公共卫生研究摘要 (2025-09-06)
共收录 58 篇研究文章
1. Association Between Disability and Life Satisfaction, Participation, and Psychological Health: A Traumatic Brain Injury Model Systems Study.
期刊: Neurology 发表日期: 2025-Sep-23 链接: PubMed
摘要
Moderate-to-severe traumatic brain injury (TBI) can result in disability across physical, social, and cognitive domains. The Glasgow Outcome Scale-Extended (GOSE), which evaluates global function, is the most frequently used TBI outcome measure. However, the GOSE may not capture all domains of recovery. We evaluated the relationship between the GOSE and domain-specific measures of life satisfaction, participation, and psychological health 1 year after TBI. We analyzed prospectively collected data from participants of the TBI Model Systems (TBIMS) study enrolled between 2010 and 2022 who completed the GOSE and at least 1 additional outcome measure 1 year after injury. We conducted pairwise comparisons to determine whether adjacent GOSE categories (e.g., GOSE 3 vs 4) are associated with different Satisfaction With Life Scale (SWLS), Participation Assessment of Recombined Tools-Objective (PART-O), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) scores. We report median differences (MDs) with 95% CIs. We also dichotomized each measure and calculated the proportion of participants above and below cut points associated with “favorable” compared with “unfavorable” GOSE outcomes. Among 19,245 participants enrolled in the TBIMS study, 7,568 participants (median [interquartile range] age 44 [27-61] years, 73% [5,541/7,568] male, 27% [2,020/7,568] female, 66% [5,007/7,568] White) met inclusion criteria. After correcting for multiple comparisons, there were no differences in median scores on SWLS between GOSE 3 vs 4 (MD = -1.00 [CI -1.00, 0.00]; p = 0.21) and GOSE 4 vs 5 (0.00 [-1.00, 1.00]; p = 0.5); PART-O between GOSE 7 vs 8 (-0.10 [-0.13, -0.06]; p = 0.0084); PHQ-9 between GOSE 3 vs 4 (0.00 [-1.00, 1.00]; p = 0.91) and GOSE 4 vs 5 (0.00 [0.00, 1.00]; p = 0.42); and GAD-7 between GOSE 3 vs 4 (0.00 [0.00, 0.10]; p = 0.07), GOSE 4 vs 5 (0.00 [0.00, 0.00]; p = 0.66), and GOSE 5 vs 6 (0.00 [0.00, 0.00]; p = 0.40). Among those with an “unfavorable” outcome (GOSE score ≤4), 44% (601/1,371), 8% (191/2,491), 67% (536/803), and 75% (602/807) had scores in the normative range for SWLS, PART-O, PHQ-9, and GAD-7, respectively. Overreliance on functional outcome measures such as the GOSE in postacute TBI assessment fails to capture critically important aspects of recovery that fall outside this domain. Persons with more functional disability often report similar levels of life satisfaction, participation, and psychological health as those with less disability. Clinicians should recognize that bidirectional dissociations between level of disability and ratings of well-being are common and should be evaluated accordingly.
2. Traumatic spinal cord injury in children and adolescents: a 20-year review from the Hospital for Sick Children.
期刊: Journal of neurosurgery. Pediatrics 发表日期: 2025-Sep-05 链接: PubMed
摘要
Traumatic spinal cord injury (SCI) in children and adolescents is uncommon but represents a substantial source of morbidity. Due in part to its rarity, there are few pediatric-specific studies on this topic. Therefore, the aim of this study was to assess demographics, injury mechanisms, treatment characteristics, and neurological outcomes in a cohort of pediatric patients with traumatic SCI, and to determine patient and injury factors associated with neurological recovery after injury. In this retrospective observational cohort study, children and adolescents with traumatic SCI presenting to a quaternary children’s hospital from January 2000 to December 2020 were identified. Patients with spinal column injury without evidence of spinal cord involvement, such as fracture and ligamentous injury alone, were excluded. Neurological examinations were abstracted from clinical notes at admission, discharge, and 3- to 4-month and 12-month follow-up time points, and the grade of injury was assessed per the American Spinal Injury Association Impairment Scale (AIS). Univariate logistic regression was used to identify associations between demographic, injury, and treatment variables with improvement of ≥ 1 AIS grade at 12 months. Seventy-five patients (45 male, mean age 10.4 years) with traumatic SCI were included in the analysis. The injury mechanism was most often motor vehicle collision (MVC; n = 35, 46.7%), followed by sports and recreation injuries (n = 23, 30.7%) and falls (n = 9, 12%). There were 36 patients (48%) with concomitant nonspinal injuries, including 24 (32%) with traumatic brain injury. Overall, 15 patients (20%) died in the hospital at a median of 1 day (IQR 1-2 days) after injury, most of which were associated with MVC, concomitant head injury, and/or craniocervical junction (CCJ) dissociation. Surgical intervention was performed for 30 patients (40%). Of the 47 patients with AIS grades A-D who survived to the 1-year follow-up, 34 (72%) improved by ≥ 1 AIS grade and 11 (23%) improved by ≥ 2 AIS grades by 12 months. A higher injury severity score (OR 0.86, 95% CI 0.77-0.93) and spinal cord hemorrhage on MRI (OR 0.09, 95% CI 0.01-0.58) were associated with lower odds of improvement. Mortality was relatively common after pediatric SCI and was associated with CCJ dissociation or concomitant nonspinal injuries. Among surviving patients who were admitted to the hospital with neurological impairment, a majority experienced improvement by ≥ 1 AIS grade at the 12-month follow-up.
3. Secure Messages, Video Visits, and Burnout Among Primary Care Providers in the Veterans Health Administration: National Survey Study.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-05 链接: PubMed
摘要
Telehealth use, including video visits and secure messages, expanded significantly in Veterans Health Administration (VHA) primary care during the COVID-19 pandemic. However, primary care provider (PCP) burnout also increased during this period. Each modality may have affected primary care workloads differently (either by substituting for or complementing in-person visits) and thereby had varying effects on PCP burnout. This study aims to examine the associations between PCP burnout and the volumes of video visits and secure messages within the health care systems in which the PCPs practiced. This study examined the associations between telehealth modalities (ie, video visits and secure messages) and burnout as reported by 17,034 PCPs in 138 health care systems in VHA from 2020 to 2023. Individual-level data were obtained from annual cross-sectional surveys, and health care system-level data were drawn from administrative data sources. We created logistic regression models using generalized estimating equations to analyze the relationships between individual-level PCP burnout and average volumes of health care system-level video visits and secure messages per 1000 patients, controlling for age, sex, race or ethnicity, and VHA tenure as well as health care system complexity and year. We then predicted the marginal means of PCP burnout by video visit or secure message volume, based on the model results. From 2020 to 2023, average PCP burnout, across repeated, annual cross-sections, increased from 42.1% to 52.7% (survey response rates of 68%-74%). Most survey respondents were aged 50 years and above (9607/17,034, 56.40%), female (10,189/17,034, 59.82%), non-White (9460/17,034, 55.54%), and with less than 10 years of tenure in the VHA (10,990/17,034, 64.52%). Over these 4 years, median annual video visits per 1000 patients in health care systems increased from 15.9 (IQR 8.4-25.5) to 227.6 (IQR 127.1-320.7), and median annual secure messages per 1000 patients increased from 23.4 (IQR 9.4-65.5) to 35.3 (IQR 11.0-87.0). In our fully adjusted models, video visit volumes in a health care system were not related to burnout, but secure message volumes were related to burnout. Burnout was significantly higher among PCPs in health care systems receiving additional secure messages per 1000 patients (odds ratio 1.001, 95% CI 1.000-1.002). On average, PCP burnout increased by 1% point for each additional increase of 43.7 (95% CI 14.0-73.4) secure messages in a health care system. Video visit volumes in a health care system were not associated with PCP burnout, but secure message volumes were associated with PCP burnout. As video visits and secure messages continue to grow, solutions to better manage message volume (eg, automation and provider-led quality improvement) are needed to mitigate the concurrent rise in PCP burnout.
4. Mental Health Challenges of Climate Change for Older Korean and Korean American Adults: Navigating Vulnerability, Isolation, and Resilience.
期刊: Social work in public health 发表日期: 2025-Sep-05 链接: PubMed
摘要
Climate change presents a growing mental health concern for older adults, particularly among Korean and Korean American populations who may experience heightened vulnerabilities due to cultural, linguistic, and socioeconomic factors. This study examines the psychological impact of climate change on this demographic, focusing on three key areas: increased vulnerability to climate-related disasters, the exacerbation of social isolation, and the role of resilience in mitigating negative outcomes. Drawing on interdisciplinary research, this study explores how environmental stressors, displacement, and disruptions to traditional support systems contribute to mental health challenges. Furthermore, it highlights protective factors such as cultural resilience, intergenerational support, and community-based interventions that can help older Korean and Korean American adults adapt to climate-related stressors. The findings underscore the need for culturally responsive mental health strategies, policy initiatives, and social support networks to promote psychological well-being and climate adaptation in aging populations.
5. Implementation of Fully Automated AI-Integrated System for Body Composition Assessment on Computed Tomography for Opportunistic Sarcopenia Screening: Multicenter Prospective Study.
期刊: JMIR formative research 发表日期: 2025-Sep-05 链接: PubMed
摘要
Opportunistic computed tomography (CT) screening for the evaluation of sarcopenia and myosteatosis has been gaining emphasis. A fully automated artificial intelligence (AI)-integrated system for body composition assessment on CT scans is a prerequisite for effective opportunistic screening. However, no study has evaluated the implementation of fully automated AI systems for opportunistic screening in real-world clinical practice for routine health check-ups. The aim of this study is to evaluate the performance and clinical utility of a fully automated AI-integrated system for body composition assessment on opportunistic CT during routine health check-ups. This prospective multicenter study included 537 patients who underwent routine health check-ups across 3 institutions. Our AI algorithm models are composed of selecting L3 slice and segmenting muscle and fat area in an end-to-end manner. The AI models were integrated into the Picture Archiving and Communication System (PACS) at each institution. Technical success rate, processing time, and segmentation accuracy in Dice similarity coefficient were assessed. Body composition metrics were analyzed across age and sex groups. The fully automated AI-integrated system successfully retrieved anonymized CT images from the PACS, performed L3 selection and segmentation, and provided body composition metrics, including muscle quality maps and muscle age. The technical success rate was 100% without any failed cases requiring manual adjustment. The mean processing time from CT acquisition to report generation was 4.12 seconds. Segmentation accuracy comparing AI results and human expert results was 97.4%. Significant age-related declines in skeletal muscle area and normal-attenuation muscle area were observed, alongside increases in low-attenuation muscle area and intramuscular adipose tissue. Implementation of the fully automated AI-integrated system significantly enhanced opportunistic sarcopenia screening, achieving excellent technical success and high segmentation accuracy without manual intervention. This system has the potential to transform routine health check-ups by providing rapid and accurate assessments of body composition.
6. Preclinical evidence on the impact of sorghum (Sorghum bicolor) genotypes, fractions, and processing methods on intestinal health: a review of an ancient grain rich in phenolic and dietary fiber.
期刊: Critical reviews in food science and nutrition 发表日期: 2025-Sep-05 链接: PubMed
摘要
Sorghum (Sorghum bicolor) is an ancient grain and the fifth most produced cereal worldwide, and the most consumed cereal in the semi-arid regions of Africa and Asia, being a key grain for the diet of about 500 million people. It is rich in phenolic compounds (like flavonoids, 3-deoxyanthocyanidins, phenolic acids), resistant starch, and dietary fiber, which may beneficially influence intestinal health. This systematic review analyzed 22 in vivo studies to assess the effects of sorghum processing on bioactive compounds and their effects on intestinal health. Evidence suggests that sorghum modulates microbiota composition, enhances epithelial barrier integrity, improves intestinal morphology, and alters short-chain fatty acid production. These benefits appear to be influenced by sorghum genotype, grain fraction, and processing method, like refinement, extrusion, and fermentation, which affect the bioavailability of phenolics. Some studies indicated the effects of sorghum phenolics on anti-inflammatory and improved tight junction protein expression. Additionally, we emphasized the lack of complete information in several studies by not specifying genotypes, varieties, processing, and profiles of bioactive compounds of the sorghums used, hindering the understanding of the mechanisms involved in improving intestinal health. Overall, this review supports the potential of sorghum as functional food and ingredient for intestinal health promotion.
