公共卫生研究摘要 (2025-09-11)
共收录 55 篇研究文章
1. Associations of Chronic Insomnia, Longitudinal Cognitive Outcomes, Amyloid-PET, and White Matter Changes in Cognitively Normal Older Adults.
期刊: Neurology 发表日期: 2025-Oct-07 链接: PubMed
摘要
The relationship between insomnia and cognitive decline is poorly understood. We investigated associations between chronic insomnia, longitudinal cognitive outcomes, and brain health in older adults. From the population-based Mayo Clinic Study of Aging, we identified cognitively unimpaired older adults with or without a diagnosis of chronic insomnia who underwent annual neuropsychological assessments (z-scored global cognitive scores and cognitive status) and had quantified serial imaging outcomes (amyloid-PET burden [centiloid] and white matter hyperintensities from MRI [WMH, % of intracranial volume]). We used mixed-effects models to examine associations between baseline insomnia (independently or with interaction with self-reported changes in habitual sleep duration) and longitudinal cognitive z-scores, log-transformed WMH, and amyloid-PET levels while adjusting for multiple confounders, including sleep apnea diagnosis. The risk of incident cognitive impairment (CI) was estimated using the Cox proportional hazards model. We included 2,750 participants (mean 70.3 ± 9.7 years old, 49.2% female) in global cognition models and 2,814 in Cox models with median follow-up of 5.6 years. A total of 1,027 and 561 participants were included in WMH and amyloid-PET models, respectively. Insomnia was associated with a 0.011 per year (95% CI -0.020 to -0.001, p-interaction = 0.028) faster decline in global cognitive scores and 40% increased risk of CI (hazard ratio [HR] 1.4, 95% CI 1.07-1.85, p = 0.015). Insomnia with reduced sleep was associated with baseline cognitive performance (β = -0.211, 95% CI -0.376 to -0.046, p-interaction = 0.012), WMH (β = 0.147, 95% CI 0.044-0.249, p-interaction = 0.005), and amyloid-PET (β = 10.5, 95% CI 0.5-20.6, p-interaction = 0.039) burden. Insomnia participants sleeping more than usual (potentially indicating remission of symptoms) had lower baseline WMH burden (β = -0.142, 95% CI -0.268 to -0.016, p-interaction = 0.028). Insomnia was not associated with the rate of WMH or amyloid accumulation over time. In participants with insomnia, hypnotic use was not associated with cognitive scores (β = 0.016, 95% CI -0.201 to 0.233, p = 0.888) or incident CI (HR 0.94, 95% CI 0.5-1.6, p = 0.832). We found an association between insomnia, cognitive decline, and increased risk for CI. Insomnia with reduced sleep was associated with worse cognitive performance and poorer brain health (WMH and amyloid burden) at baseline. Sleeping more than usual was associated with lower WMH burden.
2. Community Connectedness as a Source of Adherence to HIV Prevention Behaviors and Resilience Among Transgender Women of Color in New York City, 2020-2022.
期刊: American journal of public health 发表日期: 2025-Oct 链接: PubMed
摘要
Objectives. To examine how one’s community connectedness may act as a source of resilience and promote HIV prevention and care behaviors among transgender women of color. Methods. We analyzed survey data from 313 transgender women of color living in New York City collected from August 2020 to November 2022. The Community Connectedness Scale asks participants about their baseline feelings of connection, feelings of inclusion, feelings of belonging, feelings of isolation, and feelings of being unlike in relation to the transgender community. The HIV prevention and care outcomes of interest were measured at 6-month follow-up and included consistent condom usage, recent testing for sexually transmitted infections (STIs), current preexposure prophylaxis use, and HIV viral load suppression. Results. Those with a high (compared to low) community connectedness were 62% more likely to consistently use condoms and 16% more likely to test for STIs. Conclusions. Community connectedness was associated with a greater likelihood of HIV prevention behaviors. Public Health Implications. Future interventions could include strategies to strengthen community connectedness to improve HIV status neutral care continuums. (Am J Public Health. 2025;115(10):1631-1641. https://doi.org/10.2105/AJPH.2025.308144).
3. The Changing Landscape of Maternal Health Care in the United States: A Call to Action.
期刊: American journal of public health 发表日期: 2025-Oct 链接: PubMed
摘要
4. Medications for Opioid Use Disorder in County Jails - Outcomes after Release.
期刊: The New England journal of medicine 发表日期: 2025-Sep-11 链接: PubMed
摘要
In 2019, seven county correctional facilities (jails) in Massachusetts initiated pilot programs to provide all Food and Drug Administration-approved medications for opioid use disorder (MOUD). This observational study used linked state data to examine postrelease MOUD receipt, overdose, death, and reincarceration among persons with probable opioid use disorder (OUD) in carceral settings who did or did not receive MOUD from these programs from September 1, 2019, through December 31, 2020. Log-binomial and proportional-hazards models were adjusted for propensity-score weights and baseline covariates that remained imbalanced after propensity-score weighting. The study cohort included 6400 persons with probable OUD: 2711 (42.4%) received MOUD in jail and 3689 (57.6%) did not. Among persons treated with MOUD in jail, 67.9% received buprenorphine, 25.7% received methadone, and 6.5% received naltrexone. Treated persons were more likely than those not treated to be White (75.4% vs. 58.1%), to be sentenced (31.6% vs. 13.2%), to be receiving MOUD at jail entry (73.7% vs. 17.1%), and to receive MOUD during the first 30 days after community release (60.2% vs. 17.6%; adjusted relative risk, 1.44; 95% confidence interval [CI], 1.38 to 1.50). Only 50.4% of MOUD recipients engaged in MOUD treatment for 75% of the first 90 days after release, and 57.5% were receiving MOUD at 180 days. Receipt of MOUD in jail, as compared with no such receipt, was associated with lower postrelease risks of fatal overdose (adjusted hazard ratio, 0.48; 95% CI, 0.36 to 0.64), nonfatal overdose (adjusted hazard ratio, 0.76; 95% CI, 0.68 to 0.85), death from any cause (adjusted hazard ratio, 0.44; 95% CI, 0.35 to 0.56), and reincarceration (adjusted hazard ratio, 0.88; 95% CI, 0.81 to 0.94). The incidence of hospitalizations did not differ substantially between the two groups. Receipt of MOUD in jail was associated with an increased likelihood of postrelease MOUD initiation and decreased risks of overdose, death from any cause, and reincarceration. (Funded by the National Institutes of Health and others.).
5. Marburg Virus Disease in Rwanda, 2024 - Public Health and Clinical Responses.
期刊: The New England journal of medicine 发表日期: 2025-Sep-11 链接: PubMed
摘要
On September 27, 2024, Rwanda reported an outbreak of Marburg virus disease (MVD), after a cluster of cases of viral hemorrhagic fever was detected at two urban hospitals. We report key aspects of the epidemiology, clinical manifestations, and treatment of MVD during this outbreak, as well as the overall response to the outbreak. We performed a retrospective epidemiologic and clinical analysis of data compiled across all pillars of the outbreak response and a case-series analysis to characterize clinical features, disease progression, and outcomes among patients who received supportive care and investigational therapeutic agents. Among the 6340 patients with suspected MVD who underwent testing, 66 had laboratory-confirmed MVD, 51 (77%) of whom were health care workers. The median estimated incubation period was 10 days (interquartile range, 8 to 13), and symptom onset occurred a median of 2 days (interquartile range, 1 to 3) before hospital admission. The results of epidemiologic investigations were highly suggestive of a zoonotic origin of the outbreak: an index patient was identified who had been exposed to Egyptian fruit bats at a mining site. The case fatality rate in the outbreak was 23% (15 deaths among 66 patients). Remdesivir and the monoclonal antibody MBP091 were used under expanded access and clinical trial protocols. In addition, 1710 frontline workers and high-risk contacts received the chimpanzee adenovirus 3-vectored vaccine ChAd3-MARV under emergency use authorization in a phase 2 clinical trial. Implementation of containment measures, advanced supportive care, and access to investigational countermeasures may have contributed to reduced mortality from MVD in this outbreak. Enhancing surveillance, improving infection prevention and control in health care settings, and ensuring timely deployment of medical countermeasures will be critical for mitigating the effects of future filovirus disease outbreaks.
6. Therapists' Role in Patient Adherence to Internet-Based Cognitive Behavioral Therapy: Qualitative Study.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-10 链接: PubMed
摘要
Internet-based cognitive behavioral therapies (iCBTs) are typically categorized into 2 types: therapist-assisted and self-guided. Both formats have accumulated substantial evidence supporting their cost-effectiveness and efficacy in treating a range of mental health conditions. However, therapist-assisted iCBTs tend to show lower dropout rates than self-guided versions. The relatively high dropout rates in self-guided programs suggest that some degree of therapist involvement may be necessary to improve engagement and treatment adherence. Yet, the specific reasons for therapist support in iCBT and its functions in improving engagement and treatment adherence remain an underexplored area of research. This study aimed to explore patients’ experiences with therapist-assisted iCBT to identify the elements they perceive as important for treatment adherence and to clarify the role of therapist support in the iCBT process. This study draws on 89 semistructured in-depth interviews with iCBT users. Patients took part in 9 different therapist-assisted iCBT programs (depression [n=32], anxiety disorder [n=17], obsessive-compulsive disorder [n=10], bipolar disorder [n=5], social phobia [n=5], bulimia [n=3], alcohol abuse [n=1], panic disorder [n=10], and insomnia [n=6]), all provided nationwide by Helsinki University Hospital in Finland. The interviews were transcribed verbatim and analyzed with the qualitative Gioia method. Three key categories help explain why users consider therapist support essential for adherence in iCBTs: (1) the strengthening of individual autonomy, (2) the therapist’s commitment to strengthening the therapeutic alliance, and (3) assistance with emotion regulation. Therapist support was shown to be pivotal, often conveyed through small, text-based gestures that had a meaningful impact. The role of the therapist should not be diminished in the pursuit of digitalization, as human support remains a critical element of effective iCBT.
7. Principles of Industry-Academic Partnerships Informed by Digital Mental Health Collaboration: Mixed Methods Study.
期刊: JMIR mental health 发表日期: 2025-Sep-10 链接: PubMed
摘要
Cross-sector collaboration is increasingly recognized as essential for addressing complex health challenges, including those in mental health. Industry-academic partnerships play a vital role in advancing research and developing health solutions, yet differing priorities and perspectives can make collaboration complex. This study aimed to identify key principles to support effective industry-academic partnerships, from the perspective of industry partners, and develop this into actionable guidance, which can be applied across sectors. Mental health served as a motivating example due to its urgent public health relevance and the growing role of digital innovation. Using a 3-stage, mixed-methods approach, we conducted a web-based survey of UK-based digital mental health companies (N=22) to identify key barriers and facilitators to industry-academic partnerships. This was followed by 2 focus groups (n=5) that explored emerging themes from the survey using thematic analysis. Finally, we conducted a workshop with industry representatives, researchers, clinicians, and PPI members to co-develop the Principles of Industry-Academic Partnerships (PIP) guidance. Survey findings highlighted that industry partners valued academic collaboration for enhancing credibility, facilitating knowledge transfer, and gaining access to PPI networks. However, key barriers included high costs, slow academic timelines, and complex contracting processes. The 4 major themes that emerged from the focus groups were: advantages of collaboration, cultural differences between organizations, collaboration models, and structural barriers within universities. Through informed discussions in the workshop, these themes were explored, leading to the development of 14 actionable strategies. These strategies reflect industry perspectives and formed the PIP guidance, categorized under project initiation, defining the scope and agreements, project execution, and promoting sustainability. The PIP guidance provides a practical framework to support more effective and mutually beneficial collaborations between industry and academia. Developed through the lens of mental health research, the strategies identified are broadly applicable across disciplines where cross-sector partnerships are essential. Industry partners valued academic collaborations for their credibility and scientific rigor, but highlighted persistent structural and cultural barriers within universities. Addressing these challenges by aligning expectations and timelines, adopting flexible collaboration models, and streamlining operational processes can help foster impactful and sustainable partnerships in mental health and beyond.
8. Leveraging GPT-4o for Automated Extraction and Categorization of CAD-RADS Features From Free-Text Coronary CT Angiography Reports: Diagnostic Study.
