公共卫生研究摘要 (2025-09-10)
共收录 59 篇研究文章
1. Incidence, Etiology, and Long-Term Outcome of Acute Myelitis in Stockholm County, Sweden: A Population-Based Study.
期刊: Neurology(R) neuroimmunology & neuroinflammation 发表日期: 2025-Nov 链接: PubMed
摘要
Myelitis is a relatively common clinical entity for neurologists, with diverse underlying causes. The aim of this study was to describe the incidence of myelitis, its causes, clinical presentation, and factors predicting functional outcomes and relapses. Using the Swedish National Patient Registry, we identified all adult patients in Stockholm County between 2008 and 2018 using International Classification of Diseases, 10th Edition (ICD-10) codes likely to include myelitis. We collected medical records and classified patients using a modification of the 2002 Transverse Myelitis Consortium Group criteria. Long-term follow-up data were collected for patients not diagnosed with multiple sclerosis (MS) or neuromyelitis optica spectrum disorder as a result of the initial myelitis. We identified 2,321 individuals, of whom 461 were patients with myelitis. The crude mean incidence of all-cause myelitis was 24.9 (95% CI 16.7-33.9) cases per million person-years, of which idiopathic myelitis had an incidence of 8.0 (95% CI 3.8-12.1) cases per million person-years. Partial myelitis was found in 80% of patients. Poor functional outcome was found in 11% of the cohort and correlated, in a multivariate logistic model, with age older than 50 years (OR 4.26, 95% CI 1.75-10.40), transverse spinal cord lesions (odds ratio [OR] 6.85, 95% CI 2.68-17.52), elevated CSF count of polymorphonuclear cells (OR 6.09, 95% CI 1.56-23.72), and elevated CSF/serum albumin ratio (OR 3.17, 95% CI 1.23-8.17). The median follow-up time was 5.4 years. Relapses occurred in 27% of patients with idiopathic myelitis and 72% of patients with unspecified demyelinating disease of the CNS. An increased relapse rate after idiopathic myelitis was found to be associated, in a multivariate model, with the presence of oligoclonal bands (incidence rate ratio [IRR] 4.47, 95% CI 1.70-11.73), transverse spinal cord lesions (IRR 2.81, 95% CI 1.11-7.12), and multifocal spinal cord lesions (IRR 2.82, 95% CI 1.03-7.69). Around half (48%) of all patients with myelitis received MS diagnosis during the study period. This large population-wide study describes a relatively high incidence of myelitis and low risk of relapses after idiopathic myelitis. A complete diagnostic workup of myelitis, including MRI of the entire CNS and collection of CSF, is essential in evaluating underlying causes and prognosis.
2. Climate warming is expanding dengue burden in the Americas and Asia.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Sep-16 链接: PubMed
摘要
Climate change is expected to pose significant threats to public health, particularly vector-borne diseases. Despite dramatic recent increases in dengue that many anecdotally connect with climate change, the effect of anthropogenic climate change on dengue remains poorly quantified. To assess this link, we assembled local-level data on dengue across 21 countries in Asia and the Americas. We found a nonlinear relationship between temperature and dengue incidence with the largest impact of warming at lower temperatures, peak incidence at 27.8°C, and a decline at higher temperatures. Using this inferred temperature response, we estimate 18% (95% CI: 11 to 27%) of historical dengue incidence on average across our study countries is attributable to anthropogenic warming. Future warming could further increase incidence by 49% (95% CI: 16 to 136%) to 76% (95% CI: 27 to 239%) by midcentury for low or high emissions scenarios, respectively, with cooler regions projected to double in incidence due to warming while other currently hot regions experience little impact or even small declines. Under the highest emissions scenario, we estimate that 262 million people are currently living in places in these 21 countries where dengue incidence is expected to more than double due to climate change by midcentury. These insights highlight the major impacts of anthropogenic warming on dengue burden across most of its endemic range, providing a foundation for public health planning and the development of strategies to mitigate future risks due to climate change.
3. Global and Regional Prediabetes Prevalence: Updates for 2024 and Projections for 2050.
期刊: Diabetes care 发表日期: 2025-Sep-09 链接: PubMed
摘要
4. Evaluating the Implementation of Online Postal Self-Sampling for Sexually Transmitted Infections in England: Multisite Qualitative Study.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-09 链接: PubMed
摘要
Online postal self-sampling (OPSS) allows service users to screen for sexually transmitted infections (STIs) by ordering a self-sampling kit online, taking their own samples, returning them to a laboratory for testing, and receiving their results remotely. OPSS availability and use has increased in both the United Kingdom and globally the past decade but has been adopted in different regions of England at different times, with different models of delivery. It is not known why certain models were decided on or how implementation strategies have influenced outcomes, including the sustainability of OPSS in sexual health service delivery. This study aims to evaluate the implementation of OPSS in 3 case study areas of England, with a focus on the sustainability of implementation and the relationship between implementation strategies and outcomes. Qualitative data collection methods were used: interviews with staff and stakeholders involved in the implementation and delivery of OPSS, analysis of local implementation and national policy documents, and observations in sexual health clinics. Analysis of interviews and observations was undertaken using qualitative implementation science frameworks, including normalization process theory, the Consolidated Framework for Implementation Research, and the major system change framework. Documentary sources were used primarily to map processes over time and triangulate against interview and observational evidence. Across the 3 case study areas, 60 staff and stakeholders were interviewed, 12 observations were conducted, and data from 86 documents were collated. Rather than being a discrete digital health intervention, we found that OPSS was part of-or occurred parallel to-major system changes in all areas. These changes were driven by budgetary pressures in all areas, but there was variation in other objectives used to rationalize the decision to adopt. The financial context and organizational relationships in each area determined the implementation strategies available to decision makers, how these strategies were enacted, and, in turn, led to different outcomes at different time points. OPSS implementation was not a one-off outcome but an ongoing process in response to changes in context, which in turn affected how staff perceived and engaged with OPSS. The COVID-19 pandemic had profound but divergent effects on OPSS implementation in each area, accelerating it in some contexts and reversing it in others. In this multisite case study, OPSS implementation was part of systems change to address a wider problem of insufficient funding to deliver sexual health care. Decisions about implementing OPSS were made before sufficient evidence was available to effectively guide the process. The resultant unintended consequences need acknowledgment to enable future commissioners and sexual health services to optimize sexual health service provision. RR2-10.1136/bmjopen-2022-067170.
5. Understanding the Behavioral Determinants of First Responder App Adoption by Integrating Perspectives From the Unified Theory of Acceptance and Use of Technology and Health Belief Model: Cross-Sectional Survey.
期刊: JMIR human factors 发表日期: 2025-Sep-09 链接: PubMed
摘要
Out-of-hospital cardiac arrests (OHCAs) are a leading cause of death worldwide, yet first responder apps can significantly improve outcomes by mobilizing citizens to perform cardiopulmonary resuscitation before professional help arrives. Despite their importance, limited research has examined the psychological and behavioral factors that influence individuals’ willingness to adopt these apps. Given that first responder app use involves elements of both technology adoption and preventive health behavior, it is essential to examine this behavior from multiple theoretical perspectives. Building on the unified theory of acceptance and use of technology (UTAUT) and health belief model (HBM), this study therefore developed an integrative framework to explain which behavioral determinants and demographic and health-related factors drive an individual’s willingness to install a first responder app for OHCA. We conducted a web-based cross-sectional survey (N=3660; mean age 49.95, SD 16.75 years; n=1909, 52.2% women) in June 2024 among Belgian adults. Behavioral determinants (UTAUT and HBM constructs), demographic (eg, age), and health-related (eg, cardiopulmonary resuscitation training experience) variables were measured using (multi-item) scales. Willingness to install the app served as the outcome variable. We developed a structural equation model using the Lavaan package in R and specified regression paths, on the one hand, between the behavioral determinants and willingness to install the app, and on the other hand, between the demographic and health-related factors and the behavioral determinants. Additionally, we conducted multiple group analyses to examine the moderating role of demographic and health-related factors on the relationships between the behavioral determinants and the willingness to install the app. Our results revealed that 2 UTAUT variables (ie, facilitating conditions: β=.07; P=.003 and social influence: β=.16; P<.001) and 3 HBM variables (ie, perceived susceptibility: β=.06; P=.003, perceived barriers: β=-.29; P<.001, and perceived benefits: β=.38; P<.001) were associated with willingness to install a first responder app for OHCA. Additionally, most demographic and health-related factors were indirectly related to willingness via behavioral determinants, with age being the sole moderator. Specifically, a negative association between perceived severity and willingness was only observed among older adults. In addition, the positive relationship between perceived benefits and willingness was stronger for older adults compared to younger ones. Overall, the results of this study have both theoretical and practical implications. Theoretically, this study finds its relevance in extending the UTAUT and HBM to altruistic mobile health apps and advancing our understanding of technology adoption in health contexts. Practically, the study’s findings could inform real-life health campaigns aimed at enhancing citizen participation in first responder systems.
6. Association of Atrial Ablation Procedure and Palliative Care for High-Risk Mortality Group With Atrial Fibrillation in U.S. Hospitals: 2016-2021 National Inpatient Sample Analysis.
期刊: Journal of palliative care 发表日期: 2025-Sep-09 链接: PubMed
摘要
ObjectivesRecently, atrial fibrillation (AF) has contributed to an increase in cardiovascular deaths in the U.S. Palliative care (PC) and atrial ablation (AA) procedure can elevate quality of life of high-risk AF patients, who are associated with multiple comorbidities. We explore the combined PC and AA management among high-risk mortality groups with AF.MethodsThis pooled cross-sectional retrospective data used the National Inpatient Sample (2016-2021) and included national estimates of 2,965,334 hospital discharges in the high-risk mortality group with AF. Multivariable regression was performed to determine the factors associated with AA procedure and PC centered on CHA2DS2-VASc score, systolic heart failure, and in-hospital mortality. Race/ethnicity, health insurance, and hospital location were controlled in multivariable analyses.ResultsPalliative care utilization was on an uptrend from 9.02% in 2016 to 12.29% in 2021. Factors that were negatively associated with PC utilization were increasing CHA2-DS2-VASc score (OR = 0.878), systolic heart failure (OR = 0.976), AA procedure (OR = 0.287), racial minorities, and rural residents. Atrial ablation was positively associated with systolic heart failure (OR = 2.920) and was negatively associated with increasing CHA2-DS2-VASc score (OR = 0.951) and PC utilization (OR = 0.283). Racial minorities and rural residents were less likely to receive AA procedure.ConclusionsPalliative care utilization was associated with lower probability of AA procedures by approximately 75%, and vice versa. Atrial ablation procedures and PC utilization were discrete choice patterns indicating healthcare providers’ tendency to favor the status quo and current practices rather than initiating change. Health disparities in PC utilization and AA procedures were identified in racial minorities and rural residents. Call to action is warranted to increase PC awareness and harmonious approach of PC and AA procedure for those with high-risk mortality AF patients in the U.S. hospitals.
7. Monkeypox virus shedding despite tecovirimat treatment in a cohort in Toronto, Canada.
期刊: The Journal of infectious diseases 发表日期: 2025-Sep-09 链接: PubMed
摘要
Tecovirimat (TPOXX) is an antiviral authorized for the treatment of mpox infections in Canada, but recent clinical trials found it has no impact on symptom duration. We conducted a prospective cohort study of individuals diagnosed with mpox in Toronto, Canada. Skin lesion swabs were collected weekly to quantify infectious monkeypox virus (MPXV) shedding through cell culture. The presence of antiviral resistance mutations was assessed by PCR and sequencing the F13L gene. Among 17 participants, 9 received tecovirimat, with a median initiation time of 14 days post-symptom onset. Infectious MPXV was detected in 31% (17/55) of lesion swabs from tecovirimat-treated participants and 32% (20/62) from untreated individuals. Shedding kinetics were similar between groups, with persistent infectious virus detected in several participants beyond two weeks of symptoms. Despite more than 7 days after tecovirimat initiation, four treated participants still shed viable virus in at least one sampled lesion, including up to 15 days after tecovirimat initiation. No known resistance mutations were identified in viral sequences from a subset of lesion swabs from both treated and untreated individuals, suggesting that tecovirimat resistance mutations were not widely circulating in Toronto during the 2022 outbreak. Our findings suggest that tecovirimat does not significantly impact the duration of infectious MPXV shedding from skin lesions, aligning with recent randomized trial results. These findings highlight the need for alternative antiviral strategies and continued genomic surveillance to monitor resistance emergence.
