公共卫生研究摘要 (2025-08-21)
共收录 60 篇研究文章
1. The importance of dopamine levels and single-nucleotide polymorphism within COMT, DRD1 and DRD2 genes in obstructive sleep apnoea.
期刊: Annals of medicine 发表日期: 2025-Dec 链接: PubMed
摘要
Obstructive sleep apnoea (OSA) is a prevalent sleep disorder that contributes to serious cardiovascular comorbidities. While the mechanical aspects of OSA are well-studied, its neurobiological underpinnings remain underexplored. In this study, we investigated the role of dopamine and its genetic modulators in OSA pathophysiology. Serum dopamine levels were assessed in a cohort of 153 participants (96 OSA patients and 57 controls), and single-nucleotide polymorphisms (SNPs) in dopamine-related genes, including COMT, DRD1 and DRD2, were analysed in a cohort of 286 participants (141 OSA patients and 145 controls). Elevated serum dopamine levels were observed in OSA patients (p = 0.01), with dopamine levels correlating independently with OSA and male gender. Genotypic analysis identified the DRD2 rs1800497 T allele as a potential independent predictor of OSA severity (p = 0.011), hypopnea (p = 0.005) and arousals (p = 0.024). This study advances the understanding of OSA by identifying elevated dopamine levels and genetic variations in DRD2 rs1800497 as potential modulators of its occurrence and severity. These findings pave the way for personalized diagnostic and therapeutic approaches. By integrating neurobiology, genetics, and clinical practice, this research contributes to the evolving framework for precision medicine in sleep disorders. Patients with obstructive sleep apnoea (OSA) were observed to have elevated serum dopamine levels.Genotypic analysis identified the DRD2 rs1800497 T allele as a potential independent predictor of OSA severity.
2. Prevalence, Severity, and Progression of Cerebellar Cognitive-Affective Syndrome in Patients With Spinocerebellar Ataxias.
期刊: Neurology 发表日期: 2025-Sep-09 链接: PubMed
摘要
Cerebellar cognitive-affective syndrome (CCAS) results from cerebellar degeneration, but its prevalence in spinocerebellar ataxias (SCAs) remains underexplored. This study assessed CCAS prevalence, severity, and progression across different SCAs. We included polyglutamine (PolyQ) SCA expansion carriers (ATXN1/SCA1, ATXN2/SCA2, ATXN3/SCA3, and ATXN7/SCA7), patients with FGF14/SCA27B and SPG7, and controls. Cognitive function was assessed with the CCAS scale and ataxia severity with the Scale for the Assessment and Rating of Ataxia (SARA) and Composite Cerebellar Functional Severity (CCFS) score. We correlated CCAS score with ataxia severity, brain MRI, and plasma neurofilament light chain (NfL) levels. Subtest comparisons among genotypes were adjusted for age, education, and SARA score. In PolyQ SCA carriers, we explored CCAS progression. We included 371 participants: 66 with SCA1, 28 with SCA2, 158 with SCA3, 24 with SCA7, 35 with SPG7, 17 with SCA27B, and 43 controls. Those with SCA27B and SPG7 were older (69.5 ± 9.5 and 57.8 ± 10.6 years) with lower education (11.4 ± 4.2 and 12.7 ± 3.6 years) than those with PolyQ SCAs (from 40.3 ± 14.0 for SCA7 group to 45.9 ± 11.2 years in SCA3 group, p < 0.0001; education ranging from 14.4 ± 3.1 for SCA2 group to 15.4 ± 2.8 years for SCA7 group, p < 0.0001). Among ataxic patients, definite CCAS was detected in 88% of patients with SCA27B and 71% of SPG7 carriers, followed by SCA2 (67%), SCA7 (67%), SCA1 (50%), and SCA3 (41%) groups. Among preataxic PolyQ SCA carriers, CCAS was present in 11% (10/89), similar to controls (11.6%, p = 1). However, phonemic fluency showed an early impairment in preataxic SCA1 carriers (11.8 ± 4.5 vs 14.6 ± 3.8, p = 0.04). In PolyQ SCA carriers, the CCAS total raw score correlated with SARA score (r = -0.54, p < 0.0001), CCFS score (r = -0.45; p < 0.0001), and plasma NfL levels (r = -0.26, p = 0.002). CCAS scores correlated with cerebellar volume in those with SCA2 (r = 0.64, p < 0.001). Patients with SPG7 showed significantly poorer performance in executive function, short-term memory, and abstract reasoning compared with those with SCA3 and SCA7. In PolyQ SCA carriers, improvements were observed during the first 3 years after inclusion (+2.0 ± 0.7 points, p = 0.002; +2.6 ± 0.8 points, p = 0.0007; +2.7 ± 0.8, p = 0.001, respectively). By year 4, the increase was not significant (+0.73 ± 1.16 points, p = 0.52). We observed early cognitive impairment in PolyQ SCA carriers, correlating with clinical measures, NfL levels, and cerebellum volume. Improvement over 3 years likely reflects a practice effect, potentially limiting the scale’s longitudinal utility.
3. Financial Toxicity and Its Determinants in Individuals Living With Inherited and Acquired Neuromuscular Disorders: The BIND Study.
期刊: Neurology 发表日期: 2025-Sep-09 链接: PubMed
摘要
Individuals living with neuromuscular disease (NMD) often face substantial financial strain due to the chronic and progressive nature of these conditions. Despite growing awareness, the extent and determinants of financial toxicity (FT) in this population remain poorly understood. We assessed FT among individuals with NMD or their caregivers in Canada using a validated patient-reported outcome measure. We conducted a national, cross-sectional survey of individuals with NMD or their caregivers registered with Muscular Dystrophy Canada (MDC). The survey, available in English and French, was completed online or by telephone with assistance from MDC personnel. FT was measured using the validated Comprehensive Score for Financial Toxicity (COST)-Functional Assessment of Chronic Illness Therapy questionnaire. Multivariable generalized linear models were used to identify factors associated with FT. A total of 1,426 participants (mean [SD] age, 52.0 [19.5] years; 52% female) completed the survey. Seventy-five percent reported household incomes below the national median, primarily because of reduced employment. The average COST score was 17.2 [10.4], significantly lower than scores reported in other chronic conditions, including cancer. Moreover, 70% of respondents had COST scores below 26, indicating moderate or severe FT. After adjusting for other factors, COST scores were significantly worse among caregivers than in adults with NMDs. Lower scores were also observed among individuals identified as racialized minority (rate ratio [RR] 0.74; 95% CI 0.64-0.87); those with lower household income (RR 0.59; 95% CI 0.51-0.69), those with lower education (RR 0.91; 95% CI 0.82-1.00), and those unable to work (RR 0.74; 95% CI 0.64-0.86); students (RR 0.54; 95% CI 0.34-0.86); or early retirees (RR 0.86, 95% CI 0.74-0.99). FT was also greater among those diagnosed with autoimmune myopathies (RR 0.82; 95% CI 0.73-0.92), spinal muscular atrophy (RR 0.79; 95% CI 0.66-0.96), and limb-girdle muscular dystrophy (RR 0.87; 95% CI 0.77-0.99). FT is highly prevalent among people living with NMDs, particularly caregivers and those with socioeconomic and clinical vulnerabilities. Policies to improve financial support and health care coverage for NMD-related needs could help alleviate this burden. Further research is required to understand the mechanisms contributing to FT within NMD subgroups.
4. Outcomes After Reversible Cerebral Vasoconstriction Syndrome With Convexity Subarachnoid Hemorrhage: Individual Patient Data Analysis.
期刊: Neurology 发表日期: 2025-Sep-09 链接: PubMed
摘要
The most common cause of convexity subarachnoid hemorrhage (cSAH) in younger patients (younger than 60 years) is reversible cerebral vasoconstriction syndrome (RCVS). Evidence on the long-term outcomes of future vascular events and functional outcome after cSAH due to RCVS is limited. We aimed to assess the rates and baseline predictors of our primary outcomes (cSAH, intracerebral hemorrhage (ICH), and ischemic stroke), functional outcome, and mortality after cSAH attributed to RCVS. Individual patient data pooled analysis in patients with cSAH attributed to RCVS. A systematic literature search was conducted in PubMed and EMBASE. Two independent reviewers screened studies and extracted data. Quality assessment was assessed using the Newcastle-Ottawa Scale. Early events during the accepted time frame of an RCVS episode (<3 months) were classified as progression rather than recurrence. Follow-up was truncated at 5 years. Primary outcomes were recurrent cSAH, ICH, and ischemic stroke. Secondary outcomes were mortality and functional status measured by modified Rankin Score (mRS). We identified 21 eligible cohorts finally including 138 patients from 9 collaborative centers, which provided individual patient data. The mean age was 49.3 ± 12.1 years, and 110 (79.7%) were female. During a mean follow-up of 1.8 years, annual rates were cSAH recurrence 0.81% (95% CI 0.1-2.91), ICH 0.81% (95% CI 0.1-2.91), and ischemic stroke 0.81% (95% CI 0.1-2.91). Progression during the initial episode (shortly after admission) occurred in 10 patients for cSAH, 2 for ICH, and 8 for ischemic stroke, respectively. Of 106 patients (76.8%) with available outcome data, 100 (94.3%) achieve a mRS of ≤1 at follow-up, indicating no significant disability. Two patients died (annual rate 0.5%, 95% CI 0.09-2.9): one within 10 days and the other within 2 months of the cSAH. Our data suggest a favorable prognosis for most patients after RCVS-associated cSAH with low rates of recurrent events and a high proportion achieving functional independence. Major limitations include retrospective data collection and potential selection bias from centers providing individual patient data. Nevertheless, these findings provide prognostic information to inform clinical practice.
5. Response to Comment on Griffin et al. Use of SGLT2i Versus DPP-4i as an Add-on Therapy and the Risk of PAD-Related Surgical Events (Amputation, Stent Placement, or Vascular Surgery): A Cohort Study in Veterans With Diabetes. Diabetes Care 2025;48:361-370.
期刊: Diabetes care 发表日期: 2025-Sep-01 链接: PubMed
摘要
6. Development and Validation of Vitiligo-Specific-Belief About Therapy Questionnaire (BTQ-Vitiligo).
期刊: Pigment cell & melanoma research 发表日期: 2025-Sep 链接: PubMed
摘要
There is a need to capture therapy-related beliefs held by patients with conditions like vitiligo that have complex treatment regimens. Concerns about adverse effects and uncertainty about response to the prescribed treatment can impact adherence and the perceived treatment burden. This study aims to develop and validate a questionnaire on beliefs about therapy in patients with vitiligo. It is a cross-sectional study. A vitiligo-specific item pool was developed through literature review, in-depth interviews with patients with vitiligo (n = 10), and expert surveys (n = 8). The instrument was studied on 140 patients for psychometric properties using the Vitiligo Treatment Impact score (VITs) and Medication Adherence Rating Scale-5 (MARS-5); self-reported severity using PtGA (Patient Global Assessment) and Response VASI (Vitiligo Area Scoring Index). Exploratory factor analysis demonstrated a six-factor structure with 21 items. Discriminant validity was evidenced by correlation between response VASI and questionnaire subscales (r = -0.538). Correlation with VITs (r = -0.610), MARS-5 (r = 0.453), and PtGA (r = 0.486) demonstrated construct and criterion validity, respectively. BTQ-vitiligo demonstrated test-retest reliability (r = 0.779) during the follow-up visit. BTQ-vitiligo is a validated instrument that helps clinicians understand patients’ perspectives about therapy and tailor it accordingly to ensure adherence and further response to therapy. We developed and validated a BTQ-vitiligo, a valuable tool for capturing therapy-related beliefs in vitiligo, a complex dermatological disease with medication challenges. Although several patient-reported outcome measures (PROMs) have been developed to assess various aspects of vitiligo, none exist to capture patients’ beliefs about therapy, which is a key determinant of the perceived burden of treatment. Our questionnaire identifies general and specific medication beliefs across six domains, with 21 items included under it.
7. Targeting Adipose Inflammation and Energy Expenditure to Sustain Metabolic Health After Weight Loss.
期刊: Diabetes 发表日期: 2025-Sep-01 链接: PubMed
摘要
8. Use of Cigarettes, Cannabis, and Alcohol Among Asian American, Native Hawaiian, and Pacific Islander Adults: Community-Based National Survey Analysis.
