparisons. Compared with PCV13 2 + 1 and PCV15 2 + 1, PCV20 3 + 1 was estimated to be dominant, resulting in improved public health and economic outcomes. PCV20 was predicted to prevent more disease cases versus PCV13 (IPD: 13,510; hospitalized pneumonia: 317,136; hospitalized OM: 66,579) and PCV15 (IPD: 11,187; hospitalized pneumonia: 255,790; hospitalized OM: 53,733) and provide cost-savings of €1,567,052,379 and €1,134,653,266 versus PCV13 and PCV15, respectively. This study predicted that infant immunization with PCV20 was the most cost-effective option compared with PCV13 and PCV15. These results could help decision-makers implement the optimal PCV strategy in the French pediatric NIP.

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29. FDA Panel Casts SSRIs During Pregnancy as Risky-Many Experts Disagree.

期刊: JAMA 发表日期: 2025-Aug-15 链接: PubMed

摘要

This Medical News article discusses claims about antidepressant treatment during pregnancy presented at a recent panel organized by the US Food and Drug Administration.

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30. Sedentary time and breast cancer risk in the Sister Study Cohort.

期刊: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 发表日期: 2025-Aug-15 链接: PubMed

摘要

Previous research investigating sedentary behavior and breast cancer (BC) risk has shown mixed results. We investigated the association between sedentary time and BC incidence overall and by time-dependent menopausal status. The Sister Study recruited 50,884 women from all 50 states and Puerto Rico aged 35-74 years who had not been diagnosed with BC but had at least one affected sister. Sedentary time was collected at the first detailed follow-up from 2008-2012 and categorized as ≤5 hours/day (referent), 6-9 hours/day, and ≥10 hours/day. BC cases were reported annually. We used multivariable Cox proportional hazard regression to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for the association of sedentary time with overall BC incidence, with age as the primary time scale and adjusted for relevant covariates. Participants were followed through September 2021.We evaluated effect measure modification by menopausal status. Among the 39,111 eligible women with information on sedentary behavior and covariates, sedentary time (6-9vs.≤5 aHR=1.18 95% CI=1.08, 1.28; ≥10vs.≤5 aHR=1.19 95% CI=1.07, 1.32) was associated with higher BC incidence. The association varied by menopausal status (p-heterogeneity=0.002), with sedentary time inversely associated with BC among premenopausal women (≥10vs.≤5 aHR=0.69 95% CI=0.50, 0.95) and positively associated with BC among postmenopausal women (6-9vs.≤5 aHR=1.22 95% CI=1.11, 1.33; ≥10vs.≤5 aHR=1.28 95% CI=1.14, 1.43). Increased sedentary time was associated with BC incidence, but the direction of this association varied by time-dependent menopausal status. The impact of sedentary time on cancer risk may vary by menopausal status.

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31. Flow Reduction in a Pesticide-Exposed Stream Mesocosm Affects Emerging Aquatic Insects and Alters Riparian Spider Communities.

期刊: Archives of environmental contamination and toxicology 发表日期: 2025-Aug-15 链接: PubMed

摘要

Water scarcity can intensify streamflow reduction, alter hydromorphology, increase chemical pollution, and disrupt resource exchange between aquatic and terrestrial ecosystems. However, the effects of streamflow reduction on pesticide concentrations in sediment, and how these changes influence aquatic insect emergence and riparian spider communities, remain poorly understood. We conducted a 39-day mesocosm experiment in Southwest Germany using 12 artificial stream mesocosm with adjacent riparian areas, randomly assigned to low-flow (0.4 L s-1) treatment or control (1 L s-1) to simulate flow alteration. We sampled water daily (47 days), sediment (weeks 4 and 6), emerging insects (weekly for 5 weeks), and riparian spiders (week 6). Our results show that under low-flow conditions, the mean sediment pesticide concentrations increased slightly stronger from week 4 to week 6, compared to the control. However, the high variability within treatments resulted in no significant differences between the treatments. Low flow caused a 2.9-fold reduction in the total abundance of Ephemeroptera, Plecoptera, and Trichoptera (EPT), while total emerging insects (abundance and biomass) and spider abundance were not affected significantly. However, the web-building spider Tetragnatha sp. was 2.6-fold less abundant under low-flow conditions, likely due to vegetation-habitat-related responses and reduced EPT abundance, while the ground-hunting Lycosidae were unaffected, owing to their active hunting behavior and generalist strategy. These findings highlight the need to consider cross-ecosystem effects when assessing the ecological impacts of hydrological alterations in contaminated aquatic ecosystems.

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32. Repeated measures of decaying wood reveal the success and influence of fungal wood endophytes.

期刊: mSystems 发表日期: 2025-Aug-15 链接: PubMed

摘要

Predicting wood decomposition is challenging due to complex successional dynamics among decomposers that colonize and defend wood territory. This starts with saprotrophic fungi that reside latently in healthy wood until trees senesce, but these “endophytes” are rarely considered an endogenous wood trait that might improve predictions for decomposition rates or fates. Here, we used repeated measures to track the decomposition of paper birch (Betula papyrifera) and red pine (Pinus resinosa), assessing wood properties and microbial succession over 5 years in a northern forest (Minnesota, USA). We compared fungi and bacteria present in sound wood (endophytes) versus those arriving as external colonizers, and we used relevant treatments to vary accessibility for colonizers (ground contact versus aboveground; bark off versus bark on). Over 5 years, accessibility treatments had a significant effect on decay rates and fungal community succession. Wood rot type was unanimously white rot (lignin-degrading fungi), but fungal dominance was treatment-specific. Most dominant fungi could be traced to operational taxonomic units (OTUs) present as endophytes in sound wood, suggesting that treatments affected endophyte competition more than external colonizer success, even in ground contact. Although fungal communities lost diversity (Shannon index) as certain taxa became dominant, bacterial communities converged irrespective of treatment, without notable co-occurrence with fungi and without losing diversity, suggesting a decoupled dynamic. The results imply a strategic benefit for saprotrophic fungi to colonize trees as endophytes, and they support including fungal endophytes along with predictors of their competitive success as “plant” traits to improve predictive models.IMPORTANCEEstablishing this persistence and influence for endophytic saprotrophs has not been possible without repeated measures in a long-term study. We believe our findings are significant for two key reasons. First, they link community succession to a “trait” in wood that may be more predictable-governed by the living tree as the “gate-keeper”-compared with predicting assembly history for external colonizers. Second, they highlight a new avenue toward developing a predictable trait for wood decomposition that could improve Earth Systems modeling, which has historically been challenged in predicting carbon sequestered/released by wood, where most of Earth’s aboveground biotic carbon resides.

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33. A narrative review of genetic and environmental factors and risk for multiple sclerosis. The design of the Italian multicentric PEDIGREE study.