7. Leveraging Influencers to Reach and Engage Vulnerable Individuals With a Digital Health Intervention: Quasi-Experimental Field Study.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-05 链接: PubMed
摘要
Noncommunicable diseases are the leading cause of death, present economic challenges to health care systems worldwide, and disproportionally affect vulnerable individuals with low socioeconomic status (SES). While digital health interventions (DHIs) offer scalable and cost-effective solutions to promote health literacy and encourage behavior change, key challenges concern how to effectively reach and engage vulnerable individuals. To this end, social media influencers provide a unique opportunity to reach millions, and lasting engagement can be ensured through the design of DHIs in a manner that specifically appeals to low-SES individuals through alignment with their social background. The objectives of this study were 2-fold: to assess the effectiveness of leveraging influencers to reach vulnerable individuals (as measured via app downloads per stream viewers) and evaluate how the design of a DHI can improve engagement among this group (as measured via completion of the intervention). This study used a cross-sectional, quasi-experimental field design to assess both (1) the effectiveness of influencers in reaching vulnerable individuals and (2) the impact of specific design elements-such as gamification and storytelling-on user engagement using a stress management DHI featuring a slow-paced breathing exercise. In total, 3 differently designed versions of this DHI were developed following a fractional factorial design (StressLess, Breeze, and TragicKingdom). Reach was calculated as the number of downloads per viewers per stream and influencer. Engagement with the DHI was measured via number of conversational turns and milestone and intervention completion rates. Participants’ SES and technology acceptance were evaluated through a postintervention survey. Descriptive statistics, chi-square tests, and ANOVAs were used to examine the effects of the DHI design on reach and engagement metrics. The recruitment via 8 influencers (total streams=25; total viewers=12,667) generated 220 downloads. The average reach ratio across streams amounted to 16.2% (SD 15.5%), with significant differences between conditions (ꭓ22=8.0, P=.02; StressLess: 8.1%, SD 9.3%; Breeze: 14%, SD 10.5%; TragicKingdom: 28.4%, SD 17.6%). The intervention completion rate across all DHI versions amounted to 7.7% (17/220), with no significant differences between conditions (P=.48). This work provides the first evidence that recruitment via influencers yields high reach ratios, moving far beyond the reach of traditional social media platforms. Nonetheless, based on the data collected, the ability to leverage such platforms to recruit vulnerable individuals remains unclear. In addition, while engagement with the promoted interventions was initially high, the completion rate of the full breathing exercise was comparably low, indicating that the influencer promotion strategy cannot fully overcome the well-documented adherence barriers in digital health.
8. Physician Perspectives on Pharmaceutical Promotion.
期刊: JAMA health forum 发表日期: 2025-Sep-05 链接: PubMed
摘要
This survey study reports the responses of medical students and residents about their interactions with and attitudes toward the pharmaceutical industry and changes over 13 years, from 2011 to 2024.
9. Current Practices for Mental Fatigue Quantification and Induction in Movement Science: Introducing the SPeCIFY Guidelines.
期刊: Sports medicine (Auckland, N.Z.) 发表日期: 2025-Sep-05 链接: PubMed
摘要
Mental fatigue (MF) is a complex phenomenon with significant implications for human performance, for which there are numerous studies investigating the effects of MF. Nevertheless, there is considerable variability in the approaches used to induce and quantify MF, making it hard to compare findings across studies and draw well-supported conclusions. This review addresses the methodological variability in the induction and quantification methods of MF in movement science in the following ways: on the one hand, by providing an overview of task design strategies to induce MF, emphasizing the importance of tailoring task duration, difficulty, and nature to individual participants and specific research contexts; on the other hand, by providing an overview of current methods used to quantify MF, including behavioural, subjective, and physiological measures, and highlighting the strengths and limitations of each. Finally, this review proposes a best-practice framework for MF research, incorporating multi-method approaches for the induction and quantification of MF and introducing the Settings, Protocol establishments, Confounders, Individuals, Framework, and Yield (SPeCIFY) reporting guidelines that aim at improving consistency and transparency in future MF studies.
10. Medically-assisted reproduction in Italy, 2021 data from the Italian MAR Registry.
期刊: Minerva obstetrics and gynecology 发表日期: 2025-Sep-05 链接: PubMed
摘要
The Italian Medically Assisted Reproduction Registry (ItMARR) was established by a Decree of the Minister of Health issued on October 7th, 2005. ItMARR has a crucial role in clearly and publicly disseminating epidemiological information on MAR activities and outcomes. ItMARR data are collected in aggregate form and their submission is mandatory as stipulated by Law 40/2004. The aim of this article is to make a comprehensive overview of the activity of authorized centers that perform IUI and ART in Italy. Data used in this article refer to MAR treatments started between January 1st and December 31st, 2021. MAR techniques were performed by 340 centers. In total, 92,407 ART cycles and 15,660 IUI cycles were performed in 2021. Gametes donation cycles represent 14.6% of ART activity and 4.2% of IUI. ART cycles performed per million women of childbearing age were 9077. In 2021, 3.8% of births in the general population in Italy were a result of ART application. In 2021, MAR activity had a strong increase compared to the previous year in which there were strong limitations on reproductive treatments due to the COVID-19 pandemic. Pregnancy rates per transfers were 29.4% with fresh techniques, 35.2% with FER, 26.3% with FO, 41.2% with OD and 37.9% with SD. The decreasing trend of multiple deliveries continues. The ItMARR has become a great asset in the reproductive health scenario promoting a better MAR information dissemination. ItMARR is working on the implementation towards a “cycle-by-cycle” data collection system. This will bring the Italian monitoring system in line with others European countries.
11. Tactile-Transparent Wearable Sensor for Clinician-Friendly Pulse Wave Velocity Monitoring and Cardiovascular Risk Profiling.
期刊: ACS nano 发表日期: 2025-Sep-05 链接: PubMed
摘要
Arterial stiffening is an independent risk factor for cardiovascular diseases, particularly affecting organs with low vascular resistance, such as the brain and kidneys. Pulse wave velocity (PWV) is the clinical gold standard for arterial stiffness assessment; however, conventional equipment requires complex setups and trained operators, limiting real-world and point-of-care monitoring. Here, we introduce a tactile-transparent wearable (TTW) sensor that preserves physicians’ tactile pulse palpation abilities while providing quantitative cardiovascular risk assessment by integrating flexible Polydimethylsiloxane (PDMS) electrodes and ultrathin graphene oxide dielectric films. In a clinical study with 20 healthy volunteers (aged 22-60 years), the TTW sensor showed strong agreement with Doppler ultrasound for carotid-radial PWV (Pearson’s r = 0.88, p < 0.001; mean difference = - 0.084 m/s) and identified that arterial stiffness is significantly correlated with age and BMI (both p < 0.001). High-fidelity waveform analysis further provided dynamic vascular risk indices (augmentation index, reflection index, stiffness index) not accessible by Doppler. This TTW sensor democratizes arterial stiffness assessment, providing transformative potential for preventive cardiology and enabling widespread adoption, especially in resource-limited or community healthcare settings.
12. Reframing Periodontal Care: Communication and Fee Strategies for Effective Patient Engagement.
期刊: The International journal of periodontics & restorative dentistry 发表日期: 2025-Sep-05 链接: PubMed
摘要
Periodontal therapy remains a cornerstone of dental practice. However, effectively managing periodontitis patients throughout the continuum of care can be challenging. This article proposes a communication framework and an integrated fee model designed to support evidence-based comprehensive treatment protocols while enhancing patient education, motivation, and long-term adherence. By emphasizing prevention and patient-centered care, the proposed approach contrasts with the dominant reactive model, often focused on surgical interventions and the extraction of salvageable teeth. Instead, this approach advocates for a shift toward a proactive, value-based paradigm that prioritizes periodontal health maintenance, aligns clinician and patient goals, and fosters sustained engagement throughout treatment.
13. Wearable Point-of-Care Biosensor for Biomolecular Assay in Health Monitoring.
期刊: ACS applied bio materials 发表日期: 2025-Sep-05 链接: PubMed
摘要
Wearable biosensors represent a significant advancement in preventive health monitoring by enabling early disease detection through real-time bioanalysis. This review examines the evolution of point-of-care testing (POCT), with a focus on materials, fabrication techniques, and real-world applications. These biosensors utilize advanced materials, such as supramolecular hydrogels, and innovative manufacturing methods, providing high sensitivity, specificity, and portability. They enable continuous monitoring of biomolecules─including proteins, nucleic acids, and pathogens─in peripheral body fluids, thereby supporting the early diagnosis of diseases such as infections, cardiovascular disorders, diabetes, and cancer. The integration of wireless data transmission and artificial intelligence further enhances the applicability of these devices in both clinical and remote healthcare settings. The implementation of such technologies shows potential for reducing healthcare expenditures and improving therapeutic outcomes. However, challenges remain in standardizing POCT protocols, ensuring cost-effectiveness, and safeguarding patient data privacy. This review underscores the potential of wearable biosensors in global healthcare while emphasizing the necessity for continued research to address current limitations.
14. HIV-1 manipulates CD96 on CD4+ T cells to subvert antiviral immunity.
期刊: Science advances 发表日期: 2025-Sep-05 链接: PubMed
摘要
HIV-1 evades immune responses by modulating plasma membrane receptors. Using a flow cytometry-based screening, we profiled 332 surface receptors on HIV-1-infected primary CD4+ T cells and identified 23 down-regulated receptors, including known targets such as CD4, MHCI, CCR7, and CD62L. CD96, an inhibitory natural killer (NK) cell receptor poorly studied in human CD4+ T cells, was markedly down-regulated. This modulation, mediated by the viral proteins Nef and Vpu, surpassed that of other NK-associated receptors such as CD155 and NTB-A and is conserved across lentiviruses. CD96Hi CD4+ T cells exhibited a proinflammatory TH1/TH17 phenotype characterized by IFN-γ and IL-17 secretion and displayed impaired migration in vivo. Furthermore, CD96 ligation enhanced IFN-γ release upon viral peptide stimulation and promoted the secretion of TH1/TH17-associated cytokines. Our findings suggest that CD96 regulates antiviral immune responses and maintains proinflammatory properties in CD4+ T cells. Thus, its down-regulation represents a previously unknown HIV-1 immune evasion strategy, with implications for exploiting CD96 as immunotherapeutic target.
15. Machine learning- and multilayer molecular network-assisted screening hunts fentanyl compounds.
期刊: Science advances 发表日期: 2025-Sep-05 链接: PubMed
摘要
Fentanyl and its analogs are a global concern, making their accurate identification essential for public health. Here, we introduce Fentanyl-Hunter, a screening platform that uses a machine learning classifier and multilayer molecular network to select and annotate fentanyl compounds using mass spectrometry (MS). Our classification model, based on 772 fentanyl spectra and spectral binning feature engineering, achieved an F1 score of 0.868 ± 0.02. The multilayer network, based on spectral similarity and paired mass distances, covers more than 87% of known fentanyls. Fentanyl-Hunter identified fentanyl members in biological and environmental samples. During biotransformation, 35 metabolites from four widely consumed fentanyl derivatives were identified. Norfentanyl was the major fentanyl compound in wastewater. Retrospective screening of these biomarkers across more than 605,000 MS files in public datasets revealed fentanyl, sufentanil, norfentanyl, or remifentanil acid in more than 250 samples from eight major countries, indicating the potential widespread presence of fentanyl.
