公共卫生研究摘要 (2025-09-04)
共收录 58 篇研究文章
1. Variation in Intensive Pediatric Physical Therapy Practice in the United States: Results From a National Survey.
期刊: Pediatric physical therapy : the official publication of the Section on Pediatrics of the American Physical Therapy Association 发表日期: 2025-Sep-04 链接: PubMed
摘要
Intensive pediatric physical therapy (PT) programs are increasingly common yet lack a clear definition. This study aimed to examine current practice patterns of intensive pediatric PT in the United States. A survey was developed and administered using the FITT (frequency, intensity, time, type) model and Knowledge to Action Cycle for pediatric physical therapists providing intensive PT. Survey respondents included pediatric physical therapists providing intensive physical therapy in outpatient, non-acute settings. Data analysis used descriptive statistics and cluster analysis. Eighty pediatric physical therapists reported intensive programs involved children aged 4-6 years with cerebral palsy (90%), neuromuscular (78%), and neuromotor (44%) disorders. Greatest dose often-always ranged from 2-5 visits per week, ≤60-120 minute sessions over 3-8 weeks. Top interventions included locomotor training (80%), task-specific training (78%), and progressive resistive exercise (76%). Two clusters were identified based on therapist organization and dose. This first study of intensive pediatric PT revealed marked variability, underscoring the need for a standardized definition to improve clinical care.
2. Mobile Telehealth Intervention to Support Care Partners of Patients With Alzheimer Disease and Related Dementias (I-CARE 2): Protocol for a Randomized Effectiveness Clinical Trial.
期刊: JMIR research protocols 发表日期: 2025-Sep-03 链接: PubMed
摘要
Nearly all individuals with Alzheimer disease and related dementias (ADRD) experience behavioral and psychological symptoms of dementia (BPSD), which include symptoms such as agitation, wandering, delusions, and hallucinations. Care partners (a person, often a family member, who provides care and support to someone with ADRD) struggle to manage BPSD, making symptom management a critical focus of intervention research. Our team has developed a mobile telehealth intervention (Brain CareNotes) to help care partners manage BPSD. This paper outlines a protocol for a randomized controlled trial of 160 care partners of patients with ADRD to test the effect of Brain CareNotes on care partner burden and patients’ BPSD. Participants will be recruited from partner health systems in Indiana, United States, by word of mouth, and through community outreach efforts. They will be randomly assigned to use either the Brain CareNotes mobile app intervention-which helps care partners manage BPSD through the support of a care coach, written and visual materials on developing care skills, and BPSD measurement and tracking-or an education-only mobile app control for 12 months. Data will be collected over the phone at baseline, 6 months, and 12 months. Primary outcomes assessed for this trial are (1) care partner burden and (2) patients’ BPSD. Secondary and exploratory outcomes assessed include care partner depressive symptoms, patient and care partner acute care use, intervention usability and acceptability, and intervention use. The trial will also collect patient and care partner demographics and measure care partner self-efficacy, care partner social support, patients’ ADRD severity, and patients’ functional abilities. As of March 2025, we have enrolled 159 participants, and 42 have successfully completed the study. Brain CareNotes is a unique mobile app intervention to support care partners in managing BPSD. Due to the scalability of mobile health interventions, if Brain CareNotes is shown to be effective in reducing caregiver burden and patients’ BPSD, it has the potential for widespread adoption to support many ADRD care partners. DERR1-10.2196/73387.
3. Temporal analysis of the administration of encephalic reperfusion therapies during the COVID-19 pandemic in a Chilean hospital: An analytical cross-sectional study.
期刊: Medwave 发表日期: 2025-Sep-03 链接: PubMed
摘要
The COVID-19 pandemic had a major impact on emergency services, including stroke care. Changes in the administration times of brain reperfusion therapies for stroke have been little explored in Chile. The aim of this study was to analyze the impact that the pandemic had on critical stroke treatment times, the number of patients treated, clinical severity, and the presence of major vessel occlusion. We performed a retrospective analysis of patients undergoing encephalic reperfusion therapy in a hospital in Valparaíso, Chile. Two groups of patients treated one year before (pre-pandemic group) and one year after (pandemic group) the start of health restrictions were compared. 104 patients were included, with a mean age of 67.4 ± 13 years and a clinical severity of 13.5 ± 6.5 in the NIHSS. 91.5% received thrombolytic therapy. No significant intergroup differences were found in the metrics of treatment time, number of patients treated, clinical severity, or presence of major vessel occlusion. Although there was a non-significant trend towards delayed institutional therapeutic times, a significant correlation was found suggesting that the shorter the time from symptom onset to door, the shorter the time to access therapy (r = 0.84). There were no significant differences in the therapeutic times of stroke in the period prior to the COVID-19 pandemic and the pandemic period, showing similarities to the experience reported in Chile and highlighting the adaptation of the health system during the health crisis. Studies with more complex epidemiological designs analyzing larger samples of patients will allow us to complement these results. La pandemia de COVID-19 generó un gran impacto en los servicios de urgencia, incluyendo la atención del ataque cerebrovascular. Los cambios en los tiempos de administración de terapias de reperfusión encefálica del ataque cerebrovascular han sido poco explorados en Chile. El objetivo de este trabajo fue analizar el impacto que tuvo la pandemia en los tiempos críticos de tratamiento del ataque cerebrovascular, el número de pacientes tratados, la severidad clínica y la presencia de oclusión de vaso mayor. Se realizó un análisis retrospectivo de los pacientes sometidos a terapia de reperfusión encefálica en un hospital de Valparaíso, Chile. Se compararon dos grupos de pacientes atendidos un año antes (grupo prepandemia) y un año después (grupo pandemia) del inicio de las restricciones sanitarias. Se incluyeron 104 pacientes, con una edad promedio de 67,4 ± 13 años y una severidad clínica de 13,5 ± 6,5 en la escala NIHSS. Un 91,5% recibió terapia trombolítica. No se encontraron diferencias significativas intergrupales en las métricas de tiempo de tratamiento, número de pacientes tratados, severidad clínica, ni presencia de oclusión de vaso mayor. Aunque hubo una tendencia no significativa de retraso en los tiempos terapéuticos institucionales, se encontró una correlación significativa que sugiere que, a menor tiempo desde el inicio de los síntomas a puerta, menor tiempo de acceso a terapia (r = 0,84). No hubo diferencias en los tiempos terapéuticos del ataque cerebrovascular en el periodo previo a la pandemia y en el periodo pandémico, mostrando similitudes con la experiencia reportada en Chile y resaltando la adaptación del sistema de salud durante la crisis sanitaria. Estudios con diseños epidemiológicos más complejos y muestras mayores complementarán estos resultados.
4. Telehealth Acceptance and Perceived Barriers Among Health Professionals: Pre-Post Evaluation of a Web-Based Telehealth Course.
期刊: JMIR human factors 发表日期: 2025-Sep-03 链接: PubMed
摘要
The rapid expansion of telehealth underscores the need for comprehensive telehealth education among health care professionals. Despite increasing recognition of telehealth’s importance, many practitioners remain underprepared, particularly in navigating legal aspects, technology, and patient engagement. This study aimed to evaluate the impact of a web-based telehealth training course on health care professionals’ telehealth acceptance and their perceived barriers to telehealth adoption. An interventional study with a pre-post design was used in Austria. A total of 365 health professionals enrolled in an asynchronous web-based course covering general telehealth principles (concepts, legal and technical aspects, practical implementation) and profession-specific content (eg, nursing, speech therapy, and physiotherapy). Of these, 217 completed the course, and 185 met inclusion criteria for analysis. Participants’ telehealth acceptance (covering telemetry, telephasis, and telepraxis) and perceived barriers were assessed via standardized questionnaires before and after the course. Satisfaction with the training was measured post-intervention using the Training Evaluation Inventory. Qualitative insights were gathered from open-ended survey questions and 2 focus groups, transcribed, and summarized. Post-intervention, overall telehealth acceptance increased significantly (P<.001, r=0.21), particularly for telemetry (remote assessment and monitoring), telepraxis (remote interventions), video call-based, and asynchronous telehealth. Perceived barriers to telehealth use-such as uncertainty about legal frameworks, data protection, and reduced quality of care-diminished significantly (P<.001, r=0.39). Post-intervention satisfaction was high, with a total median Training Evaluation Inventory score of 76 (IQR 13). Participants rated the course highly for its clarity, breadth of content, and inclusion of profession-specific modules. Qualitative feedback highlighted a desire for more hands-on demonstrations, interactive components, and guidance on institutional support and patient accessibility. A structured, on-demand telehealth course significantly improved health professionals’ awareness, acceptance, and intention to use telehealth and reduced perceived barriers. While the findings highlight that targeted web-based training can increase clinicians’ confidence and readiness to use telehealth, it remains uncertain whether this will lead to an increase in its utilization. Future initiatives should incorporate blended-learning formats with additional practical examples, real-time discussions, and ongoing support to enhance long-term integration of telehealth into clinical workflows. On a policy level, we suggest coordinated actions at the EU, national, and institutional levels to standardize telehealth education and facilitate its practical implementation in everyday clinical practice.
5. Prevalence and Associated Factors of Bullying Experienced by Community Patients With Serious Mental Disorders: Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Sep-03 链接: PubMed
摘要
Individuals with serious mental disorders (SMDs) are frequently exposed to bullying, which can severely affect their well-being. However, research on this issue remains limited in the Chinese context. This study aimed to examine the prevalence and associated factors of bullying experienced by individuals with SMDs in China, with the goal of providing evidence that may inform strategies to improve their quality of life. A multistage stratified random sampling method was used to survey 486 community patients with SMDs in Shandong province, China. Participants self-reported experiences of bullying. The Stigma Scale for Chronic Illnesses, 8-item version was used to measure self-stigma; the Pittsburgh Sleep Quality Index assessed sleep quality; and the Family Apgar Scale evaluated family functioning. Single-factor analysis, logistic regression, and negative binomial regression were used to analyze the associations between variables. The prevalence rate of bullying experienced by individuals with SMDs was 42.4% (206/486). Higher levels of self-stigma were significantly associated with increased odds of being bullied (odds ratio [OR] 1.041, 95% CI 1.017-1.065; P<.001), while better family functioning was associated with lower odds of experiencing bullying (OR 0.913, 95% CI 0.850-0.980; P=.01). Verbal abuse was associated with poorer sleep quality (OR 1.056, 95% CI 1.004-1.111; P=.04), particularly when reported as perpetrated by caregivers (OR 1.068, 95% CI 1.029-1.108; P<.001). In addition, age (P<.001), education level (P=.02), only-child status (P=.04), and diagnosis type (P=.03) were significantly related to bullying experiences. Higher levels of self-stigma were associated with experiencing bullying among individuals with SMDs, whereas better family functioning was associated with lower odds of being bullied. Verbal abuse-especially by caregivers-was associated with poorer sleep quality. These findings suggest that reducing self-stigma and strengthening family support may help improve quality of life for individuals with SMDs.
6. An Ecologic Analysis of the Association of Regional Cancer Center Presence with Cancer Mortality for the continuous United States.
期刊: Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 发表日期: 2025-Sep-03 链接: PubMed
摘要
Treatment at a cancer center improves outcomes for individual patients, but the impact of cancer centers on the regions they serve is unknown. This study examines the association between cancer center presence and cancer mortality within health service areas (HSAs), which define United States regional care markets. Cancer centers and cancer mortality were mapped to HSAs using geospatial analysis. The association between cancer center presence and cancer mortality was analyzed using a multivariable spatial lag model, adjusting for percent of incident cases presenting at late stage, social vulnerability, environmental burden, and rurality. Results are reported as deaths per 100,000 people (95% Confidence Interval [CI]). Of 940 HSAs, forty-three percent (n=407) contained at least one cancer center. HSAs with a cancer center had lower cancer mortality than those without a cancer center (158 [95% CI: 155.9, 159.5] versus 165 [95% CI: 162.5, 166.6] deaths per 100,000 people). In adjusted analyses, metropolitan HSAs with cancer centers had 4.4 fewer deaths (-8.4, -0.4) than those without cancer centers while there was no observed effect of cancer center presence in non-metropolitan HSAs (1.4 [-1.4, 4.3]). Factors associated with higher cancer mortality were late stage at presentation and greater environmental burden. Cancer center presence within metropolitan healthcare markets was associated with modestly lower cancer mortality. There is a need to evaluate underlying mechanisms whereby cancer center presence may affect population-level cancer mortality in metropolitan, but not non-metropolitan HSAs, including direct patient care and indirect effects such as community health promotion.
7. Effectiveness of an Interactive Digital Intervention Program on Knowledge, Health Literacy, and Learner Engagement in Senior High School Students: Intragroup and Intergroup Comparison of 2 Teaching Models.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-03 链接: PubMed
摘要
Adolescent substance use remains a critical and persistent public health concern worldwide. The initiation of drug use during adolescence is often associated with long-term negative health, social, and academic outcomes. As structured environments where young people spend a large portion of their time, schools are in a unique position to implement early prevention strategies to effectively address this issue. In recent years, digital technologies have emerged as promising tools for delivering health education in engaging and scalable ways. This study aimed to develop and evaluate an interactive digital intervention (IDI) program designed to improve high school students’ knowledge related to illegal drugs, enhance their health literacy, and promote greater learner engagement. Specifically, the study sought to compare the outcomes of a digital teaching model with those of traditional textbook-based instruction. A quasi-experimental, pre-post design was adopted involving 768 senior high school students aged between 16 and 18 years from 9 randomly selected schools. The schools were assigned to either the IDI group (n=379, 49.3%) or the traditional didactic (TD) group (n=389, 50.7%). The IDI group received a 6-unit web-based substance use prevention program with interactive features such as videos, quizzes, and scenario-based discussions. The TD group received conventional classroom instruction using standard textbooks. After accounting for student attrition and absences, 651 students remained for final analysis (IDI: n=305, 46.9%; TD: n=346, 53.1%). Paired t tests and generalized estimating equations (GEEs) were used to assess within- and between-group differences, adjusting for age and gender. An intragroup comparison revealed that the IDI group had significantly greater improvements in the following variables: knowledge (t304=-5.23, P<.01), health literacy (t304=-3.18, P<.01), functional literacy (t304=-3.50, P<.01), critical literacy (t304=-2.79, P=.01), communicative literacy (t304=-2.26, P=.02), and learner engagement (t304=-3.40, P<.01), including cognitive engagement (t304=-2.20, P=.03) and emotional engagement (t304=-3.84, P<.01). While most results were consistent across paired t test and GEE analyses, cognitive engagement did not show significant intergroup differences. Our findings support the potential of IDIs for improving knowledge, health literacy, and engagement among high school students. Compared to traditional instruction, digital programs may provide a more engaging and impactful method for substance use prevention in educational settings. However, the intervention did not significantly improve all targeted outcomes, such as refusal skills and perceived harmfulness, suggesting the need for refined targeting and longer implementation periods. Further studies may explore the long-term behavioral outcomes and the scalability of such interventions.