8. Adherence thresholds for emtricitabine-tenofovir disoproxil fumarate preexposure prophylaxis against HIV acquisition in cisgender women: A randomized directly observed dosing study.
期刊: PLoS medicine 发表日期: 2025-Sep-09 链接: PubMed
摘要
Oral emtricitabine/tenofovir disoproxil fumarate (F/TDF) preexposure prophylaxis (PrEP) effectiveness against HIV acquisition highly depends on adherence. For men who have sex with men, a dosing study in the United States (US) population defined clinically meaningful tenofovir diphosphate (TFV-DP) thresholds in dried blood spots (DBS) based on the rounded 25th percentile for 2, 4, and 7 doses/week as 350, 700, and 1,250 fmol/punch. However, divergent efficacy results in the first generation randomized clinical trials of F/TDF PrEP among African women led to several hypotheses to question whether the pharmacology and adherence requirement for oral F/TDF PrEP may be different in cisgender women compared to what is already established for men. We conducted an open-label, parallel, randomized study of directly observed oral F/TDF PrEP among women without HIV who were not pregnant or breastfeeding in Kenya. Participants were randomly assigned to 2, 4, or 7 DOD doses/week for 8 weeks. Blood was collected weekly, and TFV-DP and emtricitabine triphosphate (FTC-TP) concentrations in DBS and peripheral blood mononuclear cells (PBMCs) were quantified using validated liquid chromatography-tandem mass spectrometry. For DBS, concentrations were quantified from a 3-mm punch using the 70% methanol/30% water (70:30) extraction method as the primary process-the same method used for the original TFV-DP benchmarks derived in US adults, and additionally with 50% methanol/50% water (50:50) extraction using punches from the same DBS spot to compare the extraction performance of 70:30 versus 50:50 methods. The primary outcome was the steady-state fitted concentrations of TFV-DP and dose proportionality in DBS and the observed PBMC TFV-DP levels by study dosing groups. Secondary outcomes included the quantitative concentrations of FTC-TP in DBS, TFV-DP half-life in DBS, and the relative TFV-DP recovery from DBS using the 70:30 versus 50:50 extraction method. One-compartment population pharmacokinetic models were fit to estimate steady-state DBS concentrations. Descriptive statistics were summarized as range, means, and medians with interquartile range (IQR) for continuous outcomes and proportions for categorical variables. Fifty-four women were enrolled and randomized. Median age was 22 (IQR, 20-25) years. The observed median (IQR) week 8 TFV-DP concentrations in DBS were 359 (266-464), 749 (596-923), and 1,389 (1,151-1,551) fmol/punch after 2, 4, and 7 doses/week, respectively. At week 8, FTC-TP was quantifiable in 71%, 19%, and 0% DBS samples for 7, 4, and 2 doses/week groups, respectively. Fitted median (IQR) steady-state DBS TFV-DP concentrations were 416 (316, 516), 832 (631, 1,033), and 1,457 (1,106, 1,808) fmol/punch for 2, 4, and 7 doses/week, respectively, similar to previous estimates in US adults. TFV-DP exhibited a mean half-life of 17.5 days (95%CI: 16.7, 18.4) in DBS and steady-state TFV-DP concentrations varied in direct proportion to the dosing frequency [slope: 1.02 90% confidence interval 0.84, 1.20]. The 50:50 DBS extraction method yielded 1.27 (95% CI 1.25, 1.28) higher TFV-DP concentrations compared to the 70:30 method. When the 1.27 conversion factor was applied to the original 70:30 method-derived TFV-DP thresholds, the updated TFV-DP adherence interpretation benchmarks based on the 50:50 extraction were: <450 for <2 dose/week, 450-899 for 2-3 doses/week, 900-1,599 for 4-6 doses/week, and ≥1,600 fmol/punch for 7 doses/week. The observed mean (standard deviation) steady-state PBMC TFV-DP concentrations was 11.99 ± 8.47, 31.81 ± 15.66, and 63.1 ± 28.97 fmol/106 cells after 2, 4, and 7 doses/week, respectively. Overall, oral F/TDF PrEP was well tolerated. No grade 3 or higher adverse events were observed during the dosing phase. The primary study limitation was dosing for 8 weeks, but population pharmacokinetic modeling enabled steady-state estimates. Steady-state DBS TFV-DP concentrations from directly observed F/TDF PrEP dosing in African cisgender women participants are similar to previous estimates defined from US-based participants. These data demonstrate that cisgender women achieve similar DBS and PBMC TFV-DP concentrations as men for the same adherence level and validate the original TFV-DP benchmarks to interpret F/TDF adherence in HIV prevention studies and PrEP programs among cisgender women. Clinicaltrials.gov: NCT05057858.
9. Association between correlated effective neural drive and electromechanical fluctuations during co-contraction: Insights from MU discharges and interference EMG.
期刊: Journal of neurophysiology 发表日期: 2025-Sep-09 链接: PubMed
摘要
This study investigated the correlation between the strength of correlated effective neural drive (END) to the antagonistic muscles and the fluctuations in neural/electrical and mechanical output around the joint during steady co-contraction, and whether the correlated END strength estimated from conventional surface EMG is correlated with that determined from motor unit (MU) discharges. Fourteen young male participants performed isometric steady co-contractions with their medial gastrocnemius and tibialis anterior muscles at 10% of maximal EMG while sitting. Correlated END strength was quantified as the maximum value of the cross-correlation function between the conventional surface EMG signals and between MU discharges decomposed from high-density surface EMG of each muscle. Correlated END strength quantified from each signal was both negatively correlated with the fluctuations in net force (MU-based: r = -0.78; EMG-based: r = -0.63, P < 0.025) but positively correlated with the fluctuations in the corresponding neural/electrical signal (MU-based: r = 0.54; EMG-based: r = 0.73, P < 0.05). Additionally, the fluctuations in MU discharge frequency was negatively correlated with the fluctuations in net ankle extension-flexion force recorded as the mechanical output (r = -0.57, P < 0.05). Furthermore, correlated END strength was highly correlated between the MU-based and EMG-estimated measures (r = 0.83, P < 0.05). These results suggest that individuals with a greater correlated END to the antagonistic muscles exhibit greater neural/electrical fluctuations yet steadier mechanical output at the joint level during co-contraction, and the strength of correlated END can be observed in conventional surface EMG in such conditions.
10. Correlation between visual function and corneal backscatter by Scheimpflug imaging or anterior segment optical coherence tomography in Fuchs endothelial corneal dystrophy.
期刊: Japanese journal of ophthalmology 发表日期: 2025-Sep-09 链接: PubMed
摘要
PURPOSE: To evaluate the correlation between corneal backscatter and visual function in patients with Fuchs endothelial corneal dystrophy (FECD). Prospective case series. This study included 53 eyes from 38 patients with FECD. Corneal backscatter was quantified using light scattering (LS) via Scheimpflug imaging, and signal intensity (SI) via anterior segment optical coherence tomography. We measured corrected distance visual acuity (CDVA) using the Landolt-C and Early Treatment Diabetic Retinopathy Study (ETDRS) charts and contrast sensitivity function with sine wave grading chart by the area under the log contrast sensitivity function (AULCSF) and letter contrast sensitivity (LCS). Significant correlations were observed between LS and SI, particularly in the posterior 60 μm of the central 0-2-mm cornea. LS in the central 6-mm cornea was significantly correlated with CDVA (Landolt-C and ETDRS) or contrast sensitivity (AULCSF and LCS) in most layers or diameters. In the central 0-2-mm cornea, LCS and posterior LS had the strongest correlation (ρ = -0.58, P < 0.01), followed by AULCSF and posterior LS (ρ = -0.55, P < 0.01). In the central 0.5-2-mm cornea, anterior or posterior SI demonstrated significant correlations with CDVA (Landolt-C and ETDRS) and contrast sensitivity (AULCSF and LCS). AULCSF and posterior SI had the strongest correlation (ρ = -0.58, P < 0.01), followed by LCS and posterior SI (ρ = -0.56, P < 0.01). The corneal backscatter of the anterior and posterior central cornea of FECD is significantly correlated with visual function across both imaging modalities.
11. Statins in Acute Ischemic Stroke: Mechanisms, Resistance, and Precision Strategies for Neurovascular and Cognitive Protection.
期刊: CNS drugs 发表日期: 2025-Sep-09 链接: PubMed
摘要
Acute ischemic stroke (AIS) remains a leading cause of mortality and long-term disability globally, with survivors at high risk of recurrent stroke, cardiovascular events, and post-stroke dementia. Statins, while widely used for their lipid-lowering effects, also possess pleiotropic properties, including anti-inflammatory, endothelial-stabilizing, and neuroprotective actions, which may offer added benefit in AIS management. This article synthesizes emerging evidence on statins’ dual mechanisms of action and evaluates their role in reducing recurrence, improving survival, and mitigating cognitive decline. Key challenges limiting the full therapeutic potential of statins include interindividual variability in response and pharmacogenomic and biomarker-related resistance, inconsistencies across clinical guidelines, and limited central nervous system bioavailability. Innovations such as pharmacogenomic-guided therapy, pleiotropy-linked biomarkers, and advanced drug delivery systems (e.g., nanoparticle and intranasal formulations) may help overcome these barriers. Combination strategies with agents such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors or sodium-glucose cotransporter 2 (SGLT2) inhibitors, and targeted interventions against neuroinflammatory resistance, show promise in enhancing treatment efficacy. In doing so, we propose a shift from conventional statin use to a precision medicine paradigm that can better serve AIS survivors, especially those at risk of post-stroke dementia or those living in resource-constrained settings. While such innovations, for example, genetic testing and novel delivery methods, may not yet be feasible in all contexts, particularly low-resource environments, they represent long-term goals for equity-driven innovation. Equity in access to high-intensity statins and novel therapies remains a global priority, particularly in low- and middle-income countries. Future research should prioritize personalized, biomarker-driven approaches and inclusive clinical trials to optimize statin use across diverse AIS populations. By advancing these strategies, statins can evolve from cardiovascular agents into integral components of precision neurovascular medicine, improving long-term outcomes and quality of life for stroke survivors. Stroke is a leading cause of death and disability worldwide. After a stroke, patients are at high risk of having another stroke, developing heart problems, or experiencing long-term difficulties with memory and thinking, often referred to as post-stroke dementia. This article explores how a group of medications called statins, commonly used to lower cholesterol, may offer additional benefits beyond cholesterol reduction. Recent research suggests that statins have “pleiotropic” effects, meaning that they can reduce inflammation, stabilize blood vessels, and potentially support brain recovery after a stroke. These effects may help lower the risk of further strokes, reduce mortality, and protect against post-stroke cognitive decline. However, the evidence for cognitive benefits remains mixed, and further high-quality clinical trials are needed. Importantly, statins do not work equally well for everyone. Some patients experience limited benefits or side effects. This article discusses emerging strategies in stroke care, including the use of genetic tests and biomarkers to predict individual responses to statin therapy. It also highlights innovative delivery methods, such as nasal sprays or nanoparticles, that may help statins reach the brain more effectively. We propose moving away from a one-size-fits-all approach toward personalized treatment that considers a patient’s stroke subtype, genetic profile, and overall health. This approach could be especially valuable in low-resource settings where access to specialized stroke care is limited. If adopted more broadly, these strategies may help statins evolve from cardiovascular drugs into tools that also support brain health after stroke.