期刊: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 发表日期: 2025-Aug-15 链接: PubMed

摘要

MS is the result of an immune-mediated disorder triggered by environmental factors in subjects genetically predisposed. Pediatric MS (pedMS) offers a unique window to study environmental triggers, as patients are close to the actual onset of the disease and have been exposed to fewer confounding factors. PedMS is strongly associated to HLA-DRB115:01 and to non-MHC (Major Histocompatibility Complex) variants, with a higher burden compared to adults. HLA-A02 allele seems to reduce MS risk. The role of rare variants is still under investigation. Several environmental causative factors have been identified: obesity, passive smoke, sun exposure, vitamin D, and others but the strongest candidate is the Epstein-Barr virus, considered a prerequisite for MS development. In this paper we provide a summary of the results obtained so far in pediatric age. Some years ago, the Italian PEDIGREE study (PEDiatric Italian Genetic and enviRonmental ExposurE) has been created to help clarify the role of genetic and environmental factors in pedMS, through a study of the genetic, epigenetic, metagenomic, transcriptomic, along with assessment of environmental factors (viral exposure, second-hand smoke and sun exposure, breastfeeding history, and other factors. A network of 29 Italian MS centers has been established, 154 pedMS patients (mean age 13.5 years) and matched controls have been recruited. For the genetic study, a cohort of 364 adult MS patients with onset < 18 years was included. The study is ongoing, the results of exposure to environmental risk factors and of genetic background will be available in the next future.

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34. Bioengineering of iron oxide nanoparticles using leaves extract of Dalbergia sissoo for the removal of diclofenac and tetracycline from water: optimization by BBD approach.

期刊: Environmental geochemistry and health 发表日期: 2025-Aug-15 链接: PubMed

摘要

Pharmaceutical compounds like tetracycline and diclofenac are causing significant environmental pollution, posing health risks and necessitating effective techniques for their elimination from water-based ecosystems. This study explores the potential of green-synthesized iron oxide nanoparticles (Fe2O3) in the adsorption of tetracycline (TC) and diclofenac (DF) and optimized the process using the Box-Behnken Design (BBD) approach. The average particle size of the synthesized Fe2O3 was found 15.71 nm. The BET results revealed that surface area, pore volume, and average pore diameter was 13.16 m2/g, 3.18 cm3/g, and 21.48 nm, respectively. At optimal conditions, TC and DF removal were 88.2-90.51%, respectively. with desirability function one. The Langmuir maximum adsorption capacity was 56.68 mg/g for TC and 62.36 mg/g for DF. The primary rate-limiting step is proposed to be chemisorption. The thermodynamics results confirm adsorption onto Fe2O3 that occurs spontaneously, endothermically, and randomly. The green Fe2O3 nanoparticles efficiently absorbed TC and DF from aqueous solutions upto five cycles, with efficiency declined from 87.9 to 67.23% and 90.01 to 65.23%, respectively, which showed economic applicability of materials. This study illustrates the efficacy of green-synthesized Fe₂O₃ nanoparticles in eliminating pharmaceutical pollutants and their significance in promoting sustainable water treatment technologies in accordance with circular economy and SDG objectives.

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35. Challenging Traditional ADME Assumptions for Physiologically Based Pharmacokinetic Models for Intravenous Administration of Iron-Carbohydrate Nanomedicines: Potential Utility of Gold Nanoparticle Models as a Roadmap.

期刊: Clinical pharmacokinetics 发表日期: 2025-Aug-15 链接: PubMed

摘要

Intravenous iron-carbohydrate complexes are a class of nanomedicines that are widely used globally to treat iron deficiency and iron deficiency anemia associated with a wide spectrum of disease states. Despite being widely used in clinical practice for more than seven decades, the understanding of their in vivo disposition including tissue biodistribution and kinetics of the nanoparticle degradation at the cellular level is not well-understood. Moreover, the critical quality attributes that influence in vivo pharmacokinetics have not been fully defined. In particular, the carbohydrate moiety plays an influential role in how the nanoparticulate iron-carbohydrate complex interacts with the biological system. Developing a physiologically based pharmacokinetic (PBPK) model would facilitate a deeper understating of the key nanomedicine attributes that predict in vivo performance. Because endogenous iron metabolism complicates pharmacokinetic modeling for this complex class of drugs, models of gold nanoparticles may provide a substantive roadmap to begin to build a viable PBPK model for iron-carbohydrate nanomedicines. In the future, PBPK models that integrate recent mechanistic data regarding tissue biodistribution and intracellular iron kinetics for parameterization have the potential to improve manufacturing quality and clinical use of these complex drugs.

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36. Mechanism of plant synergistic amendments remediation for electrolytic manganese residue contaminated with ammonia nitrogen and manganese.

期刊: Environmental geochemistry and health 发表日期: 2025-Aug-15 链接: PubMed

摘要

Electrolytic manganese residue (EMR), due to its large-scale storage, contains high concentrations of manganese (Mn) and ammonium nitrogen ( NH 4 + -N), posing a severe threat to the environment and human health with its poor physicochemical properties. The combination of amendments and phytoremediation represents an cost-effective approach for EMR management. This study investigates the effects of amendments on mitigating the harsh conditions of EMR and their influence on phytoremediation. Under non-closed greenhouse conditions, potting experiments lasting 60 days were conducted, incorporating different ratios of activated phosphorus tailings and mature sludge as amendments into EMR, alongside Lolium perenne L., Medicago sativa, and Cynodon dactylon. Results indicate that the application of amendments significantly improved the properties of EMR, optimizing plant growth conditions. Mn and NH 4 + -N became more stable, reducing their concentrations and bioavailability in leachate. Moreover, Mn content in plant roots and shoot markedly decreased, while the activities of glutamate synthase (GOGAT), glutamine synthetase (GS), and glutamate dehydrogenase (GDH) were significantly enhanced. In summary, amendments not only effectively improved the habitat quality of EMR but also increased the tolerance of remediation plants to Mn and NH 4 + -N, demonstrating potential in EMR remediation.

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37. HCQ reverses the immune imbalance related to severe infections following chemotherapy of acute myeloid leukemia and exhibits inhibitory effects on inflammatory cytokine storms.