16. Planetary Health Diet and risk of mortality and chronic diseases: Results from US NHANES, UK Biobank, and a meta-analysis.
期刊: Science advances 发表日期: 2025-Sep-05 链接: PubMed
摘要
The health benefits of the Planetary Health Diet (PHD) require further validation. We examined associations between PHD adherence and risks of mortality and chronic diseases using data from two prospective cohorts-the US NHANES (1999-2018, 42,947 participants) and the UKB (125,372 participants)-and a meta-analysis of 37 published cohort studies (3,244,263 participants). Higher adherence to PHD was associated with lower all-cause mortality in both cohorts. In the UKB, it was also associated with reduced the risk of cancer and respiratory disease mortality. In the meta-analysis, higher adherence to the PHD was associated with lower risks of all-cause, cancer, and cardiovascular disease (CVD) mortality and reduced risks of colorectal cancer, lung cancer, CVDs, coronary heart disease, stroke, and diabetes. This analysis suggests that higher adherence to the PHD may offer substantial health benefits.
17. Topography and environmental deficiencies are associated with chikungunya virus exposure in urban informal settlements in Salvador, Brazil.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Sep-05 链接: PubMed
摘要
Chikungunya virus (CHIKV) is an arbovirus with a significant global public health burden. Delineating the specific contributions of individual behaviour, household, natural and built environment to CHIKV transmission is important for reducing risk in urban informal settlements but challenging due to their heterogeneous environments. The aim of this study was to quantify variation in CHIKV seroprevalence between and within four urban communities in a large Brazilian city, and identify the respective contributions of individual, household, and environmental factors for seropositivity. A cross-sectional serological survey was conducted in four low-income communities in Salvador, Brazil in 2018 to collect individual, household and CHIKV IgG serology data for 1318 participants. Fine-scale community mapping of high-risk environmental features and remotely sensed environmental data were used to improve characterisation of the microenvironment close to the household. We categorised risk factors into three domains - individual, household, and environmental and used binomial mixed-effect models to identify associations with CHIKV seropositivity. CHIKV seroprevalence was 4.8%, 6.1% and 4.3% in three communities and 22.6% in one community which had a distinct topographical profile. The only individual domain variable associated with seropositivity was male sex (OR 1.67, 95% CI 1.11 - 2.36), but several environmental variables, including living in a house on a steep hillside, at medium to high elevations, and with surface water nearby, were associated with higher seropositivity. Our findings indicate that CHIKV exposure risk can vary significantly between nearby communities and at fine spatial scales within communities and is likely to be driven more strongly by the availability of mosquito breeding sites rather than individual exposure patterns. They suggest that environmental deficiencies and topography, a proxy for several environmental processes including the degree of urbanisation and flooding risk, may play an important role in driving risk at both of these scales.
18. The Moderating Effect of Atypical Events on the Relationship Between Heart Rate and Stress in Medical Residents Working in an Intensive Care Unit: Longitudinal, Observational Daily Diary Study.
期刊: JMIR formative research 发表日期: 2025-Sep-05 链接: PubMed
摘要
Residency is a critical period in a physician’s training, characterized by significant physical, cognitive, and emotional demands that make residents highly susceptible to stress and associated negative health outcomes. While physiological signals such as heart rate have been explored as potential biomarkers of stress, their predictive utility in high-stress environments such as the intensive care unit (ICU) remains inconclusive, especially when factoring in atypical events that can further exacerbate resident stress levels. This study aimed to investigate the relationship between daily average heart rate (AHR) and perceived stress among ICU residents and examine the moderating effect of atypical events on this relationship. The TILES (Tracking Individual Performance With Sensors)-2019 dataset collected longitudinal data from 44 ICU residents who provided daily self-reported stress ratings and wore a Fitbit device to track physiological data over a 3-week period. The main predictor variables were AHR and the occurrence of atypical events (both work and life related and daily hassles). The primary outcome was the level of perceived stress measured on a 7-point Likert scale. Linear mixed models were used to analyze the relationship between AHR and stress, accounting for within-subject and between-subject variance. Interaction effects between AHR and atypical events were also examined. The analysis revealed a significant positive association between AHR and perceived stress (β=0.032; P=.04) on standard days. However, this relationship was attenuated by the presence of negative atypical events (β=-0.076; P=.02). We further analyzed whether the severity of negative atypical events had an additional moderating effect but found no statistical significance. AHR is a potential physiological marker for perceived stress in ICU residents, but its effect is moderated by negative atypical events. Future research should replicate these findings in more diverse cohorts, assess their generalizability to broader populations, and control for additional confounding variables. Incorporating negative atypical events into stress assessment could lead to more accurate and context-sensitive interpretations of physiological data.
19. Pathological Processes Among Content Creators on Social Media: Scoping Review.
期刊: JMIR public health and surveillance 发表日期: 2025-Sep-05 链接: PubMed
摘要
Content creators (CCs), like any other worker, are exposed to various occupational hazards that can affect their physical, mental, and social well-being, with psychosocial and ergonomic risks being particularly relevant. The combination of prolonged work hours, sedentary lifestyles, excessive public scrutiny, and often job insecurity and unpredictability (manifested as continuous connectivity and anticipation of sporadic tasks) presents a significant risk for the development of health issues. This study reviews the scientific literature to identify the potential pathological processes affecting CCs on social media. The scoping review method was used. Data were obtained from the following bibliographic databases: MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, and Virtual Health Library. The terms used as descriptors and in the title and abstract fields were “Content Creator” and “Pathologic Processes.” The search was conducted in May 2024. Agreement between authors for paper selection was measured using the Cohen κ coefficient. The documentary quality of the papers was assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) questionnaire, and the level of evidence and recommendation grade were determined according to the Scottish Intercollegiate Guidelines Network recommendations. Bias was evaluated using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool. Of the 1522 references retrieved, 6 papers were selected based on the inclusion and exclusion criteria. Of the 6 studies reviewed, 3 were exclusively focused on a single gender. The agreement on the relevance of the selected studies, calculated using the κ index, was 84.9% (P<.01). The study population ranged from a minimum of 6 to a maximum of 1544 participants. The STROBE scores ranged from 81.3% to 96.8%, with a median of 14.9% (IQR 2.1). According to the Scottish Intercollegiate Guidelines Network criteria, this review provided evidence level 2++ with a recommendation grade of B. ROBINS-E highlighted a higher number of biases in Domains 5, 6, and 7. All interventions were based on interviews, either conducted online or via email. Participant activities, as documented in the respective studies, comprised influencer roles (n=2), blogging (n=2), YouTube content creation (n=1), and live streaming (n=1). The design of the reviewed works comprised 4 qualitative studies and 2 mixed methods (qualitative and quantitative) studies. The reported health impacts were diverse, comprising burnout (n=2), anxiety (n=1), co-occurring anxiety and depression (n=1), eating disorder (n=1), chronic pain (n=1), and unspecified mental health issues (n=1). All studies highlighted the necessity for further investigation into potential pathological processes among CCs engaged in social media activities. It was found that the most affected area was mental health, as observed in nearly all the reviewed studies. Despite the extensive documentation of mental health impact, it is necessary to identify the risk factors associated with the pathological processes of CCs to prevent the signs and symptoms identified in this literature review.
20. Spatio-temporal analysis of the distribution and co-circulation of dengue, chikungunya, and Zika in Medellín, Colombia, from 2013 to 2021.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Sep-05 链接: PubMed
摘要
Dengue, chikungunya, and Zika present significant public health challenges in Colombia. Spatial studies help clarify the distribution and progression of these diseases over time and location. Objective to describe the spatio-temporal distribution and clustering patterns of dengue, chikungunya, and Zika in Medellín, Colombia, between 2013 and 2021, with the aim of providing baseline spatial intelligence to support future epidemiological and policy-oriented analyses. We analyzed dengue, chikungunya, and Zika cases in Medellín from 2013 to 2021, using weekly data from 27,459 geocoded cases across 265 neighborhoods. Cases were geocoded by neighborhood based on residential addresses in the national surveillance system (SIVIGILA). Spatio-temporal analysis identified high-risk clusters and examined the co-circulation of the diseases through multivariate analysis. We used scan statistics with a discrete Poisson model to detect high-risk clusters. From 2013 to 2021, 26,350 dengue cases probable and confirmed were reported, with an annual incidence of 137.3 per 100,000 residents. Chikungunya and Zika emerged in 2014 and 2015, with 574 and 515 cases reported, resulting in incidences of 5.1 and 3.8 per 100,000 residents, respectively. We identified five dengue clusters and four clusters each for Zika and chikungunya, mainly in Medellín’s northeast. Multivariate analysis revealed six clusters, with four exhibiting high risk for all three diseases. Co-circulation of dengue, chikungunya, and Zika occurred between September 2015 and February 2017. Dengue clusters peaked between 2015 and 2016, while chikungunya and Zika peaks occurred in 2015 and 2016, respectively. This study advances understanding of spatio-temporal dynamics in arbovirus transmission in Medellín, highlighting high-risk clusters for dengue, chikungunya, and Zika and their collective presence. Our findings support targeted public health interventions to mitigate these diseases.
21. Off-Label Prescription of Benzodiazepines: A Retrospective Cohort Study of Prescribing Prevalence in Primary Care.
期刊: Clinical drug investigation 发表日期: 2025-Sep-05 链接: PubMed
摘要
Benzodiazepines are commonly prescribed medications approved for and used in the treatment of anxiolytic and sleep disorders, as well as for seizures, and alcohol withdrawal. However, benzodiazepines are also controlled substances because of their potential for abuse and personal harm, which are especially prevalent among older people. It is therefore important to understand how benzodiazepines are being prescribed, and the prevalence of off-label benzodiazepine prescribing, of which very little is known because of challenges in documenting treatment indication. The aim of this study was to detail the prevalence of benzodiazepine off-label prescribing. Data from the MOXXI (Medical Office of the XXIst century) electronic health record system in Quebec Canada were used, where specifying the treatment indication for each prescription is required, to estimate the prevalence of off-label prescribing and indications for off-label use of benzodiazepines. Each drug indication was retrospectively classified as either on-label or off-label according to the Health Canada drug database. Off-label prescriptions were further classified as having class congruence supporting their prescription if another benzodiazepine had been approved for the indication by Health Canada. There were 20,125 (17.0%) adult patients prescribed benzodiazepines out of the 118,223 patients enrolled in the MOXXI system. The patients were predominantly female (65.6%) and tended to be older with an average age of 60.14 years at the time of the first benzodiazepine prescription. A total of 101,583 unique prescriptions were written for 14 different benzodiazepines. An approximately equal number of benzodiazepines were prescribed on- and off-label (49.3% on-label, 49.2% off-label). Most off-label prescription indications were classified as having class congruence (95.2%). Benzodiazepines were frequently prescribed in the province of Quebec and were prescribed off-label approximately half of the time. When prescribed off-label, we found that most of these prescriptions were for indications that were approved for other benzodiazepines. The most common indication for off-label benzodiazepine prescriptions with class congruence was insomnia.
22. Log-probit accompanied with Tallarida and Chou-Talalay-Martin methods in an isobolographic analysis of interactions between two antiseizure medications - a comparative study.
期刊: Pharmacological reports : PR 发表日期: 2025-Sep-05 链接: PubMed
摘要
The isobolographic analysis is a gold standard in the assessment of interactions between drugs in experimental studies. Although some isobolographic approaches are available, the most popular methods to characterize drug-drug interactions are the log-probit method accompanied with statistical analysis of interactions (by Tallarida) and the method based on mass-action law using CompuSyn software (elaborated by Chou-Talalay-Martin). The aim of this study was to compare the results from these two isobolographic approaches. Two isobolographic methods (log-probit associated with Tallarida statistics and Chou-Talalay-Martin) were applied to analyze the interaction between two antiseizure medications - clonazepam and lamotrigine in the mouse maximal electroshock-induced seizure model. Both isobolographic approaches confirmed that the combination of clonazepam with lamotrigine produced synergistic interaction and allowed for detailed characteristics of the interaction at various effect levels for the two-drug mixture. Calculation of the combination index values (at various effect levels) confirmed that synergy slightly decreased when the antiseizure effect increased (combination index values increased from 0.44 for 16% to 0.65 for 84%). The log-probit method with statistical analysis of data (by Tallarida) was more subtle and precise in the assessment of the synergistic interaction, whereas the isobolographic analysis by Chou-Talalay-Martin offered more automatic options facilitating visualization of the interaction.