12. Clinical Significance of Circulating Tumor Cells in the Portal Vein of Patients with Hepatocellular Carcinoma Undergoing Anatomical Liver Resection.
期刊: Annals of surgical oncology 发表日期: 2025-Sep-09 链接: PubMed
摘要
Hepatocellular carcinoma (HCC) frequently invades the portal vein, leading to early recurrence and a poor prognosis. However, the mechanisms underlying this invasion remain unclear. In this study, we aimed to detect portal vein circulating tumor cells (CTCs) using a Glypican-3-positive detection method and evaluate their prognostic significance. This prospective study included 146 patients with HCC who underwent open anatomical hepatectomy. Blood samples from the peripheral, portal, and hepatic veins were collected intraoperatively, and CTCs were detected using magnetic enrichment and flow cytometry. Programmed cell death ligand 1 (PD-L1) expression in portal CTCs was evaluated in 40 patients. Portal vein CTCs were detected in 45.8% of cases, more frequently than hepatic vein CTCs (p = 0.031). Portal vein CTC positivity correlated with microscopic portal vein invasion (p < 0.001), poorer disease-free survival (p = 0.014), and overall survival (p = 0.001). PD-L1-positive portal vein CTCs were observed in 13 of 40 cases (32.5%) and were significantly associated with poorer prognosis (p = 0.001). Portal vein CTCs are significant predictors of portal vein invasion, recurrence, and survival in HCC. PD-L1-positive portal vein CTCs may contribute to immune evasion and tumor progression. These findings suggest that portal vein CTCs are valuable prognostic biomarkers and potential therapeutic targets.
13. Is splenectomy one of the contributory factors to pulmonary hypertension? An analysis of splenectomized hemolytic anemia and immune thrombocytopenia patients.
期刊: Annals of hematology 发表日期: 2025-Sep-09 链接: PubMed
摘要
The development of pulmonary hypertension (PH) after splenectomy is one of the recently controversial issues. This study aims to investigate whether splenectomy itself is an independent risk factor for the development of PH or if the primary contributor to PH development is the underlying condition that necessitated splenectomy. This study was conducted prospectively. We included 21 patients with immune thrombocytopenia (ITP) and 22 with hemolytic anemia. The patients’ symptoms were assessed according to a questionnaire form. Blood tests, including N-terminal pro-B type natriuretic peptide (NT-proBNP) and D-dimer levels were done and the 6-minute walk test (6MWT) was performed. PH risk was evaluated using echocardiography (ECHO) and according to the study algorithm, Q-SPECT/CT (perfusion single-photon emission computed tomography/computed tomography) and right heart catheterization (RHC) were performed on selected patients for further assessment. Only one patient in the ITP group was diagnosed as group 2 PH based on ECHO findings and 3 patients with beta thalassemia in the hemolytic anemia group were diagnosed with group 4-5 PH by RHC. There was no statistically significant difference between ECHO-assessed risk for PH in splenectomized patients with hemolytic anemia and ITP (p > 0.05). ECHO risk for PH in the hemolytic anemia patients was found to be low in patients whose hemolysis decreased and transfusion needs disappeared after splenectomy. The results of the study suggest that the development of PH after splenectomy appears to be related to the underlying condition rather than the absence of the spleen.
14. The Role of Family Communication Patterns within COVID-19 Vaccination Messaging.
期刊: Health communication 发表日期: 2025-Sep-09 链接: PubMed
摘要
As family communication is significantly related to individuals’ health decision-making, it is crucial to tap into the power of this relationship for public health initiatives. The COVID-19 pandemic provided a ripe context in which to explore whether vaccination messaging could be tailored in such a way as to target specific family communication climates to encourage vaccine promotion among family members. Specifically, our study (N = 1,276) designed pro-vaccination messaging tailored based on two types of family communication styles. The relationships of family communication patterns with several dependent variables (i.e., intent to share the message with family, perceptions of message credibility, and self-efficacy for encouraging family members to get vaccinated) were assessed. Vaccination status, age, family member considered by participant, and type of message tailoring presented were considered as moderators. Results indicate a myriad of significant relationships between the various family communication patterns (FCP) orientations and outcome variables and important moderation effects, most notably of vaccination status and family member being considered. The results and discussion of this study highlight the salience of family psychology, relationships, and communication within the context of individuals’ health-related decisions. Theoretical insights and translational implications of the study’s family-communication-tailored campaign messaging are discussed.
15. The Bubble-Bathification of Self-Care: Problematizing Possibilities for Restful Mental Health in Canada.
期刊: Medical anthropology 发表日期: 2025-Sep-09 链接: PubMed
摘要
As radical genres of self-care are co-opted under neoliberal logics, I track an emerging “bubble-bathification” of self-care, which foregrounds rest as a therapeutic avenue toward mental health. Fieldwork at Canadian universities demonstrates that the promotion of restful self-care is often juxtaposed against environments of systemic exhaustion, resulting in a cycle of fatigue for students perpetrated by the sources promoting restorative breaks. There is a simultaneous desire among students to divest themselves from inactivity in favor of pursuing justice-oriented change in their communities. I conclude that social, mental, and bodily unrest are mutually constitutive in understanding how exhaustion threatens people’s selfhood.
16. Melioidosis: An uncommon cause of neck abscess.
期刊: Tropical doctor 发表日期: 2025-Sep-09 链接: PubMed
摘要
Infection with the bacterium Burkholderia pseudomallei can cause melioidosis, a potentially life-threatening disease. As a facultative intracellular pathogen, it poses challenges for treatment and demands long-term follow-up. Neck abscesses caused by Burkholderia are rare, but it is essential to consider their possibility, as prompt diagnosis and treatment are crucial for improving outcomes and preventing complications. We report three cases of neck abscesses that were treated.
17. Intensive care management and outcomes of severe paediatric tetanus in a tertiary care hospital.
期刊: Tropical doctor 发表日期: 2025-Sep-09 链接: PubMed
摘要
Tetanus is a rapidly progressive, life-threatening illness with the clinical hallmark of muscle spasms associated with respiratory and neurological sequelae, especially in the unimmunised population. Non-neonatal tetanus continues to be a rare diagnosis. We hereby report six cases admitted to our intensive care unit, highlighting the varied clinical features, management strategies and outcomes. Early initiation of ventilatory support, aggressive spasm control, consideration of early tracheostomy and prevention of nosocomial infections are vital for positive outcomes. Additionally, consistent supportive care by doctors and nursing staff is crucial in managing severe paediatric tetanus.
18. Response to Trak and Gökçe.
期刊: Journal of the National Cancer Institute 发表日期: 2025-Sep-09 链接: PubMed
摘要
19. Call for Papers: Special Issue on Nucleic Acid Modifications.
期刊: Chemical research in toxicology 发表日期: 2025-Sep-09 链接: PubMed
摘要
20. Diversity of Salmonella enterica isolates from urban river and sewage water in Blantyre, Malawi.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Sep-09 链接: PubMed
摘要
Salmonella enterica encompasses over 2,600 serovars, including several commonly associated with severe infection in humans. Salmonella is a major cause of sepsis in Africa; however, diagnosis requires clinical microbiology facilities. Environmental surveillance has the potential to play a role in Salmonella surveillance. We undertook water-based environmental surveillance in Blantyre, Malawi, from 2019-2020, taking samples from rivers (87.9%), a sewage plant (8.85%) and other water sources (3.24%), isolating and storing 1,042 non-typhoidal Salmonella (NTS) isolates in this period. Of these, 341 NTS isolates were whole genome sequenced, genome quality was checked, duplicate genomes from any given sample were removed and core genome phylogeny was reconstructed. AMRFinder, PathogenWatch and SISTR were used to further investigate serovar, sequence type and antimicrobial resistance determinants. After quality checks, and removal of duplicate genomes, 270 NTS genomes remained for further analysis. Multiple Salmonella serovars associated with human infection were detected, of which S. Typhimurium (55/270 isolates) was the most common, including 44 of Sequence Type (ST) 313, a serovar commonly associated with severe invasive disease (iNTS). Six lineage 2 ST313 genomes possessed AMR genes predicting multidrug resistance (MDR), while 29 lineage 3 isolates contained no predicted AMR genes. PCR based detection of staG has been proposed as a diagnostic marker of S. Typhi; however, all eight genomes that contained staG identified as Salmonella enterica serovar Orion, raising concerns about the specificity of this marker as a monoplex for environmental surveillance of S. Typhi. The study identified diverse Salmonella serovars in the environment, including those reported to cause invasive disease, emphasizing the complex but potentially valuable contribution of implementing environmental surveillance for Salmonella in high burden areas lacking diagnostic microbiology capacity.
21. Perceived Chronic Stress prior to SARS-CoV-2 Infection Predicts Ongoing Symptomatic COVID-19: A Prospective Cohort Study.
期刊: Psychotherapy and psychosomatics 发表日期: 2025-Sep-09 链接: PubMed
摘要
Understanding chronic stress as a potential risk factor for COVID-19 progression could inform public health measures and personalized preventive interventions. Therefore, we investigated the influence of chronic stress prior to SARS-CoV-2 infection on symptom persistence 1 month after COVID-19 onset. The participants of this prospective cohort study named “StressLoC” were adults with COVID-19 who had tested positive for SARS-CoV-2 infection within the last 7 days. Pre-existing perceived chronic stress assessed by the Perceived Stress Scale (PSS-10) was the primary predictor. The number of stressful life events and hair cortisol concentration served as additional measures of pre-existing chronic stress. The main outcome was examined using the Long COVID Symptom and Impact Tool. It was defined as the presence of any new and impactful COVID-19-related symptom at month 1 after inclusion. Accordingly, participants were assigned to either the ongoing symptomatic COVID-19 group (OSC-G) or control group. The study cohort comprised 288 participants (73.3% female), with a median age of 46 years (IQR 35-56). A total of 210 participants (72.9%) were categorized as OSC-G. Multivariate logistic regression showed that allocation to OSC-G was predicted by perceived chronic stress in the month prior to COVID-19 (OR: 1.08, 95% CI: 1.03-1.14; p = 0.002) and the number of pre-existing symptoms (OR: 1.08, 95% CI: 1.03-1.13; p = 0.001). The number of stressful life events and hair cortisol concentration did not predict OSC-G allocation. Results suggest that higher levels of pre-existing perceived chronic stress increase the odds of developing ongoing symptomatic COVID-19.
22. Protecting Workers from Extreme Heat; US Department of Labor has Proposed a Much-Needed Regulation; Can it Survive Trump? Commentary on the Essay "An Elusive Promise: Protecting US Workers from Excessive Heat".
期刊: New solutions : a journal of environmental and occupational health policy : NS 发表日期: 2025-Sep-09 链接: PubMed
摘要
In the essay “An Elusive Promise: Protecting US Workers from Excessive Heat,” the author (who is also the author of this commentary) addresses the ever-increasing hazard that exposure to excessive heat poses to workers, both internationally and in the United States, and details the history of federal efforts to address the problem, dating back to the passage of the Occupational Safety and Health Act (the “OSH Act”) in 1970. Following years of dogged advocacy by the worker safety community, those efforts culminated in August 2024 in the publication in the Federal Register of a Notice of Proposed Rulemaking for Heat Injury and Illness Prevention in Outdoor and Indoor Work Settings. A few months later, Donald Trump was elected president. This commentary examines whether the proposed rule can survive his presidency.