期刊: Clinical and experimental medicine 发表日期: 2025-Aug-15 链接: PubMed

摘要

Acute myeloid leukemia (AML) is the most prevalent hematological malignancy in adults, characterized by a rapid progression, short clinical course, and poor prognosis. Immune imbalance following severe infections post-chemotherapy represents a critical cause of mortality in AML patients. Our study investigates the effects of hydroxychloroquine (HCQ) on immune imbalance in severe infections after AML chemotherapy and its mechanisms of action on mononuclear macrophage activation and inflammatory cytokine storm models. The findings are expected to provide significant practical implications for both basic research and clinical interventions in managing severe infections in leukemia patients. Our findings indicated that some specific chemokines and cytokines exhibited abnormal increases in AML patients, with more pronounced elevations in severely infected AML patients (AML-SI) compared to uninfected counterparts. HCQ inhibited leukemic cell proliferation and induced apoptosis, although low concentrations demonstrated minimal cytotoxicity. Co-culture of THP-1 cells with bone marrow-derived mesenchymal stem cells (BM-MSCs) from AML patients significantly increased IL-6, IL-8, and TNF-α levels, which were markedly reduced upon HCQ intervention. HCQ exerted limited effects on the CXCL12-CXCR4/7 regulatory axis but induced programmed cell death of leukemic THP-1 cells. RNA-seq showed that the differentially expressed genes in HCQ intervention group were mainly enriched in NOD-like receptor signaling pathway, chemokine signaling pathway, IL-17 signaling pathway, PPAR signaling pathway, NF-κB signaling pathway, and TGF-β signaling pathway. Furthermore, HCQ suppressed monocyte proliferation, enhanced apoptosis, and demonstrated stronger effects on activated mononuclear macrophages. Mechanistically, HCQ regulated Bcl-2 family protein expression, upregulated Bax, activated Caspase-3, and inhibited NLRP3/IL-17A and TLR4/NF-κB signaling pathways, thereby suppressing inflammatory cytokine storms. In all, HCQ effectively reverses immune imbalance and suppresses malignant biological characteristics of leukemic cells, and it also attenuates inflammatory cytokine storms by inhibiting chemokine regulatory axes and suppressing NLRP3/IL-17A and TLR4/NF-κB signaling pathways, offering promising potential for basic research and clinical applications in inflammatory cytokine storm management.

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38. Assessing the role of Escherichia coli and Klebsiella pneumoniae in colorectal cancer oncogene expression: insights from microbial colonization phenotypes.

期刊: Molecular biology reports 发表日期: 2025-Aug-15 链接: PubMed

摘要

Colorectal cancer (CRC) remains a major global health burden, ranking as the third most prevalent malignancy and the second leading cause of cancer-related mortality. Its pathogenesis involves complex interactions between genetic, environmental, and lifestyle factors, with emerging evidence implicating the gut microbiome as a key contributor. Specific pathobionts, such as Escherichia coli and Klebsiella pneumoniae, have been linked to CRC progression due to their pro-inflammatory properties. This study investigated the association of E. coli and K. pneumoniae with CRC tissues and their influence on oncogenic gene expression, particularly within the TGF-β, Notch, Wnt/β-catenin, Rho GTPase, and EGFR/MAPK signaling pathways. Using both culture and molecular-based methods, we analyzed 100 CRC patient biopsies from Taleghani Hospital, Tehran (July 2021-May 2023), assessing bacterial presence and the expression of 19 CRC-associated genes. Adhesion and invasion capabilities of isolates were evaluated in Caco-2 cells. While clinical parameters (e.g., age, survival, tumor stage) did not differ significantly between bacterial groups, gene expression analysis revealed elevated FOLH1 and MAP2K1 in adhesive-invasive K. pneumoniae isolates and increased FOLH1 in E. coli-positive samples. Tumor stage- and site-specific variations were observed, such as heightened ANXA3 expression in Stage I tumors harboring K. pneumoniae. Principal component analysis (PCA) demonstrated overlapping oncogenic profiles, suggesting complex, context-dependent microbial influences. Our findings indicate that E. coli and K. pneumoniae may exert nuanced, tumor-specific effects on oncogenic pathways, potentially mediated more by chronic inflammation than direct gene dysregulation. Further studies employing single-cell RNA sequencing are warranted to elucidate these interactions and their translational potential for CRC diagnostics and therapeutics.

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39. Perceived importance of tailored education to prevent second victim phenomenon in clinical pharmacy practice: a focus group study with community pharmacists.

期刊: International journal of clinical pharmacy 发表日期: 2025-Aug-15 链接: PubMed

摘要

The second victim phenomenon, referring to the impact of patient safety incidents on healthcare professionals, also affects pharmacists. Dispensing errors or inadequate counselling cause anxiety, reduced motivation, and staff turnover. Support programmes exist for healthcare professionals, but not specifically for pharmacists. To explore pharmacists’ perceptions of tailored education to enhance competencies in overcoming second victim experiences, including (i) potential impacts, (ii) recommended content for professional development and undergraduate curricula, (iii) preferred design and delivery methods, and (iv) experience with existing programmes. A qualitative focus group study using the experiences, opinions, and recommendations approach was conducted in Serbia. Data were collected through a semi-structured guide and a self-reported questionnaire on participation in existing programmes. Discussions continued until saturation. Recordings were transcribed verbatim and analysed using the inductive thematic approach with MAXQDA software. Descriptive statistics summarised programme participation. Participants perceived tailored education as necessary for improving error response, empowering individuals and the profession, and enhancing pharmaceutical care. Thematic analysis identified four themes: (i) impacts of tailored programmes, (ii) topics for professional development, (iii) topics for undergraduate curricula, and (iv) programme design and delivery. Key areas included soft skills, risk and stress management. Undergraduate education should strengthen communication, motivation, and career development. Preferred methods were workshops and blended learning. Of 25 participants, 20 (80%) attended support programmes; 20 (80%) reported improved competence, and 20 (80%) would recommend them to colleagues. Community pharmacists perceived tailored education addressing second victim experiences as important for professional resilience and improving pharmaceutical care.

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40. Narrative Proceedings of the Inaugural Health Systems Implementing Climate Action Conference 2024.

期刊: Journal of occupational and environmental medicine 发表日期: 2025-Aug-15 链接: PubMed

摘要

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41. Absence during pregnancy in the Danish workforce: occupational, industrial, and temporal trends in a nationwide register-based cohort study.

期刊: Scandinavian journal of work, environment & health 发表日期: 2025-Aug-15 链接: PubMed

摘要

This study aimed to describe occupational, industrial, and temporal trends in relation to absence during pregnancy in the Danish workforce. The register-based national cohort DOC*X-Generation was used to identify all pregnancies among women (18-50 years) engaged in regular employment in Denmark 1998-2018. The cohort holds individual-level data on occupations coded according to the Danish versions of the International Standard Classification of Occupations and of EU’s nomenclature (NACE, revision 2). Data on absence from work was retrieved from the Danish Register for Evaluation and Marginalization. The study population comprised 884 616 pregnancies in 547 870 women. In 48% of the included pregnancies, the women had at least one week with registered absence with a median of 8 weeks (5-95% percentile; 1-27 weeks). The highest frequencies of absence were observed among painters (75%) and women in the meat products manufacturing industry (68%), whereas the lowest were seen among professionals in physics, mathematics, engineering, and architecture (30%) and in the research and university education industry (32%). The difference between the lowest and highest number of cumulated weeks with absence was 9 weeks. From 1998-2018, the proportion of pregnancies with registered absence decreased, whereas the extent of absence per pregnancy increased. Absence during pregnancy was consistently high over time, but with vast differences across occupations and industries. A deeper understanding of underlying reasons for pregnancy-related absence is essential to develop targeted strategies for reducing absence, such as providing better opportunities for adjustments of work task early in pregnancy or other tailored interventions.

