公共卫生研究摘要 (2025-09-13)
共收录 59 篇研究文章
1. Emergent Carotid Artery Stenting in Patients With Acute Ischemic Stroke With Tandem Lesions: One-Year Follow-Up Results From the SECURIS Study.
期刊: Neurology 发表日期: 2025-Oct 链接: PubMed
摘要
Management of carotid lesions during endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) due to tandem lesions (TL) remains controversial, and long-term prognosis data are scarce. We evaluated 90-day and 1-year follow-up outcomes of emergent carotid artery stenting (eCAS) vs non-eCAS in these patients. Data from a prospective mandatory population-based registry of Code Stroke in Catalonia (Spain) between 2017 and 2023 were analyzed. Patients with large vessel occlusion and ipsilateral ≥50% atheromatous cervical internal carotid artery (ICA) stenosis undergoing EVT were identified. eCAS and non-eCAS groups were compared. The primary outcome was the shift in the modified Rankin Scale (mRS) score at 90 days and 1 year of follow-up, adjusted using inverse probability of treatment weighting. Stratified analyses in predefined key subgroups according to sex, age, degree of ICA stenosis, Alberta Stroke Program Early CT Score, baseline NIH Stroke Scale, and previous IV thrombolysis were performed. Secondary outcomes included successful recanalization (modified Thrombolysis In Cerebral Infarction ≥2b), 90-day favorable functional outcome (mRS 0-2), hemorrhagic transformation (HT), and 90-day mortality. Among 578 patients included (mean age 70.2 years old, 140 [24.2%] women), 344 patients (59.5%) underwent eCAS. eCAS was associated with a better functional outcome at 90 days (common odds ratio [cOR] for a 1-point less on the mRS score 1.47, 95% CI 1.20-1.82, p < 0.001) and 1 year of follow-up (cOR of 1.47, 95% CI 1.16-1.85, p = 0.001), and with higher successful recanalization rates (OR 4.28, 95% CI 2.61-7.0, p < 0.001), without increasing HT risk or mortality. The benefit of eCAS was consistent in both moderate (50%-69%) and severe (≥70%) ICA stenosis subgroups. Among the eCAS group, patients under dual antiplatelet therapy at 24 hours showed higher rates of favorable functional outcome (54.6% vs 22.9%, p < 0.001). Potential treatment effect differences were observed for women and older patients. In this population-based study of patients with AIS due to TL, eCAS was associated with a better mid-term and long-term functional outcome without safety concerns, even in moderate ICA stenosis. Limitations include the observational design and possible unmeasured confounders. Further studies are needed to explore the mechanisms underlying the differential effects of eCAS in women and older patients. This study provides Class II evidence that in patients with AIS and TL undergoing EVT, eCAS is associated with favorable functional outcome at 90 days compared with EVT alone.
2. Association of a History of Preterm Delivery With Stroke Risk in the Black Women's Health Study.
期刊: Neurology 发表日期: 2025-Oct 链接: PubMed
摘要
Black women experience a higher burden of preterm delivery and stroke compared with other American women. In a recent meta-analysis, history of preterm delivery was associated with an increased risk of stroke. However, previous studies were largely based on White women. This association has not been studied among Black women. We conducted a prospective cohort study consisting of self-identified Black women across the United States. Participants were parous women, free of cardiovascular disease, and enrolled in the Black Women’s Health Study (BWHS). Exposure was a self-reported history of preterm delivery. Outcome was all incident stroke cases, including self-reported stroke identified from questionnaires, stroke adjudicated through medical records, and fatal stroke identified using the National Death Index. Cox proportional hazard models were used, adjusting for maternal reproductive factors and risk factors of stroke. During a median of 20 years of follow-up among 41,788 parous Black women (mean age 40.5 years [SD 10.7]), 6,891 women reported a history of preterm delivery and 1,554 had incident stroke. Compared with women with no history of preterm delivery, Black women with a history of preterm delivery had a 1.30-fold increased stroke incidence (age-adjusted hazard ratio 1.30, 95% CI 1.14-1.47). The elevated stroke risk persisted after adjusting for history of hypertensive disorder during pregnancy and among the subset of stroke cases that were adjudicated through medical records reviewed by neurologists. In this prospective study of Black women, preterm delivery was associated with a 23% higher risk of long-term stroke. This study was limited by lack of detailed information on each pregnancy over the life course of Black women. Most of the BWHS participants were already parous at the time of enrollment in 1995. Information on the reasons for preterm delivery, timing and number of preterm deliveries, and prepregnancy risk factors is lacking. Our validation study on stroke was conducted among a small and nonrandom sample of participants who provided medical records. The negative predictive value of self-reported stroke was not assessed. The higher rate of preterm delivery likely contributes to the higher burden of stroke among Black women.
3. Policymaker Perspectives on the Role of Health Systems in Sustainable Hepatitis C Point-Of-Care Testing in Australia.
期刊: Journal of viral hepatitis 发表日期: 2025-Oct 链接: PubMed
摘要
Point-of-care testing for hepatitis C virus (HCV) offers multiple benefits to key populations and healthcare providers, but it has not achieved widespread implementation. This analysis investigates the impact of the health system on the sustainability of point-of-care HCV testing in Australia. Between September 2023 and January 2024, in-depth, semi-structured interviews were conducted with people involved in HCV policymaking in Australia. Data were coded using WHO’s Health System Building Blocks framework (i.e., Health Workforce, Health System Financing, Medical Technologies, Leadership and Governance). Thematic analysis examined how the health system supports and hinders the long-term sustainability of HCV point-of-care testing. There were 29 participants working in seven Australian jurisdictions or nationally: 13 from departments of health, six from community-led organisations, five from local health services, and five from pathology. The analysis demonstrates the interrelations between Building Blocks, but governance was consistently foregrounded across each theme. For Health Workforce, the community approach to models of care in Australia bolstered support for HCV testing outside of traditional healthcare settings. For Health System Financing, sustainability was threatened by a lack of long-term funding mechanisms for point-of-care testing. For Leadership and Governance, state and national HCV elimination targets were seen as important to drive point-of-care testing at the local level, especially when they were reflected in services’ key performance indicators. Integration into existing health system structures, sustainable funding mechanisms, and strengthened governance frameworks are needed to sustain HCV point-of-care testing in Australia. Study findings are critical to inform a long-term testing strategy in Australia and internationally.
4. Evaluating the Needs and Characteristics of Individuals of Low Socioeconomic Status Using Digital Health Technology to Address Health-Related Social Needs: Mixed Methods Study With Patients and Care Providers.
期刊: JMIR human factors 发表日期: 2025-Sep-12 链接: PubMed
摘要
Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age, encompassing social and economic factors that shape health outcomes. There is an increasing call to leverage digital health technology (DHT) to address SDOH and health-related social needs and establish connections to resources and services. This study aimed to (1) identify the DHT-related characteristics of DHT users with low socioeconomic status (SES), (2) determine the needs and preferences of DHT users with low SES, and (3) explore how current SDOH-DHT addresses these needs and preferences in addressing their health-related social needs. We used a multiphase, mixed method, user-centered design approach. In phase 1, we developed a user profile based on a literature review, aggregate data, interviews with 26 low-SES individuals, and focus groups with 28 professionals. In phase 2, we conducted a landscape analysis of 17 existing SDOH-DHTs. DHT users of low SES had diverse social and technology characteristics. Five key themes emerged regarding user needs and preferences: (1) user-centered design, including multilingual support, visual guidance, and customization; (2) efficient, solution-based assessment of social risks, assets, and needs; (3) e-caring support features; (4) user education and feedback mechanisms; and (5) trust, privacy, and security. The landscape analysis revealed that current SDOH-DHT features do not adequately meet these needs. Discrepancies between target user needs and current DHT features represent missed opportunities in developing user-centered tools for individuals of low SES. Findings underscore the importance of inclusive, empowering, and responsive design in SDOH-DHT to bridge health disparities and advance public health.
5. A Design Framework for Microintervention Software Technology in Digital Health: Critical Interpretive Synthesis.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-12 链接: PubMed
摘要
Although many digital health interventions have been studied in human-computer interaction, long-term engagement remains a challenge. Microinterventions that leverage small but meaningful steps toward health outcomes have been proposed as a method for providing flexible and engaging, yet short and focused, interventions. One way to mitigate the potentially limiting scope of each microintervention is through narratives combining multiple different microinterventions over time to facilitate greater effects and engagement. As an emerging field of research, significant focus has thus far been placed on the creation and testing of individual microinterventions with little consideration for the consolidated experience, that is, the narrative over time. A more concise terminology and framework could make it easier to design, evaluate, and compare systems for microinterventions, facilitate collaboration in the field, and foster communication across required disciplines. This paper aims to provide a framework for the creation of microintervention systems and the narratives served by these through their microinterventions. To synthesize a framework, we carried out a critical interpretive synthesis involving reciprocal translational analysis, refutational synthesis, and lines-of-argument synthesis, based on a systematic review of microintervention literature following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across the Association for Computing Machinery Digital Library, PubMed, Scopus, and Web of Science. To assess the resulting framework, we applied it retroactively back onto the literature. Based on a review including 35 studies, of which 80% (n=28) were published after 2020, we present and rationalize the Design for Microintervention Software Technology (D-MIST) framework, which can be used to better classify, design, and evaluate microinterventions. D-MIST defines a microintervention system on three levels: (1) the narrative, (2) the microintervention, and (3) the event. The narrative is the consolidated experience of engaging with multiple microinterventions over time, supporting a narrative goal, for example, a clinical goal. A microintervention is a highly focused intervention consisting of self-contained events aiming to facilitate small but meaningful steps toward the narrative goal. The event attempts a positive momentary change through a resource, for example, an exercise. Events may, for example, be designed for single use, present variations to facilitate engagement, or present order-dependent sequential resources. We additionally discuss supporting constructs, such as decision rules, conceptual models, and the system’s interaction model, that is, how the system interacts with the user through its design and other actors to create a consolidated narrative. The resulting D-MIST framework, based on current state-of-the-art literature, describes the components of microintervention systems and how these contribute to a consolidated experience. Based hereon, we suggest opportunities for personalization of microintervention systems, discuss design guidelines, and the roles of actors in creating health narratives aiming to obtain better distal health outcomes.
6. A Triple Perspective on the Triple Visit: Protocol for a Mixed Methods Evaluation of the Implementation of a Pediatric Multidisciplinary Clinic Model for Inflammatory Bowel Disease.