23. Distinct factors explain life space mobility below and above the age of 75 years old in older adults.
期刊: GeroScience 发表日期: 2025-Sep-05 链接: PubMed
摘要
Life space mobility (LSM) is important for participation in daily life. It is influenced by individual and environmental factors and tends to decline with age. Although LSM has been studied in older adults, stratification of this population into age subgroups has not been performed, creating a gap in understanding the factors associated with LSM in a more granular manner. This cross-sectional study aimed to identify the factors associated with LSM in community-dwelling older adults below and above the age of 75. Participants aged 65 and older without neurological conditions or dementia were recruited. LSM was assessed using the Life Space Assessment (LSA), mobility with the Timed Up and Go test (TUG), cognition with the Montreal Cognitive Assessment (MoCA), fear of falling with the Activities-specific Balance Confidence scale (ABC), and depression with the Hospital Anxiety and Depression Scale (HADS). Additional self-reported data included employment/volunteering, frequency of leaving the house, functional status, and number of medications. Separate regression models were conducted for each age subgroup. Two-hundred forty-two older adults (28.9% men) were recruited (mean (SD) age 73.7(6.4) years), with 40.9% aged over 75. In the younger subgroup, sex, frequency of leaving the house, TUG, and employment/volunteer status significantly explained 42.8% of the variance in LSM. In the older subgroup, sex, age, ABC, MoCA, and TUG significantly explained 46.9% of the variance in LSM. Distinct factors are associated with LSM in each age subgroup. Accordingly, future interventions should be tailored for each subgroup individually.
24. Ergonomic stress and surgical performance of general surgeons: a cross-sectional comparison of laparoscopic and open procedures.
期刊: Langenbeck’s archives of surgery 发表日期: 2025-Sep-05 链接: PubMed
摘要
Surgeons are actively seeking ways to enhance operating room ergonomics. A comprehensive report on surgeon job-related disease and injuries could raise awareness, encourage workplace improvements, and emphasize the importance of ergonomic practices such as body posture awareness, appropriate operating room setup, and exercise to lessen discomfort and improve general health. To address the ergonomic challenges that surgeons in Jordan face during their work and to investigate how demographic variables may impact a surgeon’s ability to perform open and laparoscopic procedures proficiently. This cross-sectional observational study investigated the ergonomics of surgical practice and evaluated the impact of demographic factors on the proficiency of surgeons performing both open and laparoscopic procedures. Using a self-administered questionnaire, data were gathered from 150 Jordanian doctors who had completed more than six months of surgical training and were employed by the government, the military, or the private sector. In this study involving 150 surgeons in Jordan, demographic characteristics were assessed, revealing that male respondents, particularly from the military sector, had higher mean scores in both laparoscopic and open surgical approaches. Multiple linear regression analysis identified private institutions and military affiliation as significant positive predictors for achieving high scores in laparoscopic procedures, while exclusive military affiliation emerged as the sole significant predictor for open procedures. The study highlights surgical ergonomics’ role in reducing pain and improving outcomes. Prioritizing appropriate ergonomic training, encouraging discomfort reporting, and raising awareness of official recommendations are critical for the longevity of surgeons’ careers, well-being, and, ultimately, better patient outcomes.
25. Predicting first-trimester pregnancy outcome in threatened miscarriage: A comparison of a multivariate logistic regression and machine learning models.
期刊: Radiography (London, England : 1995) 发表日期: 2025-Sep-04 链接: PubMed
摘要
Threatened miscarriage (TM), defined as first-trimester vaginal bleeding with a closed cervix and detectable fetal cardiac activity, affects up to 30 % of clinically recognised pregnancies and is linked to increased risk of adverse outcomes. This study evaluates the predictive value of first-trimester ultrasound (US) and biochemical (BC) markers in determining outcomes among women with TM symptoms. This prospective cohort study recruited 118 women with viable singleton pregnancies (5+0 to 12+6 weeks’ gestation) from Malta’s national public hospital between January 2023 and June 2024. Participants underwent US and BC assessment, along with collection of clinical and sociodemographic data. Pregnancy outcomes were followed to term and classified as live birth or loss. Univariate logistic regression identified individual predictors. Multivariate logistic regression (MLR) and random forest (RF) modelling assessed combined predictive performance. Among 118 TM cases, 77 % resulted in live birth, 23 % in loss. MLR identified progesterone, cervical length, mean gestational sac diameter (MGSD), trophoblast thickness, sFlt-1:PlGF ratio, and maternal age as significant predictors. Higher progesterone, cervical length, MGSD, and sFlt-1:PlGF ratio reduced risk, while maternal age over 35 increased it. MLR achieved 82.7 % accuracy (AUC = 0.89). RF improved accuracy to 93.1 % (AUC = 0.97), confirming the combined predictive value of US and BC markers. US and BC markers hold predictive value in TM. Machine learning, particularly RF, may improve early clinical risk stratification. This tool may support timely decision-making and personalised monitoring, intervention, and counselling for women with TM.
26. Prevalence of depressive symptoms and serious suicidal thoughts among adolescents aged 12-17 by rurality in the United States.
期刊: Public health 发表日期: 2025-Sep-04 链接: PubMed
摘要
This study examines rural vs. urban prevalence rates of depressive symptoms and serious suicidal thoughts and in a nationally representative sample of adolescents. This nationally representative cross-sectional study examined data for 22,712 adolescents aged 12-17 years from the 2021 and 2022 National Survey on Drug Use and Health (NSDUH). Prevalence estimates of adolescent depressive symptoms and serious suicidal thoughts were produced overall and across three levels of rurality: large metro, small metro, and nonmetro. Rates were compared by Rao-Scott chi-square tests, and weighted multivariable logistic regressions compared associations between rurality and sociodemographic characteristics with each outcome. Over half (54.45%) of adolescents reported ever experiencing a period of depressive symptoms, while 19.35% reported these feelings in the past year, and 13.18% reported serious thoughts of suicide in the past year. Rates of ever experiencing depressive symptoms (p = 0.31) or in the past year (p = 0.74) were not significantly different by rurality. Similarly, prevalence rates of serious suicidal thoughts did not differ significantly among adolescents in nonmetro (12.95%), small metro areas (13.71%), large metro (12.95%; p = 0.21). Ever experiencing depressive symptoms (aOR 7.18, 95%CI: 5.26-9.80) and past year depressive symptoms (aOR 5.98, 95%CI: 4.88-7.32) were related to increased odds of serious suicidal thoughts. Findings show that over 50% of adolescents reported depressive symptoms and the strong link to serious suicidal thoughts indicates the need for improved early mental health interventions for adolescents across all levels of rurality.
27. Prevalence of self-reported severe vision impairment and its association with sociodemographic characteristics and chronic diseases in Mexico: A nationwide cross-sectional study.
期刊: Public health 发表日期: 2025-Sep-04 链接: PubMed
摘要
Severe vision impairment is a major public health concern, diminishing quality of life and driving significant costs. Understanding its prevalence and associated factors is essential for effective prevention and care strategies. This study investigates the prevalence of severe vision impairment in Mexican adults and its association with sociodemographic factors and common chronic diseases. Nationwide cross-sectional study. We used data from 43,070 adults aged 20 years and older who participated in the 2018 National Health and Nutrition Survey, a nationally representative survey of the Mexican population. Severe vision impairment was assessed through the self-reported Washington Group Short Set on Functioning. We calculated prevalence and confidence intervals considering sampling weights and the complex design of the survey. We used weighted Poisson regression models adjusted by age to estimate the association between sociodemographic characteristics and chronic diseases with severe vision impairment. The age-adjusted prevalence of severe vision impairment was 2.8 %. The prevalence was higher in low socioeconomic status, low educational attainment, rural regions and among those who spoke an indigenous language or were unemployed. Participants living with diabetes or hypertension also had a higher prevalence of severe vision impairment. These results highlight subgroups with a higher prevalence of severe vision impairment. Policymakers in Mexico and countries with Mexican populations should prioritize effective eye health for marginalized and disadvantaged groups. Implementing the United Nations General Assembly resolution to include eye care in universal health coverage can reach those most affected.
28. Disparities in pediatric stroke-related mortality in the United States: Insights from the CDC WONDER database.
期刊: Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia 发表日期: 2025-Sep-04 链接: PubMed
摘要
Stroke is a rare but significant cause of mortality among the pediatric age group. Despite advances in treatment, disparities in stroke-related mortality persist. We aim to analyze stroke-related mortality among pediatric age groups in the US for over two decades. This retrospective cross-sectional study utilized the CDC WONDER database for stroke-related mortality in children (≤ 14 years). Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Annual percent changes (APC) with 95 % confidence intervals (CI) were determined from Joinpoint regression (Joinpoint Regression Program V 5.2.0). From 1999 to 2020, a total of 15,512 deaths in the United States pediatric-stroke-related mortality were reported. An overall decrease in AAMR was observed, from 1.26 in 1999 to 1.02 in 2020. Males had higher AAMR (1.28) than females throughout the period (1.03). Across regions, the Midwest had the highest AAMR (1.24), followed by the South (1.23), the West (1.17), and the Northeast (0.95). Non-Hispanic (NH) Black or African American group had the highest AAMR (1.97) followed by Hispanic or Latinos (1.08), NH Whites (1.00), and NH Asian or Pacific Islanders exhibited the lowest AAMR (0.94). The CMR per 100,000 was noted to be the highest for the <1 year age group (CMR: 8.14) while the 5-14 years group demonstrated the lowest crude rate (CMR: 0.56). Upon urbanization, the highest AAMR was observed in large central metro areas (1.23) while large fringe metro areas had the lowest AAMR (1.02). The highest AAMRs state-wise were observed in Alaska (1.79), South Dakota (1.77), and the District of Columbia (1.75). An increase in mortality trends was observed from 2012 onwards with males, infants, and African American children being the high-risk groups. A multifaceted approach, focusing on prevention, early recognition, and optimized management is required to mitigate pediatric-stroke-related mortality.
29. The role of adjuvant radiotherapy in relation to tumor size for bone-invasive pT4aN0 oral squamous cell carcinoma - A retrospective observational matched cohort study.
期刊: Oral oncology 发表日期: 2025-Sep-04 链接: PubMed
摘要
Oral squamous cell carcinoma (OSCC) with bone invasion are staged as pT4a, potentially upstaging smaller tumors. This study aimed to evaluate the oncological benefit of postoperative radiotherapy (PORT) in pT4aN0 OSCC with respect to tumor size and without other risk factors. This retrospective matched cohort study included pT4aN0 OSCC patients with bone invasion treated surgically (R0) between 2010 and 2022. Each case was 1:1 matched to a pT1-3 N0 OSCC patient based on tumor size, but without bone invasion. The primary endpoint was overall survival (OS), secondary endpoints included the recurrence-free survival and outcome predictors. A total of 156 patients were analyzed (78 per group). There were no statistically significant differences in 3-year OS between both groups in general (78.2%, 95%CI: 68.6-87.8 vs. 80.0%, 95%CI: 68.4-91.6). After stratification for pT2 criteria, there was also no significant difference between both groups if PORT was omitted (63.9%, 95%CI: 44.2-92.4 vs. 70.5%, 95%CI: 55.0-90.0). Multivariate analysis identified age and poor differentiation (grade III) as significant predictors of worse OS, while PORT showed no independent survival benefit. In small OSCC staged pT4a due to bone invasion and lacking other risk factors, PORT demonstrated no statistically significant improvement in OS when matched for tumor size. Further prospective trials and larger cohorts are warranted to confirm these findings.