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42. A Comparative Trial of Occupational Therapy Using Ayres Sensory Integration and Applied Behavior Analysis Interventions for Autistic Children.

期刊: Autism research : official journal of the International Society for Autism Research 发表日期: 2025-Aug-15 链接: PubMed

摘要

Many autistic children demonstrate sensory integration differences that impact their participation in daily living activities and tasks. Occupational Therapy using Ayres Sensory Integration (OT-ASI) is an evidence-based intervention for autistic children that addresses the sensory integrative factors impacting daily living skills and participation in a variety of tasks and activities. Applied Behavior Analysis (ABA) is the recommended evidence-based practice for autism to improve a range of developmental domains. This study compared Occupational Therapy using Ayres Sensory Integration, Applied Behavior Analysis, and no treatment on daily living skills and individualized goals for autistic children who also show sensory differences. A parallel arm comparative effectiveness trial design with participants randomized equally to OT-ASI, ABA, or no treatment. Intervention consisted of 30 one-hour sessions. Significant gains in individualized goals, measured by Goal Attainment Scaling, were found in both treatment arms over the no treatment group. Both the OT-ASI and the ABA groups improved in daily living skills measured on the Pediatric Evaluation of Disabilities Inventory; although the improvements over the no treatment group were not significant. Both OT-ASI and ABA improved individualized goals and daily living skills at comparable levels. These findings are discussed in light of their implications for intervention. Trial Registration: NCT02536365.

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43. Phthalate and Nonphthalate Plasticizer Exposure among Children of Korea, Thailand, Indonesia, and Bangladesh: Occurrences and Risk Comparison.

期刊: Environmental science & technology 发表日期: 2025-Aug-15 链接: PubMed

摘要

Children are considered vulnerable to plasticizer exposure and related adverse health effects. In many Asian countries, however, the extent of plasticizer exposure among children is poorly understood despite the increasing use of plasticizers. This study compared plasticizer exposure levels and risks among children in four Asian countries and investigated the major risk drivers. Children aged 6-14 years old were recruited between 2022 and 2023 from Korea (n = 89), Thailand (n = 111), Indonesia (n = 100), and Bangladesh (n = 100). They were measured for major metabolites of phthalates and nonphthalate plasticizers in the first morning void urine. Indonesian and Bangladeshi children showed higher exposure to phthalates but lower exposure to nonphthalate alternatives. At the same time, children from Thailand and Korea exhibited a greater transition to the alternatives. In all countries, DEHA contributed to over 80% of the total estimated daily intake (EDI) for all plasticizers. Bangladeshi children exhibited 1.5-2 times greater total plasticizer exposure than the children of the other countries across all EDI quartiles. Among the high-risk subgroup (within the top 25th percentile of the hazard index), DEHP accounted for 62 and 52% of the cumulative risk in Indonesia and Bangladesh, while DnBP contributed to 63 and 54% in Thailand and Korea, respectively. Our observations reveal critical disparities in plasticizer exposure among Asian children, highlighting an urgent need for follow-up investigations on the exposure sources of major risk drivers and region-specific interventions.

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44. Associations between home gardening and obstructive sleep apnoea: role of behavioural factors in the COMmunity-based Behaviour and Attitude Study in Tuvalu (COMBAT).

期刊: Journal of global health 发表日期: 2025-Aug-15 链接: PubMed

摘要

Tuvalu, like many Pacific Island nations, is facing a severe obesity epidemic, which is strongly associated with obstructive sleep apnoea (OSA) - a condition linked to multiple health complications and a growing public health burden. Lifestyle interventions such as home gardening have emerged as potential strategies to address obesity and its related conditions. We investigated the association between home gardening and OSA risk in Tuvalu and explored how behavioural and demographic factors may modify this relationship. We conducted a nationwide cross-sectional study in Tuvalu in 2023 using the COMmunity-based Behaviour and Attitude Study in Tuvalu (COMBAT) questionnaire. We assessed OSA risk using the validated eight-item ‘Snoring, Tiredness, Observed apnoea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender’ (STOP-Bang) questionnaire, and home gardening status was self-reported. We used logistic regression models, including multivariable adjustments and overlap weighting, to assess the association between home gardening and OSA outcomes, including total STOP-Bang score, OSA risk (≥3 points), and related symptoms (snoring, daytime fatigue, witnessed apnoea). We conducted stratified analyses by behavioural and demographic characteristics. We included 849 adult participants (mean (x̄) age = 32.9 years; 51.9% female). Among individuals who exercised, home gardening was associated with lower STOP-Bang scores (x̄ difference = -0.30; 95% confidence interval (CI) = -0.59, -0.01, P = 0.040 in overlap weighting model) and with lower odds of STOP-Bang score ≥3 (adjusted odds ratio = 0.85; 95% CI = 0.73, 0.98, P = 0.026) than non-gardeners. Furthermore, home gardening was associated with significantly lower odds of snoring among individuals who smoked, consumed alcohol, or exercised, and with borderline lower odds of STOP-Bang score ≥3 among individuals who consumed alcohol. In the COMBAT study, home gardening was associated with lower OSA probability among subgroups with specific lifestyle factors. These findings suggest that home gardening could serve as a feasible and community-based intervention to mitigate OSA risk in Tuvalu and similar low-resource settings.

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45. E-Cigarette Use and Symptoms of Depression and Anxiety Among US Middle and High School Students.

期刊: Preventing chronic disease 发表日期: 2025-Aug-14 链接: PubMed

摘要

E-cigarettes are the most commonly used tobacco product among youth. Most e-cigarettes contain nicotine, which is highly addictive and can harm the developing brain. Youth e-cigarette use is associated with poor mental health. We analyzed self-reported data from the 2024 National Youth Tobacco Survey to describe e-cigarette use and symptoms of depression and anxiety among US middle and high school students. In 2024, 42.1% of youth who currently used e-cigarettes reported moderate-to-severe symptoms of depression and anxiety compared with 21.0% of youth who never or formerly used e-cigarettes. Among youth who currently used e-cigarettes, those with moderate-to-severe symptoms of depression and anxiety (vs no-to-mild symptoms) more frequently reported symptoms of dependence - wanting to use an e-cigarette within 30 minutes of waking (28.2% vs 15.6%, P < .001) and having strong cravings (37.6% vs 22.4%, P < .001) - and “feeling anxious, stressed, or depressed” as a reason for first (41.8% vs 18.4%, P < .001) and current (51.0% vs 25.2%, P < .001) use. Most youth who used e-cigarettes attempted to quit in the past year (69.4%), but over half (58.5%) did not use any quitting resources. Moderate-to-severe symptoms of depression and anxiety are common among youth who use e-cigarettes. Youth with these symptoms may need additional support to prevent or quit e-cigarette use. Integrating mental health support into comprehensive approaches to tobacco use prevention and cessation, paired with strengthening the foundations of healthy communities for youth, may reduce youth e-cigarette use.