期刊: JMIR public health and surveillance 发表日期: 2025-Aug-20 链接: PubMed
摘要
Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations have diverse cultural, immigration, and sociodemographic characteristics. Aggregated data could mask substantial differences in substance use between cultural subgroups in this population. Yet, studies examining substance use among the AANHPI population are limited. This study aimed to describe cigarette, cannabis, and alcohol use among AANHPI adults by cultural subgroup and sex. We analyzed data from 3411 AANHPI respondents of a multilingual national survey “COMPASS” during December 2021-May 2022. Primary outcomes were self-report current (every day or some days) use of cigarettes, cannabis, and alcohol. Cultural subgroups included Asian Indian, Ethnic Chinese, Filipino, Japanese, Korean, Native Hawaiian and Pacific Islander, Vietnamese, other cultural groups, and multicultural groups. Other covariates include sex, other sociodemographics, experiences of discrimination (Everyday Discrimination Scale), and mental health (Patient Health Questionnaire 4). Multivariable logistic regressions were used to examine correlates of each substance use among AANHPI adults. The prevalence of current cigarette, cannabis, and alcohol use was 4.2% (142/3359), 5.5% (184/3235) and 37.6% (1265/3361), respectively. Cigarette use ranged from 1.0% (1/100) in Asian Indian females to 14.8% (10/71) in multicultural males. Cannabis use ranged from 1.9% among Asian Indian (1/53) and Vietnamese males (4/211) to 15.7% (11/70) in multicultural females. Alcohol use varied from 6.6% (4/61) in Native Hawaiian and Pacific Islander females to 56.3% (40/71) among multicultural males. Male participants with elevated depression and anxiety symptoms were more likely to report using all 3 substances than males with minimal symptoms. However, depression and anxiety symptoms were only associated with cannabis and alcohol use among female participants. US-born female participants were more likely to report using all 3 substances compared to foreign-born females, while being US-born was only associated with higher odds of alcohol use among males. Perceived discriminatory experience was associated with higher odds of smoking in both sexes and alcohol drinking in males. Cigarette smoking, cannabis, and alcohol use varied widely across AANHPI cultural groups, between and within each sex. These findings underscore the necessity to disaggregate data for substance use behaviors to guide health policy and intervention programs for AANHPI adults.
9. Deep Phenotyping of Obesity: Electronic Health Record-Based Temporal Modeling Study.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-20 链接: PubMed
摘要
Obesity affects approximately 40% of adults and 15%-20% of children and adolescents in the United States, and poses significant economic and psychosocial burdens. Currently, patient responses to any single antiobesity medication (AOM) vary significantly, making obesity deep phenotyping and associated precision medicine important targets of investigation. This study aimed to evaluate the potential of electronic health records (EHR) as a primary data source for obesity deep phenotyping. We conducted an in-depth analysis of the data elements and quality available from obesity patients prior to pharmacotherapy and applied a multimodal longitudinal deep autoencoder to investigate the feasibility, data requirements, clustering patterns, and challenges associated with EHR-based obesity deep phenotyping. We analyzed 53,688 pre-AOM periods from 32,969 patients with obesity or overweight who underwent medium- to long-term AOM treatment. A total of 92 laboratory and vital measurements, along with 79 ICD (International Classification of Diseases)-derived clinical classifications software (CCS) codes recorded within one year prior to AOM treatment, were used to train a gated recurrent unit with decay-based longitudinal autoencoder (GRU-D-AE) to generate dense embeddings for each pre-AOM record. Principal component analysis and Gaussian mixture modeling (GMM) were applied to identify clusters. Our analysis identified at least 9 clusters, with 5 exhibiting distinct and explainable clinical relevance. Certain clusters show characteristics overlapping with phenotypes from traditional phenotyping strategy. Results from multiple training folds demonstrated stable clustering patterns in 2D space and reproducible clinical significance. However, challenges persist regarding the stability of missing data imputation across folds, maintaining consistency in input features, and effectively visualizing complex diseases in low-dimensional spaces. In this proof-of-concept study, we demonstrated longitudinal EHR as a valuable resource for deep phenotyping the pre-AOM period at per patient visit level. Our analysis revealed the presence of clusters with distinct clinical significance, which could have implications in AOM treatment options. Further research using larger, independent cohorts is necessary to validate the reproducibility and clinical relevance of these clusters, uncover more detailed substructures and corresponding AOM treatment responses.
10. Tenofovir to Prevent HIV Infection in Western China: Pragmatic Randomized Controlled Trial.
期刊: JMIR public health and surveillance 发表日期: 2025-Aug-20 链接: PubMed
摘要
Pre-exposure prophylaxis (PrEP) programs have been implemented in multiple countries. Evidence from clinical trials and cohort studies has proven the safety and effectiveness of PrEP. However, minimizing drug-related adverse effects and cost should be primarily considered in PrEP. Most trials used tenofovir combined with emtricitabine as the intervention; yet, the use of tenofovir disoproxil fumarate (TDF) (ie, Tenofovir) alone has not been thoroughly evaluated. Furthermore, the medication regimen in most trials was used every day, with a few studies proposing an optimal medication regimen for PrEP. This study was designed to systematically evaluate the preventive efficacy and safety profile of TDF-based PrEP in the Chinese population. We also aimed to explore medication compliance, changes in sexual behavior, and hazard factors of HIV infection. We conducted a pragmatic randomized controlled trial (RCT) to evaluate the effectiveness and safety of TDF for HIV PrEP. Participants were randomly assigned (1:1:1) to a time-driven group (TDF 300 mg administered orally once daily), an event-driven group (TDF 300 mg administered orally 24 to 48 h before sexual activity and 2 hours after sexual activity, not exceeding 300 mg within 24 h), or an untreated control group. The primary outcomes were the effectiveness and safety of TDF during periods of PrEP use. Secondary outcomes focused on the effectiveness of TDF among participants with good compliance during PrEP use. Tertiary outcomes included the risk factors of HIV infection and behavioral changes from PrEP initiation to the last visit. For ethical reasons, all participants received condoms and health education. This study was registered with the Chinese Clinical Trial Registry (ChiCTR-TRC-13003849). A total of 1914 participants underwent randomization. During the follow-up of 3513.5 person-years from June 2013 to May 2016, HIV seroconversion was observed in 30 persons (2.02 per 100 person-years) in the time-driven group (time-driven vs control group: hazard ratio [HR] 0.93, 95% CI 058-1.51; P=.78), 35 (1.73 per 100 person-years) in the event-driven group (event-driven group vs control group: HR 0.83, 95% CI 0.52-1.31; P=.42), and 37 (2.06 per 100 person-years) in the control group. Post hoc analysis showed that participants with good medication compliance reduced their HIV infection risk by 53% (P=.01) and event-driven medication with good compliance reduced the risk by 62% (P=.009). We recorded no severe adverse events during the trial. For tertiary outcomes, low medication compliance, sexual role, no condom use, and more number of sexual partners remained significantly associated with HIV risk. The TDF-based PrEP is ineffective without good adherence. However, when medication compliance is achieved, event-driven dosing is recommended as an optimal PrEP regimen.
11. Communicating Antimicrobial Resistance on Instagram: Content Analysis of #AntibioticResistance.
期刊: JMIR infodemiology 发表日期: 2025-Aug-20 链接: PubMed
摘要
Antimicrobial resistance (AMR) is a major global health issue heavily influenced by human behavior. Effective communication and awareness-raising are crucial in curbing AMR, with social network sites (SNSs) significantly shaping health behaviors. Despite their potential, current analyses of AMR on SNSs have focused mainly on top-down communication initiatives. This study aims to examine AMR on Instagram (Meta Platforms), identifying key actors, content themes, and the nature of the communication to understand how AMR is portrayed and perceived. Based on the sender-message-channel-receiver model, this study used content analysis to review publicly accessible posts on Instagram. The data refer to 24 months, focusing on the hashtag “#antibioticresistance.” After cleaning the data, 610 posts (10% of the total 6105) were analyzed. Content creators were predominantly information drivers or professionals in science and health. Posts frequently featured text-dominated visuals or images of bacteria and laboratory tests. However, the AMR posts were found to be siloed, with limited engagement beyond specific interest groups. The study highlighted the neutrality and accuracy of the content but noted the challenge of reaching a broader audience. While Instagram serves as a platform for accurate and informative AMR communication, the post of it remains confined to niche groups, limiting its broader impact. To enhance engagement, AMR discussions should be integrated into more general interest content, use visually compelling formats, and encourage institutional participation and interactive user engagement.
12. Sexual and Psychosocial Risk Burdens Associated With Online Sex Seeking Among Young Men Who Have Sex With Men: Cross-Sectional Study.
期刊: Journal of medical Internet research 发表日期: 2025-Aug-20 链接: PubMed
摘要
The heightened HIV vulnerability associated with men who have sex with men (MSM) who find sex online in Western and East Asian countries may pose similar concerns for MSM in Southeast Asia. However, this line of research is underexamined among Southeast Asian MSM, especially in Southeast Asian cities with a high HIV prevalence among young MSM, such as Ho Chi Minh City, Vietnam. This study aimed to characterize the sexual behavioral and psychosocial correlates of online sex seeking in a sample of largely gay-identified young MSM in Ho Chi Minh City, Vietnam, and examine the relationships among social support, outness, and last instance of condomless anal sex while not on preexposure prophylaxis (PrEP) for HIV or antiretroviral therapy (ART). The analysis included specific attention paid to the use of different types of online sex platforms, which may contribute to the understanding of online sex seeking. Patterns of online sex seeking in a cross-sectional sample of young MSM (N=1005) were identified using latent class analysis. Multinomial logistic regressions and Poisson regressions with robust variance were used to estimate the associations between patterns of online sex seeking and other participant characteristics. We found four latent classes of MSM with distinct profiles of online platform use for sex seeking: (1) negligible app users, (2) gay app users, (3) poly app users, and (4) low-cost app users. Patterns of online sex seeking moderated the protective effects of social support and outness on last instance of condomless anal sex while not on PrEP or ART. When stratified by level of social support and outness, only gay app users were associated with a protective effect on last instance of condomless anal sex while not on PrEP or ART when social support and outness were high, respectively. Low-cost app users were marginally associated with a higher prevalence of condomless anal sex while not on PrEP or ART when the level of outness was low. Young Vietnamese MSM who find sex partners online have distinct patterns of app use, with contrasting sexual and psychosocial health burdens that indicate that online sex seeking is a socially patterned behavior. HIV prevention programs and tailored digital interventions should consider the different exposures to social influences associated with patterns of social networking app use as they could moderate the effectiveness of the delivered programs and interventions for reducing HIV vulnerability in young MSM.
13. A Cloud-Based Platform for Harmonized COVID-19 Data: Design and Implementation of the Rapid Acceleration of Diagnostics (RADx) Data Hub.