23. Testing the Efficacy of a Web-Based Intervention for Loss and Bereavement in Later Life (AgE-health Study): Results From a Randomized Controlled Trial.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-09 链接: PubMed
摘要
The loss of a loved one is a common yet stressful event in later life. Internet- and mobile-based interventions have been proposed as an effective treatment approach for individuals with prolonged grief. The AgE-health study aimed to investigate the efficacy of an eHealth intervention, trauer@ktiv, in reducing prolonged grief symptoms in a sample of older adults. The trauer@ktiv intervention is an unguided, web-based self-management intervention based on cognitive behavioral therapy principles, addressing grief in later life. The AgE-health study was designed as a randomized controlled trial with an active control group (CG). Recruitment and data assessment took place between October 2020 and September 2022. A sample of 177 older adults (aged ≥60 years) with prolonged grief symptoms was randomly assigned to the intervention group (IG; access to the trauer@ktiv eHealth intervention) or the active CG (access to an information brochure on loss and grief). Participants were interviewed at 2 time points, before and after accessing the intervention, via postal questionnaires (baseline and follow-up 4 months after the intervention). The primary outcome was the reduction in prolonged grief symptoms assessed with the Prolonged Grief-13 scale. Adjusted mixed-effects regression models were used to test for changes in primary and secondary outcomes (eg, depression and self-efficacy) as part of an intention-to-treat (ITT) analysis. The study procedure was described in detail in the study protocol. From baseline to 4 months after the intervention, 7 participants were lost to follow-up. Final analyses included a sample of 170 individuals (IG: n=81, 47.6%; CG: n=89, 52.4%). The study population had an average age of 67.3 (SD 6.4; range 60-95) years and consisted predominantly of female participants (129/170, 75.9%). While there was a pre-post-reduction in persistent grief symptoms, the ITT analysis showed no significant differences between IG and CG at follow-up (Prolonged Grief-13 scale, average marginal effect of 0.56, 95% CI -2.30 to 3.44, P=.70). Similarly, the ITT analysis showed no significant treatment effects for any of the secondary outcomes at follow-up. The trauer@ktiv intervention was rated high on satisfaction and usability. More than half of the IG (49/81, 61%) completed 5 or more of the 8 modules of the eHealth intervention. The tested eHealth intervention, trauer@ktiv, showed no superiority compared to an active CG in reducing prolonged grief symptoms in a sample of older bereaved individuals. Therefore, trauer@ktiv is not suitable as a stand-alone treatment. However, as the ease of use and satisfaction with the application were high, there may be potential for the intervention within a stepped and collaborative treatment approach. German Clinical Trials Register DRKS00020595; https://drks.de/search/de/trial/DRKS00020595. RR2-10.1016/j.invent.2021.100451.
24. Impact of sociodemographic and socioeconomic factors on functional and health-related quality of life outcomes 24 months after radical prostatectomy.
期刊: Journal of cancer research and clinical oncology 发表日期: 2025-Sep-09 链接: PubMed
摘要
High socioeconomic status (SES) is associated with improved oncological outcomes across various cancer types, including prostate cancer. However, limited evidence exists regarding the impact of SES and lifestyle factors on patient-reported outcomes (PROs), including quality of life (QoL), health status (HS), and functional recovery following radical prostatectomy (RP). We conducted a retrospective single-center analysis of 327 patients undergoing RP (177 open, 150 robotic-assisted) assessing pre- and postoperative functional outcomes (QoL, HS, erectile function, continence). PROs were evaluated 24 months postoperatively. Correlations with sociodemographic, socioeconomic (ISEI-based SES, marital status, occupational status, hometown size), and lifestyle factors (physical activity, BMI, mental stress) were analyzed. Pathological features of locally advanced tumors correlated negatively with QoL and HS. Higher SES was significantly associated with improved continence, but not with QoL, HS, or erectile function. Pre-existing mental stress negatively affected both continence and HS. Regular physical activity correlated positively with QoL and HS. Multivariable regression confirmed these findings and identified mental stress, SES, partnership and physical activity as independent predictors of PROs. Beyond adverse tumor pathology, mental stress adversely impacts functional recovery and subjective health. In contrast, physical activity and a stable partnership correlate with better PROs. These findings may inform personalized patient counseling to increase postoperative satisfaction.
25. Grasping at illusions: stimulating cutaneous afferents to create kinesthetic illusions.
期刊: Experimental brain research 发表日期: 2025-Sep-09 链接: PubMed
摘要
26. Risk of colorectal cancer and participation in fecal immunochemical test-based screening.
期刊: Public health 发表日期: 2025-Sep-08 链接: PubMed
摘要
Participation rates in fecal immunochemical test (FIT)-based colorectal cancer (CRC) screening differ across socio-demographic subgroups. The largest health gains could be achieved in subgroups with low participation rates and high risk of CRC. We investigated the CRC risk within different socio-demographic subgroups with low participation in the Dutch CRC screening program. Population-based cohort study. All individuals invited for the Dutch CRC screening program in 2018 and 2019 were included. Data from a previous study, including screening data and demographic characteristics, were augmented with CRC diagnoses in 2018 and 2019. A multivariable logistic regression was used to assess the association between socio-demographic factors and risk of CRC. Overall participation was 72.3% and age-adjusted CRC incidence was 30.3 per 10,000 individuals. Males showed lower participation (69.7 %) but had a higher-than-average CRC risk (35.1). The difference in CRC risk between males and females was less pronounced among non-participants (OR: 1.28, 95% CI: 1.20-1.36) than participants (OR: 1.41, 95% CI: 1.35-1.47). Lower income groups also had lower participation (down to 60.0 %) and higher risk of CRC (down to 30.7), but the difference in CRC risk between low-income groups and high-income groups was only significant among participants (OR lowest vs highest quintile: 1.22, 95% CI: 1.14-1.32). Conversely, individuals with a Turkish/Moroccan migration background had lower participation (48.7 %), but their CRC risk was also lower (18.8; OR: 0.54, 95% CI: 0.46-0.63). CRC risk varies significantly between low-participation groups in the Dutch CRC screening program. Interventions should prioritize the most vulnerable groups, considering both participation and risk of CRC.
27. Prognosis of lymph node metastasis confined to lateral pelvic or mesenteric nodes in mid-low rectal cancer: multicentre retrospective cohort study.
期刊: BJS open 发表日期: 2025-Sep-08 链接: PubMed
摘要
Metastases in the lateral pelvic lymph nodes or mesenteric lymph nodes represent distinct categories of mid-low rectal cancer. This study investigated the patterns of mesenteric and lateral pelvic lymph node metastases in mid-low rectal cancer; the survival benefit of postoperative treatment was also analysed in these groups. This retrospective multicentre study included consecutive patients with mid-low rectal cancer who underwent total mesorectal excision with lateral pelvic lymph node dissection in three Chinese institutions between 2012 and 2020. The primary outcome was metastatic patterns and clinicopathological features of patients with mesenteric lymph node and lateral pelvic lymph node involvement. The secondary outcome was survival. Of 566 patients treated during the study period, 407 were selected. Four lymph node metastasis patterns were compared: metastasis to both mesenteric and lateral pelvic lymph nodes (68 patients, 17%), metastasis confined to lateral pelvic lymph nodes (24 patients, 6%), metastasis confined to mesenteric lymph nodes (121 patients, 29.7%), and neither mesenteric nor lateral pelvic lymph node metastasis (194 patients, 47.7%). Patients with metastases confined to lateral pelvic nodes had a lower proportion of poor histological types (P = 0.003), lymphatic invasion (P = 0.001), and number of lateral pelvic nodal metastases (P = 0.005) compared with patients with both mesenteric and lateral pelvic lymph node metastases. Independent of preoperative treatment, metastasis confined to the lateral pelvic nodes was associated with a significantly better prognosis than metastasis in both the mesenteric and lateral pelvic lymph nodes (3-year overall survival: 78.6 versus 47.2%, P = 0.007; 3-year disease-free survival: 65.7 versus 24.9%, P = 0.011), and it was similar to that of patients with metastasis confined to the mesenteric nodes (3-year overall survival: 78.6 versus 85.4%, P = 0.559; 3-year disease-free survival: 65.7 versus 70.4%, P = 0.447). Patients with metastasis confined to lateral pelvic lymph nodes have comparable pathological features and prognoses to those with metastasis confined to mesenteric nodes; such disease can be managed and treated in the same way as regional lymph node metastasis.
28. Protocol for constructing an accessible exposure chamber for in vitro and in vivo modeling of airway environmental exposures.
期刊: STAR protocols 发表日期: 2025-Sep-08 链接: PubMed
摘要
Exposure systems to study the effects of environmental exposures can be costly to purchase and difficult to use. Here, we present an accessible and cost-effective approach to building an exposure chamber in the lab. We describe steps for constructing the exposure system and writing the code to run it and simple instructions for experiments using the system. The exposure chamber can be adapted to expose airway cells or lab mice to combustible cigarette smoke, electronic cigarette vapors, or woodfire smoke. For complete details on the use and execution of this protocol, please refer to Durra et al.1.
29. Influence of wind direction on the relationship between proximity to pig farms and risk of infection with MRSA CC398 among persons without known contact to livestock: a Danish nationwide population-based study.
期刊: Infection 发表日期: 2025-Sep-08 链接: PubMed
摘要
Livestock-MRSA (methicillin-resistant Staphylococcus aureus) can cause infections in persons without known contact to livestock, but the route of transmission is unclear. We investigated whether the risk of livestock-MRSA infection among persons with no known contact to livestock is associated with the number of pig farms near the home, and whether this association is affected by the upwind/downwind location of the farms. Register-based case-control study of 518 persons from Denmark with clinical infections with livestock-MRSA in 2016-2021 and no known exposure to livestock, and 4,944 matched controls. Distances and angles from home addresses to all pig farms within a distance of 25 km were calculated, and compared with the mean wind direction in the area. The mean number of pig farms within 13,127 m of the home address was 3.3 [0.3; 6.3] higher for cases (60.5) than controls (57.1), with a larger difference for farms upwind than downwind. The primary analysis showed that the livestock-MRSA exposure from a downwind farm was 59% [40%; 178%] of the exposure from an upwind farm, but the difference disappeared after confounder adjustment. In a post-hoc analysis, cases were surrounded by more pig farms at 50 - 6,250 m from the home address, and in the interval 1,250-6,250 m the difference was only seen in the upwind directions. The risk of livestock-MRSA infection among persons without known livestock contact was influenced by the number of and distance to pig farms. In an exploratory post-hoc analysis, but not the main analysis, the risk was also influenced by mean wind direction.
30. Immunomodulatory effects of the herbicide glyphosate following occupational exposure.
期刊: Archives of toxicology 发表日期: 2025-Sep-08 链接: PubMed
摘要
Glyphosate, a widely used herbicide, has raised concerns regarding its impact on human health and the environment due to its widespread and excessive use. Adverse effects on the immune system have been reported. In this study, 26 vineyard workers in Veneto vineyards were examined before and after glyphosate applications to investigate possible immune parameter changes. Glyphosate exposure led to alterations in plasma cytokine levels, including marked increases in IL-4 and IL-5, a modest rise in IFN-γ, and a decrease in IL-8. No changes in plasma IL-12/23p40, IL17 and IL-33 were found. The IFN-γ/IL-4 ratio decreased, accompanied by changes in T cell subpopulations. Notably, a decrease in the T helper 1/T helper 2 cell ratio, attributed to reduced Th1 cells and increased Th2 cells, was observed, aligning with the elevated Th2 cytokines. A reduction in plasmatic extracellular vesicular miR-500a levels following glyphosate exposure was found, potentially contributing to the immunological findings. A slight decrease in plasma lipopolysaccharide levels in exposed workers excluded systemic inflammation from increased intestinal permeability but hinted at a possible association with glyphosate-induced microbiota dysbiosis. Since the shikimate pathway, targeted by glyphosate, is also present in Gram-negative bacteria. Overall, these findings suggest that glyphosate can affect the immune system, favoring Th2 responses. While more research is needed to establish causality with the association of glyphosate exposure with the development of allergic reactions in susceptible individuals, our results shed light on potential underlying mechanisms.