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46. [Brief history of laboratory-based epidemiological surveillance in the Mexican Institute for Social Security].

期刊: Revista medica del Instituto Mexicano del Seguro Social 发表日期: 2025-Aug-14 链接: PubMed

摘要

Epidemiological surveillance of communicable diseases has had a cross-cutting role that has contributed to scientific advancement, knowledge generation, and, above all, to organizing and focusing public health and medical care activities in the country. We refer to laboratory-based epidemiological surveillance. In this regard, the Mexican Institute for Social Security (IMSS according to its initials in Spanish) has not fallen short of expectations with the creation of a network of laboratories for laboratory-based epidemiological surveillance in different states, with recognition of their technical competence by the Ministry of Health. These laboratories were created following the need arising from the pandemic emergency of the influenza virus in 2009 and year after year their diagnostic capacity has expanded, extending their diagnostic reach to various vector-borne pathologies and vaccine-preventable diseases that are important in Mexico. This document summarizes the main events, challenges, and successes experienced by the Institute’s network of epidemiological surveillance laboratories since its creation. The initial executor is the operational staff of the medical unit, who are those in direct contact with the sick person. La vigilancia epidemiológica de las enfermedades transmisibles ha tenido un brazo transversal que ha contribuido al avance científico, a la generación de conocimiento y, sobre todo, a organizar y focalizar las actividades de salud pública y de la atención médica en el país. Nos referimos a la vigilancia epidemiológica por laboratorio. En este sentido, el Instituto Mexicano del Seguro Social (IMSS) no se ha quedado atrás ni tampoco a la expectativa con la creación de una red de laboratorios para la vigilancia epidemiológica por laboratorio en distintas entidades federativas con el reconocimiento a la competencia técnica por la Secretaría de Salud. Dichos laboratorios nacieron tras la necesidad derivada de la emergencia pandémica del virus de influenza en 2009 y año con año se han ampliado en su capacidad diagnóstica y han extendido su alcance diagnóstico con diversas patologías transmitidas por vector y enfermedades prevenibles por vacunación que son de importancia en México. En el presente documento se plasman de forma resumida los principales eventos, retos y éxitos que ha tenido la red de laboratorios para la vigilancia epidemiológica del IMSS desde su creación hasta la fecha, donde el ejecutor inicial es el personal operativo de la unidad médica, que es el que está en contacto directo con la persona enferma.

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47. [Strategy for improving the distress level in healthcare workers].

期刊: Revista medica del Instituto Mexicano del Seguro Social 发表日期: 2025-Aug-14 链接: PubMed

摘要

Healthcare workers are at higher risk of work-related issues due to constant exposure to distress, which has an impact on their well-being and performance. To evaluate distress levels and causes of emotional discomfort among healthcare workers before and after a sensitization workshop. Observational, longitudinal, analytical, and retrospective study based on assessments conducted by SPPSTIMSS on healthcare workers who participated in the Mind, Body, and Emotions workshop from August 1, 2022, to August 21, 2023, at the Hospital of Traumatology, Orthopedics, and Rehabilitation “Dr. Victorio de la Fuente Narváez.” Variables analyzed included age, gender, workplace, shift, employment category, distress levels, causes of emotional discomfort, and intervention latency, using the Distress Thermometer. The protocol was approved by the Health Ethics and Research Committee (R-2023-3401-076). Data from 101 participants with complete records were analyzed (mean age: 38.8 ± 8.7 years, 71.2% were females). Distress levels showed a significant reduction (6.2 ± 2.8 vs. 4.7 ± 2.9, p = 0.0002), with an intervention latency of 6.3 ± 4.8 months. Causes of emotional discomfort included practical (90%), physical (88.1%), emotional (86.1%), family-related (52.4%), and spiritual (9.9%) issues. Participation of healthcare workers in the sensitization workshop significantly reduced self-perceived distress levels. el personal de salud está en mayor riesgo de problemas asociados al entorno laboral por su constante exposición al distrés, lo cual afecta su bienestar y desempeño. evaluar los niveles de distrés y las causas de malestar emocional en personal de salud antes y después de un taller de sensibilización. estudio observacional, longitudinal, analítico, retrospectivo, de las evaluaciones realizadas por SPPSTIMSS al personal de salud que participó en el taller de sensibilización Mente, Cuerpo y Emociones del 1 de agosto de 2022 al 21 de agosto de 2023 en la UMAE de Traumatología, Ortopedia y Rehabilitación “Dr. Victorio de la Fuente Narváez”. Se analizó edad, sexo, unidad de adscripción, turno, categoría, nivel de distrés, causas de malestar emocional y latencia de la intervención, y se utilizó el Termómetro de distrés. El protocolo fue aprobado por el Comité de Ética e Investigación en Salud (R-2023-3401-076). se analizaron datos de 101 participantes con registros completos (edad 38.8 ± 8.7 años, 71.2% mujeres). Los niveles de distrés mostraron una disminución significativa (6.2 ± 2.8 frente a 4.7 ± 2.9, p = 0.0002), con una latencia de intervención de 6.3 ± 4.8 meses. Las causas de malestar emocional incluyeron problemas prácticos (90%), físicos (88.1%), emocionales (86.1%), familiares (52.4%) y espirituales (9.9%). la participación del personal de salud en el taller de sensibilización redujo significativamente los niveles de distrés autopercibido.

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48. S-palmitoylation: An oily modification guardinggenome stability.

期刊: DNA repair 发表日期: 2025-Aug-08 链接: PubMed

摘要

S-palmitoylation is a dynamic post-translational lipid modification that regulates key cellular processes. It is mediated by aspartate-histidine-histidine-cysteine-family palmitoyltransferases (PATs) and reversed by acyl-protein thioesterases (APTs). This modification influences protein stability, function, subcellular trafficking, and membrane interactions. Emerging evidence identifies protein palmitoylation as a key regulator of genomic stability and integrity: it modulates DNA repair pathways, replication fork dynamics, and stress response mechanisms. Consequently, dysregulated palmitoylation cycles can lead to an impaired replication stress response, and chromosomal instability, which might drive oncogenesis. In this review, we examine the critical roles of S-palmitoylation in maintaining genome stability and speculate on its therapeutic potential in counteracting malignancy-associated genomic instability.

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49. Immune cell transcriptional profiles from pre-vaccination peripheral blood predict immune response to preventative MUC1 cancer vaccine.