8. Exploring Teacher Practices and Perceptions of Implementing Anxiety-Focused Supports in Low-Income Urban Elementary Schools.
期刊: Administration and policy in mental health 发表日期: 2025-Sep-03 链接: PubMed
摘要
Surging rates in child internalizing problems require teachers to serve as frontline responders, especially in marginalized urban communities where structural barriers constrain access to healthcare resources. The current mixed methods study examined teachers’ use and perceptions of tools for addressing anxiety in urban elementary schools serving predominately low-income and Black and Hispanic youth. Across surveys (N = 82) and interviews (n = 12), teachers were asked about their current practices, their perceptions of the most common evidence-based practice elements for youth anxiety, and their preferences for professional development (PD) materials going forward. All teachers endorsed use of evidence-based practices for anxiety. Among the practices assessed, teachers were most enthusiastic about using modeling, praise/rewards, cognitive coping, and relaxation strategies, and were least enthusiastic about exposure, self-monitoring, and psychoeducation. In interviews, teachers noted key facilitators (e.g., keeping strategies time-limited), and highlighted other “setting up for success” strategies (e.g., building relationships with students) that work to minimize anxiety in classrooms. Teachers with higher self-efficacy and sense of personal accomplishment perceived evidence-based practices for student anxiety as more usable, underscoring the importance of teachers’ job-related wellness in student mental health promotion. Teachers preferred PD materials that were time-limited, asynchronous, and engaging. Taken together, findings indicate that many teachers are already incorporating evidence-based anxiety practices into their routines. Results inform policy and practice recommendations, and suggest value in leveraging teachers’ existing practices and opinions to develop relevant PD materials that optimize practices for addressing child anxiety in urban schools.
9. Chromosomal-level assembly of Magnusiomyces clavatus: novel genetic insights on an emerging fungal pathogen.
期刊: G3 (Bethesda, Md.) 发表日期: 2025-Sep-03 链接: PubMed
摘要
Magnusiomyces clavatus is an emerging opportunistic fungal pathogen associated with severe systemic infections in immunocompromised patients, mostly among those suffering from hematological malignancies. Despite the increasing clinical significance, genomic data for M. clavatus remain limited. In this study, we report the first chromosomal-level genome assembly of M. clavatus using hybrid sequencing with Illumina and Oxford Nanopore technologies. Three clinical isolates obtained from ICU patients in Verona (Italy) were sequenced and analyzed. The M. clavatus genome was resolved into four nuclear chromosomes and one circular mitochondrial genome, with a total length of 17.6 Mb and with 4,065 predicted protein-coding genes. Comparative analyses revealed structural differences from its closely related species M. capitatus. Phylogenetic analysis of 40 strains assembled on the resolved genome identified a novel clade (D), distinct from the previously described clades A, B, and C. All isolates exhibited intrinsic resistance to echinocandins and fluconazole. Genetic analysis identified conserved mutations in the FKS1 hotspot region encoding 1,3-β-glucan synthase, mirroring resistance-associated substitutions in M. capitatus. Additionally, a putative cyp51 homologue was identified as a likely contributor to azole resistance, suggesting conserved resistance mechanisms across Magnusiomyces species. This study discloses a new chromosomal-level assembly for M. clavatus, providing a significant genomic framework. This resource could enhance the accuracy of diagnostic methods, enabling comparative genomics with closely related fungi and facilitate a deeper investigation into the mechanisms of antifungal resistance and pathogenicity of this rare but increasingly reported pathogen.
10. Care Experiences of Family Caregivers of People with Dementia: A Nationwide Survey Study Comparing Caregivers with Migrant and Native Backgrounds.
期刊: Dementia (London, England) 发表日期: 2025-Sep-03 链接: PubMed
摘要
Introduction: Having a migration background might be associated with the care experiences of family caregivers of people with dementia. For example, caregivers with a migration background often face additional challenges in accessing professional care. The aim of this study was to provide insight into differences in care experiences between family caregivers with a native Dutch and a European or a non-European migration background. Methods: Data were used from a large-scale Dutch survey among family caregivers of relatives with dementia. The sample consisted of 170 caregivers with a European migration background, 199 caregivers with a non-European migration background and 4,158 caregivers with a native Dutch background. Linear and multinomial logistic regression analyses were used to analyse the survey data. The results were adjusted for background characteristics such as sex and age. Results: No differences were found between the two migrant groups and the native Dutch group in the perceived care burden and the caregiving intensity. Family caregivers with a European migration background were less likely to feel prepared for future changes in the dementia trajectory of their relative with dementia than caregivers with a native Dutch background. In addition, caregivers with a European migration background gave a lower score for their appreciation of the overall supply of care and support. Discussion: Caregivers with a European migration background, but not caregivers with a non-European migration background, were less likely to feel prepared for future changes than caregivers with a native Dutch background. In addition, they had lower appreciation for the overall supply of care and support. Offering a good supply of professional care and support, tailored to the individual situation and support needs, is important for caregivers in general, and those with a European migration background in particular.
11. Unveiling the shifting trends and landscape of dietary-related cancer burden in China, global and different income regions: Based on GBD2021.
期刊: Cancer epidemiology 发表日期: 2025-Sep-02 链接: PubMed
摘要
This study assessed the burden of dietary risk-attributed cancers (DRAC) in China from 1990 to 2021, comparing trends with global patterns and across sociodemographic index (SDI) regions. We further projected future trajectories up to 2036. The study assesses DRAC using age-standardized disability-adjusted life-years rates (ASDR) and age-standardized mortality rates (ASMR) based on Global Burden of Disease 2021. Temporal trends were evaluated using annual percentage change (APC) and estimated annual percentage change (EAPC). Key drivers were identified through decomposition and age-period-cohort analyses, while future trends were projected using a Bayesian age-period-cohort model. From 1990 to 2021, most countries exhibited negative EAPC values for overall population ASDR and ASMR, especially in China (-2.9; - 2.7). However, since approximately 2013, APC values for ASDR and ASMR among younger adults (under 55 years) in China and middle SDI regions have been positive. As for sexes, the ASDR and ASMR for DRAC were consistently higher in males than in females across China. Specifically, a diet rich in red meat and diet deficient in whole grains posed the highest dietary cancer risk for females and males respectively. Projections suggest that by 2036, China’s ASDR and ASMR for DRAC may decrease to about 200 and 8, while global figures could drop to about 180 and 7 per 100,000. Although China’s overall DRAC burden declined particularly fast on a global scale from 1990 to 2021, projections indicate it will remain above the global average by 2036. Notably, since 2013, both China and middle SDI regions have witnessed a rising burden of dietary risk-attributed cancers among young adults. Distinct burden profiles and risk factor distributions have been observed between genders. Targeted public health policies tailored to age, sex, and leading dietary risks should be formulated and implemented in the future.
12. Epidemiology and Management for Pediatric Chronic Wounds: A Systematic Review of the Current Literature.
期刊: The Journal of surgical research 发表日期: 2025-Sep-02 链接: PubMed
摘要
Chronic wounds affect approximately 10.5 million individuals annually in the United States. Although recent studies have highlighted a surge in chronic wound cases among younger populations, the collective burden of pediatric chronic wounds remains understudied. This study aims to elucidate the epidemiology and management of pediatric chronic wounds. A comprehensive literature search was conducted across Embase, PubMed, and Web of Science databases on articles published after 2000 that specified chronicity of wounds in pediatric patients. The exclusion criteria included case reports, review articles, and proceedings. Sixteen articles met the inclusion criteria. Pilonidal sinus disease emerged as the most studied chronic wound etiology (38%), followed by dermatological disorders such as epidermolysis bullosa, pyoderma gangrenosum, and cutaneous nontuberculous mycobacterium (25%). Traumatic wounds were covered in three articles (19%), whereas burns, pressure ulcers, and osteomyelitis each represented 13% of the studies. This review revealed an interdisciplinary framework, with pediatric surgery being the most common specialty, alongside dermatology and allied health professionals. Most studies examined epidemiology, assessing demographics, nutrition status, and comorbidities, including diabetes mellitus, obesity, hidradenitis suppurativa, and myelomeningocele. Management strategies frequently discussed surgical procedures and wound dressings, whereas self-management and educational initiatives were described to enhance patient care. This systematic review synthesizes current evidence on epidemiology and management approaches for pediatric chronic wounds. Addressing this public health concern requires equitable allocation of resources toward research focused on prevention and enhanced treatment strategies.
13. No public restroom: Illinois's restroom access act and bathroom accessibility.
期刊: Health & place 发表日期: 2025-Sep-02 链接: PubMed
摘要
Restroom access acts (RAAs) provide persons with inflammatory bowel disorders (IBD) and other health conditions emergency access to a business’s employee restroom. Despite the important role these laws can play in supporting a person’s health and dignity, they remain understudied. This Article is the first to explore what if any role a RAA has in the lives of persons living with IBD. We conducted a qualitative study to explore what persons with IBD living in Illinois know about the influential RAA in this state; their experiences finding and using restrooms in public; and what changes they would like to see in the provision of publicly available restrooms. We interviewed nine participants living with IBD, primarily women living in the Chicago metropolitan area, and found that knowledge of the law was low. Participants also described harms resulting from limited access to public restrooms, including to their autonomy, freedom, and dignity. Our participants expressed skepticism of the law’s ability to effectively improve bathroom accessibility yet also found hope in the law’s existence. This Article concludes by grounding these findings in legal precedent, disability law scholarship, and research on IBD. Our findings can be used to motivate future research on RAAs and influence future laws and policies to improve public health.
14. Estimates of SARS-CoV-2 vaccine effectiveness against outpatient medically attended SARS-CoV-2 infection from April 2023 through August 2024 in Hong Kong: A test-negative design study.
期刊: Vaccine 发表日期: 2025-Sep-02 链接: PubMed
摘要
We aimed to estimate SARS-CoV-2 vaccine effectiveness (VE) against medically attended SARS-CoV-2 infection in Hong Kong. We conducted a test-negative design study in individuals aged 5-64 years who presented with recent-onset (≤3 days) acute respiratory illness from April 2023 through to August 2024. Vaccination was defined as receipt of SARS-CoV-2 vaccine within 6 months of medical presentation, and for a sensitivity analysis, within 12 months of medical presentation. VE against laboratory-confirmed SARS-CoV-2 infection was estimated separately for 5-17-year-olds and 18-64-year-olds by conditional logistic regression adjusted for potential confounders. Within the age groups, there was no statistically significant difference in vaccination (within 6 months of medical presentation) proportions between cases and controls across strata of the assessed individual sociodemographic and health-related characteristics. A moderate VE of 64 % (95 % confidence interval, CI: 9-83 %) and 54 % (95 % CI: -39 to 77 %) was estimated in 5-17-year-olds and 18-64-year-olds, respectively. However, a higher VE of 85 % (95 % CI: 32-97 %) and a moderate VE of 59 % (95 % CI: 2-83 %) were estimated in 5-17-year-olds for mRNA and inactivated vaccines, respectively, although non-statistically significantly different (p = 0.33) whereas a lower VE of 29 % (95 % CI: -81 to 73 %) and a higher VE of 70 % (95 % CI: -5 to 92 %) were estimated in 18-64-year-olds for mRNA and inactivated vaccines, respectively, which were not statistically significantly different from each other (p = 0.38). VE estimates were higher for those who had had a previous SARS-CoV-2 infection compared with those who had not. VE was also higher in 5-17-year-olds who had self-tested for SARS-CoV-2 infection before medical presentation and lower in those who had not, whereas the opposite was observed in 18-64-year-olds. SARS-CoV-2 vaccines provided substantial protection against medically attended SARS-CoV-2 infection in both children and adults in Hong Kong.
15. Boot camp translation: A novel method to increase human papillomavirus (HPV) vaccination uptake.
期刊: Vaccine 发表日期: 2025-Sep-02 链接: PubMed
摘要
Human papillomavirus (HPV) vaccine is safe and highly effective, yet HPV vaccination uptake remains suboptimal, necessitating novel interventions. Our objective was to describe the impact of a novel method of community-based participatory research, Boot Camp Translation (BCT), on HPV vaccination uptake. In a quasi-experimental matched-case-control study, we applied BCT to HPV-focused intervention programs for 9-17-year-olds in 6 pediatric clinics in 3 counties in Colorado from 6/2020 to 2/2021. In a 6-month BCT process, providers, clinic staff, parents, and adolescent patients collaboratively designed messages and campaigns to implement in their clinics. Control clinics (n = 16) were identified from the same county as intervention clinics and matched on number of patients and percentage of patients eligible for the Vaccine for Children (VFC) program. Baseline and post-intervention (each defined for a period of 6 months) HPV vaccination rates were estimated for each intervention and control clinic. Rates were compared using adjusted odds ratios (aOR) for the time-by-treatment interaction effect through hierarchical logistic regression models. There were 15,764 youths in intervention clinics and 33,155 in controls. HPV vaccine initiation and completion increased in both groups with greater improvement in initiation in intervention clinics compared to controls (intervention: 45.9 % to 56.7 %, control: 44.6 to 52.8 %; p < 0.001). In multivariable analyses, after adjustment for age, sex, race/ethnicity, percent VFC-eligibility, baseline rates, and clinic size, the odds ratio for initiation of the HPV vaccine series, baseline versus post-intervention, was 1.80 in intervention clinics (95 % confidence interval [CI], 1.71, 1.90) and 1.54 in control clinics (95 % CI, 1.49, 1.60) (interaction, p < 0.0001). For completion of the series, the odds in intervention clinics were 1.72 (95 % CI, 1.63, 1.82) and 1.52 (95 % CI, 1.47, 1.58) in control clinics (interaction, p < 0.0001). Boot Camp Translation is a promising method for increasing uptake of HPV vaccination in clinic settings.