30. Defining the Clinical Informatics Knowledge Gap in General Surgery: Evaluation of Resident Experience and Perspectives.
期刊: Journal of surgical education 发表日期: 2025-Sep-04 链接: PubMed
摘要
Despite the growing prominence of clinical informatics (CI) in surgical practice, general surgery residents receive limited formal training in this field. We aimed to define key educational opportunities by assessing general surgery resident knowledge, perceptions, and experience in CI. Survey study assessing resident demographics, prior informatics experience, perception of CI’s importance in key areas of surgical practice, and interest in informatics education topics. General surgery training programs at 7 academic institutions. General surgery residents in all postgraduate training levels, with a total of 146/406 (36%) participants. Residents expressed lack of familiarity with CI, with (64%) self-describing as “aware but inexperienced”. Few residents reported prior informatics experience (26%) or medical school training (16%). Residents expressed interest in informatics education, particularly in electronic health record (EHR) workflow optimization, artificial intelligence, and EHR utilization for research. Informatics familiarity moderately correlated with perceived importance of CI (Pearson’s r = 0.35). General surgery residents recognize the importance of CI in surgical practice but lack training and experience in this field, highlighting future educational opportunities. These findings underscore the necessity of structured CI training to prepare surgeons for the evolving world of healthcare technology.
31. Analysis of congruence between nursing metaparadigm concepts and American Academy Nursing policy 2010 to 2024.
期刊: Nursing outlook 发表日期: 2025-Sep-04 链接: PubMed
摘要
Nursology (aka nursing) is the study and practice of discipline specific knowledge. The most abstract component of nursology is its metaparadigm, which is foundational to all other nursology knowledge. The purpose of this literature review was to identify the extent to which the metaparadigm concepts are evident in American Academy of Nursing approved journal and website articles about health policy published between 2010 and 2024. A systematic review of 109 journal articles. The metaparadigm concepts evident in the 109 articles were, in descending order of frequency, nursing (41%), health (26%), environment (19%) and person (14%). As explicit nursing knowledge is articulated in health policies via the metaparadigm concepts, nursology’s national presence as a discipline will be strengthened. It is reccommended that future health policy analyses concentrate on how other components of nursology knowledge, incuding conceptual and theoretical frameworks, guide development and implementation of policies.
32. Evaluating variation in opioid prescribing for emergency general surgery patients.
期刊: Surgery 发表日期: 2025-Sep-04 链接: PubMed
摘要
Although procedure-specific guidelines have been established for postoperative opioid prescribing in the elective setting, it is unknown to what extent prescriptions in the emergency setting adhere to these standards. Variation in opioid prescribing for emergency general surgery patients may represent context-appropriate deviation or an opportunity for improved stewardship. Leveraging data from a statewide Acute Care Surgery collaborative, we identified patients undergoing 4 common procedures in the emergency setting: laparoscopic appendectomy, laparoscopic cholecystectomy, emergency hernia repair, and open colectomy. We evaluated variation in discharge prescription size and adherence to elective opioid prescribing guidelines at the facility level using risk- and reliability-adjusted multilevel models. We also evaluated patient-level factors associated with non-guideline-concordant prescriptions. This study included 10,155 patients across 10 hospitals. There was wide variation in opioid prescribing between facilities in terms of total oral morphine equivalents (1.5-3.7-fold) and opioid-free discharge (1.1-2.3-fold) for all procedures. Although most prescriptions were concordant with elective guidelines (75%-96%), colectomy prescriptions were 5 times less likely to be guideline concordant than appendectomy prescriptions (25% vs 4%). Increasing comorbidity burden (adjusted odds ratio 2.51, 95% confidence interval 1.55-4.05, P < .001) and American Society of Anesthesiologists physical status classification (adjusted odds ratio 1.77, 95% confidence interval 1.45-2.16, P < .001) were associated with non-guideline concordance. Opioid-prescribing patterns in the emergency general surgery setting are widely variable and sometimes inconsistent with elective guidelines. Procedure- and patient-level factors unique to the emergency setting may inform postoperative pathways that improve opioid stewardship.
33. Relationship between mental health professional shortages and depression and anxiety visits: a cohort study of Federally Qualified Health Centers, 2019-2022.
期刊: Healthcare (Amsterdam, Netherlands) 发表日期: 2025-Sep-04 链接: PubMed
摘要
34. Senkyunolide I alleviates allergic rhinitis by inhibiting JAK1/3-STAT3/6 and JNK signalings.
期刊: International immunopharmacology 发表日期: 2025-Sep-04 链接: PubMed
摘要
Allergic rhinitis (AR) is a common allergic disease with a high incidence rate. Senkyunolide I (SEI), a bioactive ingredient isolated from Ligusticum sinense ‘Chuanxiong’, exhibits known analgesic and anti-inflammatory effects, yet its anti-AR potential remains unexplored. Here, we aim to investigate the therapeutic efficacy and molecular mechanisms of SEI against AR. In IL-4-stimulated human nasal epithelial cells (HNEpCs), the levels of allergic mediators were quantified by RT-qPCR. The anti-AR efficacy of SEI was then validated in ovalbumin (OVA)/Al(OH)3-induced mice. Mechanistic studies combining western blotting, CETSA, and molecular docking identified the molecular mechanisms and targets of SEI. In vitro, SEI effectively reduced IL-4-induced mRNA expression of CCL11, CCL26, IL-33, periostin, VCAM-1, and MUC5AC in HNEpCs. Furthermore, oral administration of SEI significantly alleviated OVA/Al(OH)3-induced AR in mice, which mainly manifested as: (1) reduced serum levels of IL-4, IL-13, OVA-IgE, and IgE; (2) decreased nasal lavage fluid (NALF) levels of IL-4, IL-13, and OVA-IgE; (3) down-regulated mRNA expression of CCL11, CCL26, IL-5, IL-33, periostin, and MUC5AC; and (4) inhibited infiltration of eosinophils and mast cells in the nasal mucosa. Mechanistically, SEI was able to directly interact with JAK1/3 kinases, resulting in the inactivation of JAK1/3-STAT3/6 signaling cascades in IL-4-stimulated HNEpCs and OVA/Al(OH)3-challenged mice. Additionally, SEI was found to inhibit IL-4-induced JNK phosphorylation in vitro and in vivo. We confirmed that SEI alleviated AR via inhibiting JAK1/3-STAT3/6 and JNK pathways, raising the possibility that SEI could function as a promising candidate for the therapy of AR or other allergic diseases.
35. Long-chain PFAS potently disrupt renal carboxylesterase activity and exacerbate nephrotoxicity: an investigation of the chain length-dependent nephrotoxicity of PFAS.
期刊: Environment international 发表日期: 2025-Sep-03 链接: PubMed
摘要
Perfluoroalkyl and polyfluoroalkyl substances (PFAS) are recognized as critical environmental health hazards, however, their toxicity mechanisms in specific organ systems remain poorly characterized. This study systematically investigated the chain length-dependent nephrotoxicity of PFAS and their inhibitory effects on renal carboxylesterase (CES) activity. In vitro experiments revealed that PFAS were cytotoxic to Human Kidney-2 (HK-2) cells in a dose-dependent and chain length-dependent manner. Furthermore, functional group modification significantly affected the toxicity, perfluoroalkyl carboxylic acids (PFCA) showed the strongest toxic effects compared to fluorotelomer alcohols (FTOH) and perfluoroiodides of the same carbon chain length. PFAS inhibited CES activity in a concentration-dependent manner, with stronger inhibitory effects observed at higher concentrations. PFCA showed the strongest inhibition of CES activity and chain length-dependent manner. Molecular simulations indicated that the PFAS easily bind to CES, suggesting PFAS may affect the activity by affecting secondary structure of CES. In vivo experiments revealed that exposure to perfluorocapric acid (PFDA) in C57BL/6 mice significantly suppressed renal CES activity and induced kidney injury, whereas perfluorohexanoic acid (PFHxA) exerted negligible effects. In addition, kidney weight was positively correlated with CES activity, suggesting a potential causal relationship between CES and PFAS-induced nephrotoxicity. Overall, this study not only provides new insights into the toxicological mechanisms of PFAS-laying a scientific foundation for the safety assessment of alternative compounds and the formulation of risk management strategies-but also validates the reliability of in vitro cell-based assays for the early screening of PFAS biotoxicity.
36. Prematurity, Neonatal Complications, and the Development of Childhood Hypertension.
期刊: JAMA network open 发表日期: 2025-Sep-02 链接: PubMed
摘要
Preterm children face a higher risk of cardiovascular conditions, including hypertension. However, studies have not isolated the associations of prematurity with cardiovascular conditions from the associations of subsequent complications with cardiovascular conditions, especially among those admitted to a neonatal intensive care unit (NICU). To investigate prospective associations of prematurity and NICU complications with childhood hypertension while accounting for prenatal and perinatal factors. This cohort study analyzed longitudinal data from the Boston Birth Cohort on 2459 infants (695 preterm, 468 with NICU admission) born between January 1, 1999, and December 31, 2014. Statistical analysis was performed from January 1, 1999, to December 31, 2020. Children were categorized into 5 subgroups based on preterm birth status, NICU admission, and major complications (sepsis, chronic lung disease, necrotizing enterocolitis, and intraventricular hemorrhage). The primary end point was hypertension (episodic and persistent) per American Academy of Pediatrics guidelines, with elevated blood pressure (BP) and BP percentiles as secondary end points. Modified Poisson and proportional hazards regression were used to determine crude and adjusted relative risks (RRs) and hazard ratios (HRs). Secondary analyses used linear generalized estimating equations to assess repeated BP measurements over time, standardized to population-based BP percentiles. Of the 2459 infants (695 preterm: mean [SD] gestational age, 33.2 [3.5] weeks; 358 boys [51.5%]; and 1764 full term: mean [SD] gestational age, 39.4 [1.3] weeks; 879 boys [49.7%]) in this study, 468 (19.0%) were admitted to the NICU. The incidence of persistent hypertension was higher among children born preterm compared with those born at full term (25.2% [175 of 695] vs 15.8% [278 of 1764]). Preterm infants and infants admitted to the NICU had a greater risk of developing persistent hypertension compared with full term-born children without NICU admission or neonatal complications, independent of pertinent maternal and infant characteristics. Preterm infants with an NICU stay, both with (adjusted RR, 1.87 [95% CI, 1.19-2.94]) and without (adjusted RR, 1.62 [95% CI, 1.27-2.07]) a neonatal complication, had the greatest risk for persistent hypertension. Cox proportional hazards regression analysis identified preterm infants with an NICU stay, particularly those with a complication, as having the highest risk of developing persistent hypertension (adjusted HR, 2.37 [95% CI, 1.44-3.89]). On average, infants born prematurely without an NICU admission or complication (β, 2.74 percentile points [95% CI, 0.38-5.10 percentile points]) and those born prematurely with an NICU admission but no complications (β, 4.06 percentile points [95% CI, 2.11-6.02 percentile points]) had higher systolic BP percentiles and those born prematurely with an NICU admission but no complications had higher diastolic BP percentiles (β, 4.01 percentile points [95% CI, 2.52-5.49 percentile points]) during follow-up up to 18 years of age. This prospective cohort study found incrementally stronger associations for NICU admission, prematurity, and prematurity-related complications with the risk of developing persistent hypertension in childhood. These findings support the need for hypertension screening, coordinated primary and specialist care, and cardiovascular health promotion among children born preterm.