31. Patterns of Caffeine Use in Adolescents and Their Association with Sleep Quality: A Latent Class Analysis.
期刊: Journal of addictions nursing 发表日期: 2025-Sep-05 链接: PubMed
摘要
Although there is substantial evidence of the negative impact of caffeine use on sleep quality, few studies focus specifically on adolescents’ patterns of use. This study aimed to identify patterns of caffeine use among adolescents and analyze their association with sleep quality. A cross-sectional study was conducted in southern Sweden including 1,404 adolescents aged 15-17 (56.3% girls). The frequency of use for coffee, tea, and energy drinks was evaluated, as well as the quality of sleep and its dimensions. Latent class analysis and multivariate analyses were conducted. The weekly prevalence of caffeine use in adolescents reached 85% (n = 1189), with 40% (n = 559) drinking almost every day. Three caffeine-using patterns were identified: low probability caffeine use (28.1%; n = 393) characterized by sporadic use of coffee/tea, caffeinated soda use (55.2%; n = 784) related to high soda weekly consumption, and mixed caffeine use (16.7%; n = 227) that includes drinking diverse caffeine products almost every day including soda and energy drinks. Mixed caffeine pattern was associated to worse sleep followed by the soda pattern (p < .05), with significant differences observed in difficulties falling asleep (OR = 1.4; 95% CI = 1.1-1.7) or waking up (OR = 1.8; 95% CI = 1.4-2.4), greater daytime dysfunction (OR = 1.3; 95% CI = 1.1-1.7), and shorter sleep duration on schooldays (OR = 1.9; 95% CI = 1.5-2.4). Distinct severity levels were found for caffeine use patterns among adolescents based on their association with sleep quality. Findings emphasize the need for addressing caffeine misuse among adolescents to promote health and adequate sleep habits in the transition to adulthood.
32. High Prevalence of Macrolide-resistant ptxP3-prn150 Bordetella pertussis in Jiangsu Province, China, 2024.
期刊: The Pediatric infectious disease journal 发表日期: 2025-Sep-05 链接: PubMed
摘要
A significant surge in pertussis cases since early 2023 has raised serious public health concerns. To investigate the potential mechanisms contributing to this increased prevalence, we collected throat swab specimens from children exhibiting pertussis symptoms and conducted detailed molecular characterization. All Bordetella pertussis (B. pertussis) isolates underwent whole-genome sequencing using the Illumina HiSeq platform (Illumina, San Diego, CA). Genome annotation was conducted with Prokka (https://github.com/tseemann/prokka/). Allele typing of key antigens and 23S rRNA mutations was determined using the Bordetella BIGSdb database. A phylogenetic tree was constructed using the maximum likelihood method based on core genome single-nucleotide polymorphisms. A total of 118 nasopharyngeal swab specimens were collected from patients diagnosed with B. pertussis infection. Of these, 48 isolates were successfully cultured and subjected to whole-genome sequencing. Genotyping revealed that 47 of these isolates shared the allelic profile ptxA1-ptxB1-ptxC4-ptxD1-ptxE4-ptxP3-fim2-1/fim3-1. All isolates exhibited bapC1 and brkA1/tcfA2//vag8/fhaB2 profiles, and belonged to the prn150 allele. Notably, approximately half of the isolates possessed an intact prn gene due to the insertion of IS481. A high prevalence of macrolide resistance was observed, with 97.5% of isolates carrying the A2047G mutation in the 23S rRNA gene. Phylogenetic analysis demonstrated significant genetic diversity between the circulating B. pertussis strains in Jiangsu Province and vaccine strains. The increasing prevalence of macrolide-resistant B. pertussis strains exhibiting ptxP3-prn150 genotype poses a significant challenge to both disease control and treatment. The high virulence associated with these strains, coupled with antibiotic resistance, underscores the urgent need for the development of novel vaccine strategies to effectively combat this emerging threat.
33. Kidney Injury During Treatment with Aflibercept versus Ranibizumab: a Population-based Study.
期刊: Retina (Philadelphia, Pa.) 发表日期: 2025-Sep-03 链接: PubMed
摘要
Systemically administered anti-cancer VEGF inhibiting therapies can cause severe kidney injury. Intravitreal aflibercept has a greater impact on renal VEGF levels than ranibizumab. We compared the risk of kidney injury among patients receiving intravitreal aflibercept vs. ranibizumab. This population-based new-user active-comparator cohort study in Ontario, Canada, evaluated 44,571 patients aged 66 years and older, newly treated with intravitreal aflibercept or ranibizumab between August 1, 2015, and July 31, 2019. The risk of adverse renal outcomes was compared while controlling for baseline and time-varying covariates. The composite renal outcome occurred in 12.0% (1,778/14,863) of aflibercept recipients versus 10.0% (1,327/13,289) of ranibizumab recipients (Relative risk: 1.00, 95% CI: 0.93-1.06 at 5 years follow up). No significant differences were observed across retinal disease subgroups. Intravitreal aflibercept and ranibizumab carry comparable risks of renal adverse events despite their distinct systemic pharmacodynamics.
34. Recognizing the overlooked: rethinking autism spectrum disorder symptom presentation in girls.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
Autism spectrum disorder (ASD) is more frequently diagnosed in boys than in girls, possibly due to gender-based differences in symptom presentation or referral patterns. This study investigates gender-related variations in symptom severity and clinical presentation among preschool children referred for suspected ASD. This study included 125 children (boys: n=103; girls: n=22) aged 2-5 years suspected of having ASD. The Childhood Autism Rating Scale (CARS) was used to evaluate autism-related symptoms, focusing on presenting complaints and gender-specific differences in nonverbal communication and social interaction. Girls had a significantly younger median age at assessment (28 months) compared to boys (33 months, p=0.03). In the minimal to no symptoms group, girls had significantly higher total CARS scores (median 26 vs. 22.5, p < 0.001) and elevated ratings in domains such as nonverbal communication (p=0.03), relationship to people (p=0.01), imitation (p < 0.001), and visual response (p < 0.001). In the severe group, girls also showed significantly higher scores in adaptation to change, taste, smel, and touch response and use, and fear or nervousness. Effect sizes ranged from small to strong. A negative correlation was found between assessment age and total CARS score (r= -0.45, p < 0.01), particularly among girls. This study highlights that girls may exhibit more prominent symptoms by the time they are referred for clinical evaluation, raising concerns about missed or delayed recognition of milder symptom profiles.
35. Barriers and facilitators of pediatric adherence to antiretroviral therapy: perspectives from caregivers in Türkiye.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
This study aimed to describe barriers and facilitators of the adherence of children with human immunodeficiency virus (HIV) to antiretroviral therapy (ART) from the perspectives of their caregivers. In-depth interviews were held with the caregivers of 15 children. The collected data were analyzed using thematic analysis procedures. The Consolidated Criteria for Reporting Qualitative Research (COREQ) were followed in the study. The perspectives of caregivers were categorized under four themes and subthemes. Barriers and facilitators of the adherence of children with HIV to ART were categorized into 4 main themes: (1) medication-related, (2) child-related, (3) caregiver-related, and (4) health system-related. The results indicated that understanding the factors that influence pediatric ART adherence is critical to the development of adequate strategies. In addition, disclosure of HIV status to the child is also an important factor affecting drug administration in the social environment. To ensure adherence to lifelong ART, targeted caregiver support through continuous supervision, clear guidance on drug preparation, and strategies for effective administration should be integrated into context-specific interventions that address the combined influence of factors related to the child, medication, healthcare, and of the sociocultural environment.
36. A pediatric-onset case of chronic kidney disease caused by a novel sporadic ACTN4 variant and literature review.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
The α-actinin-4 (ACTN4) gene encodes an actin-binding protein, which plays a crucial role in maintaining the structure and function of podocytes. Previous studies have confirmed that ACTN4 mutations can lead to focal segmental glomerulosclerosis-1 (FSGS1), a rare disease primarily manifesting in adolescence or adulthood, characterized by mild to moderate proteinuria, with some cases progressing slowly to end-stage renal disease. We report a 12.5-year-old boy who presented with non-nephrotic range proteinuria, hyperuricemia, markedly reduced bilateral kidney volume, and stage 3 chronic kidney disease (CKD). An ophthalmic examination revealed optic disc dysplasia in the right eye. The results of whole-exome sequencing revealed a de novo variant in the ACTN4, a previously unreported variant. We reported a novel sporadic ACTN4 variant and reviewed previously reported cases. Through analysis of the genotypes and clinical phenotypes of reported cases, we found that ACTN4 variants may not always present as FSGS1, and there was significant phenotypic heterogeneity among individuals. Notably, mutations affecting residues 260-265 are associated with collapsing glomerulopathy and rapid progression to end-stage kidney disease in prior studies, whereas the p.Ala278del variant in our case, located outside this region, exhibited stable CKD3. This suggests domain-specific genotype-phenotype correlations. However, this association requires further validation through additional cases and experiments. Our findings may have significant implications for clinical diagnosis, prognosis assessment, and scientific research on kidney diseases related to ACTN4 variants.
37. Spastic cerebral palsy and quality of life in children aged 6-12 years: exploring key associated factors.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
Children with cerebral palsy (CP) may experience epilepsy and challenges with movement, posture, cognition, and musculoskeletal development, which can impact their quality of life (QOL). In this study, we investigated the relationship between demographic and clinical variables as well as QOL in children with spastic CP. Children aged 6 to 12 years with CP who were followed-up at our tertiary center were included in this cross-sectional study, regardless of the cause. They were categorized into groups based on their gestational age, motor function levels, accompanying conditions such as epilepsy and intellectual disability, and demographic variables, including mothers’ education and income levels. Subsequently, the QOL scores of these groups were compared. Among the 9-12 age group, those with sufficient intellectual capacity completed the QOL questionnaire by both the mothers and patients themselves. The Children’s Sleep Habits Questionnaire (CSHQ) was evaluated and compared with the QOL scores of the patients. A total of 71 patients were included in the study (42 males, 59%). Children whose mothers were more educated and had higher in income level, who were ambulatory with hemiplegia, and did not have epilepsy had significantly better QOL scores. Those with better CSHQ scores were found to have significantly better QOL scores. Additionally, the responses of mothers and patients within the 9-12 age group were highly compatible. Children with CP face challenges impacting their daily lives and overall QOL. Our study identified factors linked to the QOL of children with spastic CP and showed that their integration into CP management could enhance their well-being.