16. Robust evaluation of vaccine effects based on estimation of vaccine efficacy curve.
期刊: Vaccine 发表日期: 2025-Sep-02 链接: PubMed
摘要
The Cox model and its extensions assuming proportional hazards is widely used to estimate vaccine efficacy (VE). However, when VE wanes over time, estimates can become sensitive to study duration and timing of vaccine delivery relative to disease seasonality, and may be biased due to sample attrition. Additionally, estimates of vaccine impact such as number of cases averted (NCA) are sensitive to background disease incidence and timing of vaccine delivery. Comparison of the estimates between trials with different implementation features can be misleading. We propose estimation of VE as a function of time in the Cox model framework, using the area under the VE curve as a summary measure of VE, and extension of the method to estimate vaccine impact. We use simulations and re-analysis of a RTS,S/AS01 malaria vaccine trial dataset to demonstrate their properties and applications. Simulation under scenarios with different trial duration, magnitude of sample attrition and timing of vaccine delivery, all assuming vaccine protection wanes over time, demonstrated problems of conventional methods assuming proportional hazard, robustness of the proposed methods, and comparability of the proposed estimates of vaccine efficacy and impact across trials with different implementation features. Furthermore, the proposed NCA estimators are informative in determining the optimal vaccine delivery strategy in regions with highly seasonal disease transmission. The proposed method based on estimation of vaccine efficacy trajectory provides a robust, unbiased, and flexible approach to evaluate vaccine effects.
17. Wastewater-based epidemiology empowered by o-DGT passive sampling: Quantifying pharmaceuticals consumption hotspots in rural China's untreated watersheds.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Sep-02 链接: PubMed
摘要
The lack of centralized sewage treatment in rural areas has led to severe underestimation of pharmaceutical pollution, posing significant risks to aquatic ecosystems and human health. While wastewater-based epidemiology (WBE) is widely used to estimate pharmaceutical consumption in urban settings, its dependence on sewage infrastructure leads to monitoring deficiencies in rural watersheds with direct wastewater discharges into rivers. Here, we pioneer the application of organic-diffusive gradients in thin-films (o-DGT) passive sampling to conduct WBE in a representative rural area of Hunan Province, China, which lacks sewage treatment facilities. By comparing o-DGT measurements with time-weighted average concentrations from 24-h composite automatic sampling, we demonstrate that o-DGT achieves comparable detection capability and consistency for pharmaceutical monitoring while excelling in capturing temporal fluctuations in dynamic river systems. In Tuojia River, 29 out of 74 pharmaceuticals were detected by o-DGT, with total concentrations ranging from 15.6 to 869 ng/L. The average pharmaceutical consumption of residents in this rural area was 11.3 g/d/1000inh, primarily driven by antibiotics (94 %). Azithromycin was the most prevalent pharmaceutical (32 ‰). Human-use antibiotic consumption in rural areas was 1-2 orders of magnitude higher than that in urban areas of China. This study is the first to use WBE for estimating pharmaceutical consumption in livestock farming, revealing average antibiotic consumption of 1.77 g/d/1000 swine, mainly sulfamethazine (52 %) and florfenicol (47 %). Our findings establish o-DGT as a cost-effective and reliable tool for WBE, enabling comprehensive pharmaceutical pollution surveillance and informing strategies for ecological risk mitigation and sustainable resource management in decentralized regions.
18. Strengthening pathogen and antimicrobial resistance surveillance through environmental monitoring in sub-Saharan Africa: stakeholder perspectives.
期刊: International journal of hygiene and environmental health 发表日期: 2025-Sep-02 链接: PubMed
摘要
Wastewater and environmental surveillance (WES) is an emerging tool for monitoring emergence and trends of waterborne, respiratory, and antimicrobial-resistant (AMR) pathogens. In many developing countries with limited pathogen surveillance systems, WES can complement and support existing monitoring efforts and strengthen pathogen surveillance capacity. This study explored priority pathogens for WES and assessed existing surveillance practices, including WES, in Tanzania, Burkina Faso, and the Democratic Republic of the Congo (DRC). National hybrid workshops were held in each country, engaging stakeholders from diverse fields, including academia, research, policy, environmental health, and healthcare. Two structured surveys, administered via Webropol platform and Mentimeter. com, were conducted during each workshop to gather information on existing clinical and environmental surveillance systems and potential WES targets. Survey responses were analysed thematically, with each theme thoroughly evaluated using scientific evidence from the literature. Key pathogens identified for WES included waterborne pathogens, such as poliovirus, Salmonella Typhi, Vibrio cholerae, and non-waterborne pathogens, such as influenza A&B, SARS-CoV-2, measles, rubella. High-priority AMR targets for WES included multidrug-resistant Mycobacterium tuberculosis, Salmonella spp., and ESBL-producing E. coli. All three countries were found to use centralised electronic systems for clinical data collection, while WES was still limited and largely confined to project-based applications. Respondents highlighted that adopting WES could enhance surveillance systems, track circulating pathogens, and safeguard human, animal, and environmental health. Thus, WES could play a pivotal role in preventing waterborne outbreaks, protecting drinking water sources, and supporting integrated risk management, contributing to achieving various UN Sustainable Development Goals (SDGs).
19. Purine metabolism in tumorigenesis and its clinical implications.
期刊: Seminars in oncology 发表日期: 2025-Sep-02 链接: PubMed
摘要
Metabolic reprogramming constitutes a hallmark of malignant neoplasms. Purine metabolism emerges as a pivotal regulator in cellular metabolic networks through multiple mechanisms, including dysregulation of de novo biosynthesis/salvage pathway coordination, adenosine-mediated immunosuppressive microenvironment formation, and collective contributions to tumorigenesis and malignant progression. During metastatic progression, purine metabolism reinforces tumor cell plasticity through mitochondrial energy regulation and modulation of cell cycle checkpoints (eg, G1/S transition). These mechanistic revelations have positioned purine metabolism-targeting strategies as promising oncotherapeutic candidates. This review methodically analyzes (1) purine metabolic pathways and their regulatory dynamics, (2) adenosine-mediated pathophysiological interactions, and (3) the synergistic impacts of these pathways in malignant transformation. We propose a unified mechanistic framework that clarifies oncogenic purine metabolic rewiring while evaluating translational potential through three clinical dimensions: pathogenesis elucidation, diagnostic biomarker discovery, and targeted therapeutic development. This comprehensive synthesis aims to advance precision oncology through mechanistic insights and therapeutic innovation.
20. Trends in all-cause mortality attributable to particulate matter 2.5 pollution in Sub-Saharan Africa: An age-period-cohort analysis.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Sep-02 链接: PubMed
摘要
Particulate matter 2.5 (PM2.5) pollution, comprising ambient PM2.5 pollution (APMP) and household air PM2.5 pollution from solid fuels (HAP), significantly impacts population health in Sub-Saharan Africa. This study extracted mortality data and various socio-economic indices in Sub-Saharan Africa from the Global Burden of Disease 2021 and World Bank databases, aiming to evaluate PM2.5-related disease burden. The analysis revealed that APMP predominantly affected Southern and Western Sub-Saharan Africa, while Central and Eastern Sub-Saharan Africa were primarily influenced by HAP. Additionally, Additionally, PM2.5-related death proportions decreased in individuals < 5 years of age and increased in those ≥ 50 years in Sub-Saharan Africa. Between 1990 and 2021, Central Sub-Saharan Africa demonstrated the highest net drift in APMP-related mortality (0.82 % per year), while all four Sub-Saharan African regions showed a negative net drift in HAP-related mortality (ranging from -1.94 % to -1.43 % per year). Central (risk rate: 1.25 compared to reference period) and Western Sub-Saharan Africa (1.17) exhibited increased APMP-related mortality risk in the most recent period, while all four regions showed decreased HAP-related mortality risk in both the recent period (ranging from 0.49 to 0.79) and birth cohort (ranging from 0.19 to 0.35). Notably, factors including access to clean cooking fuels and technologies, forest area, and urban population may affect APMP- and HAP-related age-standardized mortality rate (ASMR). Future projections indicate most Sub-Saharan African regions will experience increased PM2.5-related deaths, and sustained initiatives targeting specific populations, implementing industrial pollution control, and enhacing energy consumption patterns remain essential.
21. Environment-wide association study of cardiovascular-kidney-metabolic syndrome based on NHANES 2013-2016.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Sep-02 链接: PubMed
摘要
Environmental chemical exposure has emerged as an important risk factor for cardiometabolic and other chronic diseases. Cardiovascular-kidney-metabolic (CKM) syndrome conceptualizes the overlap of cardiovascular, kidney, and metabolic diseases as a systemic condition, providing a comprehensive framework for systematically identifying their risk factors. This study aimed to assess the associations between multiple environmental chemicals and CKM syndrome and to examine the potential mediating role of inflammation. The analysis was based on NHANES data from the 2013-2016 period. An exposome-wide approach was applied to identify environmental chemicals associated with CKM syndrome. Restricted cubic splines (RCS) were used to examine potential nonlinear associations. To evaluate the joint associations of multiple exposures, both weighted quantile sum (WQS) regression and quantile-based g-computation (Qgcomp) were employed. Mediation analyses were performed to explore inflammation as a possible pathway. Six environmental chemicals were found to be associated with CKM syndrome, including metals (tin), volatile organic compound metabolites (VOCMs: n-A-S-(3-hydrxprpl-1-metl)-L-cys, n-ace-S-(3,4-dihidxybutl)-L-cys), polycyclic aromatic hydrocarbons (PAHs: 1-hydroxyphenanthrene, 2&3-hydroxyphenanthrene), and iodine. A U-shaped relationship was observed between barium, cobalt, strontium, thallium, nitrate, and 2&3-hydroxyphenanthrene and the risk of advanced CKM syndrome. Mixed exposure analyses suggested that combined exposure to multiple metals was associated with a higher risk of advanced CKM syndrome. Moreover, inflammation may mediate the association between environmental chemicals and CKM syndrome. This study underscored the importance of controlling exposure to harmful environmental chemicals in the prevention and control of chronic multisystem diseases, and provided new research perspectives for elucidating the potential biological mechanisms underlying CKM syndrome.
22. Exposure to diethyl phthalates impairs ovarian reserve and oocyte maturation in female mice.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Sep-02 链接: PubMed
摘要
Diethyl phthalates (DEP) are commonly used as a plasticizer and have been found to cause male reproductive defects and metabolic disease in mammals as a potential environmental endocrine disruptor. However, the effects and underlying mechanisms of DEP exposure on female follicle development and oocyte maturation were still unclear. In this study, we found that mice exposed to DEP had significantly reduced primordial follicles. DEP exposure also led to a decrease in the number of ovulated oocytes, the rate of the first polar body, and an increase in fragmentation. Transcriptome analysis showed significant changes in the transcription levels of genes related to the actin filament, reproduction, post-translational protein modification, PI3K-AKT, TGF-beta, Wnt signaling pathway, and mitochondria function. Furthermore, over ten differentially expressed genes in DEP-exposed mice overlapped with 703 genes related to ovarian function from patients with premature ovarian insufficiency (POI). In conclusion, our study demonstrates that DEP exposure can impair primordial follicle number and oocyte maturation competence by affecting mitochondria distribution and function. This study sheds light on the possible effects of plastic additives on female reproductive health and offers potential strategies for the prevention and treatment of infertility related to these additives.
23. Distribution patterns and influencing factors of pathogenic microbial communities in household municipal solid waste: A case in Beijing, China.
期刊: Waste management (New York, N.Y.) 发表日期: 2025-Sep-02 链接: PubMed
摘要
Household municipal solid waste (MSW) provides a suitable environment for the propagation and emission of pathogens, and revealing their distribution patterns and influencing factors is important for source control of the potential risks. This study analyzed the microbial communities of pathogenic bacteria and fungi in MSW, by collecting both food waste and residual waste samples from a high-density residential area in Beijing for 11 months. Alpha diversity analysis indicated that the microbial diversity differed significantly between food waste and residual waste; however, Weissella and Candida were consistently detected at high proportions. In total, 43 pathogenic bacterial and fungal species each were detected. Candida albicans, Candida tropicalis, Enterococcus faecalis, Serratia liquefaciens, and Acinetobacter johnsonii were identified as core pathogens with high relative abundances and occurrence frequencies. While warmer seasons appeared to favor the accumulation of pathogens, no significant correlation between communities and seasons was found. Pathogenic microbial communities differed significantly among waste types, with relative abundances of bacterial pathogens being higher in residual waste than in food waste, and vice versa for fungal pathogens. Waste properties, including protein, carbon, and hydrogen contents and electrical conductivity are crucial in shaping the pathogenic microbial diversity, and environmental conditions including temperature, atmospheric pressure, and relative humidity also contribute. The findings in distribution patterns and influencing factors of pathogens in household MSW provide a scientific basis for the source control and further assessment of occupational health risks in waste management.
24. Differential responses of phytoplankton and zooplankton communities to tidal and urban stressors in the Dongjiang river: From biodiversity patterns to network stability.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Sep-02 链接: PubMed
摘要
This study employed environmental DNA (eDNA) metabarcoding to investigate the differential responses of phytoplankton and zooplankton communities to combined tidal and urban stressors along the Dongjiang River, China. The results revealed distinct spatiotemporal patterns between phytoplankton and zooplankton groups: phytoplankton diversity showed significantly stronger seasonal variation (a 61.2 % increase in the wet season, P < 0.05), particularly in tidal urbanized reaches, whereas zooplankton exhibited greater stability (with only 12.8 % seasonal variation). Community assembly analyses demonstrated contrasting mechanisms-phytoplankton shifted from stochastic dominance (53.4 % explained by neutral models) in wet seasons to deterministic control (6.8 %) in dry seasons, while zooplankton remained consistently deterministic (<1 % neutral model fit) across all conditions. Network analysis revealed significant fragmentation of phytoplankton interactions in tidal urban zones, whereas zooplankton networks maintained higher stability despite reduced complexity. Temperature, nitrogen nutrients, and organic pollutants were identified as the key environmental drivers affecting phytoplankton and zooplankton community composition in the Dongjiang River. This study demonstrates how eDNA-based approaches can disentangle complex stressor interactions in urbanized estuaries, highlighting the role of seasonal hydrological variations, and provides a scientific basis for ecological management strategies aimed at preserving aquatic biodiversity and river ecosystem health.
25. Association of single and joint urinary metal exposure with carotid atherosclerosis in non-dyslipidemic middle-aged and elderly adults: A retrospective case-control study.