期刊: JMIR medical informatics 发表日期: 2025-Sep-10 链接: PubMed
摘要
Despite the Coronary Artery Reporting and Data System (CAD-RADS) providing a standardized approach, radiologists continue to favor free-text reports. This preference creates significant challenges for data extraction and analysis in longitudinal studies, potentially limiting large-scale research and quality assessment initiatives. To evaluate the ability of the generative pre-trained transformer (GPT)-4o model to convert real-world coronary computed tomography angiography (CCTA) free-text reports into structured data and automatically identify CAD-RADS categories and P categories. This retrospective study analyzed CCTA reports from January 2024 and July 2024. A subset of 25 reports was used for prompt engineering to instruct the large language models (LLMs) in extracting CAD-RADS categories, P categories, and the presence of myocardial bridges and noncalcified plaques. Reports were processed using the GPT-4o API (application programming interface) and custom Python scripts. The ground truth was established by radiologists based on the CAD-RADS 2.0 guidelines. Model performance was assessed using accuracy, sensitivity, specificity, and F1-score. Intrarater reliability was assessed using Cohen κ coefficient. Among 999 patients (median age 66 y, range 58-74; 650 males), CAD-RADS categorization showed accuracy of 0.98-1.00 (95% CI 0.9730-1.0000), sensitivity of 0.95-1.00 (95% CI 0.9191-1.0000), specificity of 0.98-1.00 (95% CI 0.9669-1.0000), and F1-score of 0.96-1.00 (95% CI 0.9253-1.0000). P categories demonstrated accuracy of 0.97-1.00 (95% CI 0.9569-0.9990), sensitivity from 0.90 to 1.00 (95% CI 0.8085-1.0000), specificity from 0.97 to 1.00 (95% CI 0.9533-1.0000), and F1-score from 0.91 to 0.99 (95% CI 0.8377-0.9967). Myocardial bridge detection achieved an accuracy of 0.98 (95% CI 0.9680-0.9870), and noncalcified coronary plaques detection showed an accuracy of 0.98 (95% CI 0.9680-0.9870). Cohen κ values for all classifications exceeded 0.98. The GPT-4o model efficiently and accurately converts CCTA free-text reports into structured data, excelling in CAD-RADS classification, plaque burden assessment, and detection of myocardial bridges and calcified plaques.
9. A Self-Guided Digital Mental Health Promotion Service Targeting Young People: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Sep-10 链接: PubMed
摘要
The high and increasing rate of poor mental health among young people is a matter of global concern. Experiencing poor mental health during this formative stage of life can adversely impact interpersonal relationships, academic and professional performance, and future health and well-being if not addressed early. However, only a few of those in need seek help. Research indicates that young people perceive digital mental health support as having many benefits compared to traditional face-to-face services. However, the effectiveness of self-guided digital mental health services is not well documented, and research on their cost-effectiveness is lacking. Mindhelper is Denmark’s largest open access, digital, self-guided mental health service for young people. While it does not provide direct psychological or therapeutic care, it offers practical strategies and tools to promote well-being and address a broad spectrum of mental health challenges, from everyday stress to more complex issues. Despite its widespread use, the effectiveness of Mindhelper has not been evaluated. This trial aims to evaluate the effectiveness of building on the results of our feasibility study. We will assess Mindhelper’s impact on mental health and well-being, psychological functioning, intentions of help seeking, and body appreciation among people aged between 15 and 25 years and provide insights into the service’s cost-effectiveness. We will recruit 4910 people aged between 15 and 25 years via social media and randomized and allocated to an intervention group (receiving information about Mindhelper) or a control group (no information about Mindhelper). Outcomes are self-assessed and collected at baseline and 2, 6, and 12 weeks after randomization through online surveys and analyzed using the intention-to-treat approach. Qualitative interviews with intervention group participants will provide complementary insights, and a cost-effectiveness analysis will also be conducted. This study was fully funded in November 2022, and the data collection started in January 2025. As of August 2025, we enrolled 2613 people. The data analysis will start after data collection concludes (by early 2026), and the results of the primary outcome are expected to be published in the second half of 2026. This study will deliver crucial evidence on the effectiveness of self-guided digital mental health promotion targeting young people. If effective, this highly scalable service may contribute to combating the trend of rising mental health issues among young people and address key challenges in primary care by delivering timely, coordinated, and effective services to young individuals, potentially at a low cost. ClinicalTrials.gov NCT06385457; https://clinicaltrials.gov/ct2/show/NCT06385457. DERR1-10.2196/73736.
10. Correction: Factors Affecting the Receptiveness of Chinese Internists and Surgeons Toward Artificial Intelligence-Driven Drug Prescription: Protocol for a Systematic Survey Study.
期刊: JMIR research protocols 发表日期: 2025-Sep-10 链接: PubMed
摘要
[This corrects the article DOI: .].
11. Implementing Social Media Strategies in Community-Partnered HIV Research: Practical Considerations From 3 Ongoing Studies.
期刊: JMIR public health and surveillance 发表日期: 2025-Sep-10 链接: PubMed
摘要
In recent years, social media has emerged as a pivotal tool in implementation science efforts to address the HIV epidemic. Engaging community partners is essential to ensure the successful and equitable implementation of social media strategies. There is a notable lack of scholarship addressing the operational considerations for studies using social media strategies in community-partnered HIV research. This article seeks to bridge this gap by consolidating field notes and practical considerations derived from 3 ongoing NIH-supported studies focused on Ending the HIV Epidemic in the United States. This article aims to inform the design, planning, and implementation of operationally effective community-partnered social media strategies in HIV research, ultimately contributing to enhancements in HIV practice and improved outcomes across the HIV prevention and care continua. Supported by the University of California, Los Angeles Rapid, Rigorous, Relevant (3R) Implementation Science Hub, the 3 Ending the HIV Epidemic projects convened to form the community-partnered social media campaigns working group. The working group used the Consolidated Framework for Implementation Research to help identify and organize key barriers and facilitators of relevance to implementation of the projects’ social media strategies. Given the high degree of interrelatedness across reported factors, the working group thematically synthesized the content into 5 practical considerations to inform use of community-partnered social media strategies in HIV research. The practical considerations identified by the community-partnered social media campaigns working group include the following: (1) the power and pitfalls of social media platforms (ie, opportunities and challenges inherent to social media platforms that may affect use of social media strategies in HIV research), (2) messengers and messages matter (ie, ensuring the appropriateness, acceptability, and quality of social media messengers and content), (3) the significance of the sociopolitical environment (ie, characterizing the sociopolitical environment surrounding HIV and its potential impact on implementing social media strategies to reach priority populations), (4) investing in academic-community partnerships (ie, cultivating positive and productive academic-community partnerships to support implementation of social media strategies in HIV research), and (5) the alignment of the institutional environment and research approach (ie, assessing and working to address features of institutional environments that may impact implementation of social media strategies in community-partnered HIV research). As use of social media in HIV research and practice continues to grow, the practical considerations presented in this paper can help research teams anticipate factors that may impact implementation of community-partnered social media strategies and take early action to mitigate potential challenges. By understanding and addressing the unique challenges and opportunities of social media in community-partnered HIV research, we can leverage these platforms to accelerate progress toward ending the HIV epidemic.
12. Distribution and Risk Factors of Scrub Typhus in South Korea, From 2013 to 2019: Bayesian Spatiotemporal Analysis.
期刊: JMIR public health and surveillance 发表日期: 2025-Sep-10 链接: PubMed
摘要
Scrub typhus (ST), also known as tsutsugamushi disease, is a common febrile vector-borne illness in South Korea, transmitted by trombiculid mites infected with Orientia tsutsugamushi, with rodents serving as the main hosts. Although vector-borne diseases like ST require both a One Health approach and a spatiotemporal perspective to fully understand their complex dynamics, previous studies have often lacked integrated analyses that simultaneously address disease dynamics, vectors, and environmental shifts. We aimed to explore spatiotemporal trends, high-risk areas, and risk factors of ST by simultaneously incorporating host and environmental information. ST cases were extracted from the 2013-2019 Korea National Health Insurance Service data at 250 municipal levels and by epidemiological weeks (International Classification of Diseases, Tenth Revision, Clinical Modification code: A75.3). Data on potential risk factors, including the maximum probability of rodent presence, area of dry field farming, forest coverage, woman farmer population, and financial independence, were obtained from publicly available sources. In particular, the maximum rodent presence probability was estimated using a maximum entropy model incorporating ecological and climate variables. Spatial autocorrelation was assessed using Global Moran I statistics with 999 Monte Carlo permutations. Spatial and temporal clusters were identified using Getis-Ord Gi* and hot and cold spot trend analyses. Bayesian hurdle models with a spatiotemporal interaction term, accounting for zero-inflated Poisson distribution, were used to identify associations between ST incidence and regional factors. Stratification analyses by gender and age group (0-39, 40-59, 60-79, and ≥80 years) were performed. Between 2013 and 2019, 95,601 ST patients were reported. ST incidence had positive spatial autocorrelation (I=0.600; P=.01), with spatial expansion from southwestern to northeastern regions. Spatiotemporal models demonstrated better fit compared with spatial and temporal models, as indicated by lower Watanabe-Akaike information criterion (WAIC) values. Municipalities with higher rodent suitability (β coefficient=0.618; 95% credible interval [CrI] 0.425-0.812) and lower financial independence from central government (β coefficient=-0.304; 95% CrI -0.445 to -0.163) had higher likelihoods of increased ST incidence, even after adjusting for spatiotemporal autocorrelation. However, risk factors varied by age group: among individuals aged 40 years or older, ST incidence was positively associated with rodent suitability, while patients in the 0-39 years age group showed no association with rodent suitability (β coefficient=0.028; 95% CrI -0.072 to 0.126), and ST incidence was negatively associated with the women farmer population (β coefficient=-0.115; 95% Crl=-0.223 to -0.006). This is the first study to investigate ST in South Korea using a spatiotemporal framework grounded in a holistic One Health perspective. We elucidated the critical role of spatiotemporal dynamics in ST distribution, highlighting rodent suitability and economic independence as key drivers of disease distribution. Our findings lay the groundwork for evidence-based, region-specific intervention strategies and may inform targeted public health strategies in South Korea and other settings with similar ecological conditions.
13. Health Inequity in People with Cystic Fibrosis: Can We Close the Gap?
期刊: Annals of the American Thoracic Society 发表日期: 2025-Sep-10 链接: PubMed
摘要
Background Although advances in care have improved cystic fibrosis (CF) outcomes in higher-income countries (HICs), the situation remains alarming in lower-income countries (LICs). Methods People with CF (pwCF) enrolled in the European Cystic Fibrosis Society Patient Registry (ECFSPR) and carrying at least one F508del variant allele were evaluated in 2017 and in 2022 for predicted percent forced expiratory volume (ppFEV1), underweight status, and chronic Pseudomonas aeruginosa (Pa) infection, according to the gross national income (GNI) per capita divided into three terciles (low-income countries, LICs; middle-income countries, MICs; and high-income countries, HICs). Survival was evaluated in the periods 2013-2017 and 2018-2022. Generalized linear models and Cox regression models were fitted. Findings From the 31,723 pwCF reported in ECFSPR in 2022, 13.5% lived in LICs, 19.9% in MICs, and 66.6% in HICs. PwCF living in LICs had a significantly lower median survival age, reduced ppFEV1, and higher prevalence of Pa infection and underweight status compared with pwCF from MICs and HICs. Data modeling indicated that avoiding underweight status and Pa infection would increase survival by 42 years for pwCF living in LICs. Access to CFTR modulators would further increase their survival by 15 to 29 years depending on their nutrition and infection status, resulting in a survival up to 82 years in the best-case scenario. Interpretation Access to CFTR modulators equalizes survival between LICs and higher income countries within Europe. Optimizing care practices and social determinants of health remains crucial in LICs.
14. Domains shaping experiences around food with implications for food insecurity among students at a public university in the United States.
期刊: Journal of American college health : J of ACH 发表日期: 2025-Sep-10 链接: PubMed
摘要
Objective: Despite alarming rates of students’ food insecurity in the US (41%), estimates may not be fully capturing experiences in university settings. Understanding students’ food insecurity is a knowledge gap flagged amidst outstanding progress on food security measurement in household settings. This study investigated the domains shaping the experiences around food with implications for food insecurity among students. Participants and Methods: Of 178 students aged 18 years or older who reported worrying about food running out, eating insufficient amounts of food, and lacking balanced meals, a purposeful sample of 30 undergraduate and graduate students participated in a semi-structured interview. Data analysis involved three rounds of inductive coding. Results: Individual, community and system domains shaped experiences around food among students. Domain-specific and multi-domain factors operated simultaneously with implications for food availability, accessibility, acceptability, and utilization. Conclusion: Authorities have an opportunity to revisit the conceptualization of students’ food insecurity and to further improve measurement tools and university services.