期刊: JMIR public health and surveillance 发表日期: 2025-Aug-20 链接: PubMed
摘要
The COVID-19 pandemic exposed significant limitations in existing data infrastructure, particularly the lack of systems for rapidly collecting, integrating, and analyzing data to support timely and evidence-based public health responses. These shortcomings hampered efforts to conduct comprehensive analyses and make rapid, data-driven decisions in response to emerging threats. To overcome these challenges, the US National Institutes of Health launched the Rapid Acceleration of Diagnostics (RADx) initiative. A key component of this initiative is the RADx Data Hub-a centralized, cloud-based platform designed to support data sharing, harmonization, and reuse across multiple COVID-19 research programs and data sources. We aim to present the design, implementation, and capabilities of the RADx Data Hub, a cloud-based platform developed to support findable, accessible, interoperable, reusable (FAIR) data practices and enable secondary analyses of the COVID-19-related data contributed by a nationwide network of researchers. The RADx Data Hub was developed on a scalable cloud infrastructure, grounded in the FAIR data principles. The platform integrates heterogeneous data types-including clinical data, diagnostic test results, behavioral data, and social determinants of health-submitted by over 100 research organizations across 46 US states and territories. The data pipeline includes automated and manual processes for deidentification, quality validation, expert curation, and harmonization. Metadata standards are enforced using tools such as the Center for Expanded Data Annotation and Retrieval (CEDAR) Workbench and BioPortal. Data files are structured using a unified specification to support consistent representation and machine-actionable metadata. As of May 2025, the RADx Data Hub hosts 187 studies and over 1700 data files, spanning 4 RADx programs: RADx Underserved Populations (RADx-UP), RADx Radical (RADx-rad), RADx Tech, and RADx Digital Health Technologies (RADx DHT). The Study Explorer and Analytics Workbench components enable researchers to discover relevant studies, inspect rich metadata, and conduct analyses within a secure cloud-based environment. Harmonized data conforming to a core set of common data elements facilitate cross-study integration and support secondary use. The platform provides persistent identifiers (digital object identifiers) for each study and supports access to structured metadata that adhere to the CEDAR specification, available in both JSON and YAML formats for seamless integration into computational workflows. The RADx Data Hub successfully addresses key data integration challenges by providing a centralized, FAIR-compliant platform for public health research. Its adaptable architecture and data management practices are designed to support secondary analyses and can be repurposed for other scientific disciplines, strengthening data infrastructure and enhancing preparedness for future health crises.
14. Identifying risk factors associated with refractoriness to radioiodine therapy in differentiated thyroid cancer.
期刊: Archives of endocrinology and metabolism 发表日期: 2025-Aug-20 链接: PubMed
摘要
To identify factors potentially associated with radioiodine-refractory disease among patients treated for differentiated thyroid carcinoma at a referral center in Northeastern Brazil. A total of 554 medical records of patients with differentiated thyroid carcinoma treated between January 2010 and August 2024 were evaluated. Radioiodine-refractory disease tumors were detected in 44 (7.9%) patients. Clinical, laboratory, and radiological data were compared between the radioiodine-refractory disease and non-radioiodine-refractory disease groups to determine factors associated with poor differentiated thyroid carcinoma outcomes. Factors most strongly associated with progression to radioiodine-refractory disease included older age, increased number of surgeries performed, aggressive histological subtypes, larger tumor size, vascular invasion, extrathyroidal extension, compromised margins, lymph node metastasis, distant metastasis at diagnosis and during follow-up, higher malignant tumor classification staging, high risk of recurrence, high thyroglobulin levels prior to radioiodine therapy, higher doses and greater number of radioiodine therapy doses, and higher frequency of incomplete responses within the first year post-treatment. Identifying possible factors associated with radioiodine-refractory disease development may allow early diagnosis and a more effective treatment.
15. Exploring thyroid eye disease in Brazil: insights from a single-center study.
期刊: Archives of endocrinology and metabolism 发表日期: 2025-Aug-20 链接: PubMed
摘要
Graves’ disease (GD) is the leading cause of hyperthyroidism globally, with 40% of affected individuals developing thyroid eye disease (TED). Treatment options for TED have advanced in recent years. This study aimed to investigate the prevalence of TED at a single center in Brazil, contributing more robust data for cost-analysis studies assessing the financial implications of novel TED treatments. Subjects and. This study evaluated the clinical histories of 660 patients diagnosed with GD from 1999 to 2019. The patients were categorized into four groups based on the presence and severity of TED. The prevalence of TED within the study population, categorized according to severity, was as follows: absent (n = 325; 49%), mild (n = 221; 33%), moderate to severe (n = 107; 16%), and sight-threatening (n = 7; 1%). A significant correlation was observed between older age at diagnosis, smoking, larger goiters, and the presence and severity of TED. The prevalence of TED identified in this single-center study contributes valuable insights for the design of cost-analysis studies and the assessment of the financial implications of novel treatments for TED within both the public and private healthcare systems in Brazil.
16. Ethical Principles Pertaining to the Care of People With Dementia: Protocol for a Qualitative Thematic Synthesis of Legal Documents.
期刊: JMIR research protocols 发表日期: 2025-Aug-20 链接: PubMed
摘要
The global prevalence of dementia presents profound challenges for health care systems, societies, and legal structures worldwide. While the ethical dimensions of dementia care have been extensively discussed in the literature, limited research addresses how ethical principles are effectively operationalized within legal frameworks governing dementia care. We aim to explore how national, European, and international legal instruments integrate and translate ethical principles such as autonomy, dignity, beneficence, and justice into dementia care legal documents, including case law and legislation. This study will be conducted by a team of 24 researchers from 15 European countries, within a European Union (EU)-funded European Cooperation in Science and Technology Action on dementia care. The project applies a combined methodological approach, using qualitative thematic synthesis and a legal document review framework. Legal documents published between 2010 and 2025 will be searched and qualitatively analyzed at 3 levels: national, EU, and international, including legislation, case law, and authoritative legal literature explicitly addressing dementia care. Researchers from each country will conduct searches in national legal databases using predefined search terms. At the EU and international levels, databases such as Westlaw, Lexis+, the European Court of Human Rights, and the European Ombudsman will be consulted. Key information from each document will be collected using a standardized data extraction tool, focusing on ethical principles and frameworks. Data analysis will combine deductive and inductive approaches, allowing the identification of ethical principles and the emergence of new concepts discussed in the documents. Thematic analysis will follow a 3-stage process: line-by-line coding, grouping codes into descriptive themes, and developing analytical themes to address the research questions. This study will identify and categorize ethical principles embedded in legal documents, analyzing their expression, interpretation, and variability across jurisdictions. The project is scheduled to be implemented throughout 2025. In January 2025, a pilot test of the data extraction tool was conducted. Between February 2025 and April 2025, a systematic search of legal documents meeting the inclusion criteria was performed, applying a structured 3-level search strategy. Data extraction and initial coding are planned from May 2025 to July 2025, followed by data analysis between September 2025 and October 2025, through iterative coding and collaborative discussion. The final research paper will be drafted in November 2025. This cross-country thematic synthesis will provide critical insights into how ethical principles guide dementia care and shape its discussion within legal systems. By systematically analyzing legal instruments through an ethical lens, this study aims to bridge the gap between ethical theory and legal practice, offering valuable guidance for future policy development. The findings will contribute to promoting ethically grounded and legally coherent frameworks for dementia care, safeguarding the rights and dignity of individuals living with dementia across diverse legal cultures. DERR1-10.2196/71490.
17. How Does Household Food Insecurity Impact Complementary Feeding, in High Income Countries, in a Cost-of-Living Crisis? A Systematic Scoping Review.
期刊: Maternal & child nutrition 发表日期: 2025-Aug-20 链接: PubMed
摘要
Complementary feeding, when infants are introduced to solid foods, is an important stage of learning new tastes, textures and eating behaviours. Austerity, post-BREXIT (in the UK) and the COVID-19 pandemic have created a cost-of-living crisis, exacerbating prevalence of food insecurity in high-income countries. Understanding how this may impact upon parents’ experience of complementary feeding is important. This systematic scoping review therefore examined how food insecurity impacts diet and feeding practices during the complementary feeding period for infants aged 6-18 months. Four electronic databases were searched, identifying 5822 articles. 3293 titles and abstracts, from which 30 full texts were screened by two independent reviewers. The final review included five articles (two qualitative and three quantitative). Three articles were conducted in Australia, one in America, one in New Zealand with 1044 parent/child dyads in total. Strategies such as encouraging children to finish their food, avoiding foods that might not be accepted and reducing food variety were common. These strategies may ensure children are fed but may reduce elements of complementary feeding that we know are important such as exposing infants to wide varieties of tastes, textures and nutrients and adopting a responsive feeding style. The sparsity of evidence in this review, particularly for research based in the UK, highlights the need for further research in high-income countries to explore the impact of household food insecurity on complementary feeding. This will help to identify priorities for those working in policy and practice to support families with complementary feeding during the cost-of-living crisis and beyond.
18. Medicaid And Methadone For Opioid Use Disorder: Expanded Coverage Increased Distribution In 10 States, 2019-24.
期刊: Health affairs (Project Hope) 发表日期: 2025-Aug-20 链接: PubMed
摘要
Methadone is a vital medication for opioid use disorder, yet it remains underused because of restrictive federal and state regulations. Before 2018, not all state Medicaid programs covered methadone treatment. This prompted passage of the 2018 Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act, mandating Medicaid coverage of methadone by 2020. This study evaluated the impact of expanded coverage on methadone distribution and opioid overdoses. Using controlled substance distribution data from the period 2016-24, as well as national mortality data, we compared states newly covering methadone in Medicaid to states with existing coverage. New coverage of methadone was associated with an increase of 86.6 grams per 100,000 population (a 13.2 percent relative change) in treatment versus control states. Still, there was an increase of 14.4 percent in opioid overdose deaths in treatment versus control states in the post period. These results suggest that the SUPPORT Act boosted population-level methadone distribution, although rising overdose rates indicate a need for broader addiction treatment policy solutions to effectively address the crisis.
19. One Surface Fits All: Validating the Venous Return Model Across Species and Scales in Circulatory Equilibrium.
期刊: American journal of physiology. Heart and circulatory physiology 发表日期: 2025-Aug-20 链接: PubMed
摘要
In the generalized framework of circulatory equilibrium, the cardiac output (CO), right (RAP) and left (LAP) atrial pressures at equilibrium are predicted from the intersection between the CO curve and venous return (VR) surface. The VR surface is represented by the following equation: VR=V/W-GS∙RAP-GP∙LAP, where V is stressed blood volume, and W, GS, and GP are parameters. For future clinical application of this framework, we examined whether the VR surface is valid, whether the parameters are allometrically scalable based on Kleiber’s law, and whether the VR surface with allometrically scaled parameters accurately predicts hemodynamic variables across different animal species and a diverse range of body weights (BW). Anesthetized dogs (n=18) and pigs (n=8) with BW ranging from 9 to 50 kg were used. In 20 animals, we characterized the VR surface under total heart bypass and examined allometric scalability of the parameters. In 19 animals, we assessed whether the allometrically scaled VR surface allows accurate predictions of CO, LAP, and RAP. VR correlated significantly with RAP and LAP as per the equation, with a median coefficient of determination (r2) of 0.95. GS and GP were allometrically scalable with BW0.75, but W was not. However, if population-representative W was combined with allometrically scaled GS and GP, predicted CO, RAP, and LAP correlated strongly with those measured (r2=0.99, 0.98, and 0.94, respectively). In conclusion, the VR surface is valid across species and body sizes, and the allometrically scaled VR surface allows accurate hemodynamic prediction, supporting the clinical application potential of this framework.
20. Defective medium-chain fatty acid β-oxidation in the liver alters the fat preference and induces hepatic steatosis and glucose intolerance.
期刊: American journal of physiology. Endocrinology and metabolism 发表日期: 2025-Aug-20 链接: PubMed
摘要
Long-chain triglycerides (LCTs) exert obesogenic effects, whereas medium-chain triglycerides (MCTs) exert anti-obesity effects. To date, most studies examining the distinct effects of MCTs and LCTs have been conducted under extreme conditions using high-fat diets (45-60 kcal% fat). In this study, we aimed to investigate the health effects of varying MCT/LCT intake ratios in 30 kcal% high-fat diets, using liver-specific medium-chain acyl-CoA dehydrogenase (MCAD)-deficient (MCADL-/-) mice. Because this fat level more closely resembles the human diet without causing overeating, it allows for a purer assessment of the metabolic effects of the MCT/LCT intake ratios compared to the results of studies using extreme high-fat conditions. We fed MCADL-/- mice 30 kcal% fat MCT and LCT diets for 12 weeks. Notably, MCADL-/- mice consumed the LCT diet more than the MCT diet, without any difference in the total caloric intake. Despite no difference in the body weight, MCADL-/- mice exhibited impaired glucose tolerance, and elevated hepatic triacylglycerol and cholesterol levels. Moreover, lipid droplet size and gene expression levels of some inflammatory markers increased in the adipose tissues of MCADL-/- mice. Overall, these results suggest that the intact metabolism of medium-chain fatty acids in the liver is crucial for dietary fat preference regulation. Furthermore, anti-obesity effects of MCTs are observed even when the percentage of MCT intake is increased without altering the total fat intake.