期刊: Ecotoxicology and environmental safety 发表日期: 2025-Sep-02 链接: PubMed
摘要
Carotid atherosclerosis (CAS) is a major contributor to cerebrovascular incidence and mortality, yet its etiology in non-dyslipidemic individuals remains poorly understood. Emerging evidence suggests that environmental metal exposure may play a critical role in CAS development. We conducted a retrospective matched case-control study involving 1290 non-dyslipidemic middle-aged and elderly individuals to examine the association between urinary metal exposure and CAS. Twenty-eight urinary metals were measured using inductively coupled plasma mass spectrometry (ICP-MS), and statistical analyses-including conditional logistic regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR)-were applied to assess single and mixed-metal effects. Mediation analysis was performed to evaluate the potential role of metabolic and inflammatory clinical indicator. Conditional logistic regression found that six metals (ORQ4vsQ1=1.63, 95 %CI: 1.14-2.34 for lithium (Li); ORQ4vsQ1= 1.65, 95 %CI: 1.16-2.35 for titanium (Ti); ORQ4vsQ1= 1.53, 95 %CI: 1.07-2.22 for cobalt (Co); ORQ4vsQ1= 1.77, 95 %CI: 1.24-2.51 for nickel (Ni); ORQ4vsQ1= 1.93, 95 %CI: 1.33-2.79 for copper (Cu), and ORQ4vsQ1= 2.14, 95 %CI: 1.45-3.18 for cadmium (Cd)) were significantly associated with increased CAS risk, while selenium (Se) (OR Q2vsQ1 = 0.65, 95 %CI: 0.46-0.93, ORQ2vsQ1 = 0.59, 95 %CI: 0.41-0.84) was negatively associated with the risk of CAS. Mixed-metal exposure analyses, including WQS (OR=1.35, 95 %CI 1.12-1.63) and BKMR, consistently demonstrated a positive correlation with CAS, primarily driven by Ti. Mediation analysis further revealed that 11.54 % of association between Cu and CAS explained by remnant cholesterol (RC). Our findings revealed a significant correlation between environmental metal exposure and CAS, independent of traditional lipid abnormalities. Future prospective studies are warranted to confirm these associations and elucidate the underlying biological mechanisms, potentially guiding targeted prevention strategies.
26. Beyond neutropenia: 14 years analysis of bloodstream infections in hematological malignancies.
期刊: Journal of infection and public health 发表日期: 2025-Sep-01 链接: PubMed
摘要
Bloodstream infections (BSIs) are a major cause of morbidity and mortality in patients with hematological malignancies (HMs). This 14-year retrospective study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, from 2007 to 2021. It examined the epidemiological profile, microbial spectrum, resistance patterns, and outcomes of BSIs in HM patients. Microbial identification was based on aerobic and anaerobic blood cultures; PCR testing was used requested as needed. Statistical analysis was performed in Excel, including one-way ANOVA, Chi-square, and linear regression. Among 2112 HM patients, 296 (14 %) experienced at least one BSI episode. Incidence peaked in 2014, 2016, and 2017, with a subsequent decline possibly reflecting improved infection control. Bacterial infections comprised 90 % of cases (n = 1341), the highest was Gram-negative organisms (n = 745) such as E. coli (n = 86) and Klebsiella pneumoniae (n = 77). Gram-positive pathogens (n = 596) included coagulase-negative Staphylococci (n = 319) and Staphylococcus aureus (n = 75). Fungal infections accounted for 4 % (n = 61), primarily Candida albicans. Resistance was high (21.1 %), particularly in Enterococcus (48.9 %), Acinetobacter (45.8 %), E. coli ESBL (40.3 %), and Klebsiella pneumoniae CRE/ESBL (45 %, 32.5 %). The overall mortality was 85 %, significantly higher for resistant Klebsiella pneumoniae (100 % vs. 88.7 %, p = 0.008) and notably elevated for E. coli ESBL (94.2 % vs. 83.1 %, p = 0.063). Adults had the highest incidence. Combined aerobic (69 %) and anaerobic (31 %) cultures improved diagnostic yield, especially in polymicrobial infections.
27. Cigarette consumption from a life-course perspective in low- and middle-income countries.
期刊: Bulletin of the World Health Organization 发表日期: 2025-Sep-01 链接: PubMed
摘要
To calculate the total life-course expenditure of smokers on cigarettes alone, before or without accounting for any economic losses as a result of smoking-attributable death and disease. We used data from Global Adult Tobacco Surveys to calculate annual cigarette consumption and expenditure in 15 low- and middle-income countries. We extracted data on average earnings from the ILOSTAT database of the International Labour Organization. We calculated life-course cigarette expenditures using cohort life expectancies and inflation, and converted these expenditures into net present value terms using a 3% social discount rate. The average age of adult cigarette smokers in our sample was 40 years, and their average expenditure on cigarettes was equivalent to 7.2% of annual average earnings. Given an average life expectancy of 55 years at the age of 15 years, we estimated an average life-course consumption of 217 752 cigarettes and a full life-course expenditure of 8481 United States dollars (US$) in net present value terms, more than twice the current average annual earnings of workers. However, by quitting, current adult smokers can avoid an average of US$ 6612 in expenditure on cigarettes over their remaining life-course. The affordability of cigarettes is an important determinant of cigarette use and tax policies can have a large effect on consumers, especially young adults. These costs will only increase over time as governments continue to raise taxes to address the market failures inherent within the tobacco market. Calculer les dépenses totales consacrées par les fumeurs à l’achat de cigarettes au cours de leur vie, avant de tenir compte ou sans tenir compte des pertes économiques liées au décès et aux maladies attribuables au tabagisme. Nous avons utilisé les données des enquêtes mondiales sur le tabagisme chez les adultes (Global Adult Tobacco Survey, GATS) pour calculer la consommation annuelle de cigarettes et les dépenses correspondantes dans 15 pays à revenu faible et intermédiaire. Nous avons extrait de la base de données ILOSTAT de l’Organisation internationale du travail les données sur les revenus moyens. Nous avons calculé les dépenses liées à la consommation de cigarettes tout au long de la vie en utilisant l’espérance de vie des cohortes et l’inflation, puis nous avons converti ces dépenses en valeur actuelle nette en appliquant un taux d’actualisation social de 3%. L’âge moyen des fumeurs adultes dans notre échantillon était de 40 ans, et leurs dépenses moyennes en cigarettes représentaient 7,2% de leur revenu annuel moyen. Compte tenu d’une espérance de vie moyenne de 55 ans lorsque les sujets sont âgés de 15 ans, nous avons estimé une consommation moyenne de 217 752 cigarettes au cours de la vie et une dépense totale de 8 481 dollars américains (USD) en valeur actuelle nette, ce qui représente plus du double du revenu annuel moyen actuel des travailleurs. Cependant, en arrêtant de fumer, les fumeurs adultes actuels peuvent éviter en moyenne 6 612 USD de dépenses en cigarettes au cours du reste de leur vie. Le caractère abordable des cigarettes constitue un facteur déterminant de leur consommation, et les politiques fiscales sont de nature à avoir un effet important sur les consommateurs, en particulier les jeunes adultes. Les coûts associés ne feront qu’augmenter parallèlement au relèvement des taxes par les pouvoirs publics en vue de remédier aux défaillances inhérentes au marché du tabac. Calcular el gasto total a lo largo del curso de vida de las personas fumadoras únicamente en cigarrillos, sin considerar las pérdidas económicas derivadas de enfermedades o muertes atribuibles al tabaquismo. Se utilizaron datos de las encuestas globales sobre el tabaquismo en adultos para calcular el consumo y gasto anual en cigarrillos en 15 países de ingresos bajos y medios. Se extrajeron datos sobre los ingresos promedio de la base de datos ILOSTAT de la Organización Internacional del Trabajo. El gasto a lo largo del curso de vida se calculó utilizando las expectativas de vida por cohorte y ajustando por inflación, y se convirtió a términos de valor actual neto utilizando una tasa de descuento social del 3%. La edad promedio de las personas adultas fumadoras en la muestra fue de 40 años y su gasto promedio en cigarrillos equivalía al 7,2% del ingreso anual promedio. Considerando una expectativa de vida promedio de 55 años a partir de los 15 años de edad, se estimó un consumo total a lo largo del curso de vida de 217 752 cigarrillos y un gasto acumulado de 8481 dólares estadounidenses (US$) en valor actual neto, más del doble del ingreso promedio anual actual de los trabajadores. No obstante, si abandonaran el consumo, las personas fumadoras adultas actuales podrían evitar, en promedio, un gasto de US$ 6612 en cigarrillos durante el resto de su vida. La asequibilidad de los cigarrillos es un factor determinante clave en su consumo. Además, las políticas fiscales pueden influir considerablemente en las decisiones de consumo, en especial entre la población adulta joven. Estos costos solo aumentarán con el tiempo, en la medida en que los gobiernos continúen incrementando los impuestos para corregir las fallas del mercado inherentes al mercado del tabaco. الغرض حساب إجمالي إنفاق المدخنين على السجائر وحدها طوال حياتهم، قبل أو دون احتساب أي خسائر اقتصادية ناجمة عن الوفاة أو المرض المرتبطين بالتدخين. الطريقة استخدمنا بيانات من المسوحات العالمية للتبغ لدى البالغين (Global Adult Tobacco Surveys) لحساب الاستهلاك السنوي للسجائر والإنفاق عليها في 15 دولة من الدول ذات الدخل المنخفض والدخل المتوسطة. قمنا باستخراج بيانات عن متوسط الدخل من قاعدة بيانات منظمة العمل الدولية (ILOSTAT). قمنا بحساب النفقات على السجائر طوال الحياة باستخدام متوسطات العمر المتوقع للفئة العمرية ومعدل التضخم، وحولنا هذه النفقات إلى صافي القيمة الحالية باستخدام معدل خصم اجتماعي قدره %3. النتائج بلغ متوسط عمر المدخنين البالغين في العينة لدينا 40 عامًا، وكان متوسط إنفاقهم على السجائر يعادل %7.2 من متوسط الدخل السنوي. بالنظر إلى متوسط العمر المتوقع البالغ 55 عامًا عند سن 15 عامًا، فقد قدرنا أن متوسط استهلاك دورة الحياة بـ 217752 سيجارة، ونفقات دورة الحياة الكاملة بـ 8481 دولارًا أمريكيًا من حيث القيمة الحالية الصافية، أي أكثر من ضعف متوسط الدخل السنوي الحالي للعمال. ومع ذلك، ومن خلال الإقلاع عن التدخين، يمكن للمدخنين البالغين الحاليين تجنب متوسط 6612 دولارًا أمريكيًا من الإنفاق على السجائر خلال دورة حياتهم المتبقية. النتائج تُعد القدرة على تحمل تكاليف السجائر عاملاً مهمًا في تحديد استخدام السجائر، ويمكن أن يكون للسياسات الضريبية تأثير كبير على المستهلكين، وخاصة الشباب الصغار. ستزداد هذه التكاليف فقط بمرور الوقت مع استمرار الحكومات في رفع الضرائب لمواجهة إخفاقات السوق المتأصلة في سوق التبغ. 旨在计算吸烟者生命全程中仅在香烟方面的总支出，不包含因吸烟所导致死亡和疾病造成的任何经济损失。. 我们运用从全球成人烟草调查中获得的相关数据来计算 15 个中低收入国家的年度香烟消费量和支出。我们从国际劳工组织的 ILOSTAT 数据库中提取了与平均收入有关的数据。我们运用队列预期寿命和通货膨胀相关数据计算了生命全程的香烟支出，并采用 3% 的社会折现率将此类支出转化为净现值。. 我们所抽取样本中成年吸烟者的平均年龄为 40 岁，且其在香烟方面的平均支出相当于年平均收入的 7.2%。假设吸烟者 15 岁时的平均预期剩余寿命为 55 年，我们估计其生命全程的平均香烟消费量为 217,752 根，且按净现值计算的生命全程支出总额为 8,481 美元 (US$)，是工人当前平均年收入的两倍以上。然而，在剩余生命全程中，当前成年吸烟者可通过戒烟避免平均金额为 6,612 美元的香烟支出。. 香烟承付能力是影响香烟消费的一个重要决定性因素，且税务政策会对消费者（特别是年轻人）产生显著影响。随着时间的推移，此类成本只会逐渐上涨，因为各国政府会继续提高税收以解决烟草市场固有的市场失灵问题。. Рассчитать затраты, которые курильщики несут на протяжении жизни, непосредственно на сигареты без учета или до вычетов любых иных экономических потерь вследствие обусловленных курением случаев смерти и заболеваний. Авторы использовали данные Глобального опроса взрослого населения о потреблении табака для расчета объема ежегодного потребления сигарет и связанных с этим затрат в 15 странах с низким и средним уровнем дохода. Данные о среднем уровне дохода были взяты авторами из базы данных ILOSTAT Международной организации труда. Расчет затрат на потребление сигарет на протяжении жизни проводился с учетом когортной ожидаемой продолжительности жизни и инфляции, и затем эти значения были приведены к чистой текущей стоимости с применением социальной ставки дисконтирования в 3% годовых. Средний возраст взрослого курильщика сигарет в исследуемой выборке составил 40 лет, и средний уровень их расходов на сигареты был эквивалентен 7,2% от среднегодового дохода. Исходя из средней ожидаемой продолжительности жизни в 55 лет для 15-летних, авторы рассчитали, что на протяжении жизни среднее потребление сигарет составляет 217 752 штуки с соответствующими затратами в 8481 доллар США (US$) в пересчете на чистую текущую стоимость. Эта сумма более чем вдвое превышает нынешний среднегодовой заработок рабочего класса. Однако, отказавшись от сигарет, взрослые курильщики могут сэкономить в среднем 6612 долларов США, которые они в противном случае потратили бы на сигареты на протяжении оставшегося ожидаемого срока жизни. Доступность сигарет является важной детерминантой их использования, и налоговая политика оказывает сильное влияние на потребителей, особенно на молодых людей. Эти затраты со временем будут только возрастать, поскольку правительства продолжают повышать налоги, чтобы справиться с проблемами, присущими рынку табака и табачных изделий.