15. Tumultuous Development of Venetoclax in t(11;14) Multiple Myeloma.
期刊: Journal of clinical oncology : official journal of the American Society of Clinical Oncology 发表日期: 2025-Sep-10 链接: PubMed
摘要
16. Strong Families Start at Home/Familias Fuertes Comienzan en Casa-Improving Child Diet Quality and Parental Feeding Practices: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Sep-10 链接: PubMed
摘要
Children in the United States have poor diet quality, increasing their risk for chronic disease burden later in life. Caregivers’ feeding behaviors are a critical factor in shaping lifelong dietary habits. The Strong Families Start at Home/Familias Fuertes Comienzan en Casa (SFSH) was a 6-month, home-based, pilot randomized-controlled feasibility trial that aimed to improve the diet quality of 2-5-year-old children and promote positive parental feeding practices among a predominantly Hispanic/Latine sample. The pilot saw significant improvements in children’s Healthy Eating Index-2015 total and whole fruit scores, as well as multiple food parenting practices, and it was received well by participants. Building on the success of the pilot study, this protocol paper describes the modifications, study design, and procedures for a fully powered randomized controlled trial. Caregiver-child dyads are randomized to a “healthy eating” intervention group or a “reading readiness” attention control group. In the intervention group, a trained community health worker conducts monthly home visits or phone calls for 6 months that focus on age-appropriate nutrition recommendations and food parenting practices. There are three home visits that include tailored nutrition education materials that address their child’s appetitive traits and eating habits, an interactive cooking activity, and a review of a family meal video with feedback. Community health workers use motivational interviewing and goal setting, which are key components of the program. The control group is similarly structured, with content focusing on reading and language development. Caregivers complete in-person and over-the-phone baseline and 6-month follow-up measurements to capture diet quality (primary outcomes: Healthy Eating Index-2015 scores via two 24-h dietary recalls and dermal carotenoids) and selected parental feeding practices and availability of healthy foods in the home (secondary outcomes). This protocol was approved by the Brown University institutional review board (protocol number 2022003389). As of March 2025, a total of 81 participants were randomized. Of these, 29 participants completed the study, and 8 participants withdrew. Recruitment will continue until 257 participants have been randomized. Data analysis is expected to conclude in 2028. Findings will determine the efficacy of the intervention to improve child diet quality and parental feeding practices, which will ultimately inform future effectiveness and the real-world of home-based food parenting programs. ClinicalTrials.gov NCT06099288; https://clinicaltrials.gov/study/NCT06099288. DERR1-10.2196/73923.
17. Effects of Injury Registry Data on Policymaking, Hospitalizations, and Mortality: Systematic Review.
期刊: JMIR public health and surveillance 发表日期: 2025-Sep-10 链接: PubMed
摘要
The Brazilian project, launched in 2021, aims to establish a nationwide injury registry that systematically collects detailed information on incidents and individuals across the country, regardless of injury severity. The registry integrates information from prehospital and hospital care, various health systems lacking interoperability, and data from sectors such as firefighters and police. Its primary aim is to enhance health surveillance by providing timely, high-quality information that guides prevention strategies and informs policymaking. In addition, the project seeks to reduce morbidity and mortality associated with injuries. This study aimed to investigate the effects of injury registry data on policymaking, hospitalization rates or duration, and mortality. The systematic review followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a protocol registered in PROSPERO (International Prospective Register of Systematic Reviews, CRD42023481528). A total of 5 databases were searched in November 2023, with an update conducted in March 2024, incorporating reference lists from the studies included. Two reviewers independently screened records, extracted data, and assessed methodological quality using the Newcastle-Ottawa Scale, resolving disagreements with a third reviewer. Studies were eligible if they reported results related to the implementation and use of injury or trauma registry data for at least one outcome of interest, while those based on other sources were excluded. Synthesis of findings was presented in tables, and the observed results were reported as number or percentage differences. Out of 9100 studies retrieved, 3951 were excluded due to duplication, leaving 5149 for selection, with 15 full texts reviewed. Only 5 studies met the inclusion criteria, highlighting a notable scarcity of research on the effects or results of registry data on injury outcomes. It is important to note that the studies included reflect correlations rather than causalities, and there are currently no publications on impact. The findings suggest that injury and trauma registries have the potential to inform policymaking, which can lead to enhanced health outcomes. One study noted a 3-day reduction in intensive care unit stay (from 16 to 13 days; P<.05) and a 4% reduction in expected hospital mortality (from 17.5% to 21.5%) for patients with an Injury Severity Score ≥16, while another showed a 42% annual decrease in traffic injury hospital admissions (from 45 to 16). Significant methodological heterogeneity and the small number of studies limited the feasibility of a meta-analysis. Establishing an injury registry in Brazil presents a significant opportunity to enhance health outcomes through informed policymaking. While it is crucial to set appropriate expectations regarding its effects on morbidity and mortality, particularly concerning the causality and transportability of the findings to the Brazilian context, its role in facilitating preventive measures and improving surveillance capabilities remains valuable.
18. Identifying Success Factors for Optimizing COVID-19 Vaccine Uptake Among Indigenous Populations in Taiwan: Cross-Sectional Questionnaire Survey.
期刊: JMIR public health and surveillance 发表日期: 2025-Sep-10 链接: PubMed
摘要
The COVID-19 pandemic has devastated economies and strained health care systems worldwide. Vaccination is crucial for outbreak control, but disparities persist between and within countries. In Taiwan, certain indigenous regions show lower vaccination rates, prompting comprehensive inquiries. This study aims to identify predictors for COVID-19 vaccination and develop strategies for indigenous communities. This cross-sectional study, conducted from May 13 to July 18, 2022, surveyed indigenous community members older than 55 years residing in a mountain area in southern Taiwan. Based on the health belief model, the questionnaire covered sociodemographic factors, health-related issues, and trust in physicians. The analysis included bivariate analysis, logistic regression, and mediation analysis. Most participants (N=203) were aged 55-64 years (102/203, 50.2%), female (129/203, 63.5%), married (104/203, 51.2%), with low education (165/203, 81.3%), and engaged in agriculture (79/203, 38.9%) or were unemployed (104/203, 51.2%). Logistic regression revealed that unvaccinated individuals were significantly more likely to perceive lower COVID-19 threats (P=.03), fewer vaccination benefits (P=.04), higher barriers to vaccination (P=.02), and weaker responses to external cues to action (P<.001), while no significant differences were observed in trust in physicians. Mediation analyses further indicated that trust in physicians influenced vaccine uptake indirectly through perceived barriers. The indirect effect was statistically significant (95% bootstrap CI 0.013 to 0.437), suggesting a full mediation effect. Effective pandemic prevention strategies for indigenous communities should be grounded in a nuanced understanding of local needs and incorporate bottom-up approaches to avoid cultural saturation and the exacerbation of existing health disparities. Ensuring the accuracy and clarity of vaccine-related information received by indigenous older adults is essential. Local health authorities should consider deploying health care professionals to engage directly with indigenous older adults and their caregivers, delivering culturally appropriate and evidence-based information to address concerns regarding vaccine safety and perceived risks. Such efforts are critical to strengthening vaccine confidence and increasing vaccination uptake in these communities.
19. Influences on Food Choices of Cambodian Women for Themselves and Their Families.
期刊: Community health equity research & policy 发表日期: 2025-Sep-10 链接: PubMed
摘要
BackgroundThe nutritional status of Cambodian women and children remain poor despite implementation of dietary intake interventions. Cambodia-specific studies have explored how education influences nutrition and health behavior, but not factors influencing Cambodian women’s food decision-making for themselves and their families.ObjectiveTo understand Cambodian women’s food decision-making, particularly related to barriers and enablers of healthy eating for themselves and their families.MethodsQualitative descriptive methodology within an experiential paradigm involving four focus groups in rural and urban locations of Siem Reap province, Cambodia. Participants were Cambodian women aged from 18 years with at least one child under 5 years of age, and primarily responsible for food provision in their family. Data was analyzed using reflexive thematic analysis.ResultsThe three main themes identified were: (1) access impacts food choice; (2) responsible, nurturing food provision role; and (3) dichotomous perceptions of food. Access to food strongly influenced Cambodian women’s food choices, particularly cost and availability. Cambodian women were driven to fulfil their role and nurturing instincts to provide for their family within their capabilities and knowledge. They considered healthy food using a wide range of factors outside of nutrient values, including food texture, immediate body response, cultural food taboos and use of chemicals such as pesticides.ConclusionsTo optimize nutrient intakes, practical, culturally appropriate nutrition interventions that address food access and perceptions of Cambodian mothers regarding their nurturing food provision role are needed.
20. When students share: Faculty experiences with mental health challenges inside and outside the classroom.
期刊: Journal of American college health : J of ACH 发表日期: 2025-Sep-10 链接: PubMed
摘要
Objectives: This study explored the impact of college students’ disclosure of mental health problems on faculty well-being. Participants: Twenty-nine full- and part-time faculty who experienced a student disclosure related to mental health during their career were recruited from a mid-size, private liberal arts university. Methods: Semi-structured, in-depth interviews explored faculty experiences with student mental health disclosures and its impact on faculty well-being. Results: Several themes were identified including the emotional toll experienced by faculty, faculty second guessing their responses to student disclosures, and role conflict among faculty. Conclusions: In recent years, higher education has focused on the mental well-being of students. While many programs exist to assist students directly, as well as to train faculty to aid students, less research and policy has focused on the well-being of faculty members to whom students report mental health challenges. Policy implications surrounding enhanced institutional support for both faculty and students are discussed.
21. Utilizing Gamification, Artificial Intelligence, and mHealth for the Professional Development of Maternal Care Providers: Exploratory Pilot Cross-Sectional Study Assessing Providers' Satisfaction in Primary Health Care Centers in Lebanon.
期刊: JMIR serious games 发表日期: 2025-Sep-10 链接: PubMed
摘要
High maternal morbidity and mortality rates globally, especially in low-income and lower-middle-income countries, highlight the critical role of skilled health care providers (HCPs) in preventing pregnancy-related complications among disadvantaged populations. Lebanon, hosting over 1.5 million refugees, is no exception. HCPs face significant challenges, including resource constraints and limited professional development opportunities, underscoring the need for continuous learning and innovative educational interventions. Artificial intelligence (AI) and gamification show promise in enhancing clinical performance and evidence-based practice. Considering the limited evidence on the effectiveness of integrating gamification and AI in a mobile app for professional development of HCPs providing maternal health services, this pilot study aims to assess the satisfaction and acceptability of HCPs with a novel mLearning tool, titled the “GAIN MHI” app (gamification, artificial intelligence, and mHealth network for maternal health improvement), at selected primary health care centers in Lebanon. This is a cross-sectional study that presents data collected from 12 participating HCPs, primarily obstetricians and midwives who have been using the GAIN MHI mobile app for professional development and learning. The survey used included Likert scale questions to assess HCPs’ satisfaction, engagement, and evaluation of the gamification and AI components of the app. Open-ended questions gathered qualitative feedback on app preferences and potential improvements. Statistical analysis was performed to derive insights from the quantitative data collected. Subsequently, a descriptive analysis was performed, presenting the frequencies and percentages of various participant characteristics, as well as responses to the survey across all sections. A total of 85% (n=10) of the HCPs, including midwives and doctors, were satisfied with the GAIN MHI mobile app, the user interface, and various content features. Engagement levels were robust (64.6%, SD 6.2%), notably impacting clinical routines and theoretical knowledge. The gamification and AI components garnered strong positive feedback, enhancing learning enjoyment (11/12, 92%). From a qualitative perspective, users expressed appreciation for the app’s diverse content, user-friendliness, and motivation for continuous learning. Suggestions for expanding the content included a wide range of health topics, highlighting the app’s potential applicability in various health care fields. HCPs, especially those practicing in underserved areas, face challenges in accessing professional development opportunities, highlighting the need for innovative pedagogical approaches using mobile technologies. This pilot study underlines the potential of using AI-based digital solutions for professional development with the aim of improving the quality of health services-in this case, maternal health services-through continuous learning and updates on the most recent evidence-based clinical guidelines. Future research should investigate the feasibility of applying similar solutions on a larger scale to reach a wider range of HCPs and cover other health topics. The applicability of such solutions in different contexts and low-resource settings should also be explored.
22. Dietary nitrate supplementation suppresses sympathetic neural responses to mechanoreflex activation during static handgrip exercise in postmenopausal women.