期刊: European journal of cancer (Oxford, England : 1990) 发表日期: 2025-Aug-05 链接: PubMed

摘要

Recent advances in vaccine technology raise hopes for effective cancer preventative vaccines. The first clinical trials (single-arm NCT007773097; double-blind, placebo controlled randomized trial NCT02134925) of a non-viral cancer preventative vaccine were conducted in individuals with previous advanced colonic adenoma to test the safety and immunogenicity of the MUC1 tumor antigen vaccine. The vaccine was safe and strongly immunogenic in 43 %-25 % of participants. The lack of response in a significant number of participants suggested that the pre-malignant immune system may have already been exposed to some level of suppression, something previously reported only in cancer. Single-cell RNA-sequencing (scRNA-seq) data were collected from banked pre-vaccination peripheral blood mononuclear cells (PBMCs) (16 immune responders and 16 non-responders) and analyzed using standard bioinformatic and novel machine learning methods. We identified specific cell types, genes, and pathways characteristic of vaccine response. A significantly higher percentage of CD4 + naïve T cells and lower percentage of CD8 + T effector memory (TEM) cells and CD16 + monocytes were present in responders. Differential gene expression (DGE) and transcription factor inference analysis showed a higher level of expression of T cell activation genes (like Fos, Jun) in CD4 + naïve T cells. Pathway analysis showed enriched signaling activity in responders. Furthermore, Bayesian graph analysis suggested that these genes were mechanistically related to response. Our analyses identified several immune mechanisms and candidate biomarkers which can be further validated as predictors of immune responses to a preventative cancer vaccine. These could facilitate selection of individuals likely to benefit from a vaccine or be used in further research to improve vaccine responses.

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50. Validating 8 Area-Based Measures of Social Risk for Predicting Health and Mortality.

期刊: JAMA health forum 发表日期: 2025-Aug-01 链接: PubMed

摘要

Area-based measures of social risk are increasingly being used in policy applications in the US. While several have been demonstrated to be predictive of health and mortality in the general population, there is a need to identify area-based measures that are most reliable for policy applications, including measures that are associated with health and mortality consistently across subpopulations. To compare the relative strength with which area and individual social risk measures are correlated with health outcomes and mortality, and the extent to which these associations are consistent across race, ethnicity, rurality, age, and gender. This cross-sectional study included a sample of patients from primary care clinics across all 50 states that are part of the PRIME registry using electronic health records (2019-2021) linked to US Census Bureau restricted-use data at the individual level from 947 US primary care practices. Eight commonly used area based measures of social risk were examined: (1) Social Deprivation Index, (2) Social Vulnerability Index, (3) Area Deprivation Index (from University of Wisconsin), (4) Area Deprivation Index (constructed using Gophal Singh’s original design), (5) Neighborhood Stress Score, (6) Index of Concentration at the Extremes for race and income, (7) French Index of Social Deprivation, and (8) the Community Resilience Estimates. Individual socioeconomic measures of education, poverty, and occupation were also examined. Hypertension, diabetes, and chronic kidney disease derived from electronic health records, and mortality from the Census Numident. Data from 2 801 000 patients were analyzed. Among these, 44% were male individuals and 56% were female individuals; 20% were younger than 25 years, 23% were aged 25 to 44 years, 30% were aged 45 to 64 years, and 27% were aged 65 years and older; 0.5% were American Indian or Alaskan Native, 2.1% Asian, 7.6% Black, 0.2% Native Hawaiian and Pacific Islander, 0.03% were 2 or more races, and 70% were White. Area-based measures of social risk were generally better predictors of hypertension, diabetes, and chronic kidney disease, whereas individual socioeconomic measures were generally better predictors of mortality. The strongest predictor across health outcomes was the Area Deprivation Index, and that Gopal Singh’s version was the most equitably predictive across rural areas and across all racial and ethnic subgroups. In this cross-sectional study, area-based measures predicted health outcomes better than individual socioeconomic measures, and generally predicted health equitably across subpopulations; thus, their use should be considered in conjunction or instead of using individual-level measures for selected health policy applications.

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51. Performance Drift in a Nationally Deployed Population Health Risk Algorithm in the US Veterans Health Administration.

期刊: JAMA health forum 发表日期: 2025-Aug-01 链接: PubMed

摘要

Clinical risk algorithms inform clinical decision support and system-level quality metrics. However, algorithm performance can drift over time and possibly promote misinformed decision-making and resource allocation. The Veterans Health Administration (VA) Care Assessment Needs (CAN) algorithm is a nationally deployed population risk algorithm used to predict risk of 90-day hospitalization and/or mortality and to allocate resources for more than 5 million veterans annually. However, drift affecting the VA CAN has not been assessed. To evaluate the impact of drift in the VA CAN algorithm and the extent, mechanisms, and clinical consequences of performance changes. This was a retrospective cohort study using electronic health records (EHRs) and administrative data from the VA Corporate Data Warehouse, which contains observations from more than 5 million veterans per study year. The data comprised 27 787 152 observations among 7 215 711 unique veterans receiving VA primary care from 2016 to 2021. Data analysis was performed from January 2023 and December 2024. Two primary outcomes were change in model performance (true positive rate [TPR], false positive rate [FPR], positive predictive value [PPV], negative predictive value [NPV], F1 score, and accuracy); and a national quality metric (% of veterans with CAN ≥90th percentile with a palliative care visit). The study population included 7 215 711 eligible veterans, with a mean (SD) age of 62.1 (16.5); 91.2% were male and 18.2% were Black, 6.6% Hispanic, and 76.2% White individuals. From 2016 to 2021, PPV decreased by 4.0% (95% CI, -2.8% to -5.1%); F1 score decreased by 4.6% (95% CI, -6.1% to 3.0%); NPV increased by 0.43% (95% CI, 0.30% to 0.57%); and FPR increased by 0.34% (95% CI, 0.10% to 0.58%), which corresponds with 18 288 increased false positive results. TPR and accuracy remained stable. The 90-day hospitalization and/or death rates decreased from 3.8% in 2017 to 3.0% in 2021. Covariate shifts were observed in 19 covariates, with demographic characteristics, health care utilization, and laboratory covariates exhibiting the largest shifts. The palliative care quality metric was 2.9% (95% CI, 2.8% to 2.9%) in 2018, 2.6% (95% CI, 2.6% to 2.7%) in 2019, and 2.8% (95% CI, 2.7% to 2.8%) in 2020, with FPRs among metric-eligible veterans increasing from 81.6% (95% CI, 81.5% to 81.7%) in 2018 to 85.7% (95% CI, 85.6% to 85.8%) in 2020. This cohort study found that CAN algorithm performance declined from 2016 to 2021 due to shifts in outcome prevalence and distributions of health care utilization and demographic covariates. Close surveillance of clinical risk algorithms and quality metrics derived from algorithm-generated risk scores could mitigate suboptimal resource allocation or decision-making.

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52. Cervical Cancer Outcomes in Women With HIV in the Age of Antiretroviral Therapy.