期刊: JMIR research protocols 发表日期: 2025-Sep-12 链接: PubMed
摘要
Given the impact of inflammatory bowel disease (IBD) on both physical health and psychosocial functioning, the management of pediatric IBD requires a multidisciplinary approach that provides holistic care, rapid access, and health education to young patients with IBD. Yet despite recommendations, a formalized clinic model for holistic pediatric IBD care remains an unmet need for this population. The objective of this study is to comprehensively evaluate the implementation of a new clinic model aimed at providing holistic care, rapid access, and health education for pediatric patients with IBD. This study uses a multiperspective mixed methods design, incorporating both qualitative and quantitative data collected simultaneously from clinicians, parents or guardians, and pediatric patients. The quantitative component includes a pre-post implementation chart review, structured observations of clinical practices, and surveys tailored to pediatric patients and their parents or guardians. The qualitative aspect encompasses semistructured interviews with clinicians and parents or guardians as well as play-based interviews with patients. Triangulation will be used to converge these different methodologies and to produce a holistic evaluation of the IBD clinic. This study was approved by the Humber River Health Research Ethics Board on December 23, 2024. Recruitment for this study began on January 30, 2025, and we anticipate a data collection end date of December 2025. Given that this clinic model is relatively new, this protocol will provide sound methodological direction for other studies that aim to evaluate or implement this type of model in their setting. The evaluation itself will provide comprehensive insights into both the successes and challenges of implementing a multidisciplinary approach that provides a holistic model of care for pediatric patients with IBD. As such, this evaluation will be foundational in providing an applied understanding of the impact and effectiveness of this holistic approach in pediatric patients with IBD. PRR1-10.2196/72670.
7. Extracting Symptoms of Complex Conditions From Online Discourse (Subreddit to Symptomatology): Lexicon-Based Approach.
期刊: JMIR medical informatics 发表日期: 2025-Sep-12 链接: PubMed
摘要
Millions of people affected with complex medical conditions with diverse symptoms often turn to online discourse to share their experiences. While some studies have explored natural language processing methods and medical information extraction tools, these typically focus on generic symptoms in clinical notes and struggle to identify patient-reported, disease-specific, subtle symptoms from online health discourse. We aimed to extract patient-reported, disease-specific symptoms shared on social media reflecting the lived experiences of thousands of affected individuals and explore the characteristics, prevalence, and occurrence patterns of the symptoms. We propose a lexicon-based symptom extraction (LSE) method to identify a diverse list of disease-specific, patient-reported symptoms. We initially used a large language model to accelerate the extraction of symptom-related key phrases that formed the lexicon. We evaluated the effectiveness of lexicon extraction against human annotation using a Jaccard index score. We then leveraged BERT-Base, BioBERT, and Phrase-BERT-based embeddings to learn representations of these symptom-related key phrases and cluster similar symptoms using k-means and hierarchical density-based spatial clustering of applications with noise (HDBSCAN). Among the different options explored in our experiments, BioBERT-based k-means clustering was found to be the most effective. Finally, we applied symptom normalization to eliminate duplicate and redundant entries in the comprehensive symptom list. In a real-world polycystic ovary syndrome (PCOS) subreddit dataset, we found that LSE significantly outperformed state-of-the-art baselines, achieving at least 41% and 20% higher F1-scores (mean 86.10) than automatic medical extraction tools and large language models, respectively. Notably, the comprehensive list of 64 PCOS symptoms generated via LSE ensured extensive coverage of symptoms reported in 7 reputable eHealth forums. Analyzing PCOS symptomatology revealed 28 potentially emerging symptoms and 8 self-reported comorbidities co-occurring with PCOS. The comprehensive patient-reported, disease-specific symptom list can help patients and health practitioners resolve uncertainties surrounding the disease, eliminating the variability of PCOS symptoms prevailing in the community. Analyzing PCOS symptomatology across varied dimensions provides valuable insights for public health research.
8. Impact of immunochemotherapy regimens on outcomes of patients with primary mediastinal B-cell lymphoma in the IELSG37 trial.
期刊: Blood 发表日期: 2025-Sep-12 链接: PubMed
摘要
The IELSG37 trial enrolled 545 patients with primary mediastinal B-cell lymphoma (PMBCL) and demonstrated that consolidation radiotherapy (RT) can be omitted in patients with complete metabolic response (CMR), defined by the Lugano classification as Deauville score (DS) 1-3. This report evaluates outcomes following different frontline rituximab- and doxorubicin-based immunochemotherapy regimens chosen according to local practice. Patients treated with R-CHOP21 showed a significantly higher percentage of DS 5 than those on other regimens (23.8% vs. 8.2% average, P< 0.001) as well as a trend toward additional unplanned treatments (53.2% vs. 46.9%, P=0.30). The increased risk of poor response was confirmed in a multinomial logistic regression analysis adjusted for age, sex, IPI score, and performance status. R-CHOP21 was also associated with smaller reductions in MTV and less pronounced decreases in SUVmax. Patients with DS 5 more often received additional treatment (RT and/or salvage chemotherapy with or without autologous consolidation) after induction immunochemotherapy (96% vs. 41%, P< 0.001) and experienced significantly poorer outcomes. Although differences in progression-free and overall survival between R-CHOP21 and more aggressive regimens were not statistically significant, R-CHOP21 may increase the risk of additional treatments and may be inadvisable as frontline therapy for PMBCL. NCT01599559.
9. Cost of Convenience in Cancer Care.
期刊: JCO oncology practice 发表日期: 2025-Sep-12 链接: PubMed
摘要
10. The Effectiveness of Adaptations for Online Remote Public Deliberation Across Three Continents: Mixed Methods Study.
期刊: Journal of participatory medicine 发表日期: 2025-Sep-12 链接: PubMed
摘要
Public deliberation is a qualitative research method that has successfully been used to solicit laypeople’s perspectives on health ethics topics, but it remains unclear whether this traditionally in-person method can be translated to the online context. The MindKind Study conducted public deliberation sessions to gauge the concerns and aspirations of young people in India, South Africa, and the United Kingdom with regard to a prospective mental health databank. This paper details our adaptations to and evaluation of the public deliberation method in an online context, especially in the presence of a digital divide. The purpose of this study was to assess the quality of online public deliberation and share emerging learnings in a remote, disseminated qualitative research context. We convened 2-hour structured deliberation sessions over an online video conferencing platform (Zoom). We provided participants with multimedia informational materials describing different ways to manage mental health data. We analyzed the quality of online public deliberation in variable resource settings on the basis of (1) equal participation, (2) respect for the opinions of others, (3) adoption of a societal perspective, and (4) reasoned justification of ideas. To assess the depth of comprehension of the informational materials, we used qualitative data that pertained directly to the materials provided. The sessions were broadly of high quality. Some sessions were affected by an unstable internet connection and subsequent multimodal participation, complicating our ability to perform a quality assessment. English-speaking participants displayed a deep understanding of complex informational materials. We found that participants were particularly sensitive to linguistic and semiotic choices in the informational materials. A more fundamental barrier to understanding was encountered by participants who used materials translated from English. Although online public deliberation may have quality outcomes similar to those of in-person public deliberation, researchers who use remote methods should plan for technological and linguistic barriers when working with a multinational population. Our recommendations to researchers include budgetary planning, logistical considerations, and ensuring participants’ psychological safety.
11. Malnutrition Mortality Among Older Adults by County and Race and/or Ethnicity in the United States, 2000-2019.
期刊: Journal of the American Geriatrics Society 发表日期: 2025-Sep-12 链接: PubMed
摘要
Older adults are at an increased risk of malnutrition due to chronic diseases and social vulnerabilities. This study estimates protein-energy malnutrition mortality rates among adults aged 65-74 and ≥ 75 by race and ethnic population group and county. We analyzed death data from the National Vital Statistics System and population data from the National Center for Health Statistics from 2000 to 2019. We calculated county-level mortality rates using small-area estimation methods, adjusting for misclassifications in death certificates. The primary outcome was deaths attributed to malnutrition. The exposures were to populations (American Indian/Alaskan Native [AIAN], Asian, Black, Hispanic/Latino, and White) and the county. From 2000 to 2019, malnutrition mortality rates increased in individuals aged ≥ 75 from 19.5 (95% uncertainty interval [UI]: 18.8-20.1) to 49.2 (48.4-50.0) deaths per 100,000, and in those aged 65-74 from 2.2 (2.0-2.3) to 4.6 (4.4-4.7). In 2019, Black individuals had the highest national mortality rates: 60.8 (58.2-63.3) for ≥ 75 years and 7.7 (7.3-8.2) for 65-74 years. In 2019, a county in Georgia had the highest rate for White individuals aged ≥ 75 at 334.9 (236.6-464.8), and a county in Montana had the highest for AIAN individuals aged 65-74 at 34.9 (13.1-72.0). Counties in the New York metro had the lowest mortality rates across all population groups and ages. Malnutrition mortality rates have increased among older adults, varying by geography and population group, underscoring the need for targeted nutritional interventions.
12. Investigating the Aliso Canyon gas blowout disaster and adverse birth outcomes: A quasiexperimental approach.
期刊: Science advances 发表日期: 2025-Sep-12 链接: PubMed
摘要
On 23 October 2015, operators at the Aliso Canyon Natural Gas Storage field in Northern Los Angeles reported an uncontrolled natural gas leak. The blowout persisted for 112 days, releasing ~109,000 metric tons of methane into the atmosphere. Elevated air toxics and fine particle pollutant levels were also measured in nearby communities. We used California’s birth records and a quasiexperimental design to assess whether pregnant women living in affected communities during the disaster experienced more adverse birth outcomes than expected. Overall, the prevalence of low birthweight and term low birthweight were 45 to 100% higher than expected among women living in the affected communities whose late pregnancy overlapped with the blowout. The strongest effects were observed among women living directly south and southwest of the facility. Furthermore, we observed a dose-response effect, where the odds of low birthweight were highest among women living closest to the well and attenuated out.
13. The Right to Explanation in AI: In a Lonely Place.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-12 链接: PubMed
摘要
Technology is increasingly being used in decision-making in all fields, particularly in health care. Automated decision-making promises to change medical practice and potentially improve and streamline the provision of health care. Although the integration of artificial intelligence (AI) into medicine is encouraging, it is also accompanied by fears concerning transparency and accountability. This is where the right to explanation has come in. Legislators and policymakers have relied on the right to explanation, a new right guaranteed to those who are affected by automated decision-making, to ease fears surrounding AI. This is particularly apparent in the province of Quebec in Canada, where legislators recently passed Law 5, an act respecting health and social services information and amending various legislative provisions. This paper explores the practical implications of Law 5, and by extension of the right to explanation internationally, in the health care field. We highlight that the right to explanation is anticipated to alter physicians’ obligation to patients, namely the duty to inform. We also discuss how the drafting of the legislation on the right to explanation is vague and hard to enforce. This dilutes the potential of the right to explanation to provide meaningful protections for those affected by automated decisions. After all, AI is a complex and innovative technology and, as such, requires complex and innovative policies. The right to explanation is not necessarily the answer.
14. Approaches to Community Engagement That Optimize the Reach and Utility of Health Education Campaigns in Newcomer Communities.