期刊: Journal of applied physiology (Bethesda, Md. : 1985) 发表日期: 2025-Sep-10 链接: PubMed
摘要
We investigated the impact of short-term dietary nitrate supplementation on sympathetic neural responses to isometric exercise in postmenopausal women. Ten healthy women aged 64±2 (SD) years participated in this randomized, placebo-controlled, double-blind, crossover study. All participants underwent two-week beetroot juice (BRJ: 800 mg nitrate/day) and placebo (nitrate-depleted BRJ) interventions with ≥14 days of wash-out. Before and after each intervention, participants performed static handgrip (SHG) at 40% of maximum voluntary contraction until fatigue, followed by 2-min post-exercise circulatory occlusion (PECO) with an upper-arm cuff inflated to 250 mmHg to isolate metaboreflex activation. Heart rate (HR; electrocardiogram), blood pressure (BP; finger photoplethysmography), and muscle sympathetic nerve activity (MSNA; microneurography) were continuously measured. BRJ increased the time to fatigue more than placebo (79±67 vs. 9±74 sec, p=0.03), which was correlated with decreases in MSNA burst frequency, total activity, and burst incidence at the first 30-sec of SHG when predominately mechanoreflex activation occurs (r=-0.65, -0.62, and -0.68, respectively, all p<0.05). However, BRJ did not alter MSNA responses to peak SHG and PECO. Subsequently, we added 4 postmenopausal women who finished the BRJ intervention only, and categorized all participants into early (n=6) and normal menopause (n=8). The early, but not normal, menopause group showed decreases in MSNA burst frequency and incidence at the first 30-sec of SHG after the BRJ intervention (both p<0.05). Collectively, nitrate supplementation prolonged the time to fatigue during SHG, and this prolongation was likely associated with attenuated sympathetic neural responses to mechanoreflex activation in postmenopausal women, especially those with early menopause.
23. The "Secret of Seven Stones": Short-Term Efficacy of an Online Intergenerational Sexual Health Education Game for Early Adolescents and Their Parents.
期刊: Games for health journal 发表日期: 2025-Sep-10 链接: PubMed
摘要
Objectives: Intergenerational games offer a potential channel to impact parent-youth sexual health communication. The “Secret of Seven Stones” (SSS) is an 18-level online adventure game and parent website designed to engage parents and youth (11-14 years) in conversations about healthy dating relationships and sexual behavior and to provide sexual health skills training to youth. Study hypotheses were that SSS exposure would increase sexual health parent-child communication, increase youth intentions to delay sexual debut, and reduce youth exposure to situations that promote sexual activity. Materials and Methods: SSS was evaluated in the homes of parent-youth dyads randomly assigned to intervention (n = 40) and comparison (n = 45) conditions. Online surveys were used to collect baseline and three-month follow-up data on dyadic sexual health communication, determinants for communication and youth sexual behavior, and game usability ratings. Results: Dyads comprised parents (n = 83, 47% white, 93% female, 44.4 ± 5.8 years) and youth (n = 83, 42% white, 54% male, 12.9 ± 1.1 years, and 96% sexually inexperienced). Frequency of parent-youth sexual health communication and youth communication self-efficacy increased in those playing SSS compared with those in the comparison group (P < 0.01). Youth perceived parent-youth communication as more open and demonstrated significant improvement in condom and human immunodeficiency virus/sexually transmitted infection knowledge and perceptions of parents’ beliefs about sex (<0.001). Usability ratings were higher on ease, credibility, and helpfulness (all >78%) but lower on duration and appeal (<56%). Conclusion: This study demonstrated the utility of an in-home intergenerational sexual health education game to impact parent-youth communication by short-term follow-up. Further investigation of longer-term behavioral impact is indicated.
24. Pharmacotherapy Management of Acute Migraine in the Emergency Department.
期刊: Advanced emergency nursing journal 发表日期: 2025-Sep-10 链接: PubMed
摘要
Migraine is an often-disabling condition and a common presentation to the Emergency Department (ED). Rapid and effective treatment are essential to reduce symptom burden, prevent recurrence, and improve patient outcomes. This review provides a comprehensive, evidence-based overview of the pharmacologic management of acute migraine in the ED, including first-line therapies, rescue medications, adjunctive care strategies, and considerations for special populations. First-line agents for acute migraine include dopamine antagonists, nonsteroidal anti-inflammatory drugs, and triptans, with treatment tailored to severity, comorbidities, and previous response. Rescue therapies such as dexamethasone, valproic acid, magnesium sulfate, and, in rare cases, dihydroergotamine and caffeine, are indicated for refractory or recurrent symptoms. Supportive interventions such as intravenous fluids and antiemetics can enhance treatment response. Special populations, including pregnant individuals, pediatric, and geriatric patients, as well as those with cardiovascular disease, require individualized management. It is critical for ED personnel to provide not only optimal pharmacotherapy but also safe medication administration, astute monitoring for adverse effects, and the provision of discharge education to prevent migraine recurrence and ensure outpatient follow-up.
25. Rapid Removal of Azo Cationic Dyes Using a Cu(II) Hydrogen-Π-Bonded Organic Framework and Its Derived Oxide: A Combined Adsorption and Photocatalysis Study.
期刊: Langmuir : the ACS journal of surfaces and colloids 发表日期: 2025-Sep-10 链接: PubMed
摘要
Azo dyes, prevalent in various industries, including textile dyeing, food, and cosmetics, pose significant environmental and health risks due to their chemical stability and toxicity. This study introduces the synthesis and application of a copper hydrogen-π-bonded benzoate framework (Cu-HBF) and its derived marigold flower-like copper oxide (MFL-CuO) in a synergetic adsorption-photocatalytic process for efficiently removing cationic azo dyes from water, specifically crystal violet (CV), methylene blue (MB), and rhodamine B (RhB). The Cu-HBF, previously available only in single crystal form, is prepared here as a crystalline powder for the first time, using a low-cost and facile procedure, allowing its application as an adsorbent and also serving as a precursor for synthesizing well-structured copper oxide (MFL-CuO). Characterization techniques, including XRD, SEM-EDX, FTIR, XPS techniques, point of zero charge (pHPZC), N2 adsorption-desorption, and UV-vis analysis, elucidated the structural and morphological properties of both materials. The synergy between adsorption and photocatalysis highlights the potential of both Cu-HBF and MFL-CuO. This combined process achieved impressive final removal rates under optimal conditions, nearly 100% removal of CV and MB in ∼5 min, and ∼85% removal of RhB in ∼8 min of total contact time. Computational density functional theory calculations revealed the implications of hydrogen interactions, π-π interactions, and electrostatic forces in the adsorption mechanisms along with the corresponding reactive sites. Photoelectrochemical measurements including cyclic voltammetry, electrochemical impedance spectroscopy (EIS), and Mott-Schottky analysis elucidate the photocatalytic mechanism, demonstrating that the rapid photodegradation of the three dyes is primarily related to the MFL-CuO’s ability to in situ generate H2O2, initiating a Fenton-like reaction (advanced oxidation process). This work contributes to the development of efficient materials for dye removal, addressing the pressing need for innovative solutions for wastewater treatment.
26. Cycling-Based Telerehabilitation: Acceptability and Feasibility Study.
期刊: JMIR human factors 发表日期: 2025-Sep-10 链接: PubMed
摘要
Telerehabilitation is a promising solution to provide continuity of care. Most existing telerehabilitation platforms focus on rehabilitating upper limbs, balance, and cognitive training, but exercises improving cardiovascular fitness are often neglected. The objective of this study is to evaluate the acceptability and feasibility of a telerehabilitation intervention combining cognitive and aerobic exercises. A virtual reality-based dual-task exercise exploiting a cycle ergometer was designed, developed, and integrated with a commercially available telerehabilitation platform. Patients with different conditions were enrolled and administered subjective questionnaires investigating attitudes toward technology, usability, technology acceptance, and subjective workload. Their therapists were interviewed, and adherence and performance data were analyzed. In total, 26 patients with neurological or post-COVID symptoms were included. Their attitude toward technology (range: 0-5) did not change after the training period (pre: 3.44 [IQR 0.63]; post: 3.50 [IQR 0.48]); the platform was rated usable and acceptable. Frustration and physical and mental workload were present, especially among younger participants. The adherence was moderate, but individual differences were present (0.59 [IQR 0.54]). The therapists highlighted the potential of remote rehabilitation programs but also identified some limitations. This study proved the feasibility and acceptability of a customized virtual reality-based telerehabilitation program allowing for the safe implementation of aerobic cycling-based dual-task training. The solution was judged meaningful for dehospitalized patients, although some environmental and technical barriers should be overcome to implement telerehabilitation more effectively.
27. Minor Physical Anomalies as a Gateway to Understanding the Neurodevelopmental Roots of Gender Dysphoria.
期刊: Journal of sex & marital therapy 发表日期: 2025-Sep-10 链接: PubMed
摘要
The etiology of gender dysphoria (GD) involves both biological and psychosocial factors and may have a neurodevelopmental aspect. We aimed to compare individuals with GD with each other and with cisgender individuals based on minor physical anomalies (MPAs). The case group comprised 108 individuals with GD (60 GD assigned female at birth [AFAB]; 48 GD assigned male at birth [AMAB]), most with same-biological-sex attraction. The control group consisted of 117 cisgender individuals with opposite-biological-sex attraction. Participants completed a sociodemographic-clinical-data form. Waldrop MPA Scale was used to assess MPAs. The total, craniofacial, and peripheral MPA scores of the AFAB-GD group were significantly higher than those of the cisgender controls. In the AMAB-GD group, the total and craniofacial MPA scores were significantly higher than those of the cisgender controls. Peripheral MPA scores were similar between AMAB and AFAB-GD groups, and both were higher than cisgender controls. Our findings reveal elevated MPA scores in individuals with GD, enhancing our understanding of the biological mechanisms, including early genetic and environmental factors, that may contribute to GD, at least in one group of individuals, although these findings may not be entirely attributable to gender identity and the potential influence of sexual orientation should be considered.
28. Differential Effects of Wildfire Smoke Pm2.5 Exposure on Respiratory Disease Emergency Department Visits in the Western United States.
期刊: American journal of respiratory and critical care medicine 发表日期: 2025-Sep-10 链接: PubMed
摘要
Wildfires significantly affect air quality in the Western United States. Although prior research has linked wildfire smoke PM2.5 to respiratory health outcomes, these studies typically have limited geographic and temporal coverage, lacking evidence from multiple states over extended periods. We obtained data on over 6 million emergency department (ED) visits for respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), upper respiratory infections (URI), and bronchitis, from five states in the Western US during 2007-2018. Daily exposure to wildfire smoke and non-smoke PM2.5 was estimated using a state-of-the-art model system. A time-stratified case-crossover design with conditional logistic regression models was used to assess the acute respiratory effects of smoke and non-smoke PM2.5 exposure. The odds ratios associated with a 1 µg/m3 increase in the 3-day average wildfire smoke PM2.5 were 1.016 (1.015-1.016) for asthma, 1.004 (1.003-1.005) for COPD, 1.001 (1.000-1.011) for upper respiratory infections (URI), and 1.004 (1.004-1.004) for bronchitis. Wildfire smoke PM2.5 had stronger estimated effects than non-smoke PM2.5, particularly for asthma (non-smoke PM2.5: OR 1.002, 1.001-1.004). Stratified analyses showed greater vulnerability among women and adults. Sensitivity analyses confirmed robust associations across exposure windows, while concentration-response functions suggested no clear threshold for adverse effects. Wildfire smoke PM2.5 was associated with elevated risks of acute respiratory outcomes. Stronger effects were observed from smoke PM2.5 than non-smoke PM2.5, particularly for asthma and upper respiratory infections. These findings underscore the need for targeted public health interventions and further research into the unique toxicological properties of wildfire emissions.
29. Developing an Interprofessional Pediatric Rehabilitation Model of Care in Northern Cree First Nation Communities: Protocol for a Needs Assessment and Codeveloped Intervention With a Qualitative and Participatory Action Approach.