38. Airway obstruction and gender affect arterial stiffness in children with cystic fibrosis.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
Vascular changes are observed in children with cystic fibrosis (cwCF), and gender-specific differences may impact arterial stiffness. We aimed to compare arterial stiffness and clinical parameters based on gender in cwCF and to determine the factors affecting arterial stiffness in cwCF. Fifty-eight cwCF were included. Pulmonary function, lean body mass, handgrip strength, and peak oxygen uptake (VO2peak) were assessed using a cardiopulmonary exercise test. Arterial stiffness (pulse wave velocity [PWV] and augmentation index [AIx@75]) and hemodynamic parameters (resting heart rate [HR] and stroke volume [SV]) were measured using brachial pulse waves. Endothelial function (ICAM-1, sVCAM-1, sE-selectin, VEGF-A, ET-1) was evaluated using blood samples. Female cwCF had significantly lower VO2peak, SV, and PWV, and higher resting HR, AIx@75, and AIx@75-z-score than male cwCF (p<0.05). AIx@75-z-score was associated with gender (r=0.516, p<0.001), age (r= -0.345, p=0.008), lean body mass (r= -0.451, p<0.001), forced expiratory volume in one second (FEV1)-z-score (r= -0.332, p=0.011), handgrip strength (r= -0.466, p<0.001), and VO2peak (r= -0.459, p<0.001) and peak workload (r= -0.527, p<0.001). AIx@75-z-score was not associated with ICAM-1, sVCAM-1, sE-selectin, VEGF-A, or ET-1 (p>0.05). The FEV1-z-score and gender explained 34.6% of the variance in AIx@75-z-score (p<0.05). Female cwCF have more impaired hemodynamics, less maximal exercise capacity, and increased arterial stiffness, indicating a higher cardiovascular risk compared to male cwCF. FEV1 and gender affect arterial stiffness in cwCF. Further studies are necessary to uncover the underlying factors for arterial stiffness and endothelial dysfunction and their clinical effects in cwCF.
39. Association of problematic internet use with health-related daily habits in adolescents: evidence from a school-based survey.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
With the development of technology, easier access to the internet and its excessive use have led to problematic internet use (PIU). The prevalence of PIU and its association with lifestyle behaviors in adolescents have become subjects of increasing academic interest. This study aimed to determine the prevalence of PIU among Turkish high school students and to investigate its association with sleep, physical activity and dietary habits. This cross-sectional study was conducted on high school students between October 2019 and March 2020. Participants completed a questionnaire regarding demographic characteristics, internet use, lifestyle habits and the “Young Internet Addiction Test-Short Form (YIAT-SF)”. Among the total 951 participants, the mean age was 15.3±1.0 years, 42.3% were female, and the prevalence of PIU was determined as 12.1%. It was shown that having daily internet usage time ≥2 hours on weekdays, having at least one type of sleep problem, having breakfast less than 3 days per week, eating salty snacks ≥3 days per week, consuming sugary-carbonated drinks ≥3 days per week were associated with PIU. PIU is a widespread public health problem that is negatively associated with the daily health habits of adolescents. There is a need for nationwide school screening programs for this problem and rehabilitation of adolescents diagnosed with PIU.
40. Mevalonate kinase deficiency in a familial Mediterranean fever endemic region: a single-center experience.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
We aimed to document childhood onset mevalonate kinase deficiency (MKD) and to explore treatment responses and diagnostic challenges in regions endemic to familial Mediterranean fever (FMF). This retrospective study included patients under 18 years of age, diagnosed with MKD and followed for at least six months at the pediatric rheumatology department of Istanbul University - Cerrahpaşa Medical Faculty between 2016 and 2024. Of 33 patients, 51.5% were female, with a median age of symptom onset at 6 (2-17.3) months. Eight patients had a history of tonsillectomy, and seven exhibited an underlying exon 10 Mediterranean FeVer (MEFV) gene mutation. The mean diagnostic delay was 67.6 months, which was longer for those with exon 10 mutations (95.0 months) and those with a history of tonsillectomy (99.5 months). The median duration of attacks was 5 (4-7) days. The median frequency of attacks was 12 (10-24) per year. The most prevalent clinical findings observed during these attacks included malaise (87.8%), arthralgia (69.6%), abdominal pain (63.6%), cervical lymphadenopathy (63.6%), diarrhea (54.5%), and maculopapular rash (51.5%). A total of 30 patients (90.9%) identified pre-attack triggers. Among the patients evaluated, 19 (57.5%) were homozygous for V377I, and 7 (21.2%) had V377I biallelic heterozygous mutation in MVK gene. Cytopenia was observed in 18 patients (54.5%) during episodes, including anemia (39.3%), lymphopenia (24.2%), leukopenia (12.1%), and neutropenia (9%). Patients presenting with periodic fever suggestive of FMF who exhibit atypical features should be evaluated for MKD. Further genetic testing should be performed when atypical clinical findings are present, even in those carrying pathogenic variants in exon 10 of the MEFV gene.
41. Excess mortality and disease burden due to conflict in Gaza: focus on the 0-14 age group.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
The ongoing conflict in Gaza continues to take an unbearable toll, with particularly severe impacts on children. Measuring the burden of conflict-related disease in Gaza in terms of disability-adjusted life years (DALYs) is important in terms of showing this effect. The aim of this study was to calculate the conflict-related DALY in Gaza among children aged 0-14 years, following the October 7 events and compare these values with global and expected values. We estimated the age and gender distribution of individuals killed or injured in Gaza, and calculated the DALYs, including Years of Life Lost (YLL) and Years Lived with Disability (YLD), attributable to the conflict. These estimates were then compared to the Institute for Health Metrics and Evaluation data for Palestine and global averages. The study also evaluated the DALY/YLD ratio and excess mortality rate. The DALY per 100,000 population was 160,745.01 (156,986.01-164,503.99) for males, 175,784.51 (170,812.52-180,756.50) for females, and 168,111.39 (164,009.17-172,213.62) overall. The daily DALY burden experienced by Gaza due to conflict indicates an increase of 181.05% compared to Palestinian estimates. The increase was calculated as 115.39% for YLL and 4,268.25% for YLD. Compared to global data for conflict and terrorism, the increases in daily DALY, YLL, and YLD values in Gaza were 1,918.08%, 1,316.32%, and 8,537.50%, respectively. The data calculated in our study indicate that the daily DALY/YLD ratio for the 0-14 age group in Gaza was 333.21 with a p-score of 6,952.0%. To reduce the devastating effects of violence, such as conflict and terrorism, on children’s health, more effective measures should be taken at the international level and preventive strategies should be developed.
42. Clinical and laboratory characteristics of children with leukemia: a 34-year single-center experience.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
Leukemia is the most common childhood malignancy and often presents with nonspecific symptoms, which may lead to delays in diagnosis. Early recognition of clinical signs and laboratory abnormalities is essential to ensure timely referral and improve outcomes. This study assesses the clinical and laboratory characteristics of pediatric patients with acute and relapsed leukemia, points out key considerations during diagnosis, and investigates potential factors contributing to delayed diagnosis. A retrospective analysis was performed on pediatric patients diagnosed with leukemia at a tertiary care hospital between the years 1986 and 2020. Early diagnosis was defined as a diagnosis made within 20 days of symptom onset. Among the 378 patients, fatigue was the most frequently reported symptom, followed by fever and bone or joint pain. Common laboratory abnormalities included anemia (83%), thrombocytopenia (80%), and leukocytosis (46%). Bone or joint pain (p< 0.001), mucosal bleeding (p=0.013), and pallor (p=0.005) were significantly associated with late diagnosis. In contrast, lymphadenopathy (p=0.014) and bone tenderness (p=0.024) were linked to earlier recognition. Among laboratory findings, low hemoglobin levels were associated with early diagnosis (p=0.023) and elevated platelet count was also significantly related to delayed diagnosis (p=0.028). In relapsed leukemia cases, abnormal blood count findings were common, and neurological symptoms were observed more frequently compared to acute leukemia patients. Fatigue, fever, and bone or joint pain were identified as the most common presenting symptoms in acute leukemia cases, while hepatomegaly, splenomegaly, and lymphadenopathy were the predominant physical findings. Bone or joint pain, mucosal bleeding, and pallor were associated with late diagnosis, whereas lymphadenopathy and bone tenderness appeared to facilitate earlier recognition.
43. Clinical spectrum of pediatric neutropenia: mostly benign, but not to be overlooked.
期刊: The Turkish journal of pediatrics 发表日期: 2025-Sep-01 链接: PubMed
摘要
Neutropenia is a common laboratory finding in children, therefore it is a common referral reason to pediatric hematology units. This study hypothesizes that most neutropenic children do not require pediatric hematology consultation, and that key clinical indicators can guide the need for referral. Medical records of 180 patients who were admitted to a tertiary reference center, were evaluated in terms of demographical data, physical examination findings, laboratory findings, and outcome measures. The patients enrolled in the study had newly diagnosed or incidental neutropenia and did not meet the criteria for chronic neutropenia. Neutropenia was classified based on absolute neutrophil count (ANC) as follows: mild (1000–1499/mm³), moderate (500–999/mm³), severe (200–499/mm³), and very severe (<200/mm³). Of the 180 patients enrolled, 51.7% were male, with a mean age of 4.8 years (min-max: 1 week- 17 years). 12 patients (6.7%) were diagnosed with congenital neutropenia. The median age for patients diagnosed with congenital neutropenia was 12 months, whereas it was 47 months for those with post-infectious neutropenia (p=0.037). 64.4% of patients had no known prior disease, and 45% were incidentally found to have neutropenia. The average ANC was 732/mm³, with 26.1% having mild, 47.2% moderate, 19.4% severe, and 7.2% very severe neutropenia. Etiological causes included post-infectious (53.9%), idiopathic/immune (25.6%), congenital (6.7%), and drug-related (6.7%) neutropenia. The median ANC for congenital neutropenia patients was 200/mm³, and their infection rates were significantly higher than the other groups (p=0.001). The mean follow-up period was 10 months, with 69.4% of patients having normal ANC at the last follow-up. Despite the increased frequency of neutropenia in childhood, a vast majority of the cases have a benign and transient clinical course.
44. "Just Being Connected, It's Like a Way of Resisting": Latinx Youth Strengthening Cultural Ties as Resilience and Resistance in the Deep South.
期刊: Journal of community psychology 发表日期: 2025-Sep 链接: PubMed
摘要
Over the last decade, a range of research has demonstrated the detrimental impacts of policies criminalizing migration (“crimmigration”) on Latinx mental health. In this study, we seek to examine youth perspectives on how crimmigration policies affect Latinx adolescents’ connections to Latinx identity, culture, and communities and the implications for Latinx youth mental health. We explored how immigration enforcement policies affect Latinx youths’ mental health using photovoice with ten youth in a high-deportation county in Atlanta in 2022. We held eight photo-elicited sessions using SHOWED/VENCER, a bilingual guide to elicit critical dialogue. Sessions were transcribed and coded for analysis, which included describing, comparing, and categorizing coded data into themes. We identified two parallel processes to describe how crimmigration policies affect Latinx youth cultural and community connections: (1) exclusionary spaces exert pressure to assimilate and bring emotional costs, (2) inclusive spaces for Latinx youth strengthen their cultural identity and connection to Latinx culture and community, promoting resilience and resistance. In their own words, youth described assimilation as a pressure that isolated them from their communities and included the adoption of a worldview that Latinx people have to prove they are worthy of citizenship and its benefits and explained how this was influenced by crimmigration policies. Furthermore, youth found resisting assimilation by preserving their culture was an important way of strengthening resilience against ongoing oppression. These important findings should shape future research and intervention in Latinx youth mental health by addressing crimmigration policies and promoting cultural assets for Latinx youth.
45. Genomic analysis of the Streptococcus pneumoniae in Taiwan: a nationwide study from 2006 to 2022.
期刊: Microbial genomics 发表日期: 2025-Sep 链接: PubMed
摘要
Streptococcus pneumoniae remains a leading respiratory pathogen for children and the elderly. In Taiwan, a national PCV13 catch-up vaccination programme for children began in March 2013. This study investigates the population structure and antimicrobial profiles of pneumococcal isolates in Taiwan from 2006 to 2022. A total of 1,343 S. pneumoniae isolates were collected biennially from 27 hospitals across 4 regions of Taiwan. All isolates were analysed for serotypes and antimicrobial resistance (AMR) profiles, and 137 isolates causing invasive pneumococcal diseases (IPDs) underwent whole-genome sequencing. In the post-PCV13 era (2014-2022), serotypes 15A, 23A, 19A, 19F and 6A predominated. The elderly populations showed an increased proportion of IPD in the post-PCV13 era. Among the 137 IPD isolates, GPSC1 (21.9%) was the primary lineage, consistently harbouring AMR genes. Serotype 15A within GPSC9 emerged rapidly, particularly in central Taiwan. In GPSC16, non-PCV13 serotype 15B/C increased significantly, replacing vaccine types. GPSC6 displayed frequent capsular switching, a unique phenomenon in Taiwan, driven by distinct recombination events post-2000. These findings underscore the importance of sustained genomic surveillance of S. pneumoniae in Taiwan to monitor age-related shifts in IPD burden and to track the expansion of persistent and highly adaptable lineages such as GPSC1 and GPSC6.