28. Prevalence and Determinants of Frailty in Community-Dwelling Iranian Older Adults: A Cross-Sectional Study.
期刊: Health science reports 发表日期: 2025-Sep 链接: PubMed
摘要
Frailty is one of the most common syndromes in old age. This syndrome, associated with adverse health outcomes and increased economic costs, can affect the quality of life of elderly people. This study investigates the prevalence and determinants of frailty in community-dwelling Iranian older adults. This analytical cross-sectional study was conducted over 5 months among the retired elderly people (> 60 years) in Isfahan. The tools used in this study included a demographic questionnaire, the Pittsburgh Sleep Quality Index (PSQI), an assessment of polypharmacy, and the Edmonton Frail Scale. Data were analyzed using statistical tests in SPSS software. The prevalence of frailty, based on the Edmonton Frail Scale, was 17.4%. No statistically significant difference in mean frailty scores was observed between men and women (p = 0.286). Logistic regression analysis showed that older age (B = 0.067, OR = 1.07, 95% CI: 1.01-1.15), lower education (B = -2.66, OR for MSc = 0.07, 95% CI: 0.00-0.74), polypharmacy (B = 1.82, OR = 6.16, 95% CI: 2.8-13.50), and poor sleep quality (B = 0.59, OR = 1.80, 95% CI: 0.88-3.78) were significantly associated with a higher likelihood of frailty (p < 0.05). This study’s results indicated that age, education, polypharmacy, and poor sleep quality are associated with an increased risk of frailty in Iranian elderly people. Therefore, timely screening and intervention are recommended to identify these factors and prevent their irreversible physical, psychological, and financial consequences.
29. The relationship between nursing students' psychological capital and occupational stigma in the Chinese context: A potential profiling analysis.
期刊: Nurse education in practice 发表日期: 2025-Sep-01 链接: PubMed
摘要
The aim of the present study is to analyse latent profiles of psychological capital and the demographic characteristics of undergraduate nursing students and to explore the relationship between each category and their awareness of occupational stigma. The conventional external view of nurses and a lack of a sense of professional identity may cause nursing students to leave the field. The psychological qualities of nursing students and how they relate to professional stigma must be studied to eliminate professional stigma through positive psychology. Descriptive cross-sectional study. Zhejiang University undergraduate nursing students were examined in July 2024. The questionnaire survey used a general information questionnaire, the Positive Psychological Capital Questionnaire and the Chinese Occupational Stigma Self-Measurement Inventory. Latent profile analysis classified nursing students’ psychological capital, and a mixed regression model examined latent categories, predictor variables and continuous outcome variables. The psychological capital of 1455 nursing students was divided into three profiles: “avoiders” (31.20 %), “compromisers” (42.34 %) and “motivators” (27.69 %). Logistic regression analysis revealed that characteristics like sex, grades, student leadership, graduate education aspirations and nursing attitudes predict psychological capital profiles (p < 0.05). BCH analyses revealed a significant difference in occupational stigma awareness scores among psychological capital profiles (p < 0.05). This study identified moderate psychological capital and occupational stigma in nursing students. It found three psychological capital profiles in nursing students and substantial disparities in occupational stigma. This study helps design treatments to improve nursing students’ psychological protective resources and prevent occupational stigma.
30. Relationship between flow-mediated dilation and urinary albumin-creatinine ratio in patients with type 2 diabetes mellitus.
期刊: Journal of diabetes and its complications 发表日期: 2025-Sep-01 链接: PubMed
摘要
To investigate the association between Flow-Mediated Dilation (FMD) and the urinary albumin-to-creatinine ratio (UACR) in individuals with type 2 diabetes mellitus (T2DM). This cross-sectional study involved 194 individuals diagnosed with T2DM. Participants were categorized into two groups based on their UACR levels: the diabetic kidney disease group (DKD) (UACR≥30 mg/g) and the non-diabetic kidney disease group (non-DKD) (UACR <30 mg/g). The relationship between FMD and UACR was evaluated through Spearman correlation analysis and multivariable logistic regression analysis. Additionally, the predictive capacity of FMD for DKD was determined using receiver operating characteristic curve analysis. Median FMD was lower in DKD group than in non-DKD group (3.9 vs 4.9, p = 0.011). Furthermore, a notable negative correlation was observed between FMD and UACR (r = -0.253, p < 0.05). Through logistic regression analysis, an increase in FMD by one standard deviation (SD) corresponded to a 35.6 % decrease in the likelihood of elevated UACR (OR: 0.644 [0.459-0.904]) (Model 1). Consistent findings were noted even after accounting for variables such as sex, age, BMI, hypertension, smoking habits, and alcohol intake (Model 2), as well as HbA1c levels, disease duration, and triglycerides (Model 3). The area under the ROC curve (AUC) for FMD was 0.686 (95 % CI 0.596-0.777). FMD is independently correlated with UACR, which provides a clinical basis for the prevention and control of vascular complications in early DKD.
31. Development and initial psychometric properties of the timed upper limb assessment in older adults with Parkinson's.
期刊: The British journal of occupational therapy 发表日期: 2025-Sep 链接: PubMed
摘要
Upper limb dysfunction is common in people with Parkinson’s. This study aimed to pilot and establish the initial psychometric properties of the timed upper limb assessment (TULA), a 10-item timed functional upper limb assessment tool. A prospective observational study was conducted with 381 participants (202 with Parkinson’s, 179 controls). The TULA was administered to both groups, with inter-rater reliability assessed in a subset (n = 47). Principal component analysis examined structural validity, while convergent validity was explored through correlations with cognitive and motor assessments. The TULA demonstrated high internal consistency (Cronbach’s α = 0.81 for Parkinson’s group) and high inter-rater reliability (intraclass correlation coefficient (ICC) > 0.9). People with Parkinson’s took significantly longer to complete all items (mean (SD) 22.2 ± 7.5) compared to controls (16.8 ± 3.7, p < 0.001). The tool showed moderate correlation with the timed up and go test (r = 0.56, p < 0.001), a significant low correlation with the Hoehn and Yahr Scale (r = 0.44, p ⩽ 0.001) and a significant low correlation with both the Montreal Cognitive Assessment (r = -0.37, p ⩽ 0.001) and the Mini Mental Status Examination (r = -0.31, p ⩽ 0.001). This study provides an alternative functional upper limb assessment tool for people with Parkinson’s attending occupational therapy. Initial data have been provided to support the reliability and validity of the TULA.
32. Gut microbiota dysbiosis exacerbates polystyrene microplastics-induced liver inflammation via activating LPS/TLR4 signaling pathway in ducks.
期刊: Poultry science 发表日期: 2025-Aug-30 链接: PubMed
摘要
Ubiquitous microplastics can bioaccumulate in organisms, resulting in detrimental health impacts, such as liver inflammation. Nonetheless, the exact mechanism by which polystyrene microplastics (PS-MPs) trigger liver inflammation via the gut-liver axis in ducks remains unclear. The purpose of this study was to clarify the impact of PS-MPs exposure to liver inflammation through the gut-liver axis in ducks. Our investigation indicated that exposure to PS-MPs markedly upregulated the levels of MDA and ROS in the liver tissue and enhanced the release of pro-inflammatory cytokines (TNF-α, IL-6, and IL-1β). Additionally, PS-MPs exposure increased the LPS level, which ultimately triggered the TLR4/NF-κB signaling pathway. Notably, exposure to PS-MPs resulted in a marked change in the gut microbiota composition, primarily indicated by an increase in the relative abundance of Brachyspiraceae and a reduction in that of CAG-74 and Oscillospiraceae. Metabolome analysis further revealed that different expressed metabolites (DEMs) in the positive and negative mode were identified between the control and HMPs groups, including 1-methylhistamine, DL-Methionine sulfoxide, Guanidinoethyl sulfonate, l-Cysteic acid, Deoxyinosine, Camp. Both metagenomic and metabolome analyses showed enrichment in the lysosomal pathway. Correlation analysis suggested association among representative gut microbiota, serum LPS, oxidative stress factors, liver DEMs and key liver inflammatory indicators. Our study sheds light on the mechanism by which PS-MPs exposure induced liver inflammation in ducks via the modulation of the gut-liver axis. These findings improved our understanding of the underlying mechanisms that contribute to PS-MPs-induced hepatotoxicity in avian species.
33. NRF2 deficiency is associated with synaptic alterations and ether-linked phospholipid imbalance in the hippocampus.
期刊: Redox biology 发表日期: 2025-Aug-30 链接: PubMed
摘要
Synaptic loss is a key factor in the cognitive decline observed during aging and in neurodegenerative diseases such as dementia, where synaptopathy plays a central role in hippocampal dysfunction. In this study, we investigated the role of NRF2, a master regulator of cellular homeostasis, in maintaining synaptic integrity. We assessed synaptic contacts both in vitro and in vivo and found that NRF2 deficiency leads to a significant reduction in vGLUT1 levels, accompanied by a decrease in the number of synaptic contacts. Because synapses are subject to highly dynamic membrane remodeling processes, we analyzed the lipid composition of hippocampi and synaptosomes from NRF2-deficient and wild-type mouse littermates. Our results revealed an accumulation of ether-linked phospholipids in NRF2-deficient mice. When primary neuronal and organotypic cultures were exposed to an ether-lipid precursor, synaptic density decreased. By contrast, the NRF2 activator 6-(methylsulfinyl)hexyl isothiocyanate (6-MSITC or hexaraphane) prevented synaptic loss. Although ether lipids are abundant components of neuronal membranes, their specific role in synaptic function and in age-related loss of homeostatic balance remains poorly understood. This study is the first to demonstrate that NRF2 plays an essential role in preserving synaptic homeostasis through lipid metabolism, suggesting its relevance in the context of aging and neurodegenerative diseases.
34. Nursing students' perceptions of renewable energy sources and awareness of reducing ecological footprint: A cross-sectional study.
期刊: Nurse education today 发表日期: 2025-Aug-30 链接: PubMed
摘要
Environmental issues pose significant health threats, requiring both individual actions and societal regulations. As educators and change agents, nurses play key roles in fostering environmental awareness and sustainable practices. Therefore, it is essential for nursing students to understand these issues and be equipped to address them. This study aimed to examine nursing students’ perceptions of renewable energy and their awareness of reducing ecological footprints. A descriptive cross-sectional study was conducted. The population of the study consisted of a total of 500 students studying in the nursing faculty of a state university, 400 students were included in study. Data were collected during the 2022-2023 academic year using a self-administered questionnaire including a sociodemographic information form, the Awareness Scale for Reducing Ecological Footprint, and the Renewable Energy Perception Scale. Nursing students demonstrated overall favorable perceptions of renewable energy (mean: 93.81 ± 14.21; range: 25-115) and awareness of ecological footprint reduction (mean: 118.7 ± 21.78; range: 30-150). Significant differences were observed in perceptions of renewable energy sources based on gender, year of study, place of residence, and whether students had taken an environmental course (p < 0.05). However, ecological footprint reduction awareness only differed significantly by year of study (p < 0.05). A strong positive correlation was identified between scores on the Awareness Scale for Reducing Ecological Footprint and the Renewable Energy Perception Scale (p < 0.01, r = 0.523). The study indicates that nursing students possess moderate to high levels of awareness regarding ecological footprint reduction and favorable perceptions of renewable energy. Increasing ecological footprint reduction awareness may enhance perceptions of renewable energy use, highlighting the importance of incorporating environmental education into nursing curricula to equip future nurses with the knowledge and responsibility to promote sustainability.
35. Vegetarian diets for longevity: friend or foe?
期刊: Maturitas 发表日期: 2025-Aug-30 链接: PubMed
摘要
Vegetarianism is a healthy dietary pattern that is postulated to increase longevity. Vegetarianism is adopted for animal ethics, environmental reasons, or religious beliefs. Vegetarian diets are believed to improve the gut microbiome, body weight, cardiovascular health and inflammation; however, a synthesis of the up-to-date evidence does not seem to support these effects. When objective measures are sought, it becomes apparent that there is a lack of high-quality evidence regarding the effect of vegetarian diets on telomere length. Moreover, studies indicating lower mortality rates for vegetarians than for meat eaters appear to be highly biased. Among the geographical areas with higher-than-expected numbers of centenarians (‘blue zones’), only one site is largely inhabited by vegetarians, whereas the rest have populations largely of flexitarians. Overall, available research does not indicate the superiority of vegetarian diets over flexitarian ones. The issue merits further research to help us understand vegetarianism’s effects on longevity.
36. Predictive modeling of bruising in broiler chickens using machine learning algorithms.
期刊: Poultry science 发表日期: 2025-Aug-29 链接: PubMed
摘要
Bruising chicken broiler is caused by physical stress and injury to the skin and underlying tissues is a major problem in poultry production, affecting both animal welfare and economic outcomes. The aim of this study was to classify the bruising class (low or high percentage of carcass showing bruise at slaughterhouse) per truckload comparing the predictive performance of six machine learning (ML) models- Least Absolute Shrinkage and Selection Operator (LASSO), Classification Tree (CT), Random Forest (RF), Naïve Bayes (NB), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGB)- and using a data set including information about season, time of transport, sex of the flock, flock size, chicken age, chicken mean body weight, housing stocking density, on farm mortality and culling rate, and feed withdrawal time. The general objective was to offer tools for the early detection of flocks with a higher likelihood of bruising and to highlight how ML can support decision-making, strengthen welfare monitoring programs, and reduce economic losses in commercial broiler production. The dataset comprised 26,031 truckloads, each averaging 3,026 ± 245 broilers, and included 14 predictors spanning the rearing, catching, transportation, and slaughtering phases. Data were collected from a commercial broiler producer in Thailand between 2021 and 2022. Bruising percentages ranged from 0 to 4%, with values above 0.8% classified as high, accounting for 41.4% of all truckloads. Due to this distribution, model training was conducted without resampling. Among the evaluated models, the XGB algorithm outperformed the other five machine learning models in predicting bruising in broilers, although the overall predictive accuracy was moderate, likely due to the absence of certain key variables. The most important variables included mean body weight, transport duration, in housing and transport crate stocking density, transport distance, mortality and culling rate throughout the birds’ entire life at the farm, feed withdrawal time, and duration in lairage. These findings demonstrate the utility of ML, especially XGB, for supporting early identification of broiler flocks prone to bruising. By applying targeted management interventions-such as maintaining bird health, in housing and transport crate stocking density, feed withdrawal, and lairage duration-producers can mitigate bruising, thereby enhancing both animal welfare and operational efficiency.
37. Blending of virtual reality with high-fidelity simulation for interprofessional team training: A mixed methods study.