期刊: Health promotion practice 发表日期: 2025-Sep-12 链接: PubMed
摘要
Linguistic and cultural factors are significant barriers to health education for newcomers, defined for this report as people who recently arrived to the United States as refugees, asylees, immigrants, migrants, and others in need of international protection. However, many newcomers are in a good position to influence health education strategies. The National Resource Center for Refugees, Immigrants and Migrants (NRC-RIM) developed campaigns using both community-informed and community co-design approaches in order to optimize their reach and utility. A community-informed approach allows organizations to create linguistically and culturally relevant health education materials relatively quickly on a large scale to meet communities’ needs. The six steps included (1) Listen, (2) Write, (3) Design, (4) Translate, (5) Validate, and (6) Scale. A community co-design approach leverages the wisdom and experience of community leaders to create hyperlocal campaigns that are rooted in community values. The three steps included (1) Inspiration, (2) Ideation, and (3) Implementation. A mixed-methods evaluation showed a complementary approach to be effective in promoting informed decision-making and health-seeking behavior among newcomers. The findings underscore the crucial need for culturally relevant communications created in genuine partnership with communities, and suggest that by investing time and resources to this process, organizations can be well-positioned to address health inequities among newcomers.
15. Impact of carotid arterial pressure measurements for cerebrovascular impedance estimation.
期刊: American journal of physiology. Heart and circulatory physiology 发表日期: 2025-Sep-12 链接: PubMed
摘要
Cerebrovascular impedance quantifies the relationship between pulsatile changes in arterial pressure and cerebral artery blood flow velocity, reflecting the Windkessel effect in dampening blood flow oscillations. For its estimation, arterial pressure can be measured at either the common carotid artery (CCA) or the internal carotid artery (ICA) using applanation tonometry. However, due to pressure wave propagation and potential waveform distortions, even over short vascular distances, pressure waveforms recorded at the ICA may differ from those at the CCA. Therefore, this study investigated the impact of measurement site (CCA vs. ICA) on cerebrovascular impedance estimation. Sixteen healthy young adults (18-25 years, nine women) underwent simultaneous recordings of ipsilateral CCA and ICA pressure and CBF velocity in the middle cerebral artery using B-mode ultrasound and transcranial Doppler. The transfer function gain from CCA to ICA pressures remained close to 1.0 up to 2.34 Hz and then declined slightly and linearly, reaching approximately 0.6 at 7.80 Hz, whereas both phase and coherence remained stable up to approximately 7 Hz. Repeated-measures correlation showed strong intra-individual agreement in cerebrovascular impedance estimates from both pressure sites, although ICA-derived values tended to be lower at higher frequencies. Importantly, no significant differences were observed below 6 Hz. Thus, the choice of carotid arterial pressure measurement site (CCA vs. ICA) has minimal impact on cerebrovascular impedance estimation within this lower frequency range.
16. "It's Just Our New Norm": A Qualitative Analysis of COVID-19 Pandemic Stressors and Protective Factors Among Caregivers of School-Aged Children.
期刊: American journal of health promotion : AJHP 发表日期: 2025-Sep-12 链接: PubMed
摘要
PurposeTo understand general COVID-19 pandemic-related stressors among caregivers of children ages 3-15, and describe institutional, interpersonal, and personal protective factors used to cope with pandemic-related stress.DesignSemi-structured, in-depth interviews.SettingMaryland.ParticipantsCaregivers of children enrolled in the COVID-19 Family Study; 38 caregivers during 2020 (T1) and 22 caregivers during repeat interviews in 2021 (T2).MethodThe research team developed interview guides informed by the Family Stress Model (FSM) for T1 and T2 interviews. Interviews were analyzed using content coding to later construct themes related to how stressors and protective factors changed over time.ResultsThe thematic analysis is described across four concepts: caregiver stressors, institutional protective factors, interpersonal protective factors, and personal factors. In T1 interviews, stressors included viral exposure, remote work and school, and social distancing. During T2 interviews, caregivers described re-opening of work, school, and businesses and shifting back into pre-pandemic routines as continuing stressors. In both rounds of interviews, caregivers described a variety of institutional, interpersonal, and personal protective factors to cope with stress. Commonly mentioned protective factors included government aid (i.e., stimulus checks, free school lunches), family time, and hobbies.ConclusionFindings highlight the necessity of multi-tiered (institutional, interpersonal, personal) approaches to support caregivers navigating stressful experiences during times of extraordinary duress, especially emphasizing interventions that incorporate various levels of the socioecological model.
17. Weight change and ischemic stroke risk among participants in the Atherosclerosis Risk in Communities (ARIC) Study.
期刊: Neuroepidemiology 发表日期: 2025-Sep-12 链接: PubMed
摘要
Introduction Conflicting findings exist between weight change and ischemic stroke risk. Studying the association between body weight change and ischemic stroke risk helps clarify the true nature of the association and supports future health promotion and stroke prevention strategies. Methods We longitudinally assessed data from 10,985 ARIC visit 4 participants (1996-1998). After excluding individuals with missing data on previous stroke or coronary heart disease at baseline (visit 4), we classified 9-year weight change (visit 4 minus visit 1 weight) into quintiles of weight change and weight loss (> -2.7 kg), no change (-2.7 to +2.7 kg), and weight gain (> +2.7 kg) categories. We used crude and adjusted Cox regression models to assess ischemic stroke hazard. We also performed an analysis stratified by BMI status to see if the weight change-stroke risk relationship differed by baseline BMI. Results Among 9,574 participants, 676 developed ischemic stroke during the 20-year follow-up. Most participants at baseline were female (58.25%) and drinkers (50.52%), with mean age of 62 and mean BMI of 28.78 kg/m2. Compared to participants with no change, those who gained weight had 23% lower hazards of ischemic stroke (hazard ratio (HR) = 0.77 (95% confidence interval (CI) = 0.60, 0.99)), while those who lost weight had 30% higher hazards (HR=1.30 (95% CI =1.05,1.62)). Conclusion Weight change showed minimal association with stroke risk overall, with moderate weight gain potentially lowering the risk, while weight loss increased it. These results emphasize the intricate relationship between weight dynamics and cerebrovascular health and the potential complex implications of the degree and direction of weight change for stroke prevention.
18. Understanding the countermovement to online presentations of psychiatric disorder that are perceived as "faked".
期刊: Journal of mental health (Abingdon, England) 发表日期: 2025-Sep-12 链接: PubMed
摘要
The self-presentation of psychiatric disorders on social media has generated a countermovement of sceptics who believe some are “faked” for reasons of self-promotion. This has been the focus of a Reddit forum called r/FakeDisorderCringe, an active community with almost 300,000 members. Given the influence of online discourse on public attitudes, understanding which diagnoses attract the most scepticism and what conversational themes surround these concerns is important in understanding lay controversies in mental health. We used topic modelling using Latent Dirichlet allocation, a natural language processing technique, to analyse over 850,000 forum posts from August 2020 to December 2022 to identify the main topics. Topic modelling identified 15 topics, of which several identified specific disorders: anxiety, depression, OCD (obsessive-compulsive disorder), ADHD (attention deficit and hyperactivity disorder), autism, Tourette’s syndrome and tics, and DID (dissociative identity disorder). Other topics included faking and attention-seeking, school and childhood context, trauma and abuse, validity of self-diagnosis, medical research evidence, gender identity and sexuality, profanity, and sarcasm-laden commentary. This scepticism does not mirror previously identified public doubts about the legitimacy of specific diagnoses and seems to more commonly focus on conditions that have seen a recent increase in diagnosis in young people.
19. Immunological and regenerative properties of lung stem cells.
期刊: Physiological reviews 发表日期: 2025-Sep-12 链接: PubMed
摘要
The human lung is subjected to inhaled harmful substances, including pathogens, pollutants, or allergens. Two abundant epithelial stem cell populations - the club cells and the alveolar type 2 (AT2) cells - are located in the airways and alveoli, respectively, and possess versatile properties including barrier repair, antimicrobial secretion, antigen presentation, as well as active communication with immune cells, to strengthen defense responses in the lung. In this Review, we summarize challenges at the lung epithelium and update our current understanding of how lung stem cells respond to environmental insults that affect the lung epithelial barrier and their importance for host defence. Active crosstalk between lung stem cells and immune cells is then discussed. We also consider how dysregulations of these stem cells contribute to pathological conditions affecting the lung, including acute infections, chronic progressions, and tumor development. Proper repopulation and functional restoration of these cells may represent a novel therapeutic strategy for treating intractable lung diseases associated with barrier disruption and immune imbalance.
20. Supplementation with GPR120 (Ffar4) ligand omega-3 does not improve survival in murine sepsis models.
期刊: American journal of physiology. Endocrinology and metabolism 发表日期: 2025-Sep-12 链接: PubMed
摘要
Sepsis is a condition marked by physiologic dysregulation secondary to infection and is influenced by the nutritional state. Despite several preclinical studies and clinical trials examining nutrition and supplements in sepsis, there are no clear guidelines. Omega-3 fatty acids are poly-unsaturated fatty acids with anti-inflammatory properties, represented mainly by alpha-linolenic (ALA - C18:3), eicosapentaenoic (EPA - C20:5), and docosahexaenoic (DHA - C22:6). Since sepsis is characterized with high levels of inflammation and subsequent organ dysfunction, we hypothesised that omega-3 ingestion would improve sepsis survival by attenuating inflammation via activation of GPR120 in immune cells. Here, we aimed to experimentally explore the role of omega-3 and the receptor that mediates their anti-inflammatory functions, GPR120, during sepsis. To evaluate GPR120 functionality, acute inflammation was induced via lipopolysaccharide (LPS) treatment in Raw 264.7 cells, 3T3-L1 cells, bone marrow derived macrophages and primary adipocytes. To evaluate the impact of omega-3 in sepsis, C57BL/6J mice were supplemented with omega-3 before LPS administration or cecal ligation and puncture (CLP) surgery. GPR120 mRNA expression decreased during inflammation. Unexpectedly, omega-3 supplementation preceding CLP worsened sepsis survival in mice. In addition, omega-3 did not affect inflammatory markers such as TNFα, IL1}, IL10, and IL6. Overall, our findings that omega-3 do not influence inflammation or improve survival in sepsis are surprising given that omega-3 supplementation is recommended for the prevention of cardiovascular diseases due to its anti-inflammatory properties. The negative impact of omega-3 supplementation on survival in the CLP model raises caution for future clinical studies involving sepsis.