期刊: JAMA network open 发表日期: 2025-Aug-01 链接: PubMed

摘要

This cross-sectional study investigates the outcomes for women living with HIV and cervical cancer in the US after the emergence of antiretroviral therapy.

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53. The Health Consequences of Nonhealth Policies in a Time of Policy Disruption.

期刊: JAMA health forum 发表日期: 2025-Aug-01 链接: PubMed

摘要

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54. Access to Essential Medicines-High-Level Insights and Unanswered Questions.

期刊: JAMA health forum 发表日期: 2025-Aug-01 链接: PubMed

摘要

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55. Understanding Model Drift and Its Impact on Health Care Policy.

期刊: JAMA health forum 发表日期: 2025-Aug-01 链接: PubMed

摘要

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56. Prices and Affordability of Essential Medicines in 72 Low-, Middle-, and High-Income Markets.

期刊: JAMA health forum 发表日期: 2025-Aug-01 链接: PubMed

摘要

Little is known about how the prices and affordability of medicines included on the World Health Organization’s Model List of Essential Medicines vary across the globe. To compare the list prices and affordability of essential medicines across high-, middle-, and low-income markets. This cross-sectional study examined data from 2022 on list prices and volumes of 549 essential medicines in 72 high-, middle-, and low-income markets (covering 87 countries). These data were obtained from IQVIA. The statistical analyses were performed between August 2024 and March 2025. Laspeyres price indices were used to compare average drug prices across countries, both in nominal and purchasing power parity-adjusted terms. The affordability of 8 essential medicines, used to treat major causes of death and disability globally, was assessed by calculating how many days of minimum wage would be required to pay for 1 month of treatment. The availability of essential medicines ranged from 225 (41%) in Kuwait to 438 (80%) in Germany (base country). After accounting for purchasing power parities, prices of essential medicines in Lebanon were, on average, 18.1% of those in Germany (Lebanon price index, 18.1 vs Germany price index, 100), while average prices in the US were 3.0 times higher than in Germany (US price index, 298.2). A positive association was observed between countries’ gross domestic product per capita (expressed in logarithmic terms) and nominal drug prices (R = 0.30; P = .01), indicating that richer countries generally had higher drug prices. However, when adjusting for the purchasing power of different currencies, an inverse association was observed (R = -0.35; P = .003), suggesting that richer countries had lower real prices. Drug affordability, as measured by the number of days’ minimum wage needed to purchase a month’s treatment, varied widely, with median affordability highest in Europe and the Western Pacific, and lowest in Africa and Southeast Asia. The results of this cross-sectional analysis showed significant variation in the prices and affordability of 549 essential medicines across 72 markets in 2022. Strategies to promote equitable drug prices and improve drug affordability are urgently needed.

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57. Clinicians Who Practice Primarily in Nursing Homes and the Quality of Care for Residents With Alzheimer Disease and Related Dementias.

期刊: JAMA health forum 发表日期: 2025-Aug-01 链接: PubMed

摘要

The number of physicians and advanced practitioners (APs) whose care is concentrated in nursing homes (often referred to as nursing home or skilled nursing facility specialists [SNFists]) has increased rapidly. Therefore, whether these clinicians provide better care is important. To examine the association between SNFist care and outcomes of long-stay nursing home (NH) residents with Alzheimer disease and related dementias (ADRD). In this retrospective cohort study of 417 378 residents with ADRD in US NHs, claims for a 20% national sample of Medicare fee-for-service beneficiaries between 2013 and 2019 were analyzed. Adjusted estimates were based on a machine learning approach that incorporated a doubly robust procedure using a generalized estimating equation with inverse probability treatment weighting. Three secondary analyses were conducted: (1) stratified analyses for physicians and APs, (2) inclusion of physicians of any specialty and APs, and (3) use of proxy outcomes for in-place deaths. Data were analyzed from June 1, 2024, to May 3, 2025. Receipt of care from a SNFist; SNFists included generalist physicians and APs. Hospitalizations and emergency department (ED) visits for ambulatory care-sensitive (ACS) conditions. Death without an ACS hospitalization and death without any hospitalization were used in secondary analyses. Of the total 417 378 residents, 242 540 received care from SNFists (mean [SD] age, 83.5 [8.7] years), and 174 838 never received care from SNFists (mean [SD] age, 84.8 [8.5] years). Compared with the residents who never received care from SNFists, the residents who received care from SNFists were more likely to be Black (12.6% vs 9.4%; P < .001), dually eligible (77.5% vs 73.1%; P < .001), and have more chronic conditions (eg, anemia, 60.9% vs 57.6%). Compared with non-SNFist clinicians, the SNFist clinicians were more likely to be female (physicians, 37.1% vs 23.3%; APs, 88.1% vs 85.1%), practice at more facilities (mean [SD] number of facilities, 9.4 [8.7] for SNFist physicians vs 6.4 [6.1] for non-SNFist physicians; 8.6 [8.1] for SNFist APs vs 7.1 [6.8] for non-SNFist APs), and less likely to practice in rural areas (physicians, 9.3% vs 25.4%; APs, 8.1% vs 20.2%). In adjusted analyses, receiving care from a SNFist vs non-SNFist was associated with 7% lower odds of an ACS hospitalization (odds ratio [OR], 0.93; 95% CI, 0.90-0.96) and 7% lower odds of an ACS ED visit (OR, 0.93; 95% CI, 0.90-0.96). In stratified analyses, receiving care from a SNFist physician vs a non-SNFist physician was associated with 13% lower odds (OR, 0.87; 95% CI, 0.83-0.90) of an ACS hospitalization and 7% lowers odds of an ACS ED visit (OR, 0.93, 95% CI, 0.88-0.97); comparisons of SNFist APs vs non-SNFist APs were not statistically significant. Estimates from the analysis including physicians of any specialty and APs were consistent with the primary results. SNFist care was associated with increased odds of in-place death. Findings of this cohort study suggest that the use of SNFists by NHs may enhance the quality of care for residents with ADRD.

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58. Little Cigar and Cigarillo Graphic Health Warnings and Quitting Behaviors: A Randomized Clinical Trial.