21. "Stop, Think, and Appreciate": A Qualitative Exploration of a Challenge Coin Suicide Prevention Intervention among Farmers.
期刊: Community mental health journal 发表日期: 2025-Aug-20 链接: PubMed
摘要
Farmers are at increased risk for suicide compared to the general population, with estimates 56% higher among males in agriculture/forestry/fishing roles than the male working population. This study explored a farmer-developed suicide prevention intervention using an adapted military challenge coin for agriculture. An agricultural community member shared a message of appreciation with the farmer recipient. Farmers recently receiving a challenge coin were purposively sampled. Semi-structured interviews via telephone/videoconference explored farmers’ challenge coin experiences and perceptions. Interviews were transcribed verbatim and de-identified before thematic coding. Participants (n = 14) were aged 28-68 years. All interviewees were non-Hispanic White, and 71% had off-farm jobs. Themes included the reception of the challenge coin, feelings elicited, and protective nature of the challenge coin against suicide, encouraging farmer connectedness and demonstrating appreciation. These data provide initial exploration of challenge coins adapted for farmer suicide prevention, developed within a farming community. Additional research regarding the impact is needed.
22. Role of prostate health index (PHI) in prostate cancer screening: cost minimization analysis through simulation modelling.
期刊: World journal of urology 发表日期: 2025-Aug-20 链接: PubMed
摘要
Prostate cancer (PCa) is the most frequently diagnosed cancer globally, with rising incidence rates, particularly in Europe. Prostate specific antigen (PSA) testing, often leads to overdiagnosis and unnecessary biopsies. This study aims to assess the cost-saving potential of incorporating the Prostate Health Index (PHI) as a biomarker in PCa screening programmes to reduce unnecessary biopsies and optimize costs in healthcare systems. A simulation model was constructed using data from an observational study in a clinical setting. PHI values were used to determine biopsy decisions in a simulated population of 10,000 men aged 50-70 with PSA levels 3-10 ng/mL. Logistic regression modeled the correlation between PHI and clinically significant PCa (csPCa). Three csPCa prevalence scenarios (10%, 20%, and 30%) were tested to assess cost-minimizing effects. Decision trees compared the PHI-guided biopsy approach to the conventional PSA-based strategy. The PHI-guided approach reduced up to 49.7% negative and low-grade biopsies and demonstrated cost savings compared to the conventional PSA-based strategy. Use of PHI resulted in cost savings of €233 per patient in csPCa detection. The mean cost of the PHI pathway was €681, compared to €915 for the conventional PSA-based pathway. However, the study’s reliance on synthetic data and the limited inclusion of MRI in the dataset may affect the generalizability of findings. Incorporating PHI into PCa screening could reduce overdiagnosis, unnecessary biopsies, and overall healthcare costs. Further prospective studies are needed to confirm PHI’s role as a cost-effective reflex test and its integration into broader PCa screening strategies.
23. Single-versus double-layer uterine closure at the time of cesarean delivery and risk of uterine scar niche: a systematic review and meta-analysis of randomized trials.
期刊: Archives of gynecology and obstetrics 发表日期: 2025-Aug-20 链接: PubMed
摘要
This systematic review and meta-analysis compared single- versus double-layer uterine closure at the time of cesarean delivery. MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from inception until May 2024. We included only randomized controlled trials (RTSs) that compared single-layer versus double-layer uterine closure at the time of cesarean delivery. Outcomes were analyzed using a random-effects model. Results are expressed as risk differences. The assessment of the risk of bias was performed by using the Risk of Bias 2 tool. The primary outcome was the incidence of scar defects (i.e., niche) at 6 months after delivery. The secondary outcomes were incidence of scar defects at 6 weeks and 3 months. A total of 18 studies were identified by the systematic review; 11 RCTs involving 6,058 participants were included in the meta-analysis. There is no statistical difference between single-layer and double-layer uterine closure of cesarean delivery incision regarding the incidence of uterine scar defect at six weeks. Single-layer closure showed a significantly lower incidence of niche after three months (RD = - 0.02 (- 0.06, 0.02); I2 = 81%, p < 0.01), and six months (RD = - 0.11, CI - 0.15, - 0.07, I2 = 91%, p < 0.01). Single-layer uterine closure at the time of cesarean delivery resulted in a lower uterine scar defects after three and six months compared to double-layer uterine closure. PROSPERO, Unique identifier: CRD42024552495.
24. Identifying Potential Targets for the Interception of Inflammatory Bowel Disease: Toward Precision Prevention.
期刊: Inflammatory bowel diseases 发表日期: 2025-Aug-20 链接: PubMed
摘要
There is growing recognition that inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is preceded by a prolonged preclinical phase marked by subtle but measurable changes in the immune system, gut microbiome, and epithelial barrier function. These early alterations, often detectable years before diagnosis, offer a window of opportunity for disease interception. In this review, we examine the current evidence for environmental, microbial, and molecular factors that may contribute to the initiation of IBD, with a particular focus on modifiable risk pathways. We discuss preventive strategies across different levels of risk-from lifestyle and environmental interventions in the general population to more targeted approaches in individuals with familial predisposition, such as first-degree relatives. We also highlight recent findings on emerging biomarkers, including anti-flagellin antibodies, anti-GM-CSF autoantibodies, glycome, and integrin-targeted immune responses, that could guide precision prevention efforts. While most evidence to date has focused on CD, we also review preclinical insights relevant to UC. As the field moves toward earlier identification of at-risk individuals, the concept of “precision prevention”-matching interventions to individual risk and biology-may ultimately shift the paradigm of IBD care from treatment to prevention.
25. Rapid and Sensitive Fluorometric Quantification of Black Carbon in Biological Fluids.
期刊: Analytical chemistry 发表日期: 2025-Aug-20 链接: PubMed
摘要
The increase in wildfire frequency worldwide has contributed to persistent atmospheric black carbon (BC) pollution, which was closely relative to multiple adverse health effects. Accurate quantification of BC in biological tissues and fluids is fundamental for evaluating its health effect; however, existing analytical methodologies are hindered by time-consuming protocols, low throughput, and the need for expensive instrumental infrastructure. In this study, we developed a fluorometric method for quantifying BC in various biological fluids with the advantages of simplicity, high sensitivity, and low cost. Specifically, this technique enables quantification of five distinct types of BC across diverse biological liquids with a detection limit (LOD) of 0.23-7.57 mg/L. The method’s LOD is comparable to the established advanced techniques for BC quantification (e.g., femtosecond illumination technique and laser desorption/ionization mass spectrometry) but avoids the use of expensive instruments. Compared with conventional ultraviolet-visible (UV-Vis) spectrophotometry, the fluorometric technique demonstrates higher accuracy and less interference from proteins, water-soluble ions, or suspended particles. The practicability of the method was examined through the A549 cell-based toxicological assays. The biologically effective exposure dose (BED, a parameter for evaluating the actual exposure dose of chemicals) of BC to A549 cells was determined to be approximately 30 pg/cell, which overcame a fundamental measurement challenge regarding the BED of BC in cellular assays. Overall, the present method addresses a significant challenge in BC analysis, thus facilitating its accurate risk assessment.
26. Identification, Formation, and Toxicity of Haloimidazoles as Emerging Nitrogenous Aromatic Disinfection Byproducts in Drinking Water.
期刊: Environmental science & technology 发表日期: 2025-Aug-20 链接: PubMed
摘要
Identification of unknown disinfection byproducts (DBPs) remains a significant challenge in the supply of safe drinking water, as identified DBPs do not fully account for DBP-related adverse effects on human health. In this study, gas chromatography coupled with high-resolution mass spectrometry, along with multiple identification using the electron ionization and chemical ionization sources, was employed to identify six haloimidazoles as newly nitrogenous aromatic DBPs in drinking water. These compounds include 4-chloroimidazole, 4-bromoimidazole, 2,4-dibromoimidazole, 4,5-dibromoimidazole, 2,4,5-tribromoimidazole, 4-iodoimidazole, and 4,5-diiodoimidazole. A 13.6% yield of haloimidazoles was observed during chlorination of the amino acid histidine, and formation pathways are proposed. The detection frequency of the individual haloimidazoles ranged from 50 to 100% in eight drinking water samples, and their concentrations ranged from below the detection limit to 28.1 ng/L, with a median value of 4.4 ng/L. The cytotoxicity of the six haloimidazoles was evaluated by using Chinese hamster ovary cells. Notably, 2,4,5-tribromoimidazole exhibited the highest cytotoxicity with an EC50 value of 53.2 μM, 138-252 times more toxic than regulated trichloromethane and dichloroacetic acid. These findings suggest that haloimidazoles are important nitrogenous aromatic DBPs in drinking water, and further investigation is needed to elucidate their potential long-term importance to human health.
27. Unraveling the Spatiotemporal Heterogeneity in the Oxidation Potential of Fine Particulate Matter in China.
期刊: Environmental science & technology 发表日期: 2025-Aug-20 链接: PubMed
摘要
The oxidative potential (OP) of fine particulate matter (PM2.5) is a more robust health impact indicator than mass concentration alone. While China’s stringent air pollution controls have significantly reduced PM2.5 levels, the temporal evolution of OP and its relationship with PM2.5 remain unclear. This study establishes a national PM2.5 OP database (2000-2020) using a source-oriented CMAQ model. Key findings reveal that OP decreases alongside PM2.5 concentrations over the study period, but the decline in OP (16%) is less pronounced than that of PM2.5 (37%) after 2012, leading to a 35% increase in mass-normalized OP (OPm). Source apportionment analysis identifies distinct phase-specific drivers: anthropogenic secondary organic aerosols (ASOA) were the dominant contributor to OP increases (∼68%) prior to 2012, while reductions in transportation, power generation, and biomass burning emissions drove OP declines during 2012-2017. Post-2017, stringent controls on anthropogenic non-methane volatile organic compounds (NMVOCs) made ASOA the dominant declining source. Notably, urban-rural disparities in OP exposure exceed those of PM2.5 mass concentrations, primarily reflecting differences in dominant emission sources. As the first nationwide study to systematically evaluate the decoupling of PM2.5 mass and OP trends in China, these findings underscore the need for targeted strategies to mitigate PM-related health risks.
28. Unveiling the Environmental Characteristics of Sub-1000-nm Nanoplastics: A Comprehensive Review of the Preparation Methods for Nanoplastic Model Samples.
期刊: Environmental science & technology 发表日期: 2025-Aug-20 链接: PubMed
摘要
Nanoplastics (NPs, < 1 μm) are ubiquitous in the environment and pose potentially more severe ecological and health risks than microplastics (MPs, 1 μm-5 mm). Nearly almost research concerning NPs was limited to few types of nanospheres especially polystyrene (PS) due to the lack of environmentally relevant NP model samples. Preparation of diverse NP samples acts as a formidable barrier to deeply reveal environmental contamination of NPs. We highlighted this current research dilemma and critical scarcity of NP models based on remarkable difference in the aspect of morphology, structure, behavior, and toxicity between NPs and MPs. For the first time, we provide a comprehensive summary of preparation methods for pristine and functionalized NP model samples including the top-down synthesis of irregular heterogeneity and bottom-up synthesis of spherical homogeneity, mainly involving physical fragmentation, emulsion polymerization, and nanoprecipitation. This review aims to facilitate in preparation of NPs with various polymer types, general applicability in different laboratories, and suitability in large-scale production, which will be crucial to understanding their environmental prevalence, behaviors, and pollution control.