21. Cryptosporidium parvum protease INS6 plays an important role in parasite proliferation and pathogenicity.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Sep-12 链接: PubMed
摘要
Cryptosporidium parvum is a common protozoan pathogen responsible for moderate to severe diarrhea in humans and animals. Parasite invasion and egress cause damage to intestinal epithelial cells, which is mediated by a variety of secretory proteins from several unique organelles, such as micronemes. Previous spatial proteomic analysis has identified insulinase-like protease 6 (INS6) as a putative microneme protein in C. parvum. However, the functional contribution of INS6 to Cryptosporidium pathogenicity remains poorly characterized. In this study, we used genetic manipulation techniques to investigate the expression and biological functions of INS6 in C. parvum. The INS6 gene was tagged and deleted in C. parvum using CRISPR/Cas9 technology. The expression of INS6 was determined by immunofluorescence analysis, ultrastructure-expansion microscopy, and immunoelectron microscopy. Endogenous labelling showed low levels of INS6 expression, which is found in C. parvum micronemes and is absent during the male gamont stage. The effect of INS6 deletion on parasite growth and pathogenicity was assessed in vitro using HCT-8 cultures and in vivo by infection of interferon-γ knockout mice. Deletion of the INS6 gene impaired C. parvum proliferation in vitro and significantly reduced the parasite burden in infected mice. In addition, mice infected with the Δins6 strain showed a significant reduction in the intestinal villus-to-crypt ratio, attenuated body weight loss and increased survival rates, compared to those infected with the INS6-3HA strain. These results indicate that INS6 protein is involved in C. parvum proliferation and plays a critical role in modulating the pathogenicity of this zoonotic parasite. Deletion of this gene affects the invasion efficiency and pathogenicity of the parasite.
22. An in-depth analysis of the sugar industry's waste management approaches in the context of the circular economy framework: A comprehensive systematic review.
期刊: Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA 发表日期: 2025-Sep-12 链接: PubMed
摘要
This study was carried out to address the current research gaps in the categorization of suggested approaches and to identify applied approaches in sugar industry waste management, taking into account the circular economy (CE) principle by systematically searching and screening trustworthy articles in databases. Along with sustainable development, the objectives of using the CE as a framework to determine the appropriate approaches are to lessen the environmental effects of waste, provide dual economic advantages and aid in selecting the best strategy for each nation and the sugar industry. The wastes produced during the crop-based sugar extraction process include filter mud, sugar beet pulp, sugar cane bagasse and sugar cane bagasse ash. This study examined several waste management approaches for the sugar sector, divided into two broad categories: suggested and applied approaches. To facilitate improved comprehension and differentiation, the evaluation of sugar industry waste management methods identified six primary categories: (A) Fuel and energy production, (B) Construction materials production, (C) Industrial application, (D) Food, pharmaceutical and cosmetic industries application, (E) Agriculture application and (F) Pollutants purification. Of these six categories, the industrial applications and pollutant purification categories have not yet been applied at the field scale and require further study before they can be implemented. However, the methods that are used are also restricted and lacking in variety. Despite the fact that numerous methods have been proposed for handling all kinds of waste in the sugar industry, very few have actually been put into practice at the field scale.
23. Agreement Between Mean Weighted Skin Temperature Formulas During Exercise.
期刊: Journal of applied physiology (Bethesda, Md. : 1985) 发表日期: 2025-Sep-12 链接: PubMed
摘要
There are many formulas to calculate mean weighted skin temperature (Tmws) with little evidence for their agreement with each other. This investigation assessed the agreement of five common Tmws formulas (≤7 sites) with a 12-site formula (Hardy-DuBois 12-site, HDB12). It was hypothesized that a formula with more measurement sites (Hardy-Dubois 7-site, HDB7) would have more agreement during steady-state exercise in moderate (20°C) and warm (30°C) conditions. Ten well-trained male participants (age: 37±12y, height: 178±7 cm, mass: 76±9 kg, body fat: 8±2%, VO2peak: 66±10 mL/kg/min) cycled at 55% of peak oxygen uptake for 60 minutes. The Tmws were calculated for HDB12, HDB7, Palmes/Park 6-site (PP6), Teichner 6-site (TEI6), Ramanathan 4-site (RAM4), and Burton 3-site (BTN3) formulas. Good agreement was determined when mean bias, mean absolute error (MAE), or root mean squared error (RMSE) was ≤0.5°C or limits of agreement (LOA) was ≤1.0°C. The Tmws formulas were in better agreement with HDB12 in warm compared to moderate conditions. The best performing formulas were RAM4, BRT3, and TEI6; mean bias was low in RAM4 (moderate: 0.2°C; warm: 0.1°C) and BRT3 (moderate: 0.1°C; warm:0.0°C) and RMSE was low in TEI6 (moderate: 0.6°C; warm: 0.4°C) compared to the others. The large deviation in torso skin temperature for HDB7 (moderate: -2.0°C; warm: -1.6°C) resulted in consistent underestimation of HDB12 (mean bias, moderate: -0.8°C; warm: -0.5°C). Due to its popularity the four-site RAM4 is acceptable for cycling in 20°C and 30°C conditions, when a 12-site formula is not feasible.
24. Interventions Based on Biofeedback Systems to Improve Workers' Psychological Well-Being, Mental Health, and Safety: Systematic Literature Review.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-12 链接: PubMed
摘要
In modern, high-speed work settings, the significance of mental health disorders is increasingly acknowledged as a pressing health issue, with potential adverse consequences for organizations, including reduced productivity and increased absenteeism. Over the past few years, various mental health management solutions, such as biofeedback applications, have surfaced as promising avenues to improve employees’ mental well-being. However, most studies on these interventions have been conducted in controlled laboratory settings. This review aimed to systematically identify and analyze studies that implemented biofeedback-based interventions in real-world occupational settings, focusing on their effectiveness in improving psychological well-being and mental health. A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched PubMed and EBSCO databases for studies published between 2012 and 2024. Inclusion criteria were original peer-reviewed studies that focused on employees and used biofeedback interventions to improve mental health or prevent mental illness. Exclusion criteria included nonemployee samples, lack of a description of the intervention, and low methodological quality (assessed using the Physiotherapy Evidence Database [PEDro] checklist). Data were extracted on study characteristics, intervention type, physiological and self-reported outcomes, and follow-up measures. Risk of bias was assessed, and VOSviewer was used to visualize the distribution of research topics. A total of 9 studies met the inclusion criteria. The interventions used a range of delivery methods, including traditional biofeedback, mobile apps, mindfulness techniques, virtual reality, and cerebral blood flow monitoring. Most studies focused on breathing techniques to regulate physiological responses (eg, heart rate variability and respiratory sinus arrhythmia) and showed reductions in stress, anxiety, and depressive symptoms. Mobile and app-directed interventions appeared particularly promising for improving resilience and facilitating recovery after stress. Of the 9 studies, 8 (89%) reported positive outcomes, with 1 (11%) study showing initial increases in stress due to logistical limitations in biofeedback access. Sample sizes were generally small, and long-term follow-up data were limited. Biofeedback interventions in workplace settings show promising short-term results in reducing stress and improving mental health, particularly when incorporating breathing techniques and user-friendly delivery methods such as mobile apps. However, the field remains underexplored in occupational contexts. Future research should address adherence challenges, scalability, cost-effectiveness, and long-term outcomes to support broader implementation of biofeedback as a sustainable workplace mental health strategy.
25. Implementing Good Psychiatric Management in mental health services.
期刊: Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists 发表日期: 2025-Sep-12 链接: PubMed
摘要
ObjectiveGood Psychiatric Management (GPM) is a structured, evidence-based approach for treating borderline personality disorder (BPD). In this study, we aimed to explore the experiences of using GPM within a multidisciplinary mental health team and to identify factors that promote or impede its implementation and practice.MethodsThe study design was informed by interpretive description methodology. Semi-structured, in-person interviews were conducted with staff based at an assertive community outreach service (ACOS) trained in GPM. Interviews were audio-recorded, transcribed and coded by reflexive thematic analysis.ResultsFrom eleven participants of social work, community support work, nursing, psychology, occupational therapy and managerial backgrounds, we identified three main themes: (1) GPM as complementary to practitioners’ values, (2) GPM as empowerment to deliver treatment confidently and consistently and (3) leadership as instrumental for the implementation of a new model.ConclusionsImplementing GPM as a shared model of care has value for health professionals by improving confidence and skills in working with people with BPD and increasing team cohesion. Effective leadership facilitates the introduction of an empirically supported evidence-based model of care, even when there are system constraints. Further research is needed to evaluate the use of GPM in general healthcare settings.
26. Morbidity and Mortality Patterns Among Marginalized Individuals: Insights from a Copenhagen Shelter Health Clinic Cohort.
期刊: Journal of dual diagnosis 发表日期: 2025-Sep-12 链接: PubMed
摘要
Objective: Homelessness is a significant social issue in developed countries, linked to high rates of substance use, psychiatric disorders, and chronic somatic health conditions, which contribute to premature mortality. Despite Denmark’s comprehensive welfare system, marginalized groups, including people in homelessness, face barriers to accessing healthcare, resulting in increased use of acute care services and poorer health outcomes compared to the general population. This study examines the health burden and mortality of some of Denmark’s most marginalized individuals by analyzing registry data from users of a low-threshold healthcare service placed at the open drug scene in Copenhagen, Denmark. Methods: This retrospective cohort study spans seven years (2009-2015). The study includes 1,242 individual health service users identified through patient records from the low threshold service linked with demographic, educational, and healthcare utilization data from Danish registries. No approval from the Danish Research Ethics Committees for the Capital Region was needed since only national registers were used. Results: The population was predominantly male with a median age of 42 years. Most participants were of ethnic Danish origin and had low educational attainment. This study revealed high morbidity, with significant proportions of the population affected by somatic diseases, psychiatric disorders, and substance use disorders, including 56% with Dual Diagnosis and 53% with Dual Diagnosis and somatic disease (Triple Diagnosis). Analysis of mortality showed 158 deaths, predominantly among males, with substance use-related causes and cardiovascular diseases being the leading causes of death. The mean age at death was 47.3 years, with a notable proportion occurring at a relatively young age. Conclusion: Our study reveals a high prevalence of both somatic and psychiatric disorders among the shelter health clinic users. Findings indicate that they are in a similar or often poorer health state than Danish shelter users overall, with a high prevalence of dual diagnoses alongside chronic somatic diseases (Triple Diagnosis) and early disease onset. This highlights the need for targeted support and the implementation of primary prevention measures to slow disease progression and improve healthcare access.
27. The use of telehealth as a strategy to provide occupational therapy services in South Africa.
期刊: Work (Reading, Mass.) 发表日期: 2025-Sep-12 链接: PubMed
摘要
BackgroundDuring COVID-19, healthcare professionals had to adapt their service delivery models to prevent virus transmissions using telehealth as a new service delivery model. Although many health professionals support telehealth, there is a void in the literature that focus on the use of telehealth in occupational therapy.ObjectiveThis study aims to explore the experiences of occupational therapists in the public and private sectors regarding the use of telehealth in OT practice in South Africa.MethodTen participants (occupational therapists who use telehealth as part of their interventions) participated in the study. The majority of the participants were 35 years of age, they were females and had 3.5 months of telehealth experience. The researchers made use of semi-structured interviews and used the process of thematic analysis to give rise to four themes.ResultsFour themes surfaced which represent the experiences and perspectives of the occupational therapists utilising telehealth including the barriers and facilitators: The themes that became evident throughout the thematic analysis comprised (1) Enablers to the use of telehealth; (2) Barriers to telehealth in occupational therapy practice; (3) The use of education and research in strengthening telehealth as a strategy; (4) Strategies to enhance the use of telehealth in occupational therapy practice.ConclusionThe participants addressed the misconception that occupational therapists should not utilise telehealth due to the type of therapy provided, by elaborating on the influence of therapist adaptability and creativity on the integration of telehealth into their practice. Although telehealth minimises geographical barriers and costs associated with travelling, most participants had difficulty conducting assessments and navigating online platforms effectively from a therapist and client perspective.