期刊: JMIR research protocols 发表日期: 2025-Sep-10 链接: PubMed
摘要
In Canada, the Indigenous population is the youngest and fastest growing, yet ongoing health disparities for Indigenous peoples are widely recognized. There is a concerning lack of research on childhood disabilities and health conditions in Indigenous populations in Canada. For children with disabilities and chronic health conditions, ongoing access to rehabilitation services, such as occupational therapy, physical therapy, speech-language pathology, and audiology, is critical in promoting positive health and developmental outcomes. Elders and the Peter Ballantyne Cree Nation health services board have guided a critical priority for addressing access challenges to pediatric rehabilitation in 3 specific northern Indigenous communities. The purpose of this manuscript is to outline the protocol for a community-directed needs assessment and subsequent development of a multidisciplinary pediatric rehabilitation service in 3 specific northern Indigenous communities. The study involves 3 phases. In phase 1, the needs assessment process was led by 2 physiotherapy clinician researchers and 2 graduate students working with health care professionals in pediatric speech-language pathology, audiology, physiotherapy, and occupational therapy with experience in both private and public health entities. The process consisted of multiple parts, which included a community-led request, a preliminary literature review, survey development, interview guide development, communication and feedback with health care professionals, a test phase with pediatric family members, and finalization of the survey and interview guides for deployment. In phase 2, the findings from phase 1 will inform the codevelopment of a pilot hybrid-care, interprofessional pediatric rehabilitation clinic for each of the communities. In phase 3, a stakeholder meeting will take place to facilitate knowledge sharing and open discussion regarding the implementation of phase 2 as well as considerations for the sustainability of this model of care. The final survey was multidisciplinary, with 6 content areas covered in 15 items. Guides for 1-on-1 interviews and sharing circles included 10 questions for community members and 12 questions for health care providers. Participant recruitment began in April 2024. Final results are anticipated in early 2026. This manuscript details the process of a community-directed needs assessment, which will inform the development and implementation of a model of care for pediatric rehabilitation services. Our process was driven by a request from the community for a needs assessment and emphasized the involvement of key stakeholders early and often during assessment development. A clear purpose of the project was identified with community direction. We used multidisciplinary inputs from both public and private sectors and maintained clear goals during our survey question design process. This study aims to inform the codevelopment and implementation of an interdisciplinary, hybrid model of pediatric rehabilitation care for remote First Nation communities, ultimately leading to improved access to patient- and family-centered care for pediatric rehabilitation. DERR1-10.2196/69438.
30. Quantifying Spatial Shadow Zones and Their Association With Hospital Falls in Acute Care Unit: Real-Time Location System Observational Study.
期刊: JMIR formative research 发表日期: 2025-Sep-10 链接: PubMed
摘要
Hospital falls represent a persistent and significant threat to safety within health care systems worldwide, impacting both patient well-being and the occupational health of health care staff. While patient falls are a primary concern, addressing fall risks for all individuals within the health care environment remains a key objective. Caregiver visibility and spatial monitoring are recognized as crucial considerations in mitigating fall-related incidents. This study aimed to investigate the association between the percentage of spatial shadow zone, defined as areas within an acute care unit unvisited by mobile workstations for prolonged periods, and the incidence of hospital falls and intensive care unit (ICU) transfers. This retrospective observational study was conducted in a 400-square-meter acute care unit of a tertiary hospital for over 210 days. An ultrawideband real-time location system was deployed to continuously track mobile workstations’ spatial coverage. Spatial shadow zones were defined as areas unvisited by mobile workstations for 60 continuous minutes. The primary outcome was hospital falls; the secondary outcome was ICU transfers. Multivariable logistic regression analysis, adjusted for patient-to-nurse ratio and day of week, was used to examine the association between the percentage of spatial shadow zone and these outcomes. Sensitivity analyses were performed by varying the spatial dilation distance (1-4 meters) and temporal shadow zone thresholds (15-90 minutes). During this study’s period, 8 hospital falls and 89 ICU transfers occurred. Real-time location system validation indicated a mean positional error of 0.346 (SD 0.282) meters. In multivariable regression, a higher percentage of spatial shadow zone was significantly associated with an increased odds of hospital falls (odds ratio 1.02, 95% CI 1.01 to 1.03, P<.001). Conversely, a higher percentage of spatial shadow zone was associated with decreased odds of ICU transfer (odds ratio 0.99, 95% CI 0.99 to 0.99, P<.001). Sensitivity analyses demonstrated consistency of the association between spatial shadow zones and falls across varying parameter settings. This study provides novel evidence for a significant positive association between the percentage of spatial shadow zones and hospital falls, underscoring the critical role of caregiver visibility in fall prevention. The findings suggest that proactively minimizing spatial shadow zones through optimized hospital design, workflow strategies, and technology-enabled monitoring may be a valuable approach to enhance patient safety and reduce hospital falls in acute care settings.
31. Melioristic Gerontology: Using Pragmatism to Reframe the Study of Aging.
期刊: The Gerontologist 发表日期: 2025-Sep-10 链接: PubMed
摘要
Aging populations in places around the globe face looming challenges from large-scale mega-trends. Gerontology needs to develop approaches for helping older people and their communities respond and share knowledge from those approaches. Based in the philosophy of pragmatism, we make a case for a ‘melioristic gerontology’ to focus gerontologists on those needs. After an introduction to pragmatism and its deep-rooted meliorism, we suggest several mega-trends-climate change, technological, and political economic-at the heart of our rationale for a melioristic gerontology. We then consider John Dewey’s theory of social inquiry and Jane Addams’ model of pragmatist praxis in communities. Both have inspired recent work to address community issues and citizens’ engagement in those pragmatist-informed processes. We distill these contributions into essential traits of melioristic gerontology and identify key roles for melioristic gerontologists. Melioristic gerontology suggests how we can fulfill our responsibility for securing a better place in a world full of uncertainty by empowering older people and their communities to blunt the harmful effects of mega-trends now and in the future.
32. Mechanistic roles of long non-coding RNAs in DNA damage response and genome stability.
期刊: Mutation research. Reviews in mutation research 发表日期: 2025-Sep-09 链接: PubMed
摘要
To maintain genomic stability, cells have evolved complex mechanisms collectively known as the DNA damage response (DDR), which includes DNA repair, cell cycle checkpoints, apoptosis, and gene expression regulation. Recent studies have revealed that long non-coding RNAs (lncRNAs) are pivotal regulators of the DDR. Beyond their established roles in recruiting repair proteins and modulating gene expression, emerging evidence highlights two particularly intriguing functions. First, some lncRNAs contain small open reading frames (sORFs) encoding functional micropeptides that actively participate in DDR pathways. Second, lncRNAs regulate R-loop homeostasis, a key mechanism for preserving genome integrity. Together, these findings expand our understanding of lncRNAs in the DDR, positioning them as both key mechanistic players and promising therapeutic targets.
33. Authors reply: "Risk factors associated with acute kidney injury in patients with traumatic brain injury: A systematic review and meta-analysis".
期刊: Journal of critical care 发表日期: 2025-Sep-09 链接: PubMed
摘要
34. Authors reply: "Risk factors associated with acute kidney injury in patients with traumatic brain injury: A systematic review and meta-analysis".
期刊: Journal of critical care 发表日期: 2025-Sep-09 链接: PubMed
摘要
35. Analyzing the toxicological effects of PET-MPs on male infertility: Insights from network toxicology, mendelian randomization, and transcriptomics.
期刊: Reproductive biology 发表日期: 2025-Sep-09 链接: PubMed
摘要
Current research indicates that polyethylene terephthalate microplastics (PET-MPs) may significantly impair male reproductive function. This study aimed to investigate the potential molecular mechanisms underlying this impairment. Potential gene targets of PET-MPs were predicted via the SwissTargetPrediction database. GWAS summary statistics for male infertility were obtained from the GWAS Catalog, and eQTL data were acquired from the eQTLGen database. SMR analysis was subsequently performed to identify genes exhibiting significant causal associations with male infertility. The potential targets of PET-MPs contributing to male infertility were ultimately identified by intersecting the two gene sets. Additionally, bulk RNA-seq and scRNA-seq analyses were employed to elucidate the potential molecular mechanisms underlying PET-MPs-induced male infertility. Our findings suggest that CLK4 may serve as a functional target through which PET-MPs contribute to male infertility, with elevated CLK4 expression representing a significant risk factor. Molecular docking and molecular dynamics simulations demonstrated that PET-MPs can form stable binding conformations with the CLK4 protein. We further identified terminally differentiated CD4+ T cells as a prominent risk factor for male infertility, revealing a significant positive correlation between CLK4 expression levels and Th1 cell infiltration. Additionally, CLK4 exhibited a biphasic expression pattern during spermatocyte-to-sperm differentiation, initially increasing before subsequent downregulation. These observations indicate that PET-MPs may participate in the pathogenesis of male infertility by targeting CLK4 to modulate Th1 cell infiltration and disrupt normal spermatogenic processes. In conclusion, our study demonstrates that CLK4 may serve as a potential target for PET-MP-induced male infertility, and we further elucidate the underlying molecular mechanisms.
36. Is Training Alone Enough? A Comparison of Serious Illness Communication Training With and Without Implementation Strategies.
期刊: Journal of palliative medicine 发表日期: 2025-Sep-09 链接: PubMed
摘要
Background: Communication skills training alone has shown limited impact on improving the frequency and quality of serious illness conversations (SICs). Implementing structured support strategies may enhance both adoption and sustained use in clinical practice. Design: Retrospective review of the impact of Serious Illness Care Program (SICP) training and implementation in outpatient and inpatient settings at a single academic center. Setting: Stanford Health Care is a health system affiliated with the Stanford School of Medicine, with 2 hospital campuses and 60 ambulatory practices throughout the San Francisco Bay Area. Participants: Physicians, physicians-in-training, advanced practice providers, and allied health professionals (occupational therapists, dieticians, social workers, and case managers) across departments. Intervention: From October 2020 to May 2023, our institution implemented the SICP, offering two communication skills training modalities: (1) Training Only and (2) Training with Implementation support, which included patient identification, data feedback, coaching, and department-specific quality improvement incentives. Analysis: We compared the adoption of SICs by examining the documentation frequencies of trained clinicians. Clinicians were categorized as never user (0 conversations), seldom users (1-4 conversations), occasional users (5-11 conversations), and frequent users (12 or more conversations) according to the number of documented SICs within one year after training. We also assessed the number of sustained users, defined as clinicians who documented SICs at least once a month over a six-month period following training. Results: Within the first 12 months of training, the Training Only group had a significantly higher percentage of never users compared with the Training with Implementation cohort (78.9% vs. 57.6%, p < 0.01). The Training with Implementation group had higher SICs documented across all other usage categories: seldom users (23.5% vs. 14.6%, p < 0.01), occasional users (10.2% vs. 4.2%, p < 0.01), and frequent users (8.5% vs. 2.2%, p < 0.01). Compared with the Training Only group, the Training with Implementation group also had more sustained users (9.4% vs. 1.6%, p < 0.01) who consistently documented SIC monthly for six months. Conclusion: Implementation support strategies enhance both the initial adoption and sustained use of SICs beyond training alone.
37. Associations between element mixtures and biomarkers of pathophysiologic pathways related to autism spectrum disorder.
期刊: Journal of trace elements in medicine and biology : organ of the Society for Minerals and Trace Elements (GMS) 发表日期: 2025-Sep-05 链接: PubMed
摘要
We previously documented that exposure to a spectrum of elements is associated with autism spectrum disorder (ASD). However, there is a lack of mechanistic understanding as to how elemental mixtures contribute to the ASD development. Serum and urinary concentrations of 26 elements and six biomarkers of ASD-relevant pathophysiologic pathways including serum HIPK 2, serum p53 protein, urine malondialdehyde (MDA), urine 8-OHdG, serum melatonin, and urine carnitine, were measured in 21 ASD cases and 21 age-matched healthy controls of children aged 6-12 years. The Mann-Whitney U test was used to compare the differences in serum elemental levels between ASD and control groups. A principal component analysis (PCA) was used to reduce the dimensionality of multiple elements into uncorrelated predictors that may capture shared patterns. Associations of PC scores with ASD risk or pathway-specific biomarkers were examined using logistic or linear regressions, respectively. Robust linear regressions were conducted to explore the association between serum and urinary elements. We observed significantly higher serum levels of chromium, titanium, lithium, vanadium, calcium, cobalt, magnesium, and arsenic, but lower levels of cadmium and palladium in ASD children. We identified four PCs. PC1 reflects a mixture of 14 elements that were significantly elevated in ASD. PC2 reflects a mixture of elements that were significantly affected by urinary excretion. PC3 reflects a mixture of 5 elements within the 14 elements in PC1. PC4 reflects barium and palladium, both lower in ASD children. PC1 and PC2 were differentially associated with pathway-specific biomarkers. Each interquartile range (IQR) increase in PC1 was associated with increases in HIPK2 (12.96 %, 95 % CI: 3.98 %, 21.94 %) and p53 (8.34 %, 95 % CI: 0.30 %, 16.38 %), and a decrease in urinary carnitine (-24.85 %, 95 % CI: -46.36 %, -3.34 %). An IQR increase in PC2 was associated with increased urinary carnitine by 19.27 % (95 % CI: 3.08 %, 35.47 %). PC4 was not associated with any biomarkers. No PCs were associated with oxidative stress biomarkers of 8-OHdG or MDA. Additionally, increased excretion of essential elements (e.g. phosphorus, calcium, zinc) and the accumulation of metals with higher molecular weight (lead, tin, molybdenum, palladium, and bismuth) were observed in ASD group. Increased levels of element mixtures of chromium, calcium, magnesium, arsenic, and antimony were associated with pro-apoptotic increases in HIPK2 and p53, whereas increased levels of cobalt, lead, and cadmium were associated with carnitine excretion. Increased urinary excretion of essential elements may contribute to ASD risk through modulating blood elemental levels. The role of oxidative stress was not observed.