46. Genomic resequencing unravels species differentiation and polyploid origins in the aquatic plant genus Trapa.
期刊: The Plant journal : for cell and molecular biology 发表日期: 2025-Sep 链接: PubMed
摘要
Trapa L. is a non-cereal aquatic crop with significant economic and ecological value. However, debates over its classification have caused uncertainties in species differentiation and the mechanisms of polyploid speciation. This study employed whole-genome resequencing together with the fruit morphology of 229 Trapa accessions (153 Asian and 76 North American samples) to elucidate species differentiation and polyploidization events in Trapa. For the species with AA genome and large fruits, clear genetic differentiation was found between two clades with different geographic origins, that is, from the Yangtze River and Amur River basins. The invasive AA species in North America (T. natans) was identified as originating from the Amur River based on genetic and morphological similarities, while all the cultivated accessions were AA species originating from the Yangtze River with severe genetic impoverishment. The separation of the two BB species with small seeds, that is, T. incisa and T. maximowiczii, was strongly supported by both morphological and genetic evidence. For the tetraploids, Asian and North American tetraploids were revealed to have distinct evolutionary origins. Asian allotetraploids (AABB) originated through hybridization between AA diploids from the Yangtze River Basin and BB diploids T. maximowiczii, supported by nuclear and chloroplast evidence. In contrast, the invasive North American tetraploids (T. bispinosa var. iinumai) exhibited an AACC-like genome, suggesting an independent polyploidization involving an unknown “CC” diploid. These findings provide critical insights into Trapa’s complex evolutionary history, polyploidizations, and invasive origins, offering a genomic foundation for the conservation and sustainable utilization of the underutilized aquatic crop amid global environmental challenges.
47. Associations of frailty and its changes with the risks of depressive symptoms: A multi-cohort study.
期刊: Archives of gerontology and geriatrics 发表日期: 2025-Aug-29 链接: PubMed
摘要
Frailty is a dynamic condition that may affect mental health. This study aimed to investigate the associations of frailty and its changes with the risks of depressive symptoms across multiple regions in aging populations. Data were drawn from five cohort studies in the United States, England, Europe, China, and Mexico. Frailty was assessed by frailty index which included chronic diseases, vision and hearing impairments, pain, self-reported health status, activity of daily living, instrumental activity of daily living, mobility, and cognitive function. Changes in frailty were evaluated by frailty at baseline and the first follow-up survey. Unadjusted and adjusted hazard ratios (HRs) with 95% confidence intervals [CIs] were estimated by Cox proportional hazards models and then pooled by meta-analyses. Of the 61,063 participants, 17,960 developed depressive symptoms during a median time of 5.9 to 9.0 years. Baseline frailty was significantly associated with an increased risk of depressive symptoms. Participants who changed from robust to pre-frail or frail status showed an elevated risk of depressive symptoms compared to stable robust participants (HR range: 1.38-1.81; pooled HR: 1.53, 95% CI: 1.37-1.72). Conversely, participants who transitioned from frail to robust or pre-frail status demonstrated a reduced risk of depressive symptoms compared to stable frail participants (HR range: 0.36-0.78; pooled HR: 0.71, 95% CI: 0.63-0.79). Baseline frailty was associated with incident depressive symptoms. Deterioration of frailty elevated the risk of depressive symptoms, whereas improvement of frailty lowered the risk. This study suggests that timely interventions for frailty may prevent depressive symptoms.
48. Nationwide Insights on Immunotherapy in a Low- and Middle-Income Country: Armenia's Struggle for Equitable Cancer Care in an Out-of-Pocket System.
期刊: JCO global oncology 发表日期: 2025-May 链接: PubMed
摘要
In Armenia, a lower-middle-income country, cancer causes 21% of all deaths, with over half of cases diagnosed at advanced stages. Without universal health insurance, patients rely on out-of-pocket payments or black-market channels for costly immunotherapies, underscoring the need for real-world data to inform equitable policy reforms. We conducted a multicenter, retrospective cohort study of patients who received at least one dose of an immune checkpoint inhibitor (ICI) between January 2017 and December 2023 across six Armenian oncology centers. Eligible patients had histologically confirmed malignancy and ≥6 months of follow-up. Demographic, clinical, biomarker, and treatment data were extracted from records. Overall survival (OS) was estimated by the Kaplan-Meier method; log-rank tests and Cox models evaluated associations. A 6-month landmark analysis adjusted for immortal time bias. Of the 585 patients screened, 373 met inclusion criteria (67% male; median age, 61 years); 68% had stage IV disease. The median OS was 31 months. Liver metastases predicted poorer survival (19 v 26 months, P = .027). Nonsmokers had better OS than smokers (31 v 24 months, P = .019). High PD-L1 expression (≥50%) was associated with improved OS (40 v 16 months, P = .025). Receiving >6 ICI cycles conferred longer OS (45 v 23 months, P < .001), although not significant in landmark analysis (P = .64). Financial hardship and disease progression were key reasons for early discontinuation. Immunotherapy shows promise in Armenia despite financial barriers. Drawing on models from India and China, pooled procurement, negotiated pricing, and partial reimbursement, Armenia could expand biomarker testing, reduce drug costs, and implement tiered insurance. These steps are vital to optimize access and outcomes in this resource-limited setting.
49. Comprehensive Overview of Breast Cancer in India.
期刊: JCO global oncology 发表日期: 2025-May 链接: PubMed
摘要
Breast cancer remains a significant public health challenge globally, as well as in India, where it is the most frequently diagnosed cancer in females. Significant disparities in incidence, mortality, and access to health care across India’s sociodemographically diverse population highlight the need for increased awareness, policy reform, and research. This review consolidates data from national cancer registries, global cancer databases, and institutional findings from a tertiary care center to examine the epidemiology, clinical challenges, and management gaps specific to India. It focuses on early detection barriers, health care infrastructure, and treatment accessibility, while discussing policy-level interventions and evolving models of care delivery. India reports over 1.4 million cancer cases and 0.9 million cancer-related deaths annually. Challenges include a lack of trained health care providers, limited access to screening, delayed diagnosis, and unequal treatment availability. Challenges include a lack of trained health care providers, limited access to screening, delayed diagnosis, and unequal treatment availability. High mortality is compounded by poor penetrance of screening biomarkers, late-stage presentation, and limited access to cost-effective diagnostics. Despite adherence to standard treatment protocols, systemic barriers continue to limit outcomes. Advances in tumor biology and the introduction of tailored, patient-centric approaches such as the hub-and-spoke care model present promising strategies. This article summarizes our current understanding of breast cancer epidemiology, its geographical diversity, and policy amendments needed for effective management in a populous nation like India. Bridging the gap between groundbreaking research and patients with cancer, families, and caregivers, and educating and empowering patients, identifying barriers, and gaining a deeper understanding of the needs of the community are all vehemently needed.
50. Challenges and Opportunities in Head and Neck Cancer Research in Developing Countries: Insights From a Fireside Chat.
期刊: JCO global oncology 发表日期: 2025-May 链接: PubMed
摘要
Head and neck squamous cell carcinoma (HNSCC) represents a significant public health burden in developing countries, where access to early diagnosis, comprehensive care, and research infrastructure is limited. This article synthesizes the insights generated during a Fireside Chat convened by members of the Latin American Cooperative Oncology Group (LACOG)-Head and Neck and the Brazilian Group of Head and Neck Cancer (GBCP), with the participation of international expert Professor Hisham Mehanna. The discussion addressed key challenges and opportunities in clinical and translational research within resource-constrained settings. Major themes included the unmet needs of patients with HNSCC, particularly regarding treatment-related toxicities and the need for biomarker-driven, personalized approaches. Barriers to research in low- and middle-income countries were explored, including patient comorbidities, late-stage presentation, and regulatory hurdles. The group emphasized the importance of pragmatic, context-sensitive research that reflects local disease burden, health care structures, and cultural factors. Capacity building, multidisciplinary teamwork, and integration of translational science into clinical care were highlighted as essential for advancing outcomes. The manuscript also outlines the preparedness of Brazilian centers for early-phase trials, strategies to enhance patient recruitment, and mechanisms to strengthen collaboration among researchers, governmental agencies, and industry. Successful models from LACOG and GBCP were presented to illustrate local leadership in advancing HNSCC research. Ultimately, the authors advocate for a coordinated national research agenda that positions Brazil and similar nations as meaningful contributors to the global head and neck cancer research landscape, fostering innovation while addressing the realities of under-represented populations.
51. Prevalence and predictors of viral load non-suppression among adolescents on dolutegravir-based antiretroviral therapy: A cross-sectional study from three urban clinics, Soroti City.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Despite advances in HIV care, viral load suppression (VLS) among adolescents living with HIV (ALHIV) in Uganda continue to lag behind that of adults, even with the introduction of dolutegravir (DTG)-based regimens, the Youth and Adolescent Peer Supporter (YAPS) model, and community-based approaches. Understanding factors associated with HIV viral load non-suppression in this population is critical to inform HIV treatment policy. This study assessed the prevalence and predictors of viral load non-suppression among ALHIV aged 10-19 years on DTG-based ART in Soroti City, Uganda. We conducted a cross-sectional study among 447 ALHIV attending three urban HIV clinics in Soroti City. Data were abstracted using a structured questionnaire and analyzed in STATA 15.0. Modified Poisson regression with robust error variance was used to identify predictors of viral load non-suppression. Adjusted relative risks (aRR) and 95% confidence intervals (CIs) were reported, with statistical significance set at p ≤ 0.05. Of the 447 participants, 53.5% were female, with a median age of 16 years (IQR: 14.0-17.6). The majority (72.9%) were from Soroti district and had been on DTG-based ART for a median of 42.5 months (IQR: 37.0-48.0). Most were receiving multi-month dispensing (MMD) (75.2%) and were active in care (98%). The prevalence of viral load non-suppression was 19.2% (86/447). Independent predictors of non-suppression included older age (15-19 vs. 10-14 years) (aRR: 1.69; 95% CI: 1.08-2.67), male sex (aRR: 1.48; 95% CI: 1.05-2.11), prior non-suppression before switching to DTG (aRR: 1.76; 95% CI: 1.19-2.59), use of non-fixed dose DTG regimens (aRR: 2.03; 95% CI: 1.23-3.33), history of poor adherence (aRR: 4.36; 95% CI: 2.05-9.26), and not receiving MMD (aRR: 2.83; 95% CI: 1.93-4.15). Nearly one in five adolescents on DTG-based ART in Soroti City had viral non-suppression, despite optimized treatment regimens. Targeted interventions-particularly enhanced adherence counseling for older and male adolescents, expanding MMD coverage, and provision of fixed-dose regimens-are urgently needed to improve VLS among ALHIV. These findings underscore the need for adolescent-centered HIV care strategies to close the viral suppression gap and advance progress towards epidemic control.
52. Improving Access to Adult Hearing Care: A Retrospective Review of an Awareness Campaign and Community Hearing Test Service.