28. Low back pain in aging populations: A global analysis of disability and healthcare burden over three decades.
期刊: Journal of back and musculoskeletal rehabilitation 发表日期: 2025-Sep-12 链接: PubMed
摘要
BackgroundLow back pain (LBP) has emerged as a critical public health concern whose associated disability burden and healthcare expenditures have been persistently escalating among aging populations worldwide.ObjectiveThis global study analyzed the disability burden of LBP among the older population for over three decades and identified interventions specifically targeting older adults.MethodsRepeated cross-sectional data on LBP among individuals aged ≥65 years from the Global Burden of Disease Study 2021 were extracted and compared to age-standardized rates of LBP incidence and disability adjusted life years (DALYs) across various demographic and geographic categories.ResultsCountries with a high sociodemographic index (SDI), advanced health systems, and high incomes, including North America and the Latin America and Caribbean region, exhibited the highest incidence rates and DALYs of LBP. Occupational ergonomics is still the primary factor for LBP in countries with low SDI, and minimal health level countries. Body mass index (BMI) was substantially increased in all global subgroups, especially in countries with low-middle SDI, limited health systems, world bank low-income level groups.ConclusionAdvanced economic development and healthcare showed a non-linear correlation with LBP. High BMI is projected to become a predominant modifiable risk factor for LBP progression, highlighting the urgent need for the implementation of lifestyle strategies.
29. Long-term exposure to air pollution and cognitive aging: Findings from a United States cohort of older adults.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Sep-12 链接: PubMed
摘要
BackgroundGrowing epidemiologic evidence suggests long-term exposure to air pollution increases the risk of Alzheimer’s disease and related dementias (ADRD) in older adults but research on its effect on early indicators of ADRD is limited.ObjectiveWe examined the effect of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) on cognitive performance and decline in a cohort of older adults.MethodsThis analysis draws from the Ginkgo Evaluation of Memory Study, a clinical trial aimed at understanding ADRD prevention. Participants aged 75 years and older completed an annual neuropsychological battery for up to 8 years. Air pollution was estimated using fine-scale models and accounted for residential history. Cognitive performance at baseline and trajectories of cognitive function across levels of air pollution were estimated using linear mixed regression models. Longitudinal analyses incorporated inverse probability weights to account for differential selection across visits.ResultsThis study included 3044 individuals. Exposure to PM2.5 was associated with slightly worse performance at intercepts for all domains. Higher exposure was not associated with faster declines in cognitive performance over follow-up. Results for NO2 follow a similar pattern.ConclusionsFindings support associations between exposure to higher concentrations of air pollution and worse cognitive performance at baseline, but not cognitive decline.
30. The Role of Susceptibility in the Association Between Exposures and Occupational Contact Dermatitis: A Scoping Review.
期刊: Contact dermatitis 发表日期: 2025-Sep-12 链接: PubMed
摘要
The objective of this review is to identify individual susceptibility factors and determine their role in the association between work-related exposures and contact dermatitis (CD). A scoping review was conducted using Medline, Embase, and CINAHL. Cohort and case-control studies were included for all types of CD, and cross-sectional studies for allergic contact dermatitis (ACD). In the absence of meta-analysis, we drew qualitative inferences summarising the findings. Twenty-one studies, primarily cross-sectional (n = 18), investigated how 44 individual susceptibility factors influenced associations between 53 work-related exposures (from six exposure categories) and CD. These factors were grouped into five categories: demographic, socioeconomic, host-related intrinsic factors, lifestyle, and exposures outside work. The factors variously mitigated, amplified, or had no effect on the exposure-CD association. The role of individual susceptibility factors in work-related exposure-CD associations remains underexplored and inconclusive. Determining their individual contributions is challenging, as studies often adjust for multiple factors, with inconsistent influence on the association. Age, sex, atopic history, hand eczema, smoking, and ethnicity may influence CD risk and should be considered in studies examining work-related exposure-CD associations. Further research is needed to clarify the role of individual susceptibility factors and guide effective prevention strategies for occupational CD.
31. Understanding hepatitis C virus reinfections in England in the context of eliminating viral hepatitis as a public health concern.
期刊: The International journal on drug policy 发表日期: 2025-Sep-11 链接: PubMed
摘要
There is a need to understand how hepatitis C virus (HCV) reinfection may influence achievement of eliminating HCV as a public health concern. We aimed to understand how the rate of HCV reinfection is changing over time, and factors associated with HCV reinfection, when including people who experience multiple reinfections. Data pertaining to individuals treated for HCV and subsequent HCV-RNA testing were extracted from surveillance systems in England. Rates of reinfection were calculated per 100 person-years (PY) between 2018 and 2023, disaggregated by people who had a history of injecting drug use (≥3 years) at first treatment, and recently injected drugs (<3 years), and by time since treatment. Poisson regression was used to understand sociodemographic factors associated with experiencing HCV reinfection. Among 29,448 individuals (74 % men, 84 % White), the reinfection rate was 6.44 (95 %CI:6.25-6.92)/100 PY. Reinfection rates appeared to decrease between 2018-2023, most notably among people who recently injected drugs. Rates among those less than one-year post-treatment remained consistently high. Poisson regression analyses found significantly higher reinfection rates among those one-year post-treatment (61.91 [57.62-66. 51]/100 PY), people who recently injected drugs (11.53 [11.11-11.95]/100 PY), and men (9.91 [9.38-10.46]/100 PY) and women (10.58 [9.36-11.96]/100 PY) who had been in prison. HCV reinfection appeared to decrease over the study period, but people were most at risk in the year post-treatment, which remained constant over time. Harm reduction services should be accessible to people who inject drugs and people who have been in prison, particularly soon after treatment.
32. Prevalence of Obesity, Excess Central Adiposity, and Cardiovascular Risk Among Older Adults.
期刊: JACC. Advances 发表日期: 2025-Sep-11 链接: PubMed
摘要
33. Risky alcohol use and violence against women: cause or consequence?
期刊: The International journal on drug policy 发表日期: 2025-Sep-11 链接: PubMed
摘要
The aim of the current study was to determine (a) whether there is a relationship between the quantity of alcohol consumed by a woman when drinking alcohol and the risk of physical violence and (b) whether experiencing physical violence increases the quantity of alcohol consumed by a woman. The research questions were addressed by fitting a series of random and fixed effect logistic regression models to data drawn from 22 waves of the HILDA survey, a nationally representative longitudinal survey of Australian households. The dataset for the current study involves 143,517 survey responses from 15,934 women. We examine (1) the cross-sectional relationship between alcohol use and physical violence among women (2) the relationship between alcohol use (or violence) at wave t and physical violence (or alcohol use) at wave t + 1 and (3) the within-subject relationship between alcohol use and physical violence (and vice versa). The risk of is nine per cent for a woman who consumes 1-2 standard drinks at a sitting, 15 per cent for a woman who consumes 7 to 8 standard drinks at a sitting and 20 per cent for a woman who normally consumes 13 or more standard drinks at a sitting. Controlling for other factors, a woman who reports having been assaulted in the previous 12 months consumes an average of 13 per cent more alcohol at a sitting than a woman who has not been assaulted in the previous 12 months. Prevention resources are always limited and are therefore best targeted at those who are most at risk, regardless of whether the correlate plays a causal role or is simply a signal of heightened risk. Women reporting they have been assaulted to health, welfare or criminal justice authorities should be assessed to determine whether they also have concurrent drug and alcohol problems.
34. Pre/post-follow-up evaluation of person-centred care education in dementia care for direct care staff in the sub-acute aged rehabilitation setting.
期刊: Geriatric nursing (New York, N.Y.) 发表日期: 2025-Sep-11 链接: PubMed
摘要
To support the holistic needs of persons living with dementia undergoing rehabilitation, an education program informed by the Kitwood model of person-centred care (PCC) was provided to the direct care nursing, medical and allied health staff (n = 66) of one sub-acute aged rehabilitation hospital. A multi-methods pre/post/follow-up study design evaluated participant reactions, learning, behaviour and outcomes. Compared to pre-PCC education, at post- and at 6-months follow-up there were significant improvements in participant PCC confidence (p < 0.001, 95 % CI), knowledge and skills (p < 0.0001, 95 % CI), care quality (p = 0.000, phi = 0.37) and a 17.5 % improvement in service quality (p = 0.369, phi=0.08). PCC was maintained through policy, practice guidelines and communication aids instigated by PCC champions. PCC education is effective when it is accessible, streamlined and includes a range of learning options catering to direct care staff’s preferred learning styles and according to learning needs.
35. Potential heterogeneity of social isolation, loneliness and associations with cognition in the oldest individuals in nursing homes: a latent profile and mediation analysis.
期刊: Geriatric nursing (New York, N.Y.) 发表日期: 2025-Sep-11 链接: PubMed
摘要
This study explored the heterogeneity of social isolation and loneliness among older adults in nursing homes and examined their influencing factors. It also investigated the mediating role of depressive symptoms between different profiles and cognition. A cross-sectional study was conducted in Ningbo, China, involving 453 individuals aged 80 and above from 11 nursing homes. Data were collected on social isolation, loneliness, depressive symptoms, and cognitive function. Analytical approaches included t-tests, analysis of variance, Pearson correlation analysis, ordinal regression, latent profile analysis, and mediation analysis. Three distinct profiles were identified: “socially normal” (52.3 %), “socially frail” (20.1 %), and “highly perceived isolation” (27.6 %). Key protective factors included being male, having education beyond primary level, good subjective socioeconomic status, having two to three children, general and above residential satisfaction, and better basic activities of daily living (all p < 0.01). Depressive symptoms significantly mediated the relationship between social profiles and cognitive function. Social isolation and loneliness among the oldest old in nursing homes are heterogeneous. The findings suggest that loneliness, as a subjective experience, may pose greater psychological and cognitive risks than social isolation, which reflects objective social conditions. The mediation results further indicate that personalized interventions targeting mental health may help preserve cognitive function in this vulnerable population.
36. Supragingival Plaque Microbial Signatures Between Radiation Related Caries and Common Caries.
期刊: International dental journal 发表日期: 2025-Sep-11 链接: PubMed
摘要
The clinical manifestations of radiation-related caries (RRC) differ considerably from those of common caries. This study aims to investigate potential differences in the microbial compositions of supragingival plaque between RRC and common caries. Supragingival plaque samples from 10 RRC and 10 patients with common caries were analyzed using Type IIB Restriction-site Associated DNA sequencing for Microbiome (2bRAD-M). Analyses of microbial diversity, relative abundance and composition were performed. LEfSe analysis was employed to identify differentially abundant species between the 2 groups. Additionally, 24 RRC and 33 common caries samples were examined using qRT-PCR. Species indicators of RRC were identified through random forest analysis. KEGG and COG functional prediction analyses were conducted to assess microbial functional pathways. 2bRAD-M sequencing revealed a significant enrichment of Prevotella conceptionensis, Treponema vincentii, and 4 Nanoperiomorbus species in the RRC group. These findings were further validated by LEfSe and qRT-PCR analyses, which confirmed the dominance of P. conceptionensis in RRC. Random forest analysis identified P. conceptionensis as a potential biomarker for RRC. The bacterial abundance in RRC samples was higher than in common caries, particularly in pathways related to glucose metabolism, including 6-phosphofructokinase activity and sugar transferases involved in LPS biosynthesis. This study uniquely identifies distinct microbial signatures in supragingival plaque associated with RRC compared to common caries. Prevotella conceptionensis was identified as a specific pathogenic bacterium linked to RRC. The underlying mechanisms may involve enhanced microbial glucose metabolism and an inflammatory response mediated by ferroptosis.
37. Development of an Electronic Medical Record-Based Score for Heart Failure Prediction in Cancer Survivors.
期刊: JACC. Advances 发表日期: 2025-Sep-11 链接: PubMed
摘要
Awareness of heart failure (HF) as a long-term complication of cancer has led to an interest in HF surveillance among survivors. However, existing HF risk scores are not tailored for survivors and not designed for the use in electronic medical records (EMRs) or administrative data sets where clinical data such as blood pressure and pathology results are often unavailable. The objective of the study is to develop a cancer-specific incident HF risk score suitable for screening in EMR or administrative data sets. The cancer-specific HF prediction from EMRs in survivor health care (CHERISH) risk score was developed from risk variables identified in 16,191 cancer survivors (mean 61 years; 59.5% female) derived from the UK Biobank. External validation was conducted in a population-based Ontario cohort (n = 446,096; mean 67 years; 53.9% female). HF risk classification with CHERISH was compared against the ARIC (Atherosclerotic Risk In Community)-HF score using area under the curve (AUC). The CHERISH score incorporates 11 clinical variables-age, years since cancer diagnosis, coronary heart disease, arrhythmia, myocardial infarct, diabetes, hypertension, leukemia, non-Hodgkin lymphoma, lung cancer, and breast cancer. CHERISH demonstrated strong prediction of 10-year HF incidence during internal validation (AUC: 0.829), exceeding ARIC-HF (AUC: 0.697; P < 0.001). In external validation, CHERISH showed an AUC of 0.721 in predicting 10-year HF incidence, compared to an AUC of 0.751 (P < 0.001) with ARIC-HF. The integration of the CHERISH score into EMR systems may provide large-scale, automated HF risk assessment in cancer survivors, using routinely collected clinical data.
38. Impact of the COVID-19 Pandemic on the Mental Health of Middle-Aged and Older Adults: A Cross-Sectional, Comparative Study.
期刊: The primary care companion for CNS disorders 发表日期: 2025-Sep-11 链接: PubMed
摘要
Objective: To identify differences in the impact of COVID-19 on mental health in middle-aged and older adults in India. Methods: An online web-based cross- sectional study was carried out in 8 countries during the COVID-19 pandemic. The current study analyzed data from India (the survey was conducted between July 2020 and September 2020). The selection criteria were having internet access, residing in India, and age at least 35 years. Participants aged ≥55 years were categorized as older adults and those aged 35-54 years as middle aged. Data were collected using a structured questionnaire and the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, and Loneliness Scale. Results: The final analysis included 181 older adults and 321 middle-aged adults. There was a higher prevalence of depression and anxiety disorder among middle-aged adults compared to older adults. The difference was significant for depression (χ2=15.09, P<.001), but not for anxiety disorder. Logistic regression analysis found that after adjustment for sociodemographic and psychosocial variables, the presence of either depression or anxiety was significantly associated with age, perception of knowledge of COVID-19, lack of companion, feeling isolated, and feeling left out. Conclusion: Older adults were found to have less depression and anxiety disorder compared to middle-aged adults. Loneliness and perception of knowledge about COVID-19 can affect the association between the presence of mental illness and age. Prim Care Companion CNS Disord 2025;27(5):25m03963. Author affiliations are listed at the end of this article.
39. Comparison of Lung Inflammatory and Transcriptional Responses in Mice and Rats Following Pulmonary Exposure to a Fiber Paradigm-Compatible and Non-Compatible MWCNT.
期刊: Nanomaterials (Basel, Switzerland) 发表日期: 2025-Sep-04 链接: PubMed
摘要
Inhalation of multi-walled carbon nanotubes (MWCNTs) poses potential health risks due to their structural similarity to asbestos and their ability to induce chronic lung inflammation, fibrosis, and lung cancer in animal models. This study investigated the pulmonary inflammatory and transcriptomic responses of two distinct MWCNTs-NM-401 (long, rigid) and NM-403 (short, thin)-in rats and mice using intratracheal instillation at matched dose levels at two post-exposure time points. Both MWCNTs induced acute neutrophilic inflammation and dose-dependent transcriptomic alterations in both species, with NM-403 eliciting a stronger response. Transcriptomic profiling revealed a substantial overlap in differentially expressed genes across materials and species, particularly at the early time point. Fibrosis-associated genes were upregulated in both species, with more persistent expression observed in rats. Acute phase response genes, including Orosomucoid 1 and Lipocalin 2 were commonly induced, while Serum Amyloid A3 and Orosomucoid 2 were selectively upregulated in mice. Functional enrichment analyses showed conserved activation of immune and inflammatory pathways. Our findings show that even short, non-fiber-like MWCNTs can provoke potent and persistent pulmonary effects, challenging assumptions based solely on MWCNT properties. Despite differences in long-term responses, the overall inflammatory and transcriptional profiles showed strong interspecies concordance, suggesting that both rats and mice are relevant models for assessing MWCNT-induced pulmonary toxicity.
40. Evaluating gendered fault lines: Nigeria's COVID-19 stimulus through a feminist political economy and OECD-DAC lens.
期刊: Evaluation and program planning 发表日期: 2025-Sep-03 链接: PubMed
摘要
This paper examines the gender responsiveness of Nigeria’s COVID-19 fiscal stimulus, the Economic Sustainability Plan (ESP), through a feminist political economy lens, using the UN Women-ILO gender assessment toolkit. By analyzing macroeconomic data, sector trends, and policies, it assesses whether the ESP effectively addressed the pandemic’s uneven socio-economic impacts on women, particularly in the informal sector. The results show that although the ESP included interventions for vulnerable groups and women-led businesses, it lacked a comprehensive strategy for gender mainstreaming and failed to address underlying inequalities in care work, labour participation, and access to health and social services. The paper calls for policy reforms that prioritize women’s economic independence and social protection systems. Beyond its policy relevance, this study contributes to evaluation research by demonstrating how macroeconomic stimulus programs can be assessed using OECD-DAC evaluation criteria and a feminist political economy perspective. This demonstrates how gender-sensitive evaluation frameworks can yield valuable insights for national policy design and inform approach shows how gender-sensitive evaluation frameworks can produce insights for national policy design and the international evaluation community. The study adds to the discussion on gender-responsive recovery in Africa by providing evidence-based recommendations for future fiscal policy responses.
41. Factors associated with acute unscheduled care visits for asthma in the all of US dataset.
期刊: The American journal of emergency medicine 发表日期: 2025-Sep-02 链接: PubMed
摘要
Asthma exacerbations can cause patients to visit the emergency department (ED) without prior appointments. This study analyzed factors associated with unscheduled ED visits among asthma patients by examining the All of Us Research Program dataset. We conducted a retrospective cohort study using the All of Us database (2018-2024). Electronic health records (EHR) were utilized to identify asthma patients based on physician-reported asthma diagnoses. Patients were divided into three groups based on ED visit frequency during the study period: General Asthma Patients (no ED visits), Single ED Visit Asthma Patients (one visit), and Frequent ED Visit Asthma Patients (more than one visit). Python and R were utilized to perform a multinomial logistic regression analysis in order to examine demographic factors, social determinants, healthcare accessibility, neighborhood conditions and comorbidities. The research included 47, 227 asthma patients from a total participant pool of 409,420 individuals. The study included 33,046 (70.0 %) General Asthma Patients with no ED visit record, 4779 (10.1 %) Single ED Visit Asthma Patients with a single reported visit and 9402 (19.9 %) Frequent ED Visit Asthma Patients with two or more ED visits. Factors significantly associated with frequent ED visits included income less than $10,000/year (OR = 1.42; 95 % CI [1.25-1.61]), Black/African American race (OR = 2.08; 95 % CI [1.61-2.68]), chest pain (OR = 2.31; 95 % CI [2.16-2.48]), hypertension (OR = 1.19; 95 % CI [1.11-1.28]), respiratory tract infections (OR = 1.60; 95 % CI [1.50-1.71]), anxiety (OR = 1.17; 95 % CI [1.08-1.28]), living near abandoned buildings (OR = 1.20; 95 % CI [1.14-1.26]), and perceived daytime neighborhood unsafety (OR = 1.07; 95 % CI [1.02-1.13]). Protective factors included higher income (>$200,000/year, OR = 0.55; 95 % CI [0.42-0.70]), insurance coverage (OR = 0.65; 95 % CI [0.58-0.71]), older age (OR per year = 0.99; 95 % CI [0.99-0.99]), and male sex (OR = 0.86; 95 % CI [0.81-0.92]). Female patients and younger age were associated with increased likelihood of ED visits. The frequency of unscheduled ED visits for asthma patients was significantly influenced by social determinants which include race, socioeconomic status, neighborhood factors, and specific comorbidities. Understanding these disparities can aid in the improvement of asthma management and the development of targeted interventions to address these critical factors.
42. Heterogeneous Evolution Among SARS-CoV-2 Genes and Variants of Concern.
期刊: Journal of medical virology 发表日期: 2025-Sep 链接: PubMed
摘要
Challenges persist regarding the influence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on public health, with growing interest in future viral molecular variants. In this context, accurate predictions demand a thorough understanding of the virus’s molecular evolution, especially proteins targeted by therapies, where certain discrepancies among studies exist. We analyzed thousands of SARS-CoV-2 genomes to assess the rate of evolution and molecular adaptation in the various SARS-CoV-2 coding regions. We found an overall low genetic diversity along the genome, with fluctuations over time and among genomic regions, and a notable increase in the Omicron variant, especially in the S and ORF6 genes. We also estimated an overall rate of molecular evolution of approximately 10-3 substitutions per site per year, though it varied among genomic regions and over time. Actually, most genomic regions did not follow the strict molecular clock. Regarding selective pressures, the protein-coding regions of SARS-CoV-2 generally exhibited evidence of purifying selection, with local diversifying selection associated with virus transmission and replication. Overall, the molecular evolution of SARS-CoV-2 displays heterogeneity among genomic regions and over time. These findings suggest that forecasting SARS-CoV-2 molecular evolution is not straightforward and remark the importance of continuing to monitor SARS-CoV-2 evolution.
43. Muscle creatine levels and sprint performance in young adult vegans and vegetarians after 7 days of creatine monohydrate supplementation.
期刊: Physiological reports 发表日期: 2025-Sep 链接: PubMed
摘要
Athletes use creatine monohydrate (CM) to enhance high-intensity exercise performance by increasing creatine phosphate availability. While CM supplementation is known to raise muscle creatine levels in vegans and vegetarians, its impact on exercise performance remains uncertain. We examined the effects of CM supplementation on muscle creatine content and exercise performance in vegans and vegetarians. In a randomized, double-blind placebo-controlled design, 15 healthy vegans and vegetarians consumed CM (0.3 g/kg/day, n = 7) or placebo (PLA, 0.3 g maltodextrin/kg/day, n = 8) four times a day for 7 days. Before and after supplementation, repeated sprint capacity was determined. Body mass and fat-free mass (FFM) were assessed by dual-energy x-ray absorptiometry. The CM group increased body mass (1.56 ± 0.57 kg, p < 0.01) and FFM (1.15 ± 0.94 kg, p < 0.05), while the PLA group showed no changes. In the CM group, muscle creatine (Cr) and total muscle creatine (TCr) increased by 18.8 ± 13.1 mmol/kg (p < 0.05) and 30.8 ± 21.2 mmol/kg (p < 0.01), respectively. The PLA group showed no changes in Cr and TCr (-4.6 ± 13.1 mmol/kg and 2.9 ± 11.6 mmol/kg, respectively). Phosphocreatine levels remained consistent within and between groups. There were no observed changes in peak and mean power output during repeated sprints. A seven-day CM supplementation in healthy vegans and vegetarians increased Cr and TCr whereas Phosphocreatine, peak and mean power output during repeated sprints was unchanged.
44. Global Nursing Offices in Academia as a Strategy to Advance the United Nations Sustainable Development Goals: A Historical Case Study.
期刊: International nursing review 发表日期: 2025-Sep 链接: PubMed
摘要
We present a historical case study of the Global Nursing Office (GNO) at the University of Alberta, Faculty of Nursing in Canada, documenting over five decades of global health leadership in nursing education, policy, and research. Academic institutions have a responsibility to contribute to achieving the United Nations (UN) sustainable development goals with the aim of achieving health for all. While there are examples of GNOs in universities worldwide, there remains limited documentation and analysis of how these academic structures operationalize internationalization mandates and influence advances in the nursing profession and global health. We completed a historical case study, using document analysis of archival records, institutional reports, and internal communications from 1970 to date, supplemented by oral history interviews with key stakeholders. The GNO’s development reflects a transformative shift from individual-led initiatives in the 1970s to an academic structure with widespread faculty engagement and strategic global partnerships. Grounded in a philosophy of health equity, cultural humility, and mutual capacity-building, key milestones included the creation of the International Nursing Centre (1998), the Ghana Partnership (1999), and the Pan American Health Organization/World Health Organization Collaborating Centre (2002). Academic nursing leadership can look to existing GNO models for achieving sustainable and impactful outcomes that advance the profession and, most importantly, progress the UN sustainable development goals. We encourage nongovernmental and governmental bodies leading global health efforts to partner with GNOs who can tap into the expertise and services of faculty and students committed to global health advancement.
45. Building a payment model for health coaching in primary care: lessons from Tennessee.
期刊: The American journal of managed care 发表日期: 2025-Sep 链接: PubMed
摘要
To describe Tennessee’s process for convening key stakeholders to develop uniform payment guidelines that encourage increased preventive service delivery and provide lessons learned that can inform similar work in other states. Descriptive case study. Observational. Tennessee’s statewide multistakeholder health care extension cooperative, the Tennessee Heart Health Network, was instrumental in convening major stakeholders, including Medicaid, health plan, and safety-net provider representatives. Stakeholders reached consensus and developed and implemented common guidelines for reimbursement of health coaching services focused on cardiovascular health in the context of team-based primary care. Tennessee’s experience suggests that statewide multistakeholder health care extension cooperatives can facilitate Medicaid and Medicare payment policy alignment and delivery system improvement. they have potential to yield important benefits in state-based efforts to improve access and quality of care.
46. Combined effects of mechanical overload and high-intensity interval training on skeletal muscle hypertrophy in male mice.
期刊: Physiological reports 发表日期: 2025-Sep 链接: PubMed
摘要
Athletes often perform concurrent training that combines different exercise modalities. It is believed that muscle hypertrophic adaptation is inhibited by endurance exercise; however, the molecular mechanisms underlying the effects of high-intensity, short-duration exercise on muscle hypertrophic responses remain unclear. In this study, we determined the effects of high-intensity interval training (HIIT) on mechanical overload-induced muscle hypertrophy in mice. Eight-week-old male mice were divided into the following three groups (n = 6-8): Sham surgery (Sham), myotenectomy-induced mechanical overload (OL), and OL with HIIT by forced swimming (OL + HIIT). After 4 weeks of intervention, the OL + HIIT group exhibited an increase in plantaris muscle weight and muscle fiber cross-sectional area as well as the OL group. The OL + HIIT group showed a similar increase in mTOR downstream proteins rpS6, S6K1, and 4E-BP1 phosphorylation compared with the OL group. AMPK was activated by HIIE and may play an inhibitory role by attenuating mTOR. To clarify its involvement, acute phase experiments were conducted to evaluate mTOR signaling immediately after a single round of HIIE. The increase of rpS6 and S6K1 phosphorylation was unchanged after a single HIIE exposure, despite AMPK upregulation. Our results suggest that interference effects induced by HIIE may not occur in mechanically overloaded mouse skeletal muscle.
47. The Efficacy and Safety of Transcranial Photobiomodulation for Mild Cognitive Impairment Due to Alzheimer's Disease: A Randomized, Double-Blind, Sham-Controlled Study.
期刊: Photobiomodulation, photomedicine, and laser surgery 发表日期: 2025-Sep 链接: PubMed
摘要
Background: Transcranial photobiomodulation (tPBM) is a promising noninvasive neuromodulation modality with potential therapeutic benefits for neurodegenerative diseases. Infrared light delivered by a tPBM device penetrates the cortex, stimulating neuronal activity by increasing mitochondrial adenosine triphosphate production and enhancing regional cerebral blood flow. Objective: This study investigated the efficacy and safety of a self-administered, at-home, wearable tPBM device for improving cognitive function in individuals with mild cognitive impairment (MCI) due to Alzheimer’s disease (AD). Methods: Individuals with MCI due to AD, diagnosed according to the National Institute on Aging and Alzheimer’s Association criteria, with a Korean version of Mini-Mental State Examination-2 (K-MMSE2) score of 23-27 and a global Clinical Dementia Rating (CDR) score of 0.5-1.0 were enrolled. Subjects self-administered tPBM six times per week for 12 weeks. Assessments were conducted at weeks 7 and 13 using the Korean version of the Montreal Cognitive Assessment (K-MoCA), K-MMSE2, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease, and the Geriatric Depression Scale. Results: A total of 26 participants were enrolled. The treatment group showed a statistically significant improvement in K-MoCA scores at week 13 (p < 0.05) compared with the sham group. Although K-MMSE2 scores improved in the treatment group, the difference was not statistically significant. No serious adverse events were reported. Conclusion: Findings suggest that tPBM is an effective and safe home-use intervention for individuals with MCI, with promising therapeutic and preventative roles in Alzheimer’s dementia.
48. Effectiveness and Prognosis of Systemic Chemotherapy for Unresectable Malignant Apocrine and Eccrine Tumors: A Real-World Multicenter Retrospective Study.
期刊: JCO global oncology 发表日期: 2025-Sep 链接: PubMed
摘要
Malignant apocrine and eccrine tumors (MAETs) are extremely rare cutaneous adnexal malignancies, accounting for only 0.005%-0.01% of all skin tumors. These tumors are highly metastatic, and evidence regarding optimal chemotherapy and prognostic outcomes remains limited. This study aimed to evaluate the efficacy of systemic chemotherapy and overall prognosis in Japanese patients with unresectable MAETs. We conducted a retrospective, multicenter study involving 81 patients with unresectable MAETs treated at 27 institutions across Japan. Patients received one of three primary chemotherapy regimens: platinum-based (cisplatin or carboplatin), taxane-based (docetaxel or paclitaxel), or TS-1 (tegafur/gimeracil/oteracil). Patient demographics, objective response rates (ORRs), overall survival (OS), and progression-free survival were assessed. Survival curves were estimated using the Kaplan-Meier method. The estimated ORRs for the platinum-based, taxane-based, and TS-1 groups were 37.0%, 25.0%, and 22.2%, respectively, with no statistically significant differences among them (P = .527). The median OS and 5-year OS rate for the entire cohort were 29.0 months and 34.0%, respectively. The median OS and 5-year OS rates by regimen were as follows: platinum-based, 29.0 months and 36.2%; taxane-based, 22.0 months and 39.7%; and TS-1, 30.0 months and 13.9%, with no significant differences observed (P = .907). In addition, there were no significant differences in ORR or OS between patients receiving combined chemoradiotherapy and those receiving chemotherapy alone. No single chemotherapeutic regimen demonstrated superior efficacy in patients with unresectable MAETs. These findings highlight the need for further investigations using larger, prospective cohorts and multidisciplinary approaches to establish optimal therapeutic strategies for this rare malignancy.
49. Effect of hyperangulated videolaryngoscopy on first-attempt success in tracheal intubations: A systematic review and meta-analysis.
期刊: The American journal of emergency medicine 发表日期: 2025-Aug-28 链接: PubMed
摘要
To determine whether hyperangulated videolaryngoscopy (HAVL) improves first-attempt success (FAS) in adult orotracheal intubations compared to standard-geometry videolaryngoscopy (SGVL), with a focus on emergency settings. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) and comparative observational studies evaluating HAVL versus SGVL in adult tracheal intubations. Comprehensive searches were performed in Ovid MEDLINE, Embase, Cochrane, Scopus, and web of science from inception through November 2024. Risk of bias was assessed using RoB2 and Newcastle-Ottawa tools, and certainty of evidence was rated using GRADE. Both emergency and operating room intubations were included; most emergency data derived from large cohort studies. Of 4445 screened records, 25 studies (17 RCTs, 8 observational; 38,597 patients) were included. HAVL was associated with lower FAS overall (87.2 % vs 91.0 %; pooled RR 0.96, 95 % CI 0.94-0.99; p = 0.002). In emergency intubations (8 studies; n = 34,927), HAVL yielded reduced FAS (RR 0.97, 95 % CI 0.95-0.99; p = 0.003). There was no significant difference in difficult airways (RR 0.98, 95 % CI 0.92-1.05; p = 0.57). HAVL was linked to higher rates of airway trauma (7.5 % vs 2.9 %; RR 1.88, 95 % CI 1.01-3.49; p = 0.046) and numerically more adverse events. Certainty of evidence was low due to risk of bias and heterogeneity. In emergency intubations, HAVL was associated with lower first-attempt success and increased airway trauma compared to SGVL. These findings support prioritizing SGVL for emergency airway management, with careful operator training if HAVL is used.
50. The impact of Long-term Care Insurance on household income inequality: Evidence from China.
期刊: Economics and human biology 发表日期: 2025-Aug-14 链接: PubMed
摘要
The stable performance of the national economy constitutes a vital component in achieving common prosperity. As a crucial element of the social security system, evaluating the actual effectiveness of Long-Term Care Insurance (LTCI) in providing a safety net for families has emerged as a core issue in current policy implementation. This paper explores the impact and mechanisms of LTCI policies on household income inequality, based on three waves of data from the China Health and Retirement Longitudinal Study (CHARLS) in 2013, 2015, 2018, and 2020, along with macro-level data from various provincial-level administrative regions. The study finds that the introduction of the LTCI policy has significantly mitigated the level of household income inequality in pilot areas. This mitigating effect exhibits significant heterogeneity concerning medical payment risk and across urban and rural regions. Furthermore, the findings demonstrate that LTCI contributes positively to reducing household income inequality primarily through two mechanisms: the social job creation effect and the reduction in family caregiving burden. Based on these findings, the research provides valuable insights for bridging income inequality and achieving common prosperity.
51. Sun protection behavior beliefs among adults living in rural United States: A qualitative study in Minnesota.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Although skin cancers are considered mostly preventable, more people in the US are diagnosed with skin cancer than all other cancers combined. Sun safety recommendations include wearing sun-protective clothing, a wide-brimmed hat, seeking shade, and using sunscreen. Some evidence exists that sun risk behaviors and skin cancer rates are more frequent among rural than urban US populations, raising questions about underlying factors. We conducted a belief elicitation survey on these four sun protection behaviors among 278 adults (aged 18-60 years) living in rural Minnesota, a state with high sunburn rates and UV-attributable melanoma cases. These qualitative data were analyzed using content analysis, and the identified codes ranked by frequency. Almost all participants emphasized that spending time outside was important to them. The most frequently reported sun protection behaviors were wearing sunscreen and protective clothing. The primary outcomes were obtained from open-ended questions on outcome, normative, and control beliefs associated with each sun protection behavior. While many different beliefs were mentioned, reducing sunburn and skin cancer risk were commonly reported across all behaviors. Beliefs about negative aspects of each behavior (e.g., interference with being physically active or doing work outside, greasy/sticky sunscreen, not getting a suntan, overheating in long clothes or when wearing hats, hats that blow off easily) typically outnumbered positive aspects (e.g., protective behaviors enabling being outside, staying cool in shade, reduced skin aging). The majority of participants believed that most people would approve of all protection behaviors, but many thought that age was a factor for behavior adoption, with young people typically thought to engage less in protective behaviors. Some commonly reported negative aspects of sun protective behaviors were related to activities more common in rural populations, such as working outside. This suggests that rural sun protection promotion may include structural interventions to make sun protection easy, convenient, and accessible without impeding rural lifestyles.
52. Support To Rural India's Public Education System (STRIPES2) and impact on numeracy and literacy scores: A cluster randomized trial in rural villages of Madhya Pradesh, India.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Rates of primary school enrolment have improved in India, but levels of learning achievement remain low. In the Support To Rural India’s Public Education System (STRIPES) trial, a para-instructor intervention improved numeracy and literacy levels in Telangana, India (2008-10). The STRIPES2 trial was designed to assess whether a similar intervention in a younger cohort of children would have similar effects in Satna and Maihar districts of Madhya Pradesh, India, and be cost-effective. In this Madhya Pradesh cluster-randomized controlled trial, 196 villages (clusters) were randomized to receive either a health (CHAMPION2: community health promotion and medical provision and impact on neonates) or education (STRIPES2) intervention. Villages receiving the health intervention were controls for the education intervention and vice versa. For children newly enrolled in primary school, the STRIPES2 intervention comprised before/after-school classes (2 hours per day, 6 days a week) given by trained para-instructors from the local community, frequent monitoring, and engagement with caregivers to motivate children, delivered by the Pratham Education Foundation. STRIPES2 activities had to be suspended twice for around ten and a half months, and some components of the intervention modified due to the COVID-19 pandemic. The period of the trial was extended with the primary outcome (a composite literacy and numeracy score of Early Grade Reading and Mathematics Assessments) assessed around 30 months after classes started. Composite test scores were significantly higher in the intervention arm (98 villages; 3054 children) than in the control arm (98 villages; 3275 children) at the end of the trial. The mean difference on a percentage point scale was 14.17; 95% CI 11.36 to 16.97; p < 0.001, equating to a 0.58 (95% CI 0.47 to 0.71) standard deviation difference. The cost per child per 0.1 SD increase in composite test score was INR 2476 (US$33.5). Despite COVID-19 interruptions and disruptions, STRIPES2 resulted in a major improvement in children’s literacy and numeracy. However, the cost of achieving such benefits was substantial.
53. Invisible inequities in type I diabetes care in India: A multi-stakeholder qualitative study from Karnataka.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Type 1 Diabetes mellitus (T1DM) affects a substantial population in India, with significant challenges related to healthcare access and financial burden. This study aims to explore the multi-level barriers and enablers of T1DM care in Karnataka state, providing evidence-based recommendations for policymakers to improve healthcare services. This qualitative study employed in-depth interviews (IDIs) and focus group discussion (FGDs) with multiple stakeholders, including ten People with Type-1 Diabetes Mellitus (PwT1DM) aged 5-23 years and their caregivers, 13 Healthcare providers (HCPs) -Endocrinologists, paediatricians, diabetes educators, and primary care physicians; and ten senior health officials and six Policymakers. Participants were selected using purposive sampling from both urban and rural settings across Karnataka. Data was collected over six months, and qualitative research software was used to analyse the transcribed data thematically. The study was approved by the Institutional Ethical Committee of M.S. Ramaiah Medical College. Significant obstacles include inadequate integration of policies within India’s national framework, erratic insulin availability, substantial out-of-pocket costs, and insufficient training for healthcare providers. Rural demographics face compounded disadvantages due to poor healthcare infrastructure, while caregivers, especially mothers, struggle with financial and emotional burdens; People with TIDM endure social stigma and mental health issues, particularly affecting females. The study highlights the critical need for formulating dedicated T1DM policies within the framework of the existing Non-Communicable Disease program. Implementation of subsidized insulin schemes and expansion of primary care services, along with a multi-sectoral strategy, encompassing enhanced training for HCPs, integration of digital health solutions, and development of community-based support systems, is essential for effective and sustainable T1DM management. Addressing financial and gender-based disparities is crucial to ensure equitable care in both urban and rural areas.
54. Trends and inequalities in full immunization coverage among two-year-olds in Sierra Leone, 2008-2019.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Immunization is a cornerstone of public health, preventing numerous vaccine-preventable diseases. However, disparities in immunization coverage persist globally, particularly in low-income countries like Sierra Leone. This study aims to examine the trends and socioeconomic and geographic inequalities in full immunization coverage among two-year-olds in Sierra Leone between 2008 and 2019. This study utilised data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. The Health Equity Assessment Toolkit software developed by the World Health Organisation was used to calculate various inequality measures, including Difference, Ratio, Population-Attributable Risk, and Population-Attributable Fraction. An assessment of inequality was conducted across six stratifiers: maternal age, maternal economic status, maternal education level, place of residence, child sex, and sub-national province. Between 2008 and 2013, the coverage of full immunization coverage among two-year-olds in Sierra Leone increased from 41.1% in 2008 to 73.1% in 2013; however, the coverage decreased to 50.4% in 2019. The inequality associated with maternal age, sex of the child, and sub-national level increased between 2008 and 2019. However, the results were not statistically significant for maternal age and sex of the child. Similarly, inequalities existed with economic status, education, and place of residence steadily decreased over the same period, but the results were also not statistically significant. The study’s findings highlight the need for sustained efforts to improve immunization coverage in Sierra Leone. While there was progress between 2008 and 2013, the subsequent decline emphasizes the importance of maintaining vital immunization programs. Addressing the significant regional disparities, particularly the gap between the southern and northern regions, is recommended. This requires targeted interventions to improve access to immunization services, strengthen health systems, and address the northern region’s underlying social and economic factors. Additionally, ongoing monitoring and evaluation are essential to identify and address emerging challenges and ensure equitable access to immunization for all children in Sierra Leone.
55. Health-economic evaluation of statins versus lifestyle changes for cardiovascular disease prevention.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The German Federal Ministry of Health aims to improve cardiovascular health by expanding statin eligibility. However, the shift in funding from lifestyle-based preventive programs to statins has raised concerns that existing prevention efforts could be undermined. This study assessed the cost-effectiveness of statins compared with lifestyle interventions for the prevention of cardiovascular disease (CVD) in Germany under constrained healthcare budgets. A cost-effectiveness analysis was conducted using secondary data. Effectiveness data for statins were drawn from meta-analyses and systematic reviews, showing a 26% reduction in major cardiovascular events. Lifestyle intervention data were derived from the US Preventive Services Task Force (2020), reporting a relative risk of 0.80 for CVD events. A z-score test compared the effectiveness, while a Bayesian analysis assessed the probability of statins being more effective. Costs were analyzed from the perspective of German statutory health insurance (SHI) enrollees, including copayments and treatment monitoring expenses. The z-score of -1.26 (p = 0.207) indicated no statistically significant difference in the effectiveness of statins compared to lifestyle interventions. However, Bayesian analysis estimated an 89.7% probability that statins are more effective. Statins were generally cheaper, especially when preventive courses are repeated annually. Statins likely offer higher cost-effectiveness than lifestyle changes, though the difference in benefits is not statistically significant. Concerns about reallocating funds from lifestyle programs to statins are somewhat mitigated by these findings.
56. Relationship between Sn elemental background values and regional longevity levels-Data from Yunnan, China.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The relationship between the geographic environment and human health has been a long-standing focus of scientific inquiry. Sn as an essential trace element for the human body, play vital roles in individual health and may influence longevity. However, the extent to which the statistical characteristics of population longevity are associated with elemental geochemical background values at a regional scale remains an important question. Based on the geochemical survey data of Yunnan Province and Chinese census data, the article utilizes Arcgis spatial analysis and mathematical statistics to explore the relationship between ω(Sn) and regional longevity level. The results of the study show that: (1) There is a close correlation between ω(Sn) and regional longevity levels. Within Yunnan Province, regions with high ω(Sn) have higher levels of longevity index and Ultra-octogenarian Index. (2) Spearman’s correlation coefficient shows that ω(Sn) is significantly positively (P < 0.01) correlated with both the longevity index and the Ultra-octogenarian Index; Linear regression further reveals that ω(Sn) always has a significant positive influence on the longevity index. For the Ultra-octogenarian Index, although the strength of the influence of ω(Sn) is not as significant as that of the longevity index, its influence on the healthy longevity of