29. Photo-Regenerable Antimicrobial Air Filter Using Monolithic Cu-Grafted TiO2 Nanotube Mesh.
期刊: Environmental science & technology 发表日期: 2025-Aug-20 链接: PubMed
摘要
Airborne transmission of pathogens has emerged as a significant public health concern amid recurring pandemics. While conventional air filtration can capture bioaerosols, it poses risks of re-emitting pathogens, necessitating long-term air sterilization. Here, we developed a photo-regenerable antimicrobial air filter by grafting Cu clusters onto a titanium dioxide nanotube mesh (CuxO/mTNT, 1 < x < 2). The in situ grown tubular nanotubes on the mesh support provide a high surface area, and the dispersed Cu clusters exhibited superior disinfection activity. The filter achieved rapid inactivation of Gram-negative Escherichia coli (4.80-log reduction) and Gram-positive Staphylococcus aureus (2.58-log reduction) and respiratory viruses including Influenza A virus (H1N1) and Human coronavirus 229E within minutes. While Cu-based nanomaterials induce antimicrobial effects through direct contact, they gradually lose efficiency as Cu(I) species oxidize to Cu(II). When Cu clusters are grafted onto TiO2, the interfacial charge transfer (IFCT) allows for the absorption of visible light and the formation of charge carriers. The Cu clusters dispersed onto the TNT continuously regenerate Cu(I) under mild visible light through IFCT, achieving sustained recovery of the antimicrobial efficiency. Integrated into a commercial air purifier, the CuxO/mTNT filter achieved efficient space disinfection of bioaerosols, showed reversible photo-regeneration over 10 cycles, and maintained durability for over six months. Field tests demonstrated that this filter achieved disinfection efficiency, whereas conventional filtration-based filters left microbial residuals, which could pose hazards to human health.
30. Identifying Metabolic Signatures of Bisphenol Analog Exposure: Implication for Rapid Toxicity Screening of New Alternatives.
期刊: Environmental science & technology 发表日期: 2025-Aug-20 链接: PubMed
摘要
The lack of toxicity assessments for bisphenol A substitutes (BPs) has resulted in a vicious circle of pollution, replacement, and repollution. Herein, we aimed to develop specific biomarkers for rapid toxic screening and evaluation. We investigated the effects of BPs exposure on 16 health indicators of liver function, kidney function, and metabolic indices. Using nontargeted and targeted metabolomics, we systematically profiled plasma metabolite alterations to elucidate potential metabolic disruptions, toxic mechanisms, and metabolic signatures. Molecular docking was used to examine the binding activity of BPs and their metabolic transformation products (MTPs) with hormone receptors, revealing potential links between biotransformation and metabolic disruption. We found that metabolic indices like cholesterol were vulnerable to BPs exposure. Exposure to bisphenol AF (BPAF), BPB, and BPAP significantly altered 554, 391, and 236 metabolites, respectively, with kynurenine and histidine identified as common metabolic signatures. Histidine/kynurenine ratio (AUC: 0.937, ACC: 0.820) exhibited superior predictive ability for distinguishing BPs exposure compared to either histidine or kynurenine alone, serving as promising biomarkers for rapid toxic evaluation of emerging BPs. Interestingly, increased formation of MTPs with weaker hormone receptor binding reduced metabolic interference, suggesting that the metabolic disruption of BPs depends on their metabolic detoxification capacity.
31. Exploring functioning and health-related quality of life in patients referred to a diagnostic cancer pathway for non-specific serious symptoms.
期刊: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 发表日期: 2025-Aug-20 链接: PubMed
摘要
To assess functioning and health-related quality of life (HRQoL) in patients referred to a cancer diagnostic pathway for non-specific serious symptoms, and to explore whether changes over 3 months differ among patients diagnosed with cancer, another serious diagnosis, or no serious diagnosis. A prospective cohort study was conducted at a hospital-based cancer diagnostic clinic. Functioning and HRQoL were assessed at baseline and after 3 months using the 36-item WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and the EuroQol 5-Domain 5-Level (EQ-5D-5L), respectively. A total of 347 patients were included, with 242 completing follow-up. At baseline, patients with another serious diagnosis reported the highest functioning difficulties (median WHODAS: 25) and lowest HRQoL (median EQ-5D-5L: 0.705). Functioning scores improved modestly across all groups at 3 months, with no statistically significant differences between them. However, HRQoL improved significantly only in patients with another serious diagnosis, compared to those with cancer or no serious diagnosis (p = 0.04). Patients referred to a cancer diagnostic pathway for non-specific serious symptoms experience considerable functioning difficulties and reduced HRQoL at referral. While functioning improved modestly across all groups, only patients with another serious diagnosis showed a significant improvement in HRQoL. These findings highlight the need for early assessment and support for all patients in this pathway, irrespective of the final diagnosis, to ensure equitable care and timely rehabilitation when needed.
32. Performance and interventional cutoffs of osteoporosis self-assessment tools in the community: implications for screening and early referral.
期刊: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA 发表日期: 2025-Aug-20 链接: PubMed
摘要
Patients with lower bone mineral density (BMD) face an increased risk of fragile fractures and should be actively screened to mitigate this vulnerability. Given the limitations of dual-energy X-ray absorptiometry (DXA), it is possible to identify high-risk osteoporosis groups through simple self-assessment tools for further BMD measurements. This study aims to evaluate the sex- and age-specific sensitivity and specificity of these simple tools for predicting osteoporosis risk to enhance the overall management of osteoporosis risk in the community. This study enrolled subjects surveyed from epidemiological cohorts in Taiwan. Osteoporosis risk was assessed via the OSTA (for Asian women), and the OSTAi and MOSTAi (for Taiwanese women and men). Osteoporosis was defined as the lowest T-score ≤ - 2.5 based on the BMD of the lumbar spine and hip, as measured via DXA. The OSTAi and MOSTAi algorithms were used to analyze the self-assessment performance via receiver operating characteristic (ROC) and area under the curve (AUC) analyses. A total of 1976 participants were enrolled in the study; 52.8% were women, with a mean age of 65.4 years. The sensitivity and specificity for detecting osteoporosis were as follows: MOSTAi (sensitivity/specificity = 0.53/0.72), OSTA (0.71/0.77), and OSTAi (0.77/0.73). The eOSTAi demonstrated favorable sensitivity in women, with AUCs of 0.8200 for osteoporosis and 0.7643 for osteopenia. In men, eMOSTAi showed fair sensitivity (AUC = 0.6690 for osteoporosis and 0.5626 for osteopenia). The cutoffs of the eOSTAi and eMOSTAi for detecting osteoporosis decreased with age. The cutoff of OSTAi is suitable for self-assessment of osteoporosis in Taiwanese women. However, for men, the cutoff of MOSTAi may need to be adjusted. Considering the differences in the prevalence of osteoporosis in the community, it is recommended that the cutoff be set according to gender and age.
33. Fomite workshop recommendations addressing the role of surfaces in virus transmission in the built environment.
期刊: mSphere 发表日期: 2025-Aug-20 链接: PubMed
摘要
The emergence of SARS-CoV-2 has led to a need to assess the role of fomites in viral transmission within the built environment. Assessing the role of fomites is necessary for developing intervention strategies for controlling emerging pathogens. A fomite workshop with experts was convened in November 2024 by academia, several government agencies, and public health officials to evaluate existing data and discuss how to mitigate risks. Fomite transmission is influenced by the nature of the built environment, population density and proximity, environmental factors (humidity, heat, etc.), virus survival, surface type, engineering controls (ventilation, physical barriers, etc.), and human behaviors. Based on our current data, direct contact with a contaminated surface/fomite, even for respiratory viruses, presents a risk of viral exposure and transmission by both contact with the fomite and resuspension in the air. Even respiratory viruses can be resuspended from fomites following human and pet movement, activities (e.g., vacuuming, toilet flushing, etc.), or changes in ventilation/indoor airflow. After resuspension from surfaces, microbes can be potentially inhaled (contributing to droplet and/or aerosol exposure) and/or re-deposited from primary to secondary fomites. Development of standard methods (molecular, chemical/physical, and infectivity assays) for detecting the presence of viruses on fomites and human behavior modeling would help to determine the most effective infection prevention strategies.
34. Relaxation of social time pressure reveals tight coupling between daily sleep and eating behavior and extends the interval between last and first meal.
期刊: Sleep 发表日期: 2025-Aug-20 链接: PubMed
摘要
As a day-active species, humans abstain from some or all foods and beverages and rest at night. The modern social clock diverged from the natural light-dark clock with far-stretching consequences for both fasting/eating and sleep/wake daily cycles. During the COVID-19 pandemic, prolonged social restrictions (SR) offered a quasi-experimental protocol to directly test the impact of the relaxed social clock on eating and sleep behaviors and the coupling between them. Using data from a global survey of 5,747 adults (mean age 37.2±13.7, 67.1% females, 100% worked/studied), we show that relaxation of the social time pressure during social restrictions led, on average, to a 42 min increase in the habitual fasting duration (FD, interval between the last and the first meal) (from 12:16±2:09 to 12:57±2:04) and a 34 min delay in the fasting window. FD was extended by lengthening both the pre-sleep fasting and sleep durations. Pre-SR breakfast eaters delayed sleep and fasting, while breakfast skippers delayed sleep and advanced meals. Stopping alarm use on workdays was associated with a larger increase in FD. The correlations between chronotype, FD, and the mid-fasting time became more robust during SR. We conclude that relaxed social time pressure extends habitual fasting duration and promotes co-alignment of daily fasting and sleeping. Given the finding that the sleep-fasting phase relationship during social restrictions remained stable, we suggest that a ‘daily sleep-fasting structure’ may be a novel circadian marker quantifying the coupling between daily rhythms. These results may inform strategies of public circadian health management.
35. Baseline characteristics of atopic eczema patients enrolled in seven European registries united in the TREatment of ATopic eczema (TREAT) registry taskforce.
期刊: Journal of the European Academy of Dermatology and Venereology : JEADV 发表日期: 2025-Aug-20 链接: PubMed
摘要
The TREAT Registry Taskforce is a collaborative effort of international registries aiming to provide real-world data on the long-term efficacy, cost-effectiveness and safety of systemic treatments and phototherapy for atopic eczema (AE). This study seeks to present a comprehensive overview of the demographics, prior systemic treatments, clinical characteristics and disease severity and burden at baseline among patients enrolled in seven TREAT registries. Moreover, the aim is to gain insight into the differences between the registries and to explore the current prescribing practices of various therapies for patients with AE across Europe. Data from June 2016 to 31 October 2022, were collected from seven observational cohorts: A-STAR (UK/Ireland), AtopyReg (Italy), Biobadatop (Spain), SCRATCH (Denmark), SwedAD (Sweden), TREATgermany (Germany) and TREAT NL/BE (Netherlands/Belgium). The analysis included 5337 patients, with a mean age of 39.1 years (6.3% paediatric, 54.4% male). Of these, 84.1% had previously received systemic treatments, primarily systemic corticosteroids (58.8%) and ciclosporin (39.0%), while 30.1% had undergone phototherapy. At enrolment, dupilumab was the most prescribed treatment (75.0%), followed by ciclosporin (7.8%) and Janus Kinase inhibitors (5.9%); only 1.7% started phototherapy. Baseline assessments showed that most patients had moderate (41.9%) to severe (30.1%) AE, with an average Eczema Area and Severity Index (EASI) score of 17.6. The Patient-Oriented Eczema Measure (POEM) score averaged 17.2, indicating severe disease impact. The Dermatology Life Quality Index (DLQI) score averaged 13.4, and the Numerical Rating Scale (NRS) for itch was 6.4. This pooled analysis from the TREAT Registry Taskforce highlights the variability and similarities in data collection across national registries, providing significant insights into the baseline characteristics of the patient population. It establishes a robust foundation for future analyses of key effectiveness and safety outcomes.
36. Lucid Dreaming: Not Just Awareness, but Agency.
期刊: Journal of sleep research 发表日期: 2025-Aug-20 链接: PubMed
摘要
During lucid dreaming (LD), dreamers are aware that they are dreaming and may be able to influence the oneiric content. There has been recent debate about the relative importance of the ability to influence the dream and having agency over the pure awareness of dreaming. To underline this, we examined the associations of lucid dreams without agency (LD-Ag) and lucid dreams with agency (LD + Ag) to sleep and mental health problems and long COVID during the pandemic. We collected data in 16 countries on four continents from May to December 2021 on 10,715 subjects. Logistic regression was performed to predict LD-Ag and LD + Ag, with a sample of 8133 participants. We found that 30% of the participants frequently knew they were dreaming during the pandemic. About half of those (17%) reported that they could influence their dreams. Female gender and anxiety symptoms were negatively associated with LD + Ag. Dream recall, nightmares, insomnia, dream enactment behaviour (DEB), sleep vocalisation, short and long COVID and PTSD were positively associated with LD + Ag. Old age, dream recall, nightmares and anxiety symptoms were positively associated with LD-Ag, while short sleep length, being an evening type, and short COVID were negatively associated with LD-Ag. The different associations for LD-Ag and LD + Ag suggest that they may be distinct sleep states. This is also the first study to show that both COVID-19 and long COVID are associated with LD.