38. Evaluation of nutritional status and swallowing functions of children with neuromuscular disordes.
期刊: Neuro endocrinology letters 发表日期: 2025-Sep-02 链接: PubMed
摘要
It is important to raise awareness of the nutritional problems that can be overlooked during the follow-up visits with children who suffer from neuromuscular diseases, as these dietary differences may lead to additional neurological and systemic problems and impair the quality of life of the patient. The aim of this study was to evaluate the nutritional status of children with neuromuscular disorders and to prevent possible complications by recognizing possible nutritional problems in advance. Patients who applied to the outpatient clinic at Cukurova University, Faculty of Medicine, Department of Pediatric Neurology beginning in April 2022 with a neuromuscular disorder diagnosis were followed up with and were included in the study. Age, gender, weight, height, body mass index (BMI), ambulation status, presence of constipation, and nutritional status of each patient at their last examination were evaluated and recorded in the standard data collection form. The Eating Assessment Tool (EAT-10) scale, which is an objective test, was used to evaluate nutritional problems. A total of 50 patients were included in the study. Of the patients followed, 27 (54%) had Duchenne muscular dystrophy (DMD), 10 (20%) had congenital muscular dystrophy (CMD), and 13 (26%) had limb girdle muscular dystrophy (LGMD). The mean age of the patients was 11 years 5 months. Eight of the patients (16%) were female and 42 (84%) were male. While all of the patients could take food orally 17 patients (34%) had constipation. Of the patients, 16 (32%) were able to walk without support, 12 (24%) were able to walk with support, and 22 (44%) were non-ambulatory. While 19 of the patients’ (38%) mealtime duration was <15 minutes, 22 (44%) ate for 15-30 minutes, and 9 (18%) ate for >30 minutes. There were 8 patients (16%) whose daily feeding time exceeded 3 hours. Of these patients, 3 were in the DMD group, 4 were in the CMD group, and only one was in the LGMD group. The mean EAT-10 score of the patients was 4.46, although it varied according to the disease subgroups. Regular monitoring of the nutritional status of children with neuromuscular disorders using objective and practical methods, along with timely and appropriate interventions when necessary, can significantly improve the quality of life and living standards of these patients.
39. Germline Findings From Tumor-Only Comprehensive Genomic Profiling in the RATIONAL Study: A Missed Opportunity?
期刊: JCO precision oncology 发表日期: 2025-Sep 链接: PubMed
摘要
Tumor comprehensive genomic profiling (CGP) may detect potential germline pathogenic/likely pathogenic (P/LP) alterations as secondary findings. We analyzed the frequency of potentially germline variants and large rearrangements (LRs) in the RATIONAL study, an Italian multicenter, observational clinical trial that collects next-generation sequencing-based tumor profiling data, and evaluated how these findings were managed by the enrolling centers. Patients prospectively enrolled in the pathway-B of the RATIONAL study and undergoing CGP with the FoundationOne CDx assays were included in the analysis. Potentially germline variants detected in 40 cancer susceptibility genes (CSGs) were classified in three classes with different actionability, most (MA), high (HA), and standard (SA), on the basis of penetrance, mutational spectrum, and intervention for prevention/early detection. On the basis of the European Society of Medical Oncology recommendations, we identified 225 potentially germline P/LP variants in 193/1,339 (14.4%) enrolled patients. In particular, 62/225 (27.5%) variants were detected in genes classified as MA-CSG class, 53/225 (23.6%) in genes belonging to the HA-CSG class, and 110/225 (48.9%) in the SA-CSG class. In addition, we detected 58 LRs in the 16/40 CSGs in 53/1,339 (3.95%) patients. Information about germline-focused analysis and follow-up was available for 99 patients with potentially germline variants. Surprisingly, 95/99 (96%) patients were not referred to oncogenetic consultation and follow-up, including 30/32 (93.75%) patients with variants in the MA-CSG class. Our data confirm the utility of CGP for the identification of potentially germline variants in CSGs, highlighting the importance of reporting LRs in addition to single-nucleotide variants and insertions/deletions. However, our findings also demonstrate a relative lack of knowledge of the implications of germline findings detected on tumor-only sequencing among oncologists and underline the need for specific training in this area.
40. Understanding the epidemiology of gastric cancer: a review and case-only analysis from Italy.
期刊: European journal of gastroenterology & hepatology 发表日期: 2025-Aug-29 链接: PubMed
摘要
Gastric cancer epidemiology evolved rapidly in the last century, shifting from being one of the main causes of cancer-related death to the sixth in high-income countries. We conducted a narrative review on gastric cancer epidemiology. Our review focused on trends of gastric cancer and its relationship with Helicobacter pylori infection; cardia and noncardia gastric cancer risk factors; early onset gastric cancer; second primary cancers in patients with gastric cancer; and implementation of gastric cancer prevention strategies. In addition, we provided results of a case-only analysis of recently diagnosed gastric cancer from a middle-risk population. Literature consistently describes the ongoing declining trend of gastric cancer rates and the overall increase in in absolute number of incident cases because of a change in population. The evolving distribution of risk factor prevalence impacts the epidemiology of gastric cancer, with an increase in early onset and in cardia gastric cancer. A negative correlation was observed between H. pylori prevalence and the proportion of cardia gastric cancer. The analysis of 117 gastric cancer cases observed between 2016 and 2020 in Bologna, Italy, showed that smoking and epigastric pain were significantly associated with increased risk of early-onset gastric cancer after accounting for confounders. Multifaceted strategies are needed to address challenges in gastric cancer control, early diagnosis, and clinical management in a changing epidemiological landscape. Prevention remains the cornerstone to reduce the gastric cancer burden.
41. The effects of missing data due to study dropout on longitudinal analysis inference using outcome-dependent sampling.
期刊: International journal of epidemiology 发表日期: 2025-Aug-18 链接: PubMed
摘要
Existing longitudinal cohort study data and associated biospecimen libraries provide abundant opportunities to efficiently examine new hypotheses through retrospective specimen testing. Outcome-dependent sampling (ODS) methods offer a powerful alternative to random sampling when testing all available specimens is not feasible or biospecimen preservation is desired. For repeated binary outcomes, a common ODS approach is to extend the case-control framework to the longitudinal setting.For ODS designs, we consider the impact of incomplete follow-up when missingness is completely at random (MCAR), missing at random (MAR), and missing not at random (MNAR). We further consider sampling from (i) complete cases, in which, in an attempt to maximize power, participants who dropped out before study completion were excluded; and (ii) all individuals, including those with incomplete follow-up. Simulation studies based on the Advancing Clinical Therapeutics Globally HIV Infection, Aging, and Immune Function Long-Term Observational Study cohort were used to examine the impact of MCAR, MAR, and MNAR missingness, assuming specimens were sampled from either (i) complete cases; or (ii) all individuals. Three ODS analytical methods were considered. When longitudinal data are MNAR, ODS methods exhibit bias similar to that seen in random sampling. MNAR and MAR bias is exacerbated when sampling only participants with complete follow-up. Simulations indicate that ODS analyses that include participants with incomplete follow-up are robust to MCAR and less biased by MAR missingness. Dropout is common in longitudinal cohort studies. Investigators utilizing ODS methods must consider the effect of dropout in both the retrospective sampling design and analysis.
42. Physical activity and salutogenesis: a necessary dialogue.
期刊: Ciencia & saude coletiva 发表日期: 2025-Aug 链接: PubMed
摘要
This essay aims to broaden the dialogue between physical activity (PA) and health by a salutogenesis-oriented concept, which emphasizes the origins of health, as opposed to the pathogenic model, which focuses on the origin of diseases. It presents the foundations of the theory, created by Aaron Antonovsky, whose health promotion model is centered on the sense of coherence (SOC), which consists of significance, comprehensibility, and manageability. Then, it explores the relationships between PA and salutogenesis, demonstrating how this framework can be applied in various life stages and practice settings. Studies indicate that people with a strengthened SOC will likely remain physically active. However, this relationship is not instrumental and depends on contextual, cognitive, and affective factors. This essay concludes by advocating for further research in Brazil and highlighting salutogenesis as a promising perspective to guide a new understanding of PA and health. Este ensaio busca ampliar o diálogo entre atividade física (AF) e saúde a partir de um conceito orientado na salutogênese (origens das saúdes) que tensiona o modelo patogênico (origem das doenças). Apresentam-se os principais fundamentos da teoria, criada por Aaron Antonovsky, cujo modelo de promoção da saúde centra-se no pilar do senso de coerência (SCo), que é constituído pela significância, compreensibilidade e capacidade de gerenciamento. Depois são apresentadas as relações entre AF e salutogênese que podem ser utilizadas nos vários ciclos da vida e nos contextos de prática. São apresentados estudos que identificam que pessoas com um SCo fortalecido apresentam maiores possibilidades de se manterem fisicamente ativas, mas essa relação não é instrumental e depende de elementos contextuais, cognitivos e afetivos. Finaliza-se indicando que novos estudos sejam feitos no Brasil e que a salutogênese se mostra como uma perspectiva profícua para orientar uma nova concepção de AF e saúde. Este ensayo busca ampliar el diálogo entre la actividad física (AF) y la salud a partir de un concepto orientado a la salutogénesis (origen de la salud) que tensiona el modelo patogénico (origen de las enfermedades). Se presentan los fundamentos principales de la teoría, creada por Aaron Antonovsky, cuyo modelo de promoción de la salud se centra en el pilar del sentido de coherencia (SCo), que se constituye por la significación, la comprensibilidad y la capacidad de gestión. Presentamos las relaciones entre la AF y la salutogénesis que pueden utilizarse en los distintos ciclos de la vida y contextos de práctica. Se presentan estudios que identifican que las personas con un SCo fortalecido tienen mayores posibilidades de mantenerse físicamente activas, pero que esta relación no es instrumental y depende de elementos contextuales, cognitivos y afectivos. Se concluye indicando que se realicen nuevos estudios en Brasil y que la salutogénesis se muestra como una perspectiva fructífera para orientar una nueva concepción de la AF y salud.
43. Building MHealth technology for Health Promotion in Reproductive Planning: innovations in primary care.
期刊: Ciencia & saude coletiva 发表日期: 2025-Aug 链接: PubMed
摘要
Reproductive Planning is a recognized basic human right and is essential to guaranteeing the quality of health providers’ work processes in Primary Health Care (PHC). This study aimed to build a prototype of a mobile application on reproductive planning to aid the ongoing education of nurses in PHC. This methodological study is based on four stages: modeling, navigation design, abstract interface design, and implementation, and was built based on the thematic categorization of article contents stemming from an integrative review, totaling 24 moblets. The initial screen is presented to access educational technology, including the key that enters the application, the contents, the other interfaces, and the presentation of the theme involved. Relevant content was emphasized for a person-centered approach, with quick and easy access to content available in just one click, involving key aspects: promoting welcoming, qualified listening, creating bonds and trust, and contraceptive counseling. Its applicability with simple language, easy access, and usability, together with a clear content based on up-to-date evidence, will offer greater quality and efficiency of care. O Planejamento Reprodutivo é um direito humano básico reconhecido, sendo fundamental a garantia da qualidade do processo de trabalho dos provedores de saúde na Atenção Primária. Objetivou-se construir um protótipo de aplicativo móvel sobre planejamento reprodutivo para auxílio à educação permanente de enfermeiros na Atenção Primária em Saúde. Estudo metodológico embasado pelas quatro etapas: modelagem, projeto de navegação, design abstrato da interface e implementação. Nesta perspectiva, foi construído com base na categorização temática de conteúdo dos artigos oriundos da revisão integrativa, totalizando 24 moblets. Para acesso à tecnologia educacional apresenta-se a tela inicial, contemplando a tecla que dá entrada ao aplicativo, aos conteúdos, as demais interfaces e apresentação da temática envolvida. Enfatizaram-se conteúdos relevantes para uma abordagem centrada na pessoa, com acesso rápido e fácil aos conteúdos dispostos em apenas um click, envolvendo aspectos fundamentais: promoção do acolhimento, escuta qualificada, criação de vínculo e confiança e aconselhamento contraceptivo. A sua aplicabilidade com linguagem simples, de fácil acesso e usabilidade, com conteúdo claro e embasado em evidências atualizadas ofertará maior qualidade e eficiência do cuidado. La Planificación Reproductiva es un derecho humano básico reconocido y es esencial para garantizar la calidad del proceso de trabajo de los prestadores de salud en Atención Primaria. Este estudio tuvo como objetivo construir un prototipo de una aplicación móvil sobre planificación reproductiva para ayudar en la educación continua de enfermeras en Atención Primaria de Salud. Este estudio metodológico se basó en cuatro etapas: modelado, diseño de navegación, diseño de interfaz abstracta e implementación. Desde esta perspectiva, se construyó a partir de la categorización temática del contenido de los artículos oriundos de la revisión integradora, totalizando 24 moblets. Para acceder a la tecnología educativa se muestra la pantalla de inicio, incluyendo la tecla que accede a la aplicación, los contenidos, las demás interfaces y una presentación del tema involucrado. Se puso énfasis en contenidos relevantes para un abordaje centrado en la persona, con acceso rápido y sencillo a contenidos disponibles en un solo clic, involucrando aspectos fundamentales: promoción de la recepción, escucha calificada, creación de vínculos y confianza y consejería anticonceptiva. Su aplicabilidad con un lenguaje sencillo, de fácil acceso y usabilidad, con contenidos claros y basada en evidencia actualizada ofrecerá una mayor calidad y eficiencia de la atención.