期刊: Nurse education today 发表日期: 2025-Aug-28 链接: PubMed
摘要
Developing interprofessional competencies at the pre-registration level is essential for preparing a collaborative practice-ready workforce committed to patient-centered care and safety. (1) To evaluate the impact of a Blended Learning Approach with Simulation-based TeamSTEPPS® (BLAST) training on nursing and medical students’ attitudes, knowledge, and perceived confidence in interprofessional collaboration, and (2) to explore the learning experiences of students and teaching experiences of simulation facilitators. Mixed-methods design using a one-group pretest-posttest design and focus group discussions. A public tertiary university in Singapore. Final year nursing and medical students participated in the BLAST training, which delivered the TeamSTEPPS® training using multi-user virtual reality simulation followed by high-fidelity simulation. Pre- and post-tests assessed students’ understanding of TeamSTEPPS® key concepts and tools, as well as their attitudes and perceived confidence in interprofessional teamwork. Nine focus group discussions were conducted with students and simulation facilitators. Quantitative and qualitative data were triangulated. Students demonstrated statistically significant improvements in their understanding of TeamSTEPPS® key concepts, overall attitudes towards interprofessional teamwork, and perceived value of interprofessional training. The virtual reality simulation was reported to improve students’ confidence in participating the high-fidelity simulation. Three themes emerged from the focus group discussions: (1) synergy of interprofessional learning, (2) blended simulation as a learning scaffold, and (3) operationalizing blended simulation. The triangulated data revealed that the integration of virtual reality simulation followed by in-person simulation was a promising pedagogical approach for interprofessional training. This study supports the use of a blended simulation-based learning approach for interprofessional team training, highlighting the benefits of scaffolded learning in enhancing knowledge, collaboration, and communication skills among nursing and medical students. The findings point to the need for innovative approaches to enable sustainable and scalable interprofessional team training.
38. Serogroup W invasive meningococcal disease outbreak in Qatar following travel to Umrah.
期刊: Journal of infection and public health 发表日期: 2025-Aug-28 链接: PubMed
摘要
Invasive meningococcal disease (IMD) is associated with significant morbidity and mortality in all age groups. Globally, reported cases predominantly belong to serogroups A, B, and C. Although serogroup W is less prevalent with regional distribution, it demonstrates shifting epidemiology linked to travel. Recently, multiple sporadic cases of serogroup W invasive disease were reported from Western countries following travel to the Middle East. In this case series, we describe a group of three unlinked cases of IMD within one week. Affected patients aged 8 months, 39 years, and 67 years and were all linked to recent travel to Umrah, Kingdom of Saudi Arabia (KSA) with no recent vaccination in the two cases. Despite early management, there were two fatalities. By reporting these cases, we aim to raise awareness to urge public health authorities and policy makers to impose meningococcal vaccine prior to Umrah along with stringent infection control measures.
39. Exposure to per- and polyfluoroalkyl substances during fetal development and risk of testicular germ cell cancer in adulthood.
期刊: Environment international 发表日期: 2025-Aug-28 链接: PubMed
摘要
Testicular germ cell cancer (TGCC) originates during fetal life. Fetal exposure to environmental chemicals may contribute to its development, but epidemiological data are lacking. We investigated per- and polyfluoroalkyl substances (PFAS), which can act as endocrine disruptors during fetal development, and TGCC risk in adulthood. We conducted a nested case-control study of 549 mother-male offspring pairs (103 TGCC cases, 446 matched controls). The source population included over 100,000 pregnant women with biobanked serum samples collected during 1985-1994, a period before PFAS restrictions. Male offspring were followed for up to 38 years, and TGCC cases were identified from the Danish Cancer Registry based on histological confirmation. Eight PFAS were quantified in maternal serum using LC-MS/MS. Associations between individual PFAS and their mixtures with TGCC risk were assessed through Cox regression and quantile g-computation models. Associations between individual PFAS and TGCC risk were modest and not statistically significant. Hazard ratios (HRs) for perfluoroalkyl sulfonic acids (PFOS, PFHxS, PFHpS) suggested higher TGCC risks per quartile increase in concentrations, but lower risks for perfluoroalkyl carboxylic acids (PFOA, PFNA, PFDA, PFHpA, PFUnDA). Mixture analyses supported this pattern, with higher TGCC risk for the joint effect of sulfonic acids (HR 1.13, 95 % CI: 0.89; 1.44). Stratified analyses by histological subtype showed higher risk for seminomas than for nonseminomas across all PFAS. We found limited evidence of an association between fetal PFAS exposure and TGCC risk. Indications of a potential adverse effect of perfluoroalkyl sulfonic acids, particularly for seminomas, merit further research.
40. An unexpected dengue outbreak in Taiwan, 2023: A retrospective analysis of potential risk factors.
期刊: Journal of infection and public health 发表日期: 2025-Aug-26 链接: PubMed
摘要
Taiwan experienced a major dengue outbreak in 2023 following the relaxation of COVID-19 border controls. The contributing factors remained unclear. This study investigated potential virological, immunological, and clinical drivers. We retrospectively analyzed laboratory-confirmed dengue virus (DENV) infections at a tertiary care hospital in southern Taiwan. Serotypes were identified by qRT-PCR. Viral origins were assessed through phylogenetic and envelope (E) gene amino acid analyses. Clinical features of DENV-1 and DENV-2 cases were compared. Neutralization and antibody-dependent enhancement (ADE) were evaluated using PRNT and ADE assays. DENV-1 and DENV-2 were identified as the predominant circulating serotypes. Clinical analysis revealed that DENV-2 infection was significantly associated with older age, diabetes mellitus, hypertension, and elevated hematocrit levels (p < 0.05), and these associations remained statistically significant in multivariate analysis. Phylogenetic analysis showed that DENV-1 isolates belonged to genotypes I and IV, while DENV-2 strains were of the cosmopolitan genotype. These viruses clustered closely with strains from Southeast Asia. Amino acid analysis indicated that DENV-1 strains exhibited 2-10 substitutions relative to 2014 isolates, while DENV-2 strains closely matched those from 2015. Sera from the 2014-2015 outbreaks demonstrated potent homotypic but limited heterotypic neutralization. ADE was observed in heterotypic infection contexts. The 2023 dengue outbreak in Taiwan was driven by co-circulation of DENV-1 and DENV-2, limited heterotypic immunity, and ADE. These findings highlight the importance of integrated virological surveillance, genotype monitoring, and immunological assessment to inform dengue control strategies in non-endemic regions experiencing imported viral threats.
41. Frequency and factors associated with the preference for self-testing for human papillomavirus detection.
期刊: Revista peruana de medicina experimental y salud publica 发表日期: 2025-Aug-25 链接: PubMed
摘要
Motivation for the study. Cervical screening is key to early detection of cancer, but its acceptability limits its implementation. It is essential to understand preferences for self-sampling to facilitate its implementation. Findings. Factors such as educational level, marital status, place of origin, religion, and knowledge are associated with a preference for self-sampling to detect human papillomavirus. Implications. Health authorities can use these findings to strengthen the promotion of self-sampling through educational campaigns focused on populations with factors that limit its acceptance, thereby improving screening coverage. To analyze the frequency and factors associated with self-sampling preference for detecting human papillomavirus (HPV) in Peruvian women at a healthcare center, 2023-2024. A cross-sectional analytical study was conducted. The sample consisted of 275 women aged 30 to 49 years who from the Rinconada Healthcare Center. The main variable was evaluated directly using a dichotomous question, which revealed the user’s preference for this method of cervical sample collection for HPV detection. The instrument was a valid and reliable questionnaire. Multivariate statistics were used to find the associated factors. We found that 75.6% of users prefer self-sampling for HPV detection. Adjusted analysis showed that higher education (RPa=1.28; 95% CI: 1.01-1.64) and secondary education (RPa=1.46; 95% CI: 1.11-1.92) increased the likelihood of preferring self-sampling; while cohabiting marital status (RPa=0.61; 95% CI: 0.44-0.83), being from the rest of the coast (RPa=0.70; 95% CI: 0.50-0.97), Catholic religion (RPa=0.84; 95% CI: 0.74-0.96) and having a higher quartile of knowledge about HPV (RPa=0.88; 95% CI: 0.71-0.95) reduced the likelihood of preferring self-sampling. The frequency of preference for self-sampling for HPV detection is high and is associated with secondary/higher education, cohabitation, living on the coast except for the capital, being Catholic, and having a higher level of knowledge about HPV. Motivation for the study. Cervical screening is key to early detection of cancer, but its acceptability limits its implementation. It is essential to understand preferences for self-sampling to facilitate its implementation. Findings. Factors such as educational level, marital status, place of origin, religion, and knowledge are associated with a preference for self-sampling to detect human papillomavirus. Implications. Health authorities can use these findings to strengthen the promotion of self-sampling through educational campaigns focused on populations with factors that limit its acceptance, thereby improving screening coverage. Analizar la frecuencia y los factores asociados a la preferencia de la autotoma para detectar el virus del papiloma humano (VPH) en peruanas de un establecimiento de salud, 2023-2024. Se realizo un estudio transversal analítico. La muestra se conformó por 275 mujeres de 30 a 49 años atendidas en el Puesto de Salud Rinconada. La variable principal fue evaluada directamente mediante una pregunta dicotómica, que evidenció la preferencia de la usuaria por esta modalidad de adquisición de muestra cervicouterina para la detección del VPH. El instrumento fue un cuestionario valido y confiable. Se uso estadística multivariada para hallar los factores asociados. El 75,6% de las usuarias prefiere la autotoma para detectar el VPH. En el análisis ajustado, el grado de instrucción superior (RPa=1,28; IC95%: 1,01-1,64) y secundaria (RPa=1,46; IC95%: 1,11-1,92) incrementaron la probabilidad de preferir la autotoma; mientras que el estado civil conviviente (RPa=0,61; IC95%: 0,44-0,83), la procedencia del resto de la costa (RPa=0,70; IC95%: 0,50-0,97), la religión católica (RPa=0,84; IC95%: 0,74-0,96) y poseer un cuartil superior de conocimientos sobre el VPH (RPa=0,88; IC95%: 0,71-0,95) redujo la probabilidad de preferir la autotoma. La frecuencia de la preferencia por la autotoma para detección del VPH es elevada y se asocia con el grado de instrucción secundaria/superior, ser conviviente, proceder de la costa exceptuando la capital, ser católica y tener mayor nivel de conocimientos sobre el VPH. Motivación. El tamizaje cervical es clave para detectar precozmente el cáncer, pero su aceptabilidad limita su realización. Es esencial conocer la preferencia por la autotoma para facilitar su implementación. Hallazgos. Factores como el nivel de instrucción, estado civil, lugar de origen, religión y conocimiento están asociados con la preferencia de autotoma para detectar el virus del papiloma humano. Implicancias. Las autoridades sanitarias pueden usar estos hallazgos para fortalecer la promoción de la autotoma a través de campañas educativas, enfocadas en poblaciones con factores que limitan su aceptación, mejorando la cobertura del tamizaje. Motivación. El tamizaje cervical es clave para detectar precozmente el cáncer, pero su aceptabilidad limita su realización. Es esencial conocer la preferencia por la autotoma para facilitar su implementación. Hallazgos. Factores como el nivel de instrucción, estado civil, lugar de origen, religión y conocimiento están asociados con la preferencia de autotoma para detectar el virus del papiloma humano. Implicancias. Las autoridades sanitarias pueden usar estos hallazgos para fortalecer la promoción de la autotoma a través de campañas educativas, enfocadas en poblaciones con factores que limitan su aceptación, mejorando la cobertura del tamizaje.
42. Disease burden from tobacco consumption in Peru and the projected effect of strengthening control measures: a modeling study.
期刊: Revista peruana de medicina experimental y salud publica 发表日期: 2025-Aug-25 链接: PubMed
摘要
Motivation for the study. Despite progress in tobacco control, the economic and disease burden in Peru remains high. Strengthening smoke-free regulations, implementing plain packaging, banning tobacco promotion and sponsorship, and increasing taxes could reduce it. Main findings. Tobacco use causes 22,350 deaths and 126,000 disease events annually in Peru, resulting in a loss of 1.28% of GDP. Strengthening tobacco control policies would prevent thousands of deaths and save billions in costs. Implications. Stricter tobacco control policies can reduce the health and economic costs associated with smoking for the advancement of public health and economic sustainability in Peru. To estimate the economic burden and disease burden associated with tobacco use in Peru and the projected effect of strengthening specific tobacco control measures. We used a Markov microsimulation model to assess smoking-attributable mortality, disease events, economic costs, and projected benefits over ten years, considering the implementation of measures such as plain packaging, full enforcement of smoke-free laws, a complete ban on tobacco advertising, promotion, and sponsorship, and increased cigarette taxes. Each year in Peru, approximately 22,350 deaths and 126,000 disease events are attributable to tobacco use, accounting for 19% of all deaths from heart disease, 18% of deaths from stroke, and 515,768 years of life lost. In addition, approximately 1.28% of gross domestic product is lost annually due to smoking. Over ten years, the implementation of plain packaging could prevent 6,218 deaths, 31,700 events, and save 576 million USD. Full compliance with smoke-free places would prevent 4,982 deaths, 25,400 events, and save 461 million USD. Banning advertising, promotion, and sponsorship could prevent 8,767 deaths, 44,700 events, and save 812 million USD. Increasing cigarette prices by 50% could prevent 20,400 deaths, 658,400 healthy life years lost, and an economic benefit of more than 3.3 billion USD. The economic and disease burden of tobacco use in Peru is significant. Greater efforts to control tobacco would significantly reduce this burden. Motivation for the study. Despite progress in tobacco control, the economic and disease burden in Peru remains high. Strengthening smoke-free regulations, implementing plain packaging, banning tobacco promotion and sponsorship, and increasing taxes could reduce it. Main findings. Tobacco use causes 22,350 deaths and 126,000 disease events annually in Peru, resulting in a loss of 1.28% of GDP. Strengthening tobacco control policies would prevent thousands of deaths and save billions in costs. Implications. Stricter tobacco control policies can reduce the health and economic costs associated with smoking for the advancement of public health and economic sustainability in Peru. Estimar la carga económica y de enfermedad asociada al consumo de tabaco en Perú y el efecto proyectado de fortalecer medidas específicas de control del tabaco. Utilizamos un modelo de microsimulación de Markov para evaluar la mortalidad atribuible al tabaquismo, eventos de enfermedad, costos económicos y beneficios proyectados a diez años considerando la implementación de medidas como el empaquetado neutro, el cumplimiento total de las leyes sobre lugares libres de humo, la prohibición completa de la publicidad, promoción y patrocinio del tabaco, y aumento de los impuestos sobre los cigarrillos. Anualmente en Perú, alrededor de 22,350 muertes y 126,000 eventos de enfermedad son atribuibles al tabaquismo, con 19% de todas las muertes por enfermedades cardíacas, 18% de las muertes por accidente cerebrovascular y 515,768 años de vida perdidos. Además, aproximadamente el 1,28% del producto bruto interno se pierde anualmente debido al tabaquismo. Durante diez años, la implementación del empaquetado neutro podría evitar 6218 muertes, 31,700 eventos y ahorrar USD 576 millones. Cumplir completamente con los lugares libres de humo evitaría 4982 muertes, 25,400 eventos y ahorraría USD 461 millones. Prohibir la publicidad, promoción y patrocinio podría prevenir 8767 muertes, 44,700 eventos y ahorrar USD 812 millones. Aumentar el precio de los cigarrillos en un 50% podría evitar 20,400 muertes, 658,400 años de vida saludables perdidos, y un beneficio económico superior a los USD 3300 millones. La carga económica y de enfermedad del uso del tabaco en Perú es importante. Un mayor esfuerzo en el control del tabaco reduciría significativamente esta carga. Motivación para realizar el estudio. A pesar del progreso en el control del tabaco, la carga económica y de enfermedad en Perú sigue siendo alta. Fortalecer las regulaciones de espacios libres de humo, implementar empaquetado neutro, prohibir la promoción y patrocinio del tabaco, e incrementar los impuestos podrían reducirla. Principales hallazgos. El tabaquismo causa 22,350 muertes y 126.000 eventos de enfermedad anualmente en Perú, resultando en una pérdida del 1,28% del PBI. Fortalecer las políticas antitabaco evitarían miles de muertes y ahorrarían miles de millones en costos. Implicaciones. Políticas más estrictas de control del tabaco pueden reducir los costos de salud y económicos asociados al tabaquismo para el avance de la salud pública y la sostenibilidad económica en Perú. Motivación para realizar el estudio. A pesar del progreso en el control del tabaco, la carga económica y de enfermedad en Perú sigue siendo alta. Fortalecer las regulaciones de espacios libres de humo, implementar empaquetado neutro, prohibir la promoción y patrocinio del tabaco, e incrementar los impuestos podrían reducirla. Principales hallazgos. El tabaquismo causa 22,350 muertes y 126.000 eventos de enfermedad anualmente en Perú, resultando en una pérdida del 1,28% del PBI. Fortalecer las políticas antitabaco evitarían miles de muertes y ahorrarían miles de millones en costos. Implicaciones. Políticas más estrictas de control del tabaco pueden reducir los costos de salud y económicos asociados al tabaquismo para el avance de la salud pública y la sostenibilidad económica en Perú.