期刊: Inquiry : a journal of medical care organization, provision and financing 发表日期: 2025 链接: PubMed
摘要
Age related hearing loss is in the top ten contributors to the global burden of disease and one of the largest modifiable risk factors for age-related dementia. However, awareness of the consequences of untreated hearing loss is poor and many adults do not seek hearing assessment. Despite World Health Organisation recommendations, no EU country currently has a national adult screening programme. The aim of this trial was to raise awareness of hearing loss by providing screening audiograms in a range of community settings. Results were explained to every participant and professional advice given. Seven hundred participants came forward for testing with a mean age of 60 to 70 years old. Data was recorded from 597 individuals (51% female and 49% male), 44% had a disabling hearing loss (≥35 dB HL in the better ear) and 15% of individuals had a moderately severe loss or greater. No participants currently wore or had been fitted with a hearing aid. Both the proportion of those with hearing loss and the severity of the hearing loss increased with age. Tinnitus was present in 38% of the sample and wax occlusion in 24%. Many individuals came forward who had not accessed the audiological services currently provided. This indicates a need for more awareness of hearing care in the population and an unmet need for audiological services.
53. ICTUSCOG: Poststroke cognitive impairment following nondisabling stroke: Study protocol of a spanish multicentre prospective cohort study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Stroke is a leading cause of death and disability globally, with frequent cognitive sequelae affecting up to 60% of stroke survivors. Despite the high prevalence of post-stroke cognitive impairment (PSCI), early detection remains underemphasized in clinical practice, with limited focus on broader neuropsychological and affective symptoms. Stroke elevates dementia risk and may act as a trigger for progressive neurodegenerative diseases. However, the underlying neurobiological mechanisms and the interaction between vascular and degenerative pathways are poorly understood. The ICTUSCOG study aims to address these gaps by determining the incidence, predictors and progression factors of PSCI in a prospective, multicenter cohort of nondisabling stroke patients. The work will explore distinct patient profiles, evaluate the role of biomarkers, and develop a predictive model to identify at risk individuals. ICTUSCOG is a five-year observational project involving four Spanish centres. Recruitment began in 2022 and includes consecutive patients aged 18-75 with no prior cognitive impairment and nondisabling stroke. Participants undergo detailed neuropsychological, functional, and neuroimaging assessments at baseline, 3, 6, and 12 months, and annually thereafter. Key data include stroke characteristics, vascular risk factors, advanced neuroimaging metrics, and biological biomarkers. Neuropsychological assessments incorporate domain-specific validated tools tailored for stroke patients. The study will quantify the incidence of early and late PSCI, identify predictors of progression, and characterise cognitive profiles. Multivariate models and clustering techniques will explore interactions among clinical, biological and imaging data. A predictive model will be developed and validated for clinical use. ICTUSCOG will provide critical insights into the mechanisms and trajectories of PSCI, informing prevention, early intervention, and rehabilitation strategies. The work aims to establish predictive tools and care pathways to mitigate the burden of cognitive impairment in stroke survivors.
54. Barriers and facilitators to implementing a single-visit, screen-and-treat approach with thermal ablation for cervical cancer prevention in Kenya.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Cervical cancer continues to be a major global threat to women’s health, with approximately 660,000 women diagnosed annually, 94% of whom are in low- and middle-income countries (LMICs). The high disease burden in LMICs is partly due to suboptimal adoption and widespread implementation of effective preventive interventions. This study explored drivers of implementation success and failure for a future single-visit, screen, and treat approach with thermal ablation (SV-SAT + TA), referred to as TIBA in Kenya. Guided by the Consolidated Framework for Implementation Research (CFIR framework), we conducted in-depth interviews with 34 participants (frontline health workers, health facility managers, and policymakers) between May and August 2022 in Kiambu, Embu, and Murang’a Counties in Kenya. All interviews were audio recorded and transcribed verbatim. We applied deductive and inductive coding for emerging themes. The participants reported the relative advantage of thermal ablation for the single-visit, screen-and-treat approach, emphasizing its lower start-up and maintenance costs and lower complexity compared to cryotherapy. Additionally, participants expressed confidence in their ability to implement TIBA, and a strong commitment from the leadership to support TIBA implementation was reported. These factors were perceived as drivers of successful TIBA implementation. In contrast, barriers, including lack of essential commodities and equipment, shortage of trained providers, staff redeployment, inadequate space, recruitment challenges, and silos within the healthcare system, were identified as drivers of implementation failure. To optimize cervical cancer prevention efforts in LMICs, it is critical to address both systemic and contextual factors through a coordinated, integrated, and system-wide approach that involves all the key stakeholders.
55. Lead yourself to the zone and be happy: The effect of self-leadership development on flow and happiness.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Self-leadership has been associated with several positive organizational outcomes (e.g., performance and innovation). Yet, individual subjective well-being constructs have seldom been explored in the self-leadership literature. We hypothesized that an increase in self-leadership results in increased positive affect resources, namely flow and happiness. A self-leadership intervention program, interlinked with a real-world longitudinal observational effectiveness-assessment design, was used to test this hypothesis. A sample of 64 middle-managers from a for-profit organization in the fast-moving consumer goods (FMCG) sector went through one 8-week self-leadership training program, and provided 4383 daily measures of self-leadership, flow, and happiness during working hours on business days, plus 242 post-training modules assessments. Email surveys were used to assess self-leadership and dispositional flow, whereas the experiencing sampling method was used to assess situational (i.e., at-the-moment) flow and happiness. Linear mixed models and mediation analysis were applied to longitudinal data. As hypothesized, an increase in self-leadership was positively associated to (1) situational and dispositional experiences of flow among employees in the FMCG sector and (2) happiness in the workplace. No mediation of flow was found between self-leadership and happiness. Results highlight the potential of self-leadership skills development and practice to shorten the distance between perceived challenges and skills in job-related tasks, as well as to make subjects feel happier in the workplace.
56. Navigating Hepatitis C care: Knowledge gaps and access barriers among young women who inject drugs in rural Appalachia.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Hepatitis C virus (HCV) and injection drug use among young women are dramatically rising in the rural United States. From 2004 to 2017, heroin use among non-pregnant women increased 22.4% biennially, mirroring increases in HCV cases, especially among younger populations. Young women who inject drugs (YWID, ages 18-35) face elevated HCV risk due to biological, behavioral, and socio-cultural factors. Barriers to HCV testing and treatment services further delay diagnoses, fuel transmission, and limit access to harm reduction services. This study applies the Theoretical Domains Framework (TDF) to identify factors influencing HCV testing and treatment among YWID in rural Appalachia Ohio. We conducted in-depth interviews with YWID (n = 30) in 2023 to understand their HCV testing and treatment experiences in rural Appalachia Ohio. Interviews were transcribed, inductively coded, and analyzed using grounded theory. Identified themes were mapped onto the TDF domains. Key TDF domains influencing HCV care included knowledge, beliefs about consequences, and intentions. While YWID knew where to get tested, they expressed uncertainty about treatment value and access while actively using drugs. Social influences, stigma, and mistreatment by healthcare providers created barriers to treatment. Environmental context and resources, such as transportation, also influenced access to care. YWID in rural Appalachia face barriers to HCV care, such as gaps in knowledge about HCV treatment, which is compounded by gendered stigma, and logistical challenges. Rapidly changing treatment restrictions led to misinformation about treatment access. These gaps highlight the need for interventions specifically designed to address YWID lived experiences.
57. Catchment prioritization for freshwater mussel conservation in the Northeastern United States based on distribution modelling.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Freshwater mussels are critical to the health of freshwater systems, but their populations are declining dramatically throughout the world. The limited resources available for freshwater mussel conservation necessitates the geographic prioritization of conservation-related actions. However, lack of knowledge about freshwater mussel spatial distributions hinders decision making in this context. In this study, we assessed the distribution of twelve native freshwater mussel species across six Northeastern states (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, and Maine) in the United States using data collected from lentic and lotic environments by eight state agencies. We first modeled individual distributions using a maximum entropy (MaxEnt) model and then compiled distribution models to assess the distribution of freshwater mussel species richness. We also determined geographic prioritization for three conservation-related actions: species surveys, land protection, and population restoration of species of high conservation concern. We found that the percent of catchments predicted to have species occurrence (based on a probability threshold) varied across species, with Elliptio complanata (Eastern elliptio) predicted to occur in the greatest percent of available catchments (33.92%) and Alasmidonta heterodon (Dwarf wedgemussel) expected in the smallest percent (5.30%). The predicted overall species richness within our modeled catchments ranged from zero to all twelve species, with an average of two species per catchment. Although conservation priorities vary depending on the conservation action of interest, we found some areas of consistent importance including much of Maine and the southern reaches of the Connecticut River. An improved understanding of freshwater mussel distribution in a landscape framework will enable managers to implement more precise and efficient conservation interventions for these essential aquatic species.
58. Microbial quality assessment of Niger seed (Guizotia abyssinica (Linnaeus f.) Cassini) oil in Gondar city: A laboratory-based cross-sectional study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Foodborne diseases pose a significant public health challenge worldwide. The increasing availability of edible oils in the market, combined with Ethiopia’s lack of stringent quality control and regulatory oversight, raises concerns about their safety. This inadequacy in regulation may contribute to microbial contamination, leading to potential public health risks. A laboratory-based cross-sectional study was conducted from May to July 2021. Twelve samples of Niger seed oil (Guizotia abyssinica (Linnaeus f.) Cassini) were collected using a universal sampling technique. In the microbiology laboratory, the samples were aseptically examined for bacterial and fungal contamination using standard microbiological methods and procedures. The collected data were entered and analyzed using Stata Version 14. Mean values and standard deviations were computed, and the results were presented in text and tables. Microbial analysis of the 12 Niger seed oil (Guizotia abyssinica (Linnaeus f.) Cassini) samples revealed varying levels of bacterial, mold, and coliform contamination. The identified bacterial species included Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa, while Aspergillus niger, Aspergillus flavus, and Aspergillus fumigatus were the predominant fungal isolates. The total aerobic bacterial count ranged from 1.3 × 103 to 9.2 × 104 cfu/ml, with the highest recorded mold count reaching 4 × 10⁵ cfu/ml. Additionally, both total and fecal coliform isolates were detected in the samples. The presence of these microorganisms suggests that the oil processing, production, handling, and storage systems lack proper hygienic handling practices. This finding highlights the urgent need for stringent hygiene measures, enhanced quality control protocols, and strict adherence to food safety regulations throughout the production and distribution processes.
59. American black bear (Ursus americanus) as a potential host for Campylobacter jejuni.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The Gram-negative bacterium Campylobacter jejuni is part of the commensal gut microbiota of numerous animal species and a leading cause of bacterial foodborne illness in humans. Most complete genomes of C. jejuni are from strains isolated from human clinical, poultry, and ruminant samples. Here, we characterized and compared the genomes of C. jejuni that were isolated from American black bears in three states in the southeastern United States from 2014 to 2016. Despite the limited sample size (n = 9), the isolates displayed substantial genotypic variability, including eight distinct sequence types (STs) and variable gene content encoding surface glycan structures such as capsular polysaccharides (CPS) and lipooligosaccharides (LOS). Phylogenetic analysis identified several C. jejuni host generalist strains among the isolates from bears that clustered with isolates from domestic poultry, cattle, and environmental sources. Three isolates (SKBC94, SKBC3, SKBC5) clustered with wildlife-associated strains, exhibiting mutations or deletions in loci associated with cytolethal distending toxin production and oxidative stress resistance, potentially influencing host-specific colonization. Additionally, strains SKBC3 and SKBC5 harbored distinct Entner-Doudoroff (E-D) loci, suggesting a potential evolutionary fitness advantage. This study provides the first evidence of C. jejuni colonization in American black bears, highlighting their potential role as reservoirs for diverse C. jejuni lineages from both anthropogenic and environmental sources. Further research is needed to determine the prevalence and host specificity of C. jejuni strains in black bears and their potential implications for public and wildlife health.