37. Molecular characterization and isolation of contemporary porcine sapoviruses from swine farms in the United States.
期刊: Veterinary microbiology 发表日期: 2025-Sep-02 链接: PubMed
摘要
Porcine sapovirus (PoSaV) is an emerging enteric pathogen in swine industry, primarily associated with diarrhea in weaning and post-weaning pigs. To date, eight genogroups of PoSaVs have been identified, with genogroup III (GIII) being the most prevalent worldwide. However, the isolation of field strains in various cell lines has achieved limited success, hindering progress in PoSaV research. We aimed to isolate contemporary PoSaVs from U.S. swine farms using different porcine cell lines. A total of 42 fecal or intestinal samples were collected from 12-28 days old pigs with mild-moderate diarrhea across five farms and screened for the presence of PoSaV using reverse transcription (RT)-PCR. Positive samples were serially passaged in swine testicular (ST) cells, porcine kidney cells (LLC-PK1), and porcine intestinal epithelial cells (IPEC-J2). Virus isolation was confirmed by RT-PCR and immunofluorescence assays, and representative PoSaV genomes were sequenced. The overall PoSaV detection rate was 60 % (25/42), with farm-level prevalence of 80 % (4/5), and all strains classified as GIII. Sequence analysis revealed high similarity among the isolates but notable divergence from classical GIII strains. The success rates of virus isolation were 8 % (2/25) in ST cells, 16 % (8/25) in LLC-PK1 cells and 0 % (0/10) in IPEC-J2 cells. To our knowledge, this is the first report of successful PoSaV propagation in ST cells, providing a new platform for PoSaV research and for vaccine development.
38. Predicting tumor response to TACE plus lenvatinib and PD-1 inhibitors for unresectable HCC: A multicenter observational study.
期刊: European journal of radiology 发表日期: 2025-Sep-01 链接: PubMed
摘要
Preoperatively identifying patients with unresectable hepatocellular carcinoma (uHCC) who are likely to achieve an objective response to the treatment regimen of transarterial chemoembolization (TACE) plus lenvatinib and programmed death-1 inhibitors (TLP) remains challenging. We aimed to develop and validate a predictive model for tumor response to TLP treatment in patients with uHCC. Patients with uHCC who received TLP treatment were divided into training (n = 107), internal validation (n = 46), and external validation (n = 52) cohorts. A nomogram model was developed based on the clinical variables of the training cohort using multivariate logistic regression. The performance of this nomogram model was evaluated using the area under the curve (AUC) and calibration curves, and its performance was compared with that of other predictive models. The Eastern Cooperative Oncology Group performance status, albumin-bilirubin grade, platelet-to-lymphocyte ratio, tumor distribution, and total bilirubin were identified as independent predictors of objective response. These variables were incorporated to develop the EAPTT model. The AUCs of the EAPTT model were 0.84, 0.90, and 0.85 in the training, internal validation, and external validation cohorts, respectively-statistical analysis via the DeLong test showed that these AUCs were significantly higher than those of the other seven predictive models. Stratification of patients into objective responders and non-responders via the EAPTT model revealed statistically significant progression-free survival and overall survival differences between the two groups. The EAPTT model may enable precise stratification of the efficacy of patients with uHCC receiving TLP treatment, serving to assist in identifying the optimal candidates.
39. Post-COVID-19 Alopecia Universalis: Autoimmune Hair Loss and the Challenge of Relapse Management.
期刊: Journal of drugs in dermatology : JDD 发表日期: 2025-Sep-01 链接: PubMed
摘要
Alopecia universalis (AU) is the most severe form of alopecia areata (AA), characterized by complete scalp and body hair loss. While post-COVID-19 hair loss is often attributed to telogen effluvium (TE), emerging evidence suggests that COVID-19 may also trigger AU through immune dysregulation, particularly via interferon-gamma (IFN-γ)-mediated inflammation. The chronic and relapsing nature of AU raises challenges in long-term disease management, particularly regarding treatment duration and relapse prevention. We present a 79-year-old woman with no personal or family history of hair loss who developed sudden-onset AU one month after recovering from COVID-19. Initial treatment with topical and intralesional corticosteroids failed, prompting systemic therapy initiation. Over 10 months of treatment, she achieved significant hair regrowth. However, 3 months after discontinuation, hair loss recurred, reinforcing the relapsing nature of post-COVID-19 AU. This case uniquely demonstrates the rapid onset and relapsing nature of post-COVID-19 AU, distinguishing it from idiopathic AU and emphasizing the need for modified long-term treatment strategies. While Janus kinase (JAK) inhibitors and other immunomodulatory therapies show promise, the risk of relapse upon treatment discontinuation highlights the need for further research into long-term management strategies and maintenance therapy in post-viral AU.
40. A single-molecule biosensor based on multiple fluorophore nucleic acid probe and STORM imaging for detection of Hantaan virus.
期刊: Talanta 发表日期: 2025-Aug-30 链接: PubMed
摘要
Hemorrhagic fever with renal syndrome (HFRS), caused by Hantaan virus, poses a serious public health threat. Current diagnostic methods remain limited by low sensitivity, complex procedures, and high sample requirements. To address this, we developed a highly sensitive single-molecule biosensor using multi-fluorophore nucleic acid probes and STORM imaging for the detection of Hantaan virus RNA. The probe was synthesized via PCR incorporating EdUTP, enabling site-specific coupling of multiple Cy5 fluorophores through copper-catalyzed click chemistry. This multi-fluorophore probe, combined with magnetic beads and a capture sequence, specifically targeted viral RNA and enabled quantification by super-resolution imaging. Compared to conventional single-fluorophore probes, our system exhibited a significantly lower detection limit of 57.54 aM. Notably, this is the first application of STORM to a single-molecule viral RNA detection platform. The method offers a broadly applicable, ultrasensitive strategy for early clinical diagnostics of Hantaan virus and potentially other pathogens.
41. AI-assisted near-infrared ratiometric fluorescent sensor for ultrafast and portable visual detection of Bacillus anthracis biomarkers.
期刊: Journal of colloid and interface science 发表日期: 2025-Aug-29 链接: PubMed
摘要
Contamination by Bacillus anthracis in food and the environment poses a significant public health risk to both humans and animals, with dipicolinic acid (DPA) serving as an effective biomarker for its detection. In this work, a novel AI-assisted near-infrared ratiometric fluorescent sensing system based on rapid coordination cross-linking and multiple fluorescence response mechanisms was proposed for ultrafast and portable visual detection of Bacillus anthracis biomarkers. A near-infrared (NIR) ratiometric fluorescent probe with multiple fluorescence response mechanisms was developed for sensitive detection of DPA, using carbon dots (B-CDs) and CdTe quantum dots (QD686). Notably, the system exhibits a rapid fluorescence color transition from red to blue within 3 s when exposure to DPA. The strong metal-coordinating ability of DPA enables rapid binding with QD686, inducing nanoparticle aggregation that activates a multi-mechanism synergistic (Fluorescence resonance energy transfer-Inner filter effect, FRET-IFE) quenching effect, thereby enabling highly sensitive and selective fluorescence detection of DPA. Additionally, a portable device leveraging AI (YOLOv12 algorithm) and a smartphone was developed for DPA detection within 10 s, achieving a detection limit of 0.097 μM (S/N = 3) and demonstrating satisfactory accuracy (recovery: 93.6-116.0 %) and precision (RSD: 1.5-3.4 %, n = 5) in validation studies. This work not only provides a novel strategy for DPA sensing but also establishes a reliable protocol for rapid visual detection, showcasing its potential applications in food safety and environmental monitoring.
42. Optimising fibromyalgia criteria: evidence from the UK Biobank.
期刊: Seminars in arthritis and rheumatism 发表日期: 2025-Aug-28 链接: PubMed
摘要
To evaluate the performance of the 2016 revisions to the modified fibromyalgia criteria (FM2016) in identifying individuals with self-reported fibromyalgia in a large population sample, and to test whether simplified symptom thresholds and alternative definitions of widespread pain improve case-finding utility. We used data from 167,184 UK Biobank participants who completed an “Experience of Pain” online questionnaire. Logistic regression and clinical utility indices (CUI+ and CUI-) were used to assess the performance of the FM2016 criteria and alternative modifications in case-finding and screening self-reported fibromyalgia diagnoses. Cut-off combinations for the scales of the FM2016, the Widespread Pain Index (WPI), Symptom Severity Scale (SSS), and the Polysymptomatic Distress Scale (PSD) were iteratively optimised. We also compared different definitions of widespread pain, including a single self-reported item on “pain all over the body”. The FM2016 criteria showed high specificity (98·4 %) but low sensitivity (37·0 %) and case-finding utility (CUI+=0·111). A simplified set of criteria, WPI≥4, SSS≥4, and PSD≥12, conditional on self-reported chronic pain all over the body, improved case-finding utility (CUI+=0·163) while maintaining high screening ability (CUI-=0·974). Other definitions of widespread pain performed less well. In this large population-based study, simplified criteria incorporating a single question on widespread pain and easier-to-apply symptom cut-offs performed marginally better in identifying those with a diagnosis of FM.
43. Medicaid prescription cap policies and acute care use and mortality among enrollees with opioid use disorder.
期刊: Drug and alcohol dependence 发表日期: 2025-Aug-27 链接: PubMed
摘要
Twelve state Medicaid programs limit the monthly number of covered prescriptions. Such cap policies may force enrollees to forego essential medications with important health consequences. We aimed to determine the impact of cap policies on acute care use and all-cause mortality among enrollees with opioid use disorder (OUD). Using 2016-2019 T-MSIS Analytical Files, we propensity-score matched enrollees with OUD in 12 states with cap policies and 26 states without cap policies. Outcomes measured over 12 months included emergency department (ED) visits, hospitalization, and all-cause mortality and were analyzed via generalized linear regression models. We conducted subgroup analyses by use of medications for OUD (MOUD) and comorbidity level and sensitivity analyses to examine the role of cap policy characteristics. Unadjusted risks were 64.0 % vs. 62.5 % for ED visits, 27.6 % vs. 27.5 % for hospitalizations, and 3.2 % vs. 2.7 % for mortality in cap states and non-cap states, respectively. After adjustment, hospitalization risk was higher (RR=1.89, 99.5 %CI:1.13,3.16) in cap states than non-cap states whereas ED visits and mortality did not differ. There were largely no outcome differences by cap status in subgroups. Strict prescription limits allowing 3-4 prescriptions monthly (RR=1.90, 95 %CI:1.09,3.30) and lack of MOUD exemptions (RR=2.23, 95 %CI:1.32,3.78) were associated with increased hospitalization risk relative to non-cap states. Medicaid prescription cap policies were associated with increased hospitalization risk, but there were no differences in ED use or all-cause mortality. Cap policies may undermine the health of individuals with OUD and could be counterproductive to state efforts to curb Medicaid spending.
44. Triggered: Qualitatively exploring structural and social drivers of firearm violence exposure among LGBTQ+ young adults of color in Detroit.
期刊: Social science & medicine (1982) 发表日期: 2025-Aug-27 链接: PubMed
摘要
Firearm violence is a leading cause of injury and death among youth and young adults in the U.S. with notable inequities across race and ethnicity, geography, and gender. Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young adults are largely absent from firearms research. Guided by structural violence and Social Safety theory, we qualitatively explored structural and social influences on firearm violence exposure among LGBTQ+ young adults of color in Detroit, Michigan. Through analysis of in-depth interviews with 24 participants, we developed three themes aligned with this aim. First, participants’ accounts reflected how contemporary and historical structural racism in Detroit is the root cause of the firearm violence. Second, participants characterized firearms as a source of protection in the absence of structural safety. Finally, participants described how firearm violence against LGBTQ+ people is often an attempt to regain social status lost to structural violence. These themes indicate that structural racism in Detroit has unique impacts on LGBTQ+ young adults of color’s exposure to firearms and firearm violence. Future research with this community is needed to guide protective interventions and policy changes.
45. The missing link: TNF-α as a unifying mechanism in methamphetamine-induced neuronal dysfunction and blood-brain barrier compromise.