44. [Between gender and health technologies: an analysis of HPV and cervical cancer prevention campaigns from 2014 to 2020].
期刊: Ciencia & saude coletiva 发表日期: 2025-Aug 链接: PubMed
摘要
In this article an analysis of the preventive campaigns against cervical cancer (CC) and human papillomavirus (HPV) vaccination developed by the National Cancer Institute (INCA) of the Ministry of Health was conducted, in addition to some campaigns produced by non-governmental organizations and private institutions, from 2014 to 2020. From a socio-anthropological point of view, the objective was to understand how these health technologies trigger and produce gender representations. Seven categories of analysis were developed (“Generationality of care”, “Schooling”, “Childhood and Youth”, “Gamification”, “Health risk”, “Men’s health” and “Neutrality”) that permitted discussion of the themes that emerged in graphic pieces. Through the medicalization and monitoring of women’s sexual and reproductive health, the campaigns highlight what is known here as the politicization of the uterus that maintains excessive scrutiny of the female body. Neste artigo analisamos as campanhas preventivas do câncer no colo do útero (CCU) e de vacinação de papilomavírus humano (HPV) desenvolvidas pelo Instituto Nacional de Câncer (INCA) do Ministério da Saúde, além de algumas campanhas produzidas por organizações não governamentais e instituições privadas, no intervalo de 2014 a 2020. À luz de um olhar socioantropológico, nosso objetivo é compreender como estas tecnologias de saúde acionam e produzem representações de gênero. Desenvolvemos sete categorias de análise (“Geracionalidade do cuidado”, “Escolarização”, “Infância e Juventude”, “Gamificação”, “Risco à saúde”, “Saúde do Homem” e “Neutralidade”) que nos permitiram discutir as temáticas que surgiram nas peças gráficas. Por meio da medicalização e monitoramento da saúde sexual e reprodutiva das mulheres, as campanhas evidenciam o que chamamos aqui de uma politização do útero, que mantém excessivo escrutínio do corpo feminino. En este artículo analizamos las campañas preventivas de vacunación contra el cáncer de cuello uterino (UCC) y el virus del papiloma humano (VPH) desarrolladas por el Instituto Nacional del Cáncer (INCA) del Ministerio de Salud, además de algunas campañas producidas por organizaciones e instituciones no gubernamentales privado, de 2014 a 2020. Desde un punto de vista socio-antropológico, nuestro objetivo es comprender cómo estas tecnologías de la salud desencadenan y producen representaciones de género. Desarrollamos siete categorías de análisis (“Generacionalidad del cuidado”, “Escolarización”, “Infancia y Juventud”, “Gamificación”, “Riesgo a la salud”, “Salud de los hombres” y “Neutralidad”) que permitieron discutir los temas que surgieron en piezas gráficas. A través de la medicalización y vigilancia de la salud sexual y reproductiva de las mujeres, las campañas resaltan lo que aquí llamamos una politización del útero, que mantiene un escrutinio excesivo del cuerpo femenino.
45. [Biomonitoring of military firefighters working in Brumadinho/MG, Brazil, after the breakdown of the tailing dam].
期刊: Ciencia & saude coletiva 发表日期: 2025-Aug 链接: PubMed
摘要
In January 2019, the state of Minas Gerais was struck by an environmental tragedy resulting from the collapse of the Córrego do Feijão Mine Dam, in Brumadinho. On this occasion, the Military Fire Brigade of the State of Rio de Janeiro (CBMERJ) designated specialized teams for emergency intervention, in aid of agents from the local corporation involved in providing care and support to victims and residents of the affected areas. However, these professionals were exposed to mud containing substances that cause harm to health. The objective of this study was to describe the concentrations of inorganic elements in the biological samples of Military Firefighters who participated in the actions after the collapse of the tailings dam in Brumadinho. To this end, a cross-sectional descriptive observational study was carried out. All samples contained levels above reference values, except for Mg, Al and Ca, which indicates excessive exposure. Even using personal protective equipment, which is a standard and mandatory procedure for the corporation, these professionals were exposed to high amounts of different contaminants and this biomonitoring aimed to expand health surveillance actions, however, in isolation, they cannot predict the occurrence of a certain pathology. Em janeiro de 2019, o estado de Minas Gerais foi assolado por uma tragédia ambiental resultante do rompimento da Barragem da Mina de Córrego do Feijão, em Brumadinho. Por ocasião, o Corpo de Bombeiros Militar do Estado do Rio de Janeiro (CBMERJ) designou equipes especializadas para a intervenção emergencial, em auxílio aos agentes da corporação local envolvidos no atendimento e suporte às vítimas e aos moradores das áreas atingidas. Porém, esses profissionais foram expostos à lama contendo substâncias que causam danos à saúde. O objetivo deste estudo foi descrever as concentrações de elementos inorgânicos nas amostras biológicas dos bombeiros militares que participaram das ações após o rompimento da barragem de rejeitos em Brumadinho. Para tal, foi realizado um estudo observacional descritivo do tipo transversal. Todas as amostras continham níveis acima dos valores de referência, exceto para Mg, Al e Ca, o que indica uma exposição excessiva. Mesmo utilizando os equipamentos de proteção individuais, o que é procedimento padrão e obrigatório da corporação, esses profissionais foram expostos a altas quantidades de diferentes contaminantes, e este biomonitoramento visou ampliar as ações de vigilância em saúde, porém, isoladamente, não podem predizer a ocorrência de determinada patologia. En enero de 2019, el estado de Minas Gerais fue golpeado por una tragedia ambiental derivada de la ruptura de la presa de la mina Córrego do Feijão, en Brumadinho. En esta ocasión, el Cuerpo de Bomberos Militares del Estado de Río de Janeiro (CBMERJ) designó equipos especializados para intervención de emergencia, para auxiliar a los agentes del Cuerpo de Bomberos local involucrados en la asistencia y apoyo a las víctimas y habitantes de las zonas afectadas. Sin embargo, estos profesionales estuvieron expuestos a lodos que contienen sustancias que causan daños a la salud. El objetivo de este estudio fue describir las concentraciones de elementos inorgánicos en las muestras biológicas de los Bomberos Militares que participaron en las acciones posteriores a la ruptura de la presa de relaves en Brumadinho. Para tal fin se realizó un estudio descriptivo observacional de corte transversal. Todas las muestras contenían niveles superiores a los valores de referencia excepto Mg, Al y Ca, lo que indica una exposición excesiva. Incluso utilizando equipos de protección individual, que es un procedimiento estándar y obligatorio para la corporación, estos profesionales estaban expuestos a altas cantidades de diferentes contaminantes y este biomonitoreo tenía como objetivo ampliar las acciones de vigilancia de la salud, sin embargo, de forma aislada, no pueden predecir la ocurrencia de una determinada patología.
46. Work process of community health workers: analysis of the influence of urban violence and COVID-19.
期刊: Ciencia & saude coletiva 发表日期: 2025-Aug 链接: PubMed
摘要
In this multicenter, cross-sectional and quantitative study we evaluated the influence of urban violence and COVID-19 on the work process and team rapport of community health workers (CHWs) in eight municipalities of Northeastern Brazil. The collected information covered sociodemographics, work routines, exposure to violence, self-efficacy and coronavirus anxiety. A logistic regression was performed using as outcome variable the answer to the question: “Do you think your team work process changed during the pandemic?” The sample included 1,944 CHWs, of whom 56.60% stated that violence interfered in their work, and almost 75% reported adaptations in their work process to cope with COVID-19. During the sanitary emergency, team rapport was positively associated with the absence of such adaptations (OR = 1.60; 95%CI = 1.22-2.10) and with occupational exposure to violence (OR = 2.73; 95%CI = 1.72-4.34). Our results confirmed that urban violence and COVID-19 affected the work process of the CHWs. A better understanding of this dynamic can help design interventions to make primary health care more resilient and better prepared for future stressors. Tem-se por objetivo analisar a influência da violência urbana e da COVID-19 no processo de trabalho dos agentes comunitários de saúde (ACS). Trata-se de um estudo multicêntrico, transversal, quantitativo realizado em oito cidades do Nordeste do Brasil. Abordaram-se dados sociodemográficos, processo de trabalho, exposição à violência, autoeficácia e a ansiedade relacionada à COVID-19. Realizou-se regressão logística, cuja variável de desfecho foi “Você considera que o seu processo de trabalho em equipe foi afetado durante a pandemia?”. De um total de 1.944 ACS, 56,60% informam que a violência interfere no trabalho. Quase 75% relatam adaptação do serviço durante a COVID-19. O melhor entrosamento do ACS para o trabalho em equipe durante a pandemia associou-se positivamente ao serviço não ter sido adaptado para atender paciente com COVID-19 (OR = 1,60; IC95% 1,22-2,10) e estar exposto à violência no território (OR = 2,73; IC95% 1,72-4,34). A violência urbana e a COVID-19 afetam o processo de trabalho dos ACS. Compreender essas relações pode favorecer o desenvolvimento de intervenções na atenção primária para torná-la mais resiliente e preparada para futuros estressores. Este estudio tuvo como objetivo analizar la influencia de la violencia urbana y la COVID-19 en el proceso de trabajo de los agentes comunitarios de salud (ACS). Se trata de un estudio cuantitativo, transversal y multicéntrico, realizado en ocho ciudades del Nordeste de Brasil. Se abordaron datos sociodemográficos, proceso de trabajo, exposición a la violencia, autoeficacia y ansiedad relacionada al COVID-19. Se realizó una regresión logística, cuya variable de resultado fue “¿Considera usted que su proceso de trabajo en equipo se vio afectado durante la pandemia?” De un total de 1944 encuestados, el 56,60% afirma que la violencia interfiere en el trabajo. Casi el 75% reporta adaptación del servicio durante COVID-19. La mejor integración del ACS para el trabajo en equipo durante la pandemia se asoció positivamente con que el servicio no estuviera adaptado para la atención a pacientes con COVID-19 (OR = 1,60; IC95% 1,22-2,10) y estuviera expuesto a violencia en el territorio (OR = 2,73; IC95% 1,72-4,34). La violencia urbana y el COVID-19 afectan el proceso de trabajo de ACS. Comprender estas relaciones puede favorecer el desarrollo de intervenciones en Atención Primaria para hacerla más resiliente y preparada ante futuros estresores.
47. Listen, Empower, Co-Create: Adapting Boot Camp Translation Methods to Create Culturally Responsive Health Messages and Materials.