43. Infections resulting from wild land and aquatic species injuries: A case series from Mornington Peninsula, Australia.
期刊: Injury 发表日期: 2025-Aug-24 链接: PubMed
摘要
Urban expansion into natural habitats has increased human interactions with wild terrestrial and aquatic species, leading to a rise in animal-related injuries. These incidents often result in complex infections, posing major public health challenges. This study examines the epidemiology, therapeutic interventions, and clinical outcomes of infections from non-domesticated animal injuries in the Mornington Peninsula, Australia. This retrospective study (February 2021-April 2024) evaluated medical records of patients presenting with injuries from wild species who subsequently developed infections. Selection criteria included only cases with confirmed infections determined by clinical assessment or positive microbial cultures. Injuries from domestic animals, insects, or humans were excluded. The analysis assessed timing of infection onset, microbial culture results, antibiotic sensitivity profiles, and postoperative trajectories. A total of 52 bites from non-domesticated animals were documented, with 23 % (12/52) being infected. Most were males with an average age of 43 years. Among the 12 infected cases, Staphylococcus aureus was isolated in 3/12 (25 %), β-haemolytic streptococci in 2/12 (17 %), Enterococcus faecalis in 1/12 (8 %), Pseudomonas aeruginosa in 1/12 (8 %), Prevotella bivia in 1/12 (8 %), and Vibrio vulnificus in 1/12 (8 %); mixed coliform growth was observed in 3/12 (25 %). Compared to typical dog and cat bites, usually caused by Pasteurella multocida, streptococci, staphylococci and anaerobes, our series revealed a higher presence of marine-associated pathogens such as Vibrio species and environmental Gram-negative bacilli. Management involved wound debridement with adjunctive medical therapy (7/12), delayed primary closure (3/12), and medical management alone (3/12). All patients received empirical broad-spectrum antibiotics, which were later adjusted based on culture results. Most isolates were pan-sensitive, except for Vibrio vulnificus (ciprofloxacin-sensitive, resistant to penicillins/cephalosporins) and penicillin-resistant Staphylococcus aureus. All patients recovered without complications following comprehensive wound care and targeted antibiotic therapy. Notably, some marine-derived infections exhibited unique resistance patterns that required specific antimicrobial regimens. The necessity for immediate comprehensive wound management and empirically guided antibiotic therapy, adjusted based on culture results, was essential for managing these complex infections. The data derived from this study provides essential insights into the microbial dynamics and clinical management of wild animal bite infections, emphasizing the need for individualized medical strategies.
44. The use of discrete choice experiments in evaluating telehealth: a systematic review.
期刊: Health policy (Amsterdam, Netherlands) 发表日期: 2025-Aug-22 链接: PubMed
摘要
There is a growing body of evidence from discrete choice experiments related to telehealth. Discrete choice experiments offer valuable insights in informing the design and evaluation of telehealth services and supporting the telehealth implementation and policy. This review aims to examine studies assessing consumer preferences for telehealth using discrete choice experiments. A systematic review was conducted, searching five health and multidisciplinary databases from inception until 4 April 2024. Grey literature searches, hand-searching, and reference list checks were also performed. Of 2832 studies screened, 52 met the inclusion criteria. Most studies were conducted from the patient perspective (n=47/52, 90 %) and covered a wide range of populations and settings. Of the included studies eligible for quality assessment, 68 % (n=23/34) received high-quality ratings, while others were assessed as moderate. Studies comparing face-to-face consultations with telehealth generally found a preference for face-to-face appointments. Telehealth is viewed more favourably if it can be offered at a lower cost, reduces wait times, and is part of a comprehensive care plan. Telehealth tends to be preferred by younger patients and clinicians, those digitally literate, and those with less severe or more private and stigmatised health conditions. While face-to-face consultations are generally preferred, telehealth is viewed as advantageous if it reduces costs, shortens wait times, and is integrated into comprehensive care. The findings highlight the importance of considering these attributes when designing telehealth preference studies and informing the adoption and design of telehealth services.
45. A secondary analysis of the effects of IQOS use on cigarette smoking: Do the effects differ by sex?
期刊: Drug and alcohol dependence 发表日期: 2025-Aug-22 链接: PubMed
摘要
Through secondary data analyses, we investigated sex differences in the effects of IQOS, a heated tobacco product, on combustible cigarette smoking. Adults who smoke cigarettes (N = 118; 21-65 years old) completed a baseline ad-lib smoking period (days 1-5), two laboratory visits (days 6-7), and a 14-day period where they were instructed to switch from smoking cigarettes to using IQOS 3.0 (days 8-21). Models estimated the changes in cigarettes smoked per day (CPD) and the percentage of baseline CPD substituted by HeatSticks during the switch period. Bivariate statistics assessed sex differences in covariates and IQOS-associated effects (i.e., subjective reward, relative reinforcing value, craving relief, and withdrawal relief) for model inclusion. Males and females significantly reduced their CPD to 29.8 % and 21.8 % of their baseline CPD by the end of the switch period, respectively. CPD slopes were significant for males (β =-0.46/day [CI95 % -0.97 to -0.04] p = 0.002) and females (β =-0.83/day [CI95 % -1.34 to -0.31] p < 0.001), although slopes did not significantly differ (p = 0.3). Males and females substituted HeatSticks at 83.2 % and 67.4 % of their baseline CPD across the switch period. The IQOS slopes were significant for males (β =1.136/day [CI95 % 0.59-2.14] p = 0.001) but not females (β =0.64/day [CI95 % -0.67-1.94] p = 0.34), although the slopes did not significantly differ (p = 0.36). There were no significant sex differences in IQOS-associated effects (all p values > 0.05). Males and females do not appear to differ in IQOS-associated effects or the initial substitutability of IQOS for combustible cigarettes.
46. What matters most to the population in case of chronic conditions? Results from a discrete choice experiment in Italy.
期刊: Health policy (Amsterdam, Netherlands) 发表日期: 2025-Aug-20 链接: PubMed
摘要
Relational continuity, care coordination, and teamwork are widely recognized as key components of quality in primary care. This study investigates population preferences regarding organizational models of primary care, with a particular focus on the roles of general practitioners, specialists, and nurses. A Discrete Choice Experiment (DCE) was conducted through a nationwide online cross-sectional survey, employing a full factorial experimental design with 20 randomly selected choice sets to minimize cognitive burden. The attributes examined included coordination, relational continuity, and teamwork. Data were collected from a representative sample of 2,553 respondents across Italy in early 2021. Results underscore the centrality of teamwork (OR=1.85 in mild and 2.31 in severe chronic conditions), followed by relational continuity (OR=1.60 in mild and 1.55 in severe conditions). Coordination ranks third (OR=1.31) for mild conditions but reaches parity with relational continuity in the context of severe chronic conditions. These findings offer robust evidence of differentiated preferences based on chronic disease severity and support the design of tailored primary care models. In conclusion, this analysis highlights the importance of incorporating coordination, relational continuity, and teamwork in the configuration of primary care services, offering policy-relevant insights for adapting delivery models to the needs of patients with varying levels of chronicity.
47. Spatial and seasonal assessment of heavy metal contamination in Golden Horn sediments, İstanbul, Türkiye: Ecological impacts, human health risks, and environmental monitoring.
期刊: Journal of contaminant hydrology 发表日期: 2025-Aug-20 链接: PubMed
摘要
This study investigates the concentrations of heavy metals (As, Hg, Cd, Cr, Cu, Ni, Pb, Zn) in surface sediments of the Golden Horn, a historically significant natural harbor and UNESCO World Heritage Site inlet of the Bosphorus in İstanbul, Türkiye. The novelty of this research lies in providing the first comprehensive dual-risk assessment for the Golden Horn estuary, integrating ecological impact evaluation with human health risk characterization via ingestion and dermal contact pathways, considering both carcinogenic and non-carcinogenic effects of sediment-bound heavy metals. Concentrations exhibited significant seasonal variation, with summer months showing peak levels, notably for for Cu (1279.70 mg/kg)), Zn (1071.96 mg/kg), and Pb (894.14 mg/kg). Several metals exceeded Probable Effect Concentration (PEC) thresholds, indicating potential ecological risks such as biodiversity decline and food chain contamination. Pollution Load Index (PLI) values ranged from 2.09 to 10.25 (PLI > 1), confirming substantial sediment pollution. Enrichment Factor (EF) values varied between 0.80 and 17.44, highlighting considerable contamination, particularly by Cu, Pb, As, Zn, Cd, and Cr. Potantial Ecological Risk Factor (Er) values for Cu, Pb, and Zn indicate a very high ecological threat. Potantial Ecological Risk Index (RI) values ranged from 1045.69 to 7317.72, suggesting severe ecological risks, whereas the Toxic Risk Index (TRI) indicated low toxic risk for Cu (5.78). Health risk assessments revealed increased vulnerability in children, with carcinogenic risk values exceeding acceptable limits for both children and adults. These results underscore the urgent need for remediation to mitigate environmental and human health risks posed by heavy metal contamination in the Golden Horn sediments. ENVIRONMENTAL IMPLICATION: This study highlights the presence and distribution of heavy metals in the sediments of the Golden Horn, indicating potential ecological degradation and risks to marine biodiversity. The findings indicate that certain locations exceed sediment quality guidelines, posing threats to benthic organisms and the safety of the food chain. Ecological and human health risk assessments suggest that prolonged exposure may lead to bioaccumulation and adverse health effects. These results underscore the urgent need for pollution control strategies, sustainable management of industrial discharges, and continuous environmental monitoring to protect coastal ecosystems and safeguard public health in the region.
48. Overcoming the barriers to treatment of rare cancer patients in the era of precision oncology: A call to action.
期刊: Cancer treatment reviews 发表日期: 2025-Aug-14 链接: PubMed
摘要
Rare cancers account for a quarter of cancer diagnoses in Europe yet clinical research, diagnosis, treatment access, and survival outcomes lag significantly behind common cancers. Despite the potential of precision oncology, the consistent implementation of comprehensive genomic profiling in routine clinical practice and robust evidence-generation remains a challenge in this population, compounded by regulatory hurdles and a lack of investment in drug development. A concerted effort across all stakeholders is required to optimise diagnostics, including access to molecular profiling, to expedite clinical trials and treatment access, and to gather high-quality data, including patient-reported outcomes, in rare cancers. Some initiatives are already showing promise including the establishment of national expert reference centres and European Reference Networks such as EURACAN. However, further collaboration is required to speed up the diagnostic trajectory so that rare cancer patients present with less late-stage disease, and to facilitate clinical trials leading to wider access to precision oncology drugs shown to be safe and effective. In the context of so many hurdles (diagnosis, treatment, research, development and regulatory), there is an even greater role for patient and clinical trial organisations and funders to help fill the aforementioned gaps. Innovative solutions are urgently required to address the high unmet medical need for patients with rare cancers.
49. Expansive bodies and chronic obstructive pulmonary disease under mass supervision.
期刊: Social science & medicine (1982) 发表日期: 2025-Aug-14 链接: PubMed
摘要
Negative health outcomes experienced by individuals and communities impacted by carceral systems have been documented across the social science and public health literature for some time. This research has tended to prioritize the health impact of incarceration, while outcomes associated with the largest system of correctional control, community supervision (e.g. parole and probation), have only recently begun to be examined. These examinations have tended to prioritize structural pathways, deploying a “social determinants of health” framework ubiquitous in public health research and policy making. While a powerful tool in revealing structural violences and understanding population level health disparities, this approach does little in terms of addressing the nuance of individual experience and its implications for health. Understanding the nuance of “experience” requires not only rigorous qualitative data collection, but also frameworks which can help in interpreting this kind of data. In this paper, I argue that an integrated political ecology of bodies framework (PEB 2.0) more usefully explains the health experiences and outcomes of people who live under community supervision (parole and probation). To do so, I use existing epidemiological and biomedical literature to examine the prevalence of COPD among people serving sentences of parole and probation. By using a PEB framework that imagines the production of embodied health and wellbeing as always simultaneously structural, discursive and experiential, this paper demonstrates a more nuanced understanding of people’s experiences of negative health outcomes. Furthermore, instead of focusing on incarcerated people, this article addresses a glaring absence in the public health literature by focusing on the health outcomes of people in the largest system of correctional control, community supervision. As such, this paper suggests more productive lines of inquiry not only in public health research, but also in advancing abolitionist praxis.
50. Association of deep learning-derived histologic features of placental chorionic villi with maternal and infant characteristics in the New Hampshire birth cohort study.