期刊: Journal of neuroimmunology 发表日期: 2025-Aug-26 链接: PubMed
摘要
Methamphetamine use disorder remains a significant public health concern, impacting neuronal function, immune responses, and vascular integrity. Of particular interest is methamphetamine’s disruption of the blood-brain barrier (BBB), a key event that triggers neuroimmune dysfunction and the development of neurodegenerative conditions. While the systemic effects of methamphetamine are well-characterized, the mechanism(s) governing its dysregulation of BBB physiology remain poorly understood. Emerging evidence suggests that the methamphetamine-induced production of tumor necrosis factor (TNF), occurring both in the periphery and within the central nervous system, triggers a cascade of molecular events that compromises BBB permeability. This review provides a comprehensive overview of current findings on the cross interaction between methamphetamine and the BBB, with particular emphasis on the potential role of TNF in dysregulation of BBB permeability and dysfunction. By elucidating the complex interplay between methamphetamine, TNF, and the BBB, we aim to inform the development of targeted interventions and preventative strategies to mitigate methamphetamine-induced neurovascular and neuroimmune dysfunction.
46. Duck plague virus ICP27 protein suppresses IFN-β production by dual targeting of DNA- and RNA-sensing pathways.
期刊: Veterinary microbiology 发表日期: 2025-Aug-25 链接: PubMed
摘要
Duck plague virus (DPV), an alphaherpesvirus causing severe economic losses in global waterfowl industries, adopts sophisticated strategies to subvert host antiviral immunity. Here, we identify DPV ICP27 as a pivotal immune evasion protein that concurrently inhibits both DNA (cGAS-STING) and RNA (RIG-I/MDA5-MAVS) innate immune sensing pathways-a novel function unreported in avian herpesviruses. Through co-transfection and infection assays in duck embryo fibroblasts (DEFs), we demonstrate that ICP27 suppresses key immune sensors’ transcriptional and protein expression levels (STING, RIG-I) and the transcription factor IRF7. Co-immunoprecipitation confirms ICP27 binds to IRF7, impairing interferon regulatory functions, impairing interferon regulatory functions. Crucially, infection with ICP27-knockout DPV (DPV-ΔICP27) significantly enhances IFN-β, IL-6, Mx, and OASL expression compared to wild-type virus. Phylogenetic analyses reveal conserved yet species-specific functional divergence of ICP27 across herpesviruses. Our findings identify a unique “multi-target cooperative suppression” mechanism employed by DPV, which enhances our understanding of avian herpesviral immune evasion and offers potential targets for developing novel antiviral strategies.
47. Medical gender affirmation appears protective against problematic substance use among transgender women and transfeminine adults: Findings from The LITE Study.
期刊: Drug and alcohol dependence 发表日期: 2025-Aug-22 链接: PubMed
摘要
To estimate the association between medical and legal gender affirmation with problematic substance use among transfeminine adults. Data from a longitudinal cohort (The LITE Study) were analyzed (n = 1186). Participants were enrolled between March 2018 and August 2020 and followed for 2 years. We tested the association between baseline medical and legal gender affirmation with problematic drug use (DAST-10 ≥3) and problematic alcohol use (AUDIT-C≥4) at 12-months. We used Poisson regression to estimate adjusted prevalence ratios (aPR) and 95 % confidence intervals (CI). Mean age was 31.0 years (standard deviation=11.2). For race and ethnicity, 55.8 % were non-Latinx, white, 13.0 % were non-Latinx Black/African American, 17.1 % were Latinx, and 14.1 % were Asian, American Indiana/Alaskan Native, Native Hawaiian/Pacific Islander, or multiracial. For exposures, 75.1 % had met need for medical gender affirmation, 16.4 % did not seek medical gender affirmation, 8.5 % had unmet need for medical gender affirmation, and 19.5 % had all IDs match their chosen name/gender. At follow-up, 24.1 % had problematic drug use, and 27.6 % had problematic alcohol use. Participants with met need for medical gender affirmation were less likely to have problematic drug use at follow-up (aPR=0.70, 95 %CI=0.49-0.99) compared to those with unmet need. Compared to those who did not seek medical gender affirmation, those with met need (aPR=0.72, 95 %CI=0.57-0.91) and unmet need (aPR=0.68, 95 %CI=0.47-0.97) were less likely to have problematic alcohol use. Medical gender affirmation appears protective against problematic substance use. Increasing access to medical gender affirmation may improve substance use outcomes among transfeminine adults who desire such services.
48. Total tumor volume predicts overall survival and response to induction chemotherapy in patients with colorectal cancer liver metastases: An ancillary study of the phase 3 CAIRO5 trial.
期刊: European journal of cancer (Oxford, England : 1990) 发表日期: 2025-Aug-21 链接: PubMed
摘要
This study aimed to assess whether total tumor volume (TTV) outperforms RECIST1.1 for treatment response assessment in patients with colorectal liver metastases (CRLM), and to investigate TTV as a predictive biomarker for the optimal systemic treatment regimen for individual patients with initially unresectable CRLM. Patients with initially unresectable liver-only CRLM from the phase 3 CAIRO5 trial (NCT02162563) were included. All patients received induction systemic treatment. Baseline TTV and changes in TTV and RECIST1.1 in response to systemic treatment were calculated using the CT scans before systemic treatment and at first follow-up, and were assessed for their prognostic and predictive value with multivariable Cox regression models. Results In total, 425 patients were included. In multivariable analyses, baseline TTV (adjusted HR [aHR] for 100 mL vs 10 mL, 2.44 [95 % CI, 1.25-4.76]; P = 0.006) and relative change in TTV were the strongest predictors for OS (aHR for 0 % change vs 50 % decrease, 2.57 [1.83-3.60]; P < 0.0001). In contrast, RECIST1.1 was not independently associated with OS (aHR for partial response vs progressive disease, 0.63 [95 % CI, 0.33-1.20]). Higher baseline TTV predicted a stronger treatment benefit of FOLFOX-/FOLFIRI-bevacizumab vs FOLFOX-/FOLFIRI-panitumumab on OS (Pinteraction=0.017). This study demonstrates that TTV (i) outperforms traditional risk factors for OS prognostication, and (ii) may be a more accurate and sensitive treatment response assessment method compared to the currently used RECIST1.1 system in patients with initially unresectable CRLM. Moreover, TTV assessment is a promising approach for individualized clinical decision-making between bevacizumab and panitumumab.
49. Changes in gut microbiota signatures associated with the epidemiological dynamics of wild European rabbits facing haemorrhagic disease outbreaks.
期刊: Veterinary microbiology 发表日期: 2025-Aug-21 链接: PubMed
摘要
The new variant of rabbit haemorrhagic disease virus (RHDV2 or RHDVb) is responsible for a lethal, emerging infectious disease in several species of lagomorphs, and is globally threatening wild rabbit populations. It is known that the gut microbiota plays a crucial role in modulating host health, including immune responses and disease susceptibility. We hypothesize potential association of gut microbiota with the epidemiological dynamics of RHDV2 outbreaks that may provide key insights into how this lethal, emerging pathogen impacts wild rabbit populations. We report on changes in the gut microbiota signatures associated with the epidemiological status of a wild population of European rabbits before, during, and after an RHD outbreak in NW Morocco. Two populations were also studied in NE Spain after an independent RHD outbreak. From each individual, we sampled liver, blood, and fresh hard faecal pellets to determine the presence of antigen (i.e. presence of RHDV RNA), antibodies against RHDV, and changes in gut microbiota composition after massive 16S rRNA gene analysis, respectively. Correlational analysis and differential abundance tests were carried out to unveil significant differences in the gut microbiota among the different serological and antigen profiles. A B/F ratio based on several selected taxa within the order Bacteroidales vs. several taxa within the phylum Firmicutes showed a threshold value of 1 that split susceptible (B/F <1) and non-susceptible individuals (B/F >1) both in Morocco and in Spain. The highest proportion of individuals B/F < 1 was found in juveniles, and 100 % of the juveniles RHD dead and 75 % of the adults RHD dead scored B/F < 1. Although the exact nature of this association remains to be determined, this work shows an interesting potential take-off to both explore RHDV2’s ecological dynamics with regards to intestinal microbiota and developing potential targeted treatments or management strategies for conservation and pest control.
50. Potential high arbovirus exposure in INDOPACOM during U.S. service member deployment or exercises in Papua New Guinea.
期刊: MSMR 发表日期: 2025-Aug-20 链接: PubMed
摘要
Arboviruses pose a significant health threat to U.S. military personnel deployed in the U.S. Indo-Pacific Command (INDOPACOM) region. In 2023 we conducted a sero-epidemiological study to determine the arboviruses circulating in 185 Papua New Guinea military personnel (PNGMP), using the neutralizing antibody (NAb) assay. Overall, sero-positivity rates among the 185 PNGMP tested were: anti-Zika virus (ZIKV), 87% (n=161); anti-Japanese encephalitis virus (JEV), 62.2% (n=115); anti-Ross River virus (RRV), 44.3% (n=82); anti-Murray Valley encephalitis virus (MVEV), 39.5% (n=73); anti-chikungunya virus (CHIKV), 33.5% (n=62); anti-Barmah Forest virus (BFV), 10.8% (n=20); and anti-West Nile virus (WNV), 5.9% (n=11). The monotypic NAb sero-positivity rates for dengue virus (DENV) serotypes were: anti-DENV-1 94.6% (n=175), anti-DENV-2 93% (n=172), anti-DENV-3 95.1% (n=176), and anti-DENV-4 31.4% (n=57). These findings indicate that the majority of PNGMP had prior exposure to DENV and ZIKV, with a notable proportion exposed to CHIKV, RRV, JEV, and MVEV, and lower levels of exposure to BFV and WNV. Low or moderate prior exposure may leave individual PNGMP immunologically naïve and more susceptible to infection and disease upon first exposure. Furthermore, secondary DENV infections with a different serotype can increase risk of severe disease due to immune enhancement mechanisms such as antibody-dependent enhancement. Understanding these exposure patterns is crucial for assessing population risk and informing surveillance and prevention strategies. U.S. soldiers exercising or deploying to Papua New Guinea should adhere to strict preventive measures for minimizing mosquito bites and reducing their risk of arboviral infections. To our knowledge, this study provides the first comprehensive examination of arbovirus sero-positivity rates in Papua New Guinea military personnel (PNGMP) following the COVID-19 pandemic. After examining sero-positivity of 11 arboviruses, we found a majority of PNGMP with neutralizing antibodies (NAb) to dengue and Zika viruses, with some NAb to chikungunya, Japanese encephalitis, Ross River, and Murray Valley encephalitis viruses. Sero-prevalence to Barmah Forest and West Nile viruses was less common.
51. Craving for opioid and cannabis use among adults with chronic pain: Insights from a 30-day ecological momentary assessment study.
期刊: Drug and alcohol dependence 发表日期: 2025-Aug-17 链接: PubMed
摘要
Craving is an aversive state and risk factor for progression to nonmedical substance use. The aims of this secondary analysis of Ecological Momentary Assessment (EMA) data were 1) to test whether craving was elevated on days of co-use of opioids and cannabis, and 2) to examine pain, pain catastrophizing, affect, and stress as risk factors for current and next-moment craving, among patients with chronic pain. Adults with chronic pain (N = 46) who used both opioids and cannabis were recruited online and completed a 30-day EMA study, consisting of four momentary surveys per day that assessed opioids and cannabis craving, use, pain and pain catastrophizing, affect, and stress. Linear mixed effects models estimated associations between pain, pain catastrophizing, affect, and stress with craving, at the same occasion and prospectively. Most participants experienced some craving, though about a third of participants included in analyses reported minimal or no craving for the duration of the study. Craving for opioids and cannabis was higher on days of co-use and in the context of greater pain catastrophizing; smaller effects were observed correlating pain intensity, affect, and stress to opioid and cannabis craving. In adjusted analyses, pain catastrophizing prospectively predicted future opioid craving, albeit the effect was small. The findings highlight that subset of patients do not report experiencing craving, but those who do tend to experience craving on days with heightened pain intensity and catastrophizing. Future research should investigate the role of pain catastrophizing in craving among patients with chronic pain.