37. Long-term trends in interstitial lung diseases incidence in Spain.
期刊: Medicina clinica 发表日期: 2025-Aug-19 链接: PubMed
摘要
This study analysed long-term trends in interstitial lung diseases (ILDs) incidence in Spain from 1992 to 2021, focusing on age, sex and temporal patterns. We conducted an ecological trend study using data from the Global Burden of Disease (GBD) Study 2021. Age-standardized incidence rates (ASIRs) were calculated, and joinpoint regression was applied to evaluate temporal trends. An age-period-cohort (A-P-C) analysis was performed to assess the influence of age, calendar periods, and birth cohorts on incidence patterns. From 1992 to 2021, 141,141 incident cases of ILDs were estimated in Spain, with a slight male predominance (53.2%). ASIRs increased over the study period, with an average annual percentage change (AAPC) of 1.3% for men and 1.7% for women. Incidence rates rose with age, peaking in the 70-79 age group for both sexes. A-P-C analysis identified cohort effects, with later-born cohorts showing higher risks of ILDs. Period effects indicated a steady increase in incidence. Men consistently exhibited higher incidence rates than women, although the gap narrowed slightly over time. The increasing incidence of ILDs in Spain underscores a growing public health challenge. Early diagnosis, targeted interventions, and ongoing research are vital to mitigate this rising burden.
38. The effect of the 'Stable Sugar Winner' board game on dietary knowledge, attitudes, and behavioral self-efficacy in preventing diabetes among community-dwelling older adults.
期刊: Geriatric nursing (New York, N.Y.) 发表日期: 2025-Aug-19 链接: PubMed
摘要
The purpose of this study was to develop and evaluate the effectiveness of the ‘Stable Sugar Winner’ board game program in enhancing dietary knowledge, dietary attitudes, and dietary behavioral self-efficacy for diabetes prevention among older adults. This quasi-experimental study involved 49 community-dwelling older adults from two community activity centers. Participants engaged in the ‘Stable Sugar Winner’ board game program once a week for 90 min, over a 4-week period. The weekly themes were as follows: Week 1 - Types of food and My Healthy Plate; Week 2 - Glycemic index and My Healthy Plate; Week 3 - Dietary calories and My Healthy Plate; Week 4 - My healthy diet pattern. After completing intervention, the older adults had significantly higher mean scores for dietary knowledge, attitudes, and behavioral self-efficacy in preventing diabetes compared to before the intervention. This study can serve as a reference for older adult health promotion.
39. Evidence-based summary of the prevention and management of constipation in patients with Parkinson's disease.
期刊: Geriatric nursing (New York, N.Y.) 发表日期: 2025-Aug-19 链接: PubMed
摘要
To summarize the best evidence for preventing and managing constipation in Parkinson’s disease (PD) and provide practical guidance for healthcare professionals. Guided by the “6S” model, a comprehensive, top-down search of relevant literature was conducted. The search included ten clinical guideline repositories, six professional association websites, and seven academic literature databases. Evidence summaries, clinical practice guidelines, expert consensus statements, best practice recommendations, and systematic reviews were identified. All literature published up to December 20, 2024, was considered. A total of 15 high-quality studies were included, comprising 2 clinical decisions, 4 guidelines, 4 systematic reviews, 4 expert consensus documents, and 1 best practice document. Based on professional judgment, the evidence was synthesized into nine dimensions: screening and assessment, dietary management, exercise rehabilitation, physical therapy, pharmacotherapy, Traditional Chinese Medicine interventions, health education, important clinical considerations, and multidisciplinary management. In total, 39 best evidence statements were generated. This study provides a robust foundation for clinicians to apply personalized, evidence-based strategies to alleviate constipation, enhance quality of life, and improve PD management.
40. Association of injury-related mortality with unique domains of social determinants of health across the urban-rural continuum.
期刊: Surgery 发表日期: 2025-Aug-18 链接: PubMed
摘要
Social determinants of health impact outcomes after traumatic injury. Little is known regarding if and how this impact of social determinants of health in trauma varies across different geographic settings. Our objective was to evaluate whether social determinants of health associated with injury-related mortality vary based on geographic region. We conducted a retrospective cohort study using the Pennsylvania Trauma Study Outcomes database merged with data from the Association for Healthcare, Research, and Quality social determinants of health database. Bootstrapped elastic net regression determined the association between risk-adjusted mortality and social determinants of health factors in urban, suburban, and rural areas. A total of 374,136 patients were included in the study (285,062 urban, 71,847 suburban, and 17,227 rural). Economic context and physical infrastructure were the most important domains for urban populations, whereas social context was the most important domain for suburban and rural populations. In urban populations, the increasing proportion of White race was most strongly associated with lower morality risk (coefficient: -0.045; 95% confidence interval: -0.044, -0.046), whereas income/poverty, transportation, and health insurance were the most common features associated with mortality. In suburban and rural communities, US born citizens were most strongly associated with lower mortality risk (coefficient: -0.024; 95% confidence interval: -0.023, -0.025), while demographics and housing were most commonly associated with mortality. The social determinants of health associated with mortality after injury vary across geographic settings. This may inform risk stratification and more effectively target policy and community interventions by geography to reduce the burden of injury.
41. Regulating Private Equity in Health Care - The Massachusetts Model.
期刊: The New England journal of medicine 发表日期: 2025-Aug-16 链接: PubMed
摘要
42. Reforming the Prescription Drug User Fee Program.
期刊: The New England journal of medicine 发表日期: 2025-Aug-16 链接: PubMed
摘要
43. Implementation evaluation of a school- and primary care-based multicomponent intervention to improve HPV vaccine coverage: Results from the PrevHPV randomized controlled trial.
期刊: Journal of infection and public health 发表日期: 2025-Aug-15 链接: PubMed
摘要
Human papillomavirus (HPV) vaccine coverage (VC) remains lower than expected in France. The PrevHPV national research program aimed to codevelop and evaluate an intervention including three components: ‘education and motivation’ of adolescents in schools, ‘at-school vaccination’, ‘general practitioners (GPs)’ training’. This study aimed to evaluate the implementation outcomes of each component, whether they affected effectiveness, and identify factors influencing implementation in schools. A mixed-method study embedded in a cluster randomized controlled trial in 91 French municipalities (July 2021-June 2022). Quantitative data were collected through activity reports and questionnaires, and qualitative data through focus groups with school staff. The implementation outcomes were fidelity, dose, reach, acceptability and sustainability, as defined in the Medical Research Council guidance for process evaluation of complex interventions and Proctor et al.’s Implementation Outcomes Framework; the effectiveness outcome was HPV VC (≥ 1 dose) two months after the end of the intervention. Qualitative data were analyzed using the Consolidated Framework for Implementation Research. The fidelity, acceptability, and sustainability of all three components among participants who completed the intervention were high. However, the withdrawal of one-third of schools before the trial started and difficulties in mobilizing GPs negatively impacted the dose and reach outcomes. Estimates for the on-treatment analyses of the effectiveness were greater than those for which the dose of intervention received was not considered; ‘at-school vaccination’ (11.25 percentage points, p < 0.001) and ‘GPs’ training’ (3.56 percentage points, p = 0.049) increased VC, while ‘education and motivation’ remained nonsignificant. Increasing HPV VC among adolescents could be achieved by combining interventions in both schools and primary care settings. This study provides practical implications for implementing such interventions in real life. Clinicaltrials.gov, NCT04945655. Registered 30 June 2021, https://clinicaltrials.gov/study/NCT04945655.
44. Discovery of 8-hydroxy-tetrahydroquinoline ferroptosis inhibitors for the treatment of acute kidney injury.
期刊: Bioorganic chemistry 发表日期: 2025-Aug-12 链接: PubMed
摘要
Acute kidney injury (AKI) is a severe public health challenge, characterized by high incidence and mortality rates, alongside a lack of effective therapeutic interventions. Emerging evidence highlights kidney tubular ferroptosis as a key driver of AKI pathogenesis. While α-tocopherol, a natural lipid antioxidant, exhibits potent anti-ferroptotic activity, its therapeutic potential remains limited by a lack of structural optimization. Here, we present the discovery of 8-hydroxy-tetrahydroquinoline (compound 6), a rationally designed derivative inspired by α-tocopherol’s simplified core structure (6-chromanol), which effectively protects against renal ischemia/reperfusion (I/R) injury by suppressing ferroptosis. Quantum chemistry and reaction kinetics analyses reveal that enhancing p-π conjugation and introducing hydrogen bond donors significantly improve radical trapping activity (RTA), thereby strengthening ferroptosis inhibition. Compound 6 displayed broad-spectrum anti-ferroptotic efficacy across multiple inducers in renal tubular epithelial cells, with nanomolar potency and robust suppression of lipid ROS. Mechanistically, compound 6 neither chelated iron nor altered GPX4 expression, indicating its protection arises via direct peroxyl radical scavenging. In vivo, compound 6 significantly ameliorated renal I/R injury in mice, reducing histological damage, functional impairment, and inflammatory cytokine expression, while decreasing lipid peroxidation biomarkers such as 4-hydroxynonenal. Collectively, this work identifies compound 6 as a promising ferroptosis-targeted therapeutic scaffold for AKI and provides a framework for rational antioxidant design based on natural phenolic structures.
45. Safeguarding Vulnerability: COVID-19's Impact on Immunocompromised Patients With Cancer.
期刊: Oncology (Williston Park, N.Y.) 发表日期: 2025-Aug-08 链接: PubMed
摘要
The COVID-19 pandemic has exposed significant vulnerabilities among patients who are immunocompromised, who remain at increased risk for severe disease despite widespread vaccination in the general population. This commentary reviews insights from Dorry L. Segev’s, MD, PhD, keynote lecture at MedNews Week, highlighting reduced vaccine efficacy, prolonged viral shedding, and increased severity of COVID-19 in this population. Emerging strategies such as monoclonal antibody prophylaxis, oral antivirals, personalized vaccine approaches, and T cell-based therapies show promise in mitigating these risks. Additionally, the commentary discusses the implications of hybrid immunity and the potential for within-host viral evolution to generate resistant variants, underscoring the need for targeted genomic surveillance. Ethical considerations are raised regarding the use of advanced oncologic treatments with marginal survival benefits but substantial toxicity in the context of COVID-19 vulnerability. To effectively protect immunocompromised patients, tailored public health measures, dedicated vaccination programs, and integrative lifestyle interventions are required. Synergistic efforts among clinicians, researchers, and policy makers are essential to ensure equitable access to preventive and therapeutic strategies, strengthening health care resilience for vulnerable populations during the ongoing pandemic and beyond.
46. Determinants of sleep quality in burn patients: The role of pain, psychological factors, and environmental factors.
期刊: Burns : journal of the International Society for Burn Injuries 发表日期: 2025-Aug-05 链接: PubMed
摘要
Sleep disturbances are a common and significant challenge for burn patients, often exacerbated by various factors, including pain, anxiety, and environmental conditions. Poor sleep quality can negatively affect recovery and overall well-being. This study aimed to examine the relationship between sleep quality and factors such as pain, itching, anxiety, and environmental stressors among burn patients. This correlational study was conducted from May to September 2022 and included 157 patients admitted to the burn wards of Sina Hospital, selected using a convenience sampling method. Data were collected using the Visual Analog Scale (VAS) for pain and itching intensity, the Burn-Specific Pain Anxiety Scale (BSPAS), the Revised Impact of Event Scale (RIES), the Depression Anxiety Stress Scale (DASS-21), and the Pittsburgh Sleep Quality Index (PSQI), along with questions assessing environmental factors affecting sleep. Multiple regression was used to identify significant predictors of sleep quality. The average sleep quality score was 8.66 (SD = 3.823), indicating poor sleep quality among the burn patients. Pain intensity (p < 0.01, r = 0.45), itching intensity (p < 0.01, r = 0.38), environmental factors (p < 0.01, r = 0.33), burn-specific pain anxiety (p < 0.01, r = 0.42), impact of the traumatic event (p < 0.01, r = 0.40), anxiety (p < 0.01, r = 0.37), and depression (p < 0.01, r = 0.35) all significantly correlated with poor sleep quality. Pain intensity and stress emerged as the strongest predictors of sleep disturbance, whereas itching and burn-related anxiety were not significant in the final model. Burn patients experience significantly poor sleep quality, largely influenced by pain and stress. Environmental factors such as noise and bed comfort further exacerbate sleep disturbances. Effective interventions focusing on pain management, environmental improvements, and psychological support are critical to improving sleep quality and overall recovery in burn patients. Future care practices should prioritize a multidisciplinary approach, integrating both physical and mental health strategies for optimal patient outcomes.