期刊: JAMA network open 发表日期: 2025-Aug-01 链接: PubMed

摘要

Although little cigars and cigarillos (LCCs) are common combustible tobacco products, the effects of LCC warning labels on behavioral outcomes remain untested. To evaluate the effects of LCC graphic health warnings (GHWs) on promoting LCC quitting intentions and behaviors. This randomized clinical trial included 1029 adult LCC users from a Qualtrics online panel who were randomized to (1) LCC GHWs (n = 339), (2) existing US Food and Drug Administration (FDA) text-only warnings (n = 346), or (3) no stimulus control (n = 344). Participants accessed messages via email from May 1 to August 31, 2023, and completed surveys each day, with repeated exposure to LCC packages based on study condition. Participants were exposed to 6 new LCC GHWs or FDA text-only cigar warnings 18 times over 3 weeks. The control group received no visual stimuli. The primary outcome was postintervention quit intentions, measured by a score ranging from 1 (low quit intention) to 4 (high quit intention). Secondary outcomes were the proportion having forgone or butted out (ie, extinguished an LCC that they had already lit) LCCs in the past week and the proportion having attempted to quit or reduced LCC use in the past week. Data were analyzed on an intent-to-treat basis using mixed-model analysis of variance and were adjusted for baseline behaviors. Among the 1029 participants, the mean (SD) age was 43.9 (11.3) years, 578 (56.2%) were men, and 767 (74.5%) were users of both types of LCCs. Retention to trial end was high across all arms (LCC GHWs, 307 of 339 [90.6%]; FDA text-only warnings, 316 of 346 [91.3%]; and control group, 308 of 344 [89.5%]). Participants in the LCC GHW group reported significantly higher postintervention (and change from preintervention to postintervention) quit intentions (mean score, 2.9 [95% CI, 2.8-3.0]) compared with FDA text-only participants (mean, 2.5 [95% CI, 2.4-2.6]) and control (mean, 2.6 [95% CI, 2.4-2.7]) (P < .001). The mean proportion of participants reporting quit attempts after the intervention was significantly higher for participants in the LCC GHW group compared with participants in the text-only group (0.4 [95% CI, 0.4-0.5] vs 0.3 [95% CI, 0.2-0.3]). Participants in the LCC GHW group were more likely than those in the text-only group to forgo or butt out LCCs (adjusted estimate [SE]: forgoing little cigars, 0.12 [0.03]; forgoing cigarillos, 0.13 [0.03]; butting out little cigars, 0.07 [0.04]; butting out cigarillos, 0.07 [0.03]). No significant difference occurred in the change (from pre to post) in quit attempts between the LCC GHW and control groups. This randomized clinical trial found that LCC GHWs were effective in increasing quit intentions and reducing LCC use behaviors. Current FDA warnings appear insufficient. Findings support enhanced GHWs on LCC packages to address significant public health gaps, aligned with global tobacco control strategies. ClinicalTrials.gov Identifier: NCT05849051.

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59. Suicidal Behavior in US Army Special Operations Forces.

期刊: JAMA network open 发表日期: 2025-Aug-01 链接: PubMed

摘要

Research on suicide risk among the US Army’s elite special operations forces (SOF) has been extremely limited. To examine suicidal behaviors during the Iraq and Afghanistan war in the 2 major SOF elements: operators (ie, elite soldiers trained in unconventional warfare), and support personnel (ie, soldiers who assist operators and SOF missions). This retrospective cohort study of administrative data identified all operator, support, and other regular Army enlisted person-months from 2004 through 2012 with a first nonfatal suicide attempt and an equal-probability control sample. Separate case-control samples were drawn to examine suicide death and suicide ideation. Analyses were carried out from July 8, 2024, to May 27, 2025. Serving as an SOF operator or support soldier. Suicide ideation and nonfatal suicide attempt were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes and Department of Defense Suicide Event Report records. Suicide death were identified using the Armed Forces Medical Examiner Tracking System. Sociodemographic, Army career, and mental health variables were constructed from administrative personnel and medical records. The total weighted sample of regular Army enlisted soldiers was 48 103 189 person-months (41 717 105 male [86.7%]; mean [SD] age, 28.8 [8.6] years; 32 263 202 younger than aged 30 years [67.1%]). Operator suicide attempt crude rates were 70% lower than those of SOF support personnel (rate ratio [RR], 0.3; 95% CI, 0.2-0.3) and 90% lower than those of the total regular force (RR, 0.1; 95% CI, 0.1-0.2). Operator suicide ideation crude rates were 70% lower than rates for SOF support personnel (RR, 0.3; 95% CI, 0.2-0.3) and 80% lower than those of the total regular enlisted force (RR, 0.2; 95% CI, 0.1-0.2), whereas suicide death rates did not differ. The ratio of suicide attempts to suicide deaths was 2.1 (95% CI, 1.9-2.3) for operators, 7.6 (95% CI, 7.5-7.7) for support personnel, and 15.0 (95% CI, 15.0-15.0) for the total regular force. Adjusting for sociodemographic and Army career differences attenuated but did not eliminate operators’ lower risk of suicide attempt and suicide ideation. In multivariable analyses, only 3 of 9 risk factors were associated with suicide attempt among both operators and support personnel: lower rank, past-year demotion, and mental health diagnosis during service. Odds were higher for female operators (OR, 7.4; 95% CI, 3.2-17.1). Sex was not associated with attempts among support personnel. In this study of US regular Army enlisted soldiers during the Iraq and Afghanistan wars, SOF operators were less likely than other soldiers to engage in suicidal behavior, but it was more likely to be fatal when they did. Larger studies are needed to understand suicide risk among female operators.

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60. Assessing Social Participation Among Kidney Transplant Recipients Using PROMIS Computer Adaptive Testing.

期刊: Kidney international reports 发表日期: 2025-Aug 链接: PubMed

摘要

Social participation is a valued aspect of quality of life among kidney transplant recipients; however, few validated measures exist to assess it. This study aimed to explore the reliability and validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Ability to Participate in Social Roles and Activities (PROMIS-SP), administered as a computer adaptive test (CAT), among kidney transplant recipients. This was a cross-sectional study involving a convenience sample of adult recipients from Toronto, Canada. Participants completed the PROMIS-SP CAT and legacy measures of social participation on an electronic data capture platform. Reliability of the PROMIS-SP CAT was determined using standard error of measurement (SEM) and test-retest reliability using intraclass correlation coefficient. Convergent validity was assessed by calculating Spearman’s correlation between the PROMIS-SP CAT and legacy measures, and construct validity was assessed using known group comparisons. We recruited 284 participants with a mean (SD) age of 53 (14) years and a median of 5.5 years since kidney transplantation; 61% were male, 53% were White, and 30% had diabetes. The mean (SD) PROMIS T-score was 51 (9). Reliability (r = 0.93) and test-retest reliability (intraclass correlation coefficient = 0.97) of the PROMIS-SP CAT were excellent. Strong correlations were observed between PROMIS-SP CAT and social difficulty inventory (SDI) (rho = -0.65), SDI “everyday living” (rho = -0.68), and EuroQol-5 Dimensions-5 Levels (EQ5D5L) “usual activities” (rho = -0.66). PROMIS-SP CAT scores were significantly different between known groups in the expected direction. Our results support the validity and reliability of PROMIS-SP CAT among kidney transplant recipients, and suggest that this tool can be used to identify recipients with restricted social participation.

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61. Understanding Changes in Serum Creatinine During Work in Heat.

期刊: Kidney international reports 发表日期: 2025-Aug 链接: PubMed

摘要

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