52. Emergency Department Preparedness in a Mega Mass Casualty Incident While Under Missile Fire: Lessons Learned From Israel on October 7, 2023.
期刊: The Journal of emergency medicine 发表日期: 2025-Jul-29 链接: PubMed
摘要
On October 7, 2023, approximately 2,500 Hamas terrorists infiltrated southern Israel from Gaza. Over 1,200 people were killed and 1600 were injured in the largest mass casualty incident (MCI) in Israel’s history. Emergency departments (EDs) throughout the country were overwhelmed with patients and working under missile fire. Injuries included high-velocity gunshot wounds, blast injuries, and burns. The objective of this article is to outline the lessons learned from the response of EDs in Israel to a large, multi-front MCI, in Israel known as a mega MCI, with a specific focus on the clinical care provided to patients in accordance with Israel’s National Hospital Disaster Preparedness Plan mandates. This is a retrospective descriptive analysis of the implementation of Israel’s National Hospital Preparedness Plan to the events of October 7, 2023. The working group that performed this analysis are Israeli and international emergency physicians who are involved in disaster preparedness at either their hospital or on a national level. The study is based on institutional after-action reviews. Any data presented is from the Israel Ministry of Health. A total of 1632 victims from October 7 were seen at 19 EDs throughout the country from the morning of the mega MCI until midnight. The EDs of the Soroka Medical Center, and the Barzilai Medical Center saw the most patients- 624 and 323 respectively. Israel’s National Committee for Mass Casualty Incidents (NCMCI) sets comprehensive guidelines and supervises yearly mandatory comprehensive hospital-wide exercises related to MCIs. Based on this, the EDs were able to easily call in additional staff and critical patients were treated using a multidisciplinary approach. Additional patient care areas were opened. There were instances of compromised patient care due to large numbers of arriving patients. Also, there was a need for more secondary transfers. Being the largest MCI in Israel’s history, October 7 tested the performance of the 19 EDs involved. Overall, staffing was sufficient and additional patient care areas were successfully opened. However, there were issues of compromised care and the need for increased numbers of secondary transfers. These lessons are important for the future management of MCIs in Israel and worldwide.
53. The impact of breast cancer awareness campaigns on the knowledge, attitudes, and practices of breast cancer screening among Saudi female employees.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Breast cancer (BC) stands as a significant and prevalent malignancy impacting women. The increase in statistics is primarily due to delayed detection, often attributed to a lack of awareness of symptoms. Additionally, emotional barriers and unfavourable attitudes toward breast screening contribute to the escalating prevalence of BC. This study targeted female university employees due to their dual role as professionals and caregivers, with a high potential for personal and community impact. This study aimed to evaluate the effectiveness of the university’s breast cancer (BC) health campaign related to the knowledge, attitudes, and practices (KAP) of female employees. A cross-sectional descriptive study was conducted in October and November 2023, following a BC awareness campaign. An online self-administered questionnaire was used to collect the data. The campaign, in the form of awareness, included posters, brochures, and lectures. The subjects were 290 female workers recruited from various departments of the university. Validation of the sampling and questionnaire, using a pilot test and reliability analysis, was conducted. Demographic data was analysed using frequency and percentage. Independent t-tests and one-way ANOVA were used to analyse the differences in knowledge and attitude towards breast cancer between various demographic variables. The results revealed that the health campaign significantly increased knowledge and fostered positive attitudes toward BC. Participants who had previously attended any prior BC health campaign scored higher in both knowledge (7.45 ± 0.98) and attitude (5.30 ± 1.48) compared to those who had never attended (knowledge: 6.10 ± 1.10, attitude: 4.10 ± 1.41). There were significant differences in the knowledge scores based on education level (p = 0.044), with participants with higher education having a higher mean knowledge score (7.50 ± 0.85) compared to those with a bachelor’s degree (6.70 ± 1.02). Participants with a family history of breast cancer had similar knowledge scores to those without but lower attitude scores. Independent t-tests and one-way ANOVA indicated that education level and attendance at the breast cancer health campaign were the significant factors associated with knowledge and attitude scores. The findings show that there was a positive attitude towards BC. Nevertheless, additional interventions, such as counselling services and promoting available BC screening, must be added to facilitate screening behaviour. Future campaigns are also recommended to use diverse, culturally sensitive strategies targeting both younger and older women, as well as men.
54. Association between receiving the Aksi Bergizi Social Behavioral Change Communication (SBCC) intervention and dietary habits among secondary school students in Padang, Indonesia.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The Government of Indonesia and UNICEF introduced the Aksi Bergizi Social Behavioral Change Communication (SBCC) intervention to promote healthy dietary behaviors among adolescents. However, no systematic assessment of the Program’s effect has been made. The objectives of this study are: 1) to assess the extent to which exposure to the Aksi Bergizi Program is associated with dietary behaviors among secondary school students, and; 2) to assess mediation of the mentioned association by dietary self-efficacy. We conducted a school-based cross-sectional study in Padang Municipality, Indonesia. We collected data from 253 students attending Aksi Bergizi target schools, and 253 students from non-target schools, using self-administered questionnaire with a food frequency questionnaire (FFQ) section. We analyzed data using descriptive statistics with analysis of mediation by self-efficacy in dietary consumption. We identified three distinct dietary patterns among the students: one characterized by higher frequencies of eating meat, processed foods, and dessert (i.e., “High Protein and Processed Foods” dietary pattern), another by higher frequencies of eating snacks and sweetened drinks (“Snacks and Sugary Drinks”), and another by higher frequencies of eating soybean products and fresh fruits and lower frequency of eating preserved vegetables (“Healthier Diet”). Students in the Aksi Bergizi target schools were significantly less likely than students in the non-target schools to have the High Protein and Processed Foods dietary pattern (40.2% vs. 53.9%, Adjusted OR = 0.44; 95% CI = 0.20, 0.99) and more likely to have a Healthier Diet pattern, although the difference of the latter was not statistically significant. Students in the target schools, however, were also more likely than students in the non-target schools to have the Snacks and Sugary Drinks dietary pattern (78.7% vs. 40.4%, Adjusted OR = 6.22; 95% CI = 2.68, 14.42). Regarding mediation, students in the Aksi Bergizi target schools had significantly different dietary self-efficacy from students in the non-target schools (p < 0.001). However, self-efficacy was not significantly associated with dietary habits. The association in the non-mediated pathway between exposure to the Aksi Bergizi program and dietary habits was statistically significant (p < 0.001). The findings of this study have implications for stakeholders in adolescent health. However, limitations regarding the cross-sectional design (which precludes the ability to make causal inference), social desirability, and limited generalizability should be considered in the interpretation of the study findings.
55. Exploring Wellness Interventions for Graduate Students: A Pilot Study.
期刊: Journal of allied health 发表日期: 2025 链接: PubMed
摘要
This mixed-method design pilot study explored healthcare graduate students’ perceptions of a two-phase wellness intervention. Occupational therapy and physical therapy entry-level graduate students (n=53). An initial survey guided content for wellness interventions. The first phase (8 weeks) invited students to weekly in-person educational wellness sessions. The second phase (~9 weeks) gave access to a “wellness cart” stocked with wellness supplies. Students shared quantitative and qualitative feedback about the educational sessions and the wellness cart. Data indicated students perceived the interventions as useful and applicable. Two predominant themes emerged from the group sessions: intentionality in caring for self and sharing techniques for social connection. Students positively perceived the wellness interventions. Students reported intentionality to incorporate wellness strategies daily and share wellness strategies with others.
56. Acute kidney disease in patients with COVID-19. A prospective, multicenter, multinational study in Latin America.
期刊: Jornal brasileiro de nefrologia 发表日期: 2025 链接: PubMed
摘要
Acute kidney disease (AKD) is defined as functional and/or structural abnormalities of kidneys with health implications and a duration of ≤90 days. This study aimed to evaluate AKD as a more appropriate approach to these conditions for which we used a cohort of COVID-19 patients in whom kidney impairment is expressed by proteinuria and/or loss of function. Observational, prospective, longitudinal, multinational cohort study conducted across five Latin American countries. Adult patients with diagnosis of COVID-19 were included. Upon hospital admission, urinalysis or urine strip test was performed. If protein was not detected, a follow-up search was conducted five days later. Patients were classified in four AKD categories: non-kidney disease, proteinuria only, acute kidney injury (AKI) only, and proteinuria and AKI. Three hundred and sixty patients were included. AKD was present in 273 (75.8%), of whom 142 (52.0%) had only proteinuria, 11 (4.1%) had AKI without proteinuria, and 120 (43.9%) had both proteinuria and AKI. Overall, proteinuria with or without AKI was present in 262 patients (72.8%). AKI with or without proteinuria occurred in 131 patients (36.4%). AKI was mainly severe, non-oliguric, and hospital-acquired. In-hospital mortality increased with the severity of AKD: non-kidney disease 9.5%, proteinuria only 22.8%, AKI only 56.7%, and proteinuria plus AKI 53.0% (p = 0.001). Our data endorse a comprehensive approach based on the concept of AKD. This integrative approach, encompassing the structural and functional continuum of AKI, AKD, and CKD, enables timely interventions and the implementation of preventive and therapeutic strategies.
57. Secondary metabolites isolated from Fernandoa adenophylla (Wall. ex G.Don) steenis as multitarget inhibitors of cholinesterases for the treatment of Alzheimer's Disease, followed by molecular docking studies.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Alzheimer’s disease (AD) is a neurodegenerative disorder categorized by the progressive loss of cognitive function, with acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE) as key therapeutic targets. In this study, we report the isolation, characterization, and evaluation of the cholinesterase inhibitory potential of phytochemicals from Fernandoa adenophylla (Wall. ex G. Don) Steenis, a plant known for its medicinal properties. Using in-vitro enzyme inhibition assays, we identified five bioactive compounds, including lapachol (1), α-lapachone (2), peshawaraquinone (3), dehydro-α-lapachone (4), and an indanone derivative (5), which demonstrated significant inhibition of AChE and BuChE. The compounds exhibited varied inhibitory potency, with peshawaraquinone (3) showing the most promising AChE (IC50 = 0.90 ± 0.04 µM) and BuChE (IC50 = 8.39 ± 0.14 µM) inhibition, followed by dehydro-α-lapachone (4), which exhibited an AChE IC50 value of 2.64 ± 0.08 µM. Further, the selectivity index (SI) for AChE over BuChE was highest for dehydro-α-lapachone (SI = 21.1), suggesting its potential as a selective inhibitor. Molecular docking studies provided insights into the binding interactions between these compounds and the enzyme active sites, highlighting key interactions that may contribute to their inhibitory activity. These findings suggest that phytochemicals from F. adenophylla possess significant cholinesterase inhibition potential and may serve as leads for the development of novel therapeutic agents for Alzheimer’s disease.
58. Artificial vision models for the identification of Mediterranean flora: An analysis in four ecosystems.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Object identification has been widely used in several applications, utilising the annotated data with bounding boxes to specify each object’s exact location and category in images and videos. However, relatively little research has been conducted on identifying plant species in their natural environments. Natural habitats play a crucial role in preserving biodiversity, ecological balance, and overall ecosystem health. So, effective monitoring of habitats is necessary for safeguarding them, and one way of doing this is by identifying the typical and early warning plant species. Our study quantitatively evaluates the performance of six popular object detection models on our dataset collected in the wild, comprising various plant species from four habitats: screes, dunes, grasslands, and forests. The dataset employed in this work includes the data collected by human operators and the quadrupedal robot ANYmal C. The pre-trained object detection models have been chosen for experiments, and they are fine-tuned on our dataset to achieve better performance. These models incorporate two one-stage (RetinaNet and YOLOv8n), two two-stage (Faster RCNN and Cascade RCNN), and two transformer-based detectors (DETR and Deformable DETR). Extensive experimentation has been performed on the four habitat datasets by applying class balancing and hyperparameter tuning, and the obtained results are discussed.