47. Research in Partnership With Older People-Involvement in Conducting and Analysing Focus Groups.
期刊: Health expectations : an international journal of public participation in health care and health policy 发表日期: 2025-Aug 链接: PubMed
摘要
Data collection and analysis in collaboration with co-researchers has rarely been described, and its impact on the research process and outcomes remains unknown. Thus, this study involved older co-researchers in the moderation and analysis of focus groups and describes process and outcomes. The SeFallED project included collaboration with co-researchers in the moderation and analysis of focus group interviews. Three focus groups were co-moderated by an academic researcher and three by a co-researcher. The co-analysis was conducted in collaboration with two co-researchers for three transcripts. Research diaries were maintained throughout the process for reflection. These were supplemented by feedback from the focus group participants. Moderation and analysis were described with regard to the questions and derived categories. Reflections on the process highlight both facilitators and challenges in involving co-researchers. A positive atmosphere and training for co-researchers can be beneficial, whereas the significant time requirements can be challenging. With regard to outcomes, our analysis showed that collaboration led to a greater focus on focus group participants’ feelings and facilitated a more profound comprehension of their statements. The present study provides recommendations for the process of co-researcher involvement in conducting and analysing focus groups. Involving co-researchers requires a positive atmosphere, training and adequate time. Furthermore, our findings help to sensitise researchers to the potential impacts on research outcomes. Three co-researchers collaborated in the moderation and analysis of the focus groups. All three co-researchers reviewed this paper. The SeFallED project was registered at the German Clinical Trial Register (DRKS00025949, Registration Date: 4 November 2021).
48. Safe and Responsible Use of Artificial Intelligence in Health Care: Current Regulatory Landscape and Considerations for Regulatory Policy.
期刊: JCO clinical cancer informatics 发表日期: 2025-Aug 链接: PubMed
摘要
The integration of artificial intelligence (AI) into health care promises transformative advancements in diagnostics, treatment, and operational efficiency. However, this transformation introduces significant clinical, technical, and socioethical risks. This article examines these emerging risks and analyzes a fragmented landscape of federal, state, and international regulations attempting to govern the development and deployment of AI in health care. It highlights the need for a multifaceted approach, combining robust regulatory frameworks with ethical considerations, and ongoing vigilance from AI developers, health care providers, and policymakers.
49. Provision of Quality Contraceptive Services: Updates From National Guidelines.
期刊: American family physician 发表日期: 2025-Aug 链接: PubMed
摘要
In 2024, the Centers for Disease Control and Prevention and the US Department of Health and Human Services Office of Population Affairs updated national guidelines on provision of quality contraceptive services and sexual and reproductive health care. New recommendations systematically promote care that is person-centered and accessible for all people. Contraceptive services may be addressed through a stepwise approach in which the clinician asks about an individual’s contraceptive preferences based on their needs, desires, and prior experiences and then collaboratively works with the patient to align methods with their values and preferences. The clinician should discuss all methods that can be used safely based on medical eligibility criteria regardless of method availability and defer the decision to the patient. Physical assessment includes in-office or self-reported blood pressure measurement before starting an estrogen-containing contraceptive or pelvic examination when inserting an intrauterine device. If it is reasonably certain that the patient is not pregnant, any contraceptive may be started immediately; otherwise, a nonintrauterine bridge method may be initiated with follow-up pregnancy testing. To reduce barriers, a 1-year supply of short-acting or injectable contraceptives may be prescribed, and telehealth may be incorporated. The Centers for Disease Control and Prevention supports advance provision of emergency contraceptives. New recommendations include pain control during intrauterine device insertion, management of bleeding irregularities related to contraception, updated eligibility criteria (eg, venous thromboembolism, kidney disease), and new methods (eg, progestin-only formulations). Expanded sexual and reproductive health care services, such as screening for cervical cancer or sexually transmitted infections, should be offered, but patient acceptance of these services is not required during contraception management.
50. Outpatient Care of the Premature Infant.
期刊: American family physician 发表日期: 2025-Aug 链接: PubMed
摘要
Family physicians oversee the complex care of premature infants after discharge from the neonatal intensive care unit, taking into consideration the degree of prematurity and unique complications that can occur. Early family engagement is critical for these infants. Before hospital discharge, at least two caregivers should demonstrate the ability to appropriately feed and provide necessary care for the infant. Premature infants are at risk of hypoxic-ischemic encephalopathy, periventricular leukomalacia, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage. Routine vaccination is recommended. This includes newer prevention options for respiratory syncytial virus (eg, nirsevimab [Beyfortus]) and the prenatal vaccine Abrysvo. Growth of premature infants is monitored using corrected age and may improve with use of breast milk fortifiers or enriched formulas. Premature infants are also at risk for neurodevelopmental disabilities, including cerebral palsy, intellectual disability, and vision and hearing impairment. Developmental screening using corrected age is recommended at ages 9, 18, and 30 months, with screening for autism spectrum disorder at 18 and 24 months.
51. Drought, Extreme Heat, and Intimate Partner Violence in Low- and Middle-Income Countries.
期刊: JAMA network open 发表日期: 2025-Aug-01 链接: PubMed
摘要
Recent evidence has shown that elevated temperatures are associated with a higher risk of intimate partner violence (IPV), a serious violation of human rights. However, it remains unclear whether drought also heightens the risk and whether drought and extreme heat jointly affect IPV. To investigate the interactive association between drought, extreme heat, and IPV in 42 low- and middle-income countries (LMICs). This cross-sectional study included women answering multicluster surveys in sub-Saharan Africa, South and Southeast Asia, Latin America, and the Caribbean between 2003 and 2020. The analysis was conducted from January to July 2024. Drought was measured by the standardized precipitation evapotranspiration index at a timescale of 1, 3, 6, or 12 months. Extreme heat days were defined as days with maximum temperature above the 90th, 92.5th, 95th, or 97.5th percentile of the cluster-specific distribution. The respective numbers of extreme heat days and drought months were calculated to evaluate the interaction between drought and extreme heat. IPV against women experienced in the past 12 months before the survey, including emotional, physical, and sexual violence. Among a total of 494 471 women (mean [SD] age, 32.1 [8.5] years) surveyed, the prevalence for any, emotional, physical, and sexual IPV was 28.3% (139 901 women), 16.8% (83 100 women), 19.5% (96 531 women), and 7.4% (36 804 women), respectively. Overall drought exposures at all timescales were associated with increased IPV risk, with the largest effect size at the 12-month scale (relative risk [RR], 1.07 [95% CI, 1.06-1.09]), where mild (RR, 1.08 [95% CI, 1.06-1.09]) and severe (RR, 1.06 [95% CI, 1.04-1.08]) drought were also associated with any IPV. When stratifying violence IPV by type, the largest effect sizes were observed for overall drought with emotional violence at the 1-month scale and with physical violence at the 12-month scale. When estimating relative excess risk due to interaction in 2 ways, there was a negative and significant interaction between drought and extreme heat, defined using the threshold of the 97.5th percentile of the distribution. In this cross-sectional study of 42 LMICs, drought conditions with various durations were associated with increased IPV risk. Given the increasing extreme events under climate change, there is a pressing need for enhanced initiatives to prevent domestic violence.
52. Changes in chronic disease prevention resources and activities in Canada during the COVID-19 pandemic.
期刊: Health promotion and chronic disease prevention in Canada : research, policy and practice 发表日期: 2025-Aug 链接: PubMed
摘要
The COVID-19 pandemic disrupted public health efforts for chronic disease prevention (CDP) in Canada and elsewhere. We describe COVID-19-related disruptions in CDP resources and activities among Canadian public health organizations. We surveyed all organizations in Canada with mandates for primary CDP, including “resource organizations” that develop or transfer CDP initiatives and “user organizations” that deliver these CDP initiatives to target populations. Key informants most knowledgeable about CDP activities and resources within each organization reported pandemic-related changes in CDP resources and activities. User organizations also reported on the status of 18 specific CDP activities and rated whether pandemic containment measures were barriers to or facilitators of CDP activities. Of the 298 participating organizations (88% response), 129 were resource organizations (37% formally mandated organizations [FMOs]; 63% non-governmental organizations [NGOs]) and 169 were user organizations (48% FMOs; 52% NGOs). Overall, 36% reported decreases in CDP funding (24% major, 12% minor), 30%-41% reported decreases in full-time, volunteer and managerial staff (19%-27% major, 11%-14% minor) and 32% reported decreases in CDP activities (23% major, 9% minor). User FMOs were most affected by decreases. Among user organizations, 16%-39% decreased, suspended or discontinued specific CDP activities. Still, 8%-39% increased their activities, particularly those targeting mental health, marginalized populations, racialized communities and specific gender groups. Half (53%) of user organizations perceived COVID-19 contagion restrictions as barriers to CDP activities. Continued monitoring of CDP resources and activities can inform emergency preparedness and ensure that CDP remains a priority during public health crises. La pandémie de COVID-19 a perturbé les efforts de santé publique en matière de prévention des maladies chroniques au Canada et ailleurs. Nous décrivons les perturbations liées à la pandémie de COVID-19 dans les ressources et les activités de prévention des maladies chroniques au sein des organisations de santé publique canadiennes. Nous avons interrogé toutes les organisations canadiennes ayant un mandat de prévention primaire des maladies chroniques, que ce soient les « organisations ressources », celles qui développent ou transfèrent des initiatives de prévention des maladies chroniques, ou les « organisations utilisatrices », celles qui mettent en oeuvre ces initiatives auprès des populations cibles. Les informateurs clés les mieux informés sur les activités et les ressources de prévention des maladies chroniques au sein de chaque organisation ont fait état de changements liés à la pandémie dans les ressources ainsi que dans les activités de prévention des maladies chroniques. Les organisations utilisatrices ont également rendu compte de l’état d’avancement de 18 activités spécifiques de prévention des maladies chroniques et ont évalué si les mesures d’endiguement de la pandémie constituaient des obstacles ou des éléments facilitateurs pour ces activités. Sur les 298 organisations participantes (88 % de réponses), 129 étaient des organisations ressources (37 % d’organisations formellement mandatées, 63 % d’organisations non gouvernementales [ONG]) et 169 étaient des organisations utilisatrices (48 % d’organisations formellement mandatées, 52 % d’ONG). Dans l’ensemble, 36 % ont signalé une diminution du financement de la prévention des maladies chroniques (24 % majeure, 12 % mineure), entre 30 % et 41 % ont signalé une diminution du personnel à temps plein, des bénévoles et des gestionnaires (19 % à 27 % majeure, 11 % à 14 % mineure) et 32 % ont signalé une diminution des activités de prévention des maladies chroniques (23 % majeure, 9 % mineure). Les organisations formellement mandatées utilisatrices ont été les plus touchées par les réductions. Parmi les organisations utilisatrices, 16 % à 39 % ont réduit, suspendu ou interrompu des activités spécifiques de prévention des maladies chroniques. Dans le même temps, 8 % à 39 % ont augmenté leurs activités, en particulier celles ciblant la santé mentale, les populations marginalisées, les communautés racisées et des groupes spécifiques en matière de genre. La moitié (53 %) des organisations utilisatrices ont perçu les restrictions de contagion de la COVID-19 comme un obstacle aux activités de prévention des maladies chroniques. La surveillance continue des ressources et des activités de prévention des maladies chroniques peut contribuer à la préparation aux situations d’urgence et garantir que la prévention des maladies chroniques reste une priorité lors des crises de santé publique. At least one-third (30%–41%) of public health organizations reported decreases in chronic disease prevention (CDP) funding, personnel and activities during the COVID-19 pandemic. Formally mandated public health user organizations had particularly high decreases in CDP resources and activities. There were marked decreases in tobacco control, healthy eating and healthy weight activities. Activities targeting mental health, marginalized populations, racialized communities and specific gender groups increased. More than half of user organizations viewed COVID-19 public health measures as barriers to CDP activities. Au moins un tiers (30 % à 41 %) des organisations de santé publique ont signalé une diminution du financement, du personnel et des activités de prévention des maladies chroniques durant la pandémie de COVID-19. Les organisations de santé publique utilisatrices formellement mandatées ont connu des diminutions particulièrement importantes des ressources et des activités de prévention des maladies chroniques. Les activités de lutte contre le tabagisme, de promotion d’une alimentation saine et d’un poids santé ont fortement diminué. Les activités ciblant la santé mentale, les populations marginalisées, les communautés racisées et des groupes spécifiques en matière de genre ont augmenté. Plus de la moitié des organisations utilisatrices ont considéré les mesures de santé publique liées à la COVID-19 comme des obstacles aux activités de prévention des maladies chroniques.