期刊: Health literacy research and practice 发表日期: 2025-Jul 链接: PubMed
摘要
Community engagement is key to developing culturally responsive public health interventions that resonate with diverse populations and promote health equity. We applied an adapted version of Boot Camp Translation (BCT), a community-based participatory approach, to develop culturally and locally relevant messaging and materials for diverse populations. This adapted BCT approach focuses on three core themes: (1) Listen, (2) Empower, and (3) Co-Create, or LEC. The LEC method helps community leaders and champions learn from community members about barriers and gaps in health care (listen), share health information in a collaborative way (empower), and develop messages and materials that resonate with and motivate community members to take control of their own health (co-create). LEC follows a 3 to 4 month process: an in-person session with expert presentations and group discussions, followed by two virtual meetings to share and refine co-created messages and materials. The LEC approach was successfully conducted in diverse communities, engaging participants in preferred venues like churches, clinics, and tribal centers over 3 to 4 months. Tailored messages resonated with cultural values, while common themes included family and faith. Preferred materials were fact sheets, pamphlets, posters, videos, and visual stories. Participant evaluations showed high satisfaction, comfort sharing opinions, and improved understanding of how to take care of one’s health. The LEC method fosters collective responsibility between community members and researchers to collaboratively address health needs. To support implementation, we offer best practices for LEC application, and customizable materials and guidance tailored to community preferences. This flexible, adaptable approach may enhance effectiveness, relevance, and sustainability of public health efforts across diverse settings. Plain Language Summary An adapted Boot Camp Translation method was used to create culturally relevant health messages and materials for diverse communities. The process involved listening, empowering, and co-creating over 3 to 4 months. Participants engaged in familiar settings, resulting in tailored materials focusing on messaging that resonates with community perspectives and preferences. This approach improved understanding of health issues and fostered collaboration between researchers and communities.
48. Iodine deficiency and iodine supplementation in pregnancy and lactation. A literature review.
期刊: Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego 发表日期: 2025 链接: PubMed
摘要
Aim: Iodine is an essential nutrient for the synthesis of thyroid hormones. It has a huge impact on the normal brain development of the foetus and the health of the pregnant woman. During pregnancy and lactation, the need for iodine increases significantly. This review aims to summarize the role of iodine supplementation in addressing these elevated demands and preventing associated health risks.. Materials and Methods: The review is based on the thorough analysis of the materials selected from “PubMed” and “Google Scholar” scientific databases using the following key words: iodine; pregnant; lactation; supplementation. These key words were chosen based on their relevance to the matter of the article. Conclusions: Iodine supplementation is essential for optimal maternal and foetal health. However, comprehensive strategies are needed to address iodine deficiency, including public education on iodine-rich diets, policy initiatives on salt iodisation and minimising exposure to harmful chemicals in the environment. These measures can affect the health of pregnant and lactating women and their children. Moreover, the paper discusses the potential implications of excessive iodine intake, which may lead to thyroid dysfunction. This review underlines the crucial role of interdisciplinary collaboration in ensuring optimal maternal and neonatal health outcomes.
49. Trust or money? Barriers to health and healthcare behavior during the COVID-19 pandemic.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
This study aimed to examine how trust in institutions and changes in household finances were associated with healthcare utilization and preventive behaviors during and immediately after the COVID-19 pandemic. The COVID-19 pandemic worsened health disparities, ignited distrust in healthcare systems, and contributed to household economic shifts for many United States (US) residents. To examine these issues, we surveyed a nationally representative sample of US residents in July 2020 (n = 1,085) and May 2023 (n = 2,189). These repeated cross-sectional surveys enabled investigation of how trust in key stakeholders (e.g., federal government, the healthcare system) and household finances were linked with various types of healthcare utilization (e.g., annual preventive visits, receipt of pharmacy-based healthcare), preventive health care (e.g., influenza vaccination), and preventive behaviors (e.g., exercise, healthy eating). In 2023, the likelihoods of using some types of healthcare (annual health check and pharmacy-based healthcare) and engaging in preventive health behaviors increased relative to 2020. Improved household finances were associated with greater odds of healthy eating, exercising, and receiving annual preventive visits. Trust in the healthcare system was positively associated with all healthcare use types examined including preventive care such as influenza immunization and the individual prevention behavior of healthy eating but not exercise. Findings highlight the important role healthcare systems can have as trusted entities in potentially supporting healthcare utilization and prevention in the post-pandemic environment. Policy implications of these findings include increased efforts by payers and healthcare systems to facilitate positive health behaviors for US residents via specific strategies, such as making annual preventive health checks more accessible. At the same time, it is critical to support maintaining and building trust in healthcare systems to promote appropriate healthcare utilization.
50. Human papillomavirus: problems and prospects for women's reproductive health (systematic review).
期刊: Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego 发表日期: 2025 链接: PubMed
摘要
Aim: To consider the specific activity of drops and suppositories of PROTEFLAZID® at the stage of preclinical study, to assess the effectiveness and safety of use in clinical practice in papillomavirus-associated diseases of the female reproductive system.. Materials and Methods: Analysis of scientific publications on the treatment of palilomavirus infection with PROTEFLAZID® in women over the past decade. Results: Medicines have a direct antiviral effect on papillomaviruses. Clinical trials have shown that the drugs are safe and effective agents for the treatment of papillomavirus-associated CIN1 and CIN2 in the mode of simultaneous systemic and topical use. The proposed scheme is a promising method of treating class I-II neoplasias in women of reproductive age, as it avoids cervical damage, early and late complications and preserves female reproductive function. Conclusions: PROTEFLAZID® (drops and suppositories) are safe and effective etiopathogenetic drugs for the systemic and topical treatment of papillomavirusassociated diseases in women. Medicines demonstrate the potential for the prevention of cervical cancer, as they allow organ-preserving treatment in women of reproductive age as a guarantee of future motherhood.
51. Rational nutrition as a factor of healthy lifestyle and prevention of chronic non-communicable diseases.
期刊: Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego 发表日期: 2025 链接: PubMed
摘要
Aim: The aim is to conduct medical and sociological research on public awareness of the impact of rational nutrition on promoting human health and preventing chronic non-communicable diseases. Materials and Methods: The research was conducted in 2022-2024 and involved 214 respondents of different ages and genders who were patients of outpatient clinics in Zhytomyr (Ukraine). Research methods included theoretical analysis of literary sources, medical and sociological (questionnaire), mathematical and statistical, system analysis, and logical generalization. Results: It has been found that less than a third of the surveyed population (31.0 %) is in good health; 26.0 % report chronic diseases of the cardiovascular, excretory, hepatobiliary, and endocrine systems; 12.1 % of the respondents each suffer from diabetes and obesity. Despite this, only 18.0 % of the respondents adhere to healthy eating habits, and more than half abuse junk food and violate their diet. It has also been found that 79.0 % of the respondents do not have sufficient information about healthy eating; 93.0 % expressed a desire to improve their knowledge of the basics of healthy eating. Conclusions: It has been found that rational nutrition is the most important factor in the body’s vital activity, which ensures human health and working capacity, the ability to withstand adverse environmental influences, and determines the quality and duration of life. The article substantiates a set of measures for organizing public health professionals’ outreach and awareness-raising activities to promote public health and prevent chronic non-communicable diseases through dietary nutrition.
52. Improving spaces for women first responders: A grounded theory on gender equity.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Emergency response work has historically been performed by men and thus designed with them in mind; however, during the past few decades, increasing numbers of women are conducting this work. Despite growing participation, research suggests women first responders continue to face unsupportive workplace structures and cultures. This study explored the occupational experiences of women who work as firefighters, police officers, and paramedics from Southern Ontario, Canada. Semi-structured interviews conducted with this population (n = 20) focused on resiliency and stress, diversity and inclusion, and gender and the role of professional identity. Constructivist grounded theory guided analysis and cross-profession comparisons. Participants described significant improvements to women’s inclusion in first response work, however, they also identified continuing challenges. While some environments were described as highly supportive, many women still faced sexism and glass ceilings. Despite persisting obstacles, participants were deeply passionate about their work, and actively encouraged other women to join the field. Study results suggest that future advances can be encouraged by addressing the need for improved access to uniforms and equipment, on-the-job training to address barriers to promotions, flexible scheduling and childcare supports, and legislating equity, diversity, and inclusion training for all leaders and workers in the first responder community.
53. A life course perspective on predictors of midlife socioeconomic status.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Previous studies have found paternal occupation, childhood intelligence, and educational attainment to be important predictors of socioeconomic status (SES) later in life. However, these factors only explain part of the variance in SES and thus, it is important to identify other predictors of SES and trajectories of influence from early childhood to adulthood. To analyze predictors of SES attainment during the life course from early childhood to midlife with special emphasis on identifying direct and indirect effects on midlife SES of early childhood, late childhood and young adult characteristics. This study uses questionnaire and national registry data, including data on parental social background, intelligence, education, and midlife SES for 6,294 members of the Metropolit 1953 Danish Male Birth Cohort. The study sample included cohort members with information on intelligence at age 12 who were living in Denmark at age 50. Using structural equation modelling, direct and indirect mediated effects on midlife SES were estimated for early childhood, late childhood, and young adult characteristics. Educational attainment, intelligence, parental education, and father’s occupational class had the strongest influences on midlife SES. A prediction model only including education and intelligence could only be slightly improved by the inclusion of other predictors, from 53.5% to 54.1% explained variance in midlife SES. Educational attainment was a particularly strong predictor of status attainment. Other early and late childhood factors had relatively weak direct effects, but significant indirect effects. Thus, it was possible to identify trajectories of influence from early childhood to midlife. Young adult education and intelligence were the strongest predictors of midlife SES. Early and late childhood factors influence young adult characteristics, but over the life course the direct effects of early life variables tend to decrease, and the effects on midlife SES become mediated and indirect.
54. Wastewater analysis of chemical markers of public health concern at small spatial scales: A scoping review.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Wastewater analysis is a promising approach to obtaining population-based health information. It has proven useful for different applications, including monitoring illicit drugs or assessing population-level exposure to chemicals. Studies have often analysed samples from wastewater treatment plants, which does not allow for small-scale intra-sewershed differentiations needed for a detailed assessment of the target population. The small-scale approach offers various benefits, but a comprehensive review of its application to chemicals has not yet been undertaken. This scoping review aims to provide a detailed overview of the current knowledge on wastewater analysis of chemical markers of public health concern, including methodological aspects. We conducted a systematic database search for peer-reviewed articles. Data were analysed using quantitative summaries and qualitative narrative synthesis. Out of 2283 articles, 99 studies were included. Most were published after 2010. The studies analysed wastewater from different settings, with a focus on points of interest such as healthcare and education facilities, and few studies at neighbourhood-level. Pharmaceuticals, industrial and environmental chemicals and stimulants were most commonly investigated. While most studies reported their sampling mode, few provided detailed specifications. Small-scale sampling sites were characterized to varying degrees, with many studies reporting only a single characterization criterion. Advancing the area of research of small-scale wastewater analysis requires consistent and transparent methodological reporting and a more detailed sampling site characterization. Wastewater analysis of chemical markers of public health concern at small spatial scales shows great potential for further public health applications, including occupational health and monitoring chemical exposure in schools.
55. Determinants of access to insecticide-treated nets in Sub-Saharan Africa: A multilevel cross-country analysis using 29 DHS data.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Having access to Insecticide-Treated Nets (ITNs) is crucial for avoiding malaria in Sub-Saharan Africa (SSA), where the disease burden is disproportionately high. Despite their efficacy, socioeconomic, demographic, and geographic factors continue to cause notable differences in ITN access within and between nations. By employing a multilevel analysis of data from 29 Demographic and Health Surveys (DHS) throughout SSA, this study seeks to fill knowledge gaps about the factors that influence access at the individual and community levels. The study utilized data from 29 DHS surveys in SSA, which encompassed 214,181 households. Factors affecting access to ITN at the individual and community levels were examined using multilevel logistic regression models. Household head characteristics (sex, marital status, education, wealth index, television access, and family size) were among the individual-level factors. On the other hand, community-level characteristics included geography, kind of home, poverty, media exposure, and education. The Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and deviance were used to evaluate the model’s fitness. Measures of variation, including the Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and Intraclass Correlation Coefficient (ICC), were used to assess the effects at the community level. ITNs were reported by just 32.11% of households, with notable differences across socioeconomic classes and geographical areas. Higher ITN access was substantially correlated with married household heads, wealthier families, larger family sizes, and higher educational attainment. Access was also greatly enhanced by community-level factors such as urban residency, media exposure, and higher education. The best fit was Model 3, which explained 15.24% of the variance in ITN access by combining characteristics at the person and community levels. There were clear regional differences, with West Africa having higher probabilities of access than East Africa (AOR = 4.48). The study highlights the multifaceted determinants of ITN access in SSA, emphasizing the need for targeted interventions addressing both individual and community-level barriers. Strengthening distribution networks, increasing funding for subsidized ITN programs and enhancing public health education is essential for achieving universal coverage and reducing the malaria burden in the region.