期刊: Placenta 发表日期: 2025-Jul-23 链接: PubMed
摘要
Quantification of placental histopathological structures is challenging due to a limited number of perinatal pathologists, constrained resources, and subjective assessments prone to variability. Objective standardization of placental structure is crucial for easing the burden on pathologists, gaining deeper insights into placental growth and adaptation, and ultimately improving maternal and fetal health outcomes. Leveraging advancements in deep-learning segmentation, we developed an automated approach to detect over 9 million placenta chorionic villi from 1531 term placental whole slide images from the New Hampshire Birth Cohort Study. Using unsupervised clustering, we successfully identified biologically relevant villi subtypes that align with previously reported classifications - terminal, mature intermediate, and immature intermediate - demonstrating consistent size distributions and comparable abundance. We additionally defined tertile-based combinations of villi area and circularity to characterize villous geometry. This study applies these cutting-edge AI methods to quantify villi features and examine their association with maternal and infant characteristics, including gestational age at delivery, maternal age, and infant sex. Increasing gestational age at delivery was statistically significantly associated (p = 0.003) with an increase in the proportion of mature intermediate villi and a decrease in the proportion of the smallest, most circular villi (p < 0.001). Maternal age and infant sex were not statistically significantly associated with measures of villous geometry. This work presents a workflow that objectively standardizes chorionic villi subtypes and geometry to enhance understanding of placental structure and function, while providing insights into the efficiency, growth, and the architecture of term placentas which can be used to inform future clinical care.
51. Who's Not Talking? Nonresponse Bias in Healthcare Employee Well-Being Surveys.
期刊: Journal of healthcare management / American College of Healthcare Executives 发表日期: 链接: PubMed
摘要
Employee well-being surveys are essential tools used by healthcare leaders to assess workforce functioning, such as burnout, team dynamics, and perceptions of support, but surveys frequently have low response rates, which may skew results. Research on nonresponse bias is limited because of the difficulty in sourcing data on outcomes of interest from nonrespondents. This study aimed to examine whether nonrespondents and respondents differed on key outcomes of interest to healthcare leaders to understand whether results of an employee well-being survey were valid. Specifically, we examined differences between respondents and nonrespondents in terms of demographics, turnover over one-year postsurvey, and employee functioning such as productivity and work outside of regular work hours. By using objective data as a proxy for physician functioning, our innovative approach allowed us to study nonresponse bias without relying on a follow-up survey of nonrespondents. The goal was to inform leaders about potential biases that impact survey conclusions and, therefore, better interpret the survey results in decision-making. The longitudinal study included physicians (N = 348) and advanced practitioners (APs) (i.e., physician assistants, nurse practitioners, and certified nurse midwives; N = 143) from obstetrics and gynecology clinics in the Midwest and Northwest United States, who were invited to complete an employee well-being survey in 2021. Data on demographics, turnover, and other workplace environment indicators-i.e., productivity measured by relative value units (RVUs), work outside of regular work hours, duration of encounters, and appointment cancellations-were collected from electronic health records (EHRs) and human resources information systems (HRIS). Employment status was tracked for 1.25 years post-survey. The study examined demographic differences (i.e., age, gender, race/ethnicity, marital status), assessed the relative risk of turnover at each quarter over 1.25 years, and evaluated differences in productivity and workplace variables between respondents and nonrespondents. For relative risk, we observed turnover differences between retirement age and below retirement age subgroups. AP nonrespondents had a nearly 10 times higher risk in the full sample and a 12 times risk in the below-retirement age sample of turnover in the quarter after the survey was deployed. Physician nonrespondents below retirement age had a 5 times relative risk of turnover in the two quarters postsurvey. Among APs, nonrespondents were significantly older and more likely to be married; no differences existed for physicians. Results demonstrate that individuals at higher risk within an organization, as indicated by higher turnover risk and lower productivity, are less likely to fill out employee surveys. This suggests that employee survey results are skewed by nonresponse bias with respect to outcomes of interest, and that relying solely on survey data may lead to incorrect conclusions about workforce functioning, and subsequently, interventions that do not meet the needs of those most at risk within the organization. In addition to the valuable qualitative insights that surveys provide, healthcare leaders should leverage alternative data-collection methods, such as EHRs and HRIS data, to augment survey data and find out how nonrespondents differ from respondents. In this way, they can gain a comprehensive understanding of employee functioning to inform procedural and policy changes to enhance employee well-being and decrease negative outcomes, such as turnover and low productivity.
52. Enhanced Physical and Mental Function and Promotion of Social Participation in a Cerebral Palsy Patient Through Participation in Para-Jujutsu.
期刊: Cureus 发表日期: 2025-Aug 链接: PubMed
摘要
While sports participation for individuals with disabilities is promoted by the Basic Act on Sport and policies for the promotion of parasports, the actual participation rate remains low (32.8% for individuals with disabilities compared to 52.5% for able-bodied individuals), and many challenges exist in continuing competitive sports. While international reports highlight the physical and mental benefits of Jujutsu participation for individuals with disabilities, there are few practical reports on this topic in Japan. This report aims to elucidate, from an occupational therapy perspective, the changes in physical function and quality of life (QOL) experienced by an adult male with cerebral palsy-induced motor paralysis who continuously engaged in Brazilian Jujutsu (BJJ), a combat sport. The subject was a right-handed male in his 30s with motor paralysis in his left upper and lower limbs due to cerebral palsy. He had prior experience in disabled professional wrestling and Judo from age 17, and began BJJ at age 22. We collected initial assessment data (Fugl-Meyer Assessment, Modified Ashworth Scale, range of motion, etc.) and qualitative data based on his narratives, documenting changes gained through BJJ practice and competition participation. During BJJ training, he received technical guidance tailored to his disability characteristics and diligently practiced with an occupational therapist, confirming body movements and techniques. His narratives revealed increased intrinsic motivation, stating things like, “It became easier to move by devising ways to use my left hand and foot”, and “I started wanting to compete in matches”. Twenty years after starting sports, in addition to improvements in physical function (Fugl-Meyer Assessment (FMA) upper extremity 20 points → 59 points, lower extremity 27 points → 47 points, increased range of motion (ROM), and reduced Modified Ashworth Scale (MAS)), the patient experienced an enhanced sense of fulfillment in life due to interpersonal interaction and a sense of achievement in competition. Furthermore, he competed not only in para-jujutsu but also in able-bodied divisions, progressing to the point of winning against able-bodied opponents in the purple belt category. This suggests that the benefits extended beyond mere physical improvement, contributing to the acquisition of psychological fulfillment, such as enhanced self-esteem and the formation of social connections. This case suggests the potential for multifaceted physical, psychological, and social benefits when individuals with disabilities proactively engage in combat sports like BJJ. Moreover, the style of support provided by an occupational therapist who actively participates in the sport alongside the individual is considered effective as a practice that goes beyond mere exercise instruction, closely aligning with the individual’s life and values. Moving forward, it is necessary to accumulate more diverse case studies and research on the potential of disabled sports, including combat sports like Jujutsu, and explore how health support can contribute to the independence and social participation of people with disabilities.
53. Can China's national fitness policy contribute to achieving universal health? Analysis based on the three-dimensional framework.
期刊: Frontiers in public health 发表日期: 2025 链接: PubMed
摘要
A lack of physical activity is widely regarded as an important factor contributing to the increase in non-communicable diseases and mortality rates. To improve the physical fitness and health levels of its citizens, the Chinese government has launched the National Fitness Program (NFP) to promote public health and well-being. However, the mechanisms and performance of these policies in promoting public health still require further exploration. This paper conducts a systematic analysis and evaluation of the NFP from 1995 to 2025 from three dimensions: policy themes, policy tools, and policy consistency, using text analysis, content analysis, and the Policy Modeling Consistency (PMC) model. The results show that the core themes of the NFP focus on infrastructure development, mass sports activities, and the public health service system. In terms of policy tools, there is an overall structural imbalance and internal disarray, with environmental policy tools dominating, supplemented by supply-side policies, while demand-side policies are insufficient. The level of policy consistency is good, and the design is relatively scientific and reasonable. However, there are significant differences between policies, and some indicators need improvement. Therefore, we recommend: enhancing cross-departmental, cross-disciplinary, and cross-regional cooperation, emphasizing evidence-based decision-making; promoting the balanced development of national fitness, increasing the inclusivity of policies, and focusing on the rights of special groups; Increasing incentive measures to encourage social participation; increasing the use of demand-oriented policy tools; improving the policy evaluation system to achieve dynamic optimization of policies.
54. Food and nutrition actions and continuing education in Primary Healthcare: a cross-sectional study Paraíba, 2021.
期刊: Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil 发表日期: 2025 链接: PubMed
摘要
Describe the actions to promote adequate and healthy eating conducted in Primary Care, in addition to presenting the training provided to healthcare professionals when obesity care is offered and its association with the implementation of lines of care and food and nutritional surveillance in municipalities in the state of Paraíba, Brazil. This was a cross-sectional study carried out with health professionals from January to June 2021, in municipalities in Paraíba. Descriptive analysis was performed and, to test the associations, Pearson’s chi-square test and Fisher’s exact test were used, as necessary. The Community actions were the most frequent, adopted by teams in 56.1% of cases, followed by group actions that occurred with a frequency of 55.0%. The implementation of the line of care was greater in municipalities with less than 30 thousand inhabitants that carried out permanent education (p-value<0.001). The implementation of food and nutritional surveillance was higher in the total sample in municipalities with 30,000 to 150,000 inhabitants and with less than 30,000 inhabitants (p-value<0.001) who carried out permanent education actions. Community and group actions were adopted in Primary Care in Paraíba. Continuing education showed a positive association with the implementation of lines of care and nutritional surveillance, especially in smaller municipalities. These results highlighted the importance of evaluating, monitoring and expanding continuing education initiatives in Paraíba to strengthen food and nutrition actions..
55. An adaptive simulation intervention decreases emergency physician physiologic stress while caring for patients during COVID-19: A randomized clinical trial.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Stressful work environments and burnout in emergency medicine (EM) physicians adversely impact patient care quality. The future EM workforce will need to prioritize clinician well-being to ensure optimal patient care. This prospective, randomized, controlled study aimed to determine whether an adaptive simulation intervention, COVID-19 Responsive Intervention: Systems Improvement Simulations (CRI:SIS), decreased physiologic stress as measured by heart rate variability (HRV) in front-line EM physicians during the COVID-19 pandemic. HRV was measured with smart shirts and self-reported State-Trait Anxiety Inventory (STAI) were collected at baseline and during four 8-hour clinical shifts for all participants. The intervention group (n = 40) received a 3-hour virtual educational simulation intervention consisting of four simulation scenarios (CRI:SIS). The control group (n = 41) received no simulation intervention. There were no significant differences in demographics between groups. HRV data collected from 81 physicians across a total of 324 clinical shifts showed an increase in HRV (decrease in physiologic stress) in shifts immediately following CRI:SIS in the intervention group as measured by a root mean square standard deviation (RMSSD) difference of 11.55 ms (95% CI, -19.90 to -3.20; P = 0.007) compared to the control group. Post-intervention STAI did not significantly differ between intervention and control. An adaptive simulation-based educational intervention led to decreased physiologic stress (increased HRV) among emergency physicians who received a simulation education intervention. Reduced physiologic stress generated by adaptive simulation interventions may improve both patient safety and clinician well-being.
56. Evaluation of the HAL® lumbar type exoskeleton in long-term care: protocol for a mixed-methods feasibility study.
期刊: Frontiers in digital health 发表日期: 2025 链接: PubMed
摘要
Lower back pain (LBP) is one of the most common occupational health issues among healthcare professionals, particularly in long-term care settings. The HAL® Lumbar Type Exoskeleton is a wearable assistive technology designed to reduce strain on the lower back during physically demanding care activities. However, evidence regarding its feasibility, usability, and acceptance in real-world long-term care settings remains limited. This study aims to evaluate the feasibility, usability, and user acceptance of the HAL® Lumbar Type Exoskeleton in long-term care facilities. Specifically, the study assesses whether the exoskeleton can reduce self-reported lower back pain and improve the ergonomic conditions for caregivers. This is a non-randomized, exploratory interventional feasibility study using a mixed-methods design. A total of 30 caregivers from two long-term care facilities will participate in a 90-day intervention. The exoskeleton will be integrated into daily care routines, and caregivers will undergo training on its proper use. Visual Analog Scale (VAS) for pain assessment before and after using the exoskeleton. Oswestry Disability Index (ODI) and Short-Form Health Survey (SF-8) at baseline (T1), mid-study (T2), and post-intervention (T3). Qualitative methods include semi-structured interviews with eight caregivers, exploring usability, perceived benefits, and barriers to adoption. Data will be analyzed using descriptive statistics, repeated measures ANOVA, and thematic content analysis for qualitative data. Findings will inform future studies on integrating wearable assistive technologies into caregiving workflows. This study will provide essential insights into the feasibility and usability of exoskeletons in long-term care, potentially contributing to improved ergonomic conditions and caregiver well-being.
57. Interoperability in universal healthcare systems: insights from Brazil's experience integrating primary and hospital health care data.
期刊: Frontiers in digital health 发表日期: 2025 链接: PubMed
摘要
58. Developing an Inpatient Substance Use Disorder Program in a Middle-Income Country: The Experience of Sbrana Psychiatric Hospital, Botswana.
期刊: Substance use : research and treatment 发表日期: 2025 链接: PubMed
摘要
The prevalence of substance use disorders (SUDs) is rising globally, significantly affecting public health. These disorders are associated with reduced quality of life, comorbid mental health conditions, and increased risk of infectious diseases such as HIV. This paper describes the development and implementation of group therapy as an intervention for SUDs in a resource-constrained setting. An 8-week inpatient group therapy program was established at Sbrana Psychiatric Hospital in Botswana. The interdisciplinary team includes a social worker, psychologist, occupational therapist, psychiatric residents, and a psychiatrist. To date, 9 cohorts comprising 55 patients have fully participated. The average age was 35 years; most were males (61%), with alcohol being the most used substance, followed by crack cocaine. Of these, 21 have remained abstinent for at least 3 months and reintegrated into society, 11 have relapsed, and 23 are lost to follow-up. Challenges encountered include client dropouts, poor reintegration into the community, limited follow-up systems, and financial constraints. Key components contributing to the program’s impact include peer support, relapse prevention, coping strategies, psychoeducation on triggers, and elements of the 12-step recovery model. Program improvement areas include strengthening follow-up through objective measures, such as urine drug testing, and incorporating structured wellness and recreational activities to support recovery.