53. Adherence to antiretroviral treatment in adults with HIV: knowledge translation in website creation.
期刊: Revista latino-americana de enfermagem 发表日期: 2025 链接: PubMed
摘要
to create a website to promote adherence to antiretroviral treatment for adults living with the human immunodeficiency virus. methodological research in which the content was developed based on the synthesis of scientific evidence and validated by experts on the subject. The image content was created and linked to the text content for the development of the website. The analysis was performed based on the Content Validity Index by 20 experts recruited using the snowball technique. the content was structured into three axes: self-efficacy, social support and quality of life. Each axis presents a concept, a total of 11 Life Situations with proposals for promoting adherence and 14 images. The overall Content Validity Index obtained a score >0.78. The website is freely accessible. the educational-care technology typified as an informative website was validated by experts on the subject for use by the target population of adults living with the human immunodeficiency virus as a tool for promoting adherence to antiretroviral treatment. (1) Care-educational technology for adherence to antiretroviral treatment for HIV. (2) Website with text and image content for adults living with HIV. (3) Health promotion using a non-pharmacological method and based on digital intervention. (4) Knowledge translation with health professionals and public policy managers.
54. COVID-19 preventive behavior and associated factors in nursing students.
期刊: Revista gaucha de enfermagem 发表日期: 2025 链接: PubMed
摘要
To evaluate COVID-19 preventive behavior and associated factors in nursing students. Cross-sectional study carried out between March and October 2023, involving 126 nursing graduates. An instrument was applied to assess the knowledge, behaviors, symptoms, and vaccination status in regard to COVID-19. COVID-19 tests were carried out to detect IgG/IgM antibodies, as well as RT-PCR. Descriptive and multivariate analyses were performed. 54.8% of participants reported they followed the recommendations for preventing and controlling the spread of COVID-19 and 10.3% said they used masks in crowded situations in open spaces, while 41.3% said they did so in closed places. All participants obtained reactive results for antibodies against COVID-19 and reported being vaccinated, with no cases of active infection. Factors associated with adequate preventive behaviors include self-declared black skin color and the use of masks when in crowds. This study found self-care indicators that may contribute to the development of public policies for disease prevention and health promotion in the university environment.
55. Why Global Health Security Should be Managed as a Value-Based Enterprise.
期刊: Health security 发表日期: 2025 链接: PubMed
摘要
Efforts to improve global health security should be a key international priority. In this commentary, I argue that while global health security is increasingly perceived as the domain of various professional and academic disciplines, ranging from global health to international relations, it is crucial to recognize it also as a value-based enterprise. Drawing on ethics literature, this commentary shows how a value-based approach is useful for analyzing ethical challenges in global health security in 4 key areas: analyzing the implicit values shaping global health security’s problematic meaning, considering whether solidarity might be useful for grounding compensation for those facing an increased surveillance burden, examining how labelling outbreaks by origin can disguise questions of responsibility, and addressing how reasonable demands of nationalism are balanced. If global health security is not acknowledged as a value-based enterprise, there is a risk that those working in it will not develop the skills required to ask necessary moral questions or provide moral justifications that should be provided about their work, ultimately compromising global health security’s potential to protect populations globally.
56. Corynoline alleviates renal ischemia-reperfusion injury by enhancing Nrf2/HO-1 pathway.
期刊: Acta cirurgica brasileira 发表日期: 2025 链接: PubMed
摘要
The potential of corynoline in ameliorating oxidative stress and inflammatory responses has been extensively demonstrated across various diseases. However, its specific role in the context of renal ischemia-reperfusion (IR) injury remains elusive. The aim of this study was to investigate the role of corynoline in renal IR injury and its mechanism. A rat model of renal IR injury was successfully developed. Samples of kidney tissue and blood were obtained to evaluate alterations in tissue damage, inflammatory response, oxidative stress, and apoptosis. Corynoline significantly reduced renal IR injury, thus leading to improved renal function and mitigated tissue structure damage and cell apoptosis. Moreover, corynoline effectively suppressed the oxidative stress and inflammatory response induced by IR by increasing the superoxide dismutase (SOD) content, reducing the malondialdehyde (MDA) level, inhibiting neutrophil infiltration, and suppressing the release of proinflammatory cytokines. Mechanistically, corynoline successfully restored the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1), which were significantly inhibited during renal IR injury. Furthermore, when coadministered with ML-385 (an Nrf2 inhibitor), the protective effect of corynoline against renal IR injury was counteracted. Corynoline protects against renal IR injury by suppressing oxidative stress, inflammatory responses, and apoptosis, and its mechanism of action may involve the activation of the Nrf2/HO-1 pathway.
57. Evaluating the prevalence and adequate treatment for congenital syphilis in a Brazilian reference maternity hospital.
期刊: Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo 发表日期: 2025 链接: PubMed
摘要
To delineate characteristics associated with congenital syphilis in newborns from a capital city of Brazil, as well as to report prevalence rates, diagnostic approaches, and treatment data through document analysis. A cross-sectional, retrospective, and documentary observational study was conducted at a maternity hospital based on congenital syphilis cases reported through notification forms produced between 2016-2019. Statistical analysis involved absolute and relative frequency evaluations. A total of 879 cases were included, with 2018 being the year with the most cases. Analysis revealed a high proportion of mothers with secondary education (289; 33.0%), and most selfidentifying as mixed-race (400; 45.6%). Infection diagnosis occurred at the time of or following delivery in a large percentage of the women (337; 38.4%). Among newborns, 249 cases (28.3%) exhibited symptoms, with jaundice being the most prevalent (235; 26.9%). While most newborns were discharged following treatment, four cases (0.4%) resulted in syphilis-related fatalities, including one abortion and one stillbirth. This study highlights deficiencies in the diagnosis and treatment of mothers affected by syphilis, emphasizing the importance of access to early diagnostic testing in pregnant women, as well as newborn screening. We further call attention to the critical need for expanded health education initiatives targeting congenital syphilis awareness among pregnant women and their partners.
58. Spatial and social determinants of tuberculosis in the Brazilian Amazon: a five-year multilevel and cluster-based analysis in Pará state, 2018-2022.
期刊: Brazilian journal of biology = Revista brasleira de biologia 发表日期: 2025 链接: PubMed
摘要
Tuberculosis remains a major public health concern in Brazil, particularly in the Amazon region, where its distribution is shaped by persistent social inequalities and environmental pressures. This study analyzed the spatial and sociodemographic dynamics of tuberculosis in the state of Pará, Northern Brazil, between 2018 and 2022. A total of 26,127 confirmed cases were identified through the Notifiable Diseases Information System and the National Registry of Health Establishments. We applied empirical Bayes smoothing and Kulldorff’s spatial scan statistic to detect high-risk territorial clusters and used multilevel logistic regression to assess individual and contextual predictors of unfavorable treatment outcomes. The disease primarily affected men, young adults aged 15-49 years, individuals with low educational attainment, and those self-identified as of mixed race. Spatial analysis revealed persistent high-risk clusters in the Metropolitan Region of Belém and a progressive expansion into Southeastern and South-Central municipalities. Lower education and Black or mixed-race identity were independently associated with a higher likelihood of unfavorable outcomes. The findings underscore the importance of integrating spatial epidemiology with multilevel modeling to uncover both individual and territorial determinants of tuberculosis. They highlight the need for geographically targeted interventions, the expansion of primary care services, and intersectoral public policies aimed at mitigating structural vulnerabilities in the Brazilian Amazon. Our results provide evidence to support precision public health strategies and enhance local planning in regions of high social and environmental risk.
59. Understanding artificial intelligence in critical care: opportunities, risks, and practical applications.
期刊: Critical care science 发表日期: 2025 链接: PubMed
摘要
Artificial intelligence technologies are rapidly advancing and significantly impacting healthcare, particularly in critical care environments where rapid, precise decision-making is crucial. They promise reductions in clinical errors, enhanced diagnostic accuracy, optimized treatment plans, and better resource allocation. Artificial intelligence applications are widespread across medical fields, with numerous artificial intelligence/machine learning-enabled medical devices approved by regulatory bodies, like the US Food and Drug Administration, aiding in diagnosis, monitoring, and personalized patient care. However, integrating artificial intelligence into healthcare presents challenges, notably the potential to exacerbate existing biases and disparities, especially when systems are trained on homogeneous datasets lacking diversity. Biased artificial intelligence can negatively affect patient outcomes for underrepresented groups, perpetuating health disparities. Additional concerns include data privacy and security, lack of transparency, algorithmic bias, and regulatory hurdles. Addressing these risks requires ensuring diverse and representative datasets, implementing robust auditing and monitoring practices, enhancing transparency, involving diverse perspectives in artificial intelligence development, and promoting critical thinking among healthcare professionals. Furthermore, the environmental impact of artificial intelligence, huge models reliant on energy-intensive data centers, poses challenges due to increased greenhouse gas emissions and resource consumption, disproportionately affecting low-income countries and exacerbating global inequalities. Systemic changes driven by corporate responsibility, government policy, and adopting sustainable artificial intelligence practices within healthcare are necessary. This narrative review explores the current landscape of artificial intelligence in healthcare, highlighting its potential benefits and delineating associated risks and challenges, underscoring the importance of mitigating biases and environmental impacts to ensure equitable and sustainable integration of artificial intelligence technologies in healthcare settings.
60. Impact of occupational sedentary behavior on mental health: A systematic review and meta-analysis.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Despite numerous meta-analyses on the effects of leisure time sedentary behavior, the effect of sedentary behavior at work on mental health is largely under debate. We aimed to systematically identify and synthetize the literature examining the association between sedentary behavior at work on mental health. PubMed, Embase, Cochrane, and Psycinfo databases were searched for articles reporting risks for mental health due to occupational sedentary behavior. We computed random-effects meta-analysis using all risks and both intermediate and severe levels of mental health issues, following by sensitivity analysis on severe mental health issues using 1) all risks, then only 2) fully adjusted and 3) crude or less adjusted lowest risks (pessimistic models), and 4) fully adjusted and 5) crude or less adjusted highest risks (optimistic models). We conducted meta-regression on possible influencing factors. We included 12 studies in the systematic review and 7 in the meta-analysis, for a total of 40,314 workers (35 years old, 65.5% men). Exposure to sedentary behavior at work increased the risk of intermediate and severe mental health issues by +34% (95 CI 18-49%). All sensitivity analyses on severe mental health issues were also significant, whatever the model: + 35% (12-58%) using all risks, 39% (15-63%) using fully adjusted pessimistic model, + 36% (13-59%) using crude or less adjusted pessimistic model, 85% (27-143%) using fully adjusted optimistic model, + 85% (26-143%) using crude or less adjusted optimistic model. Age may have an increased risk of mental health issue when exposed to occupational sedentary behavior, while high education reduced the risk. Our meta-analysis shows that occupational sedentary behavior increases the risk of mental health issue. Inconsistent results precluded robust conclusion for variables that may further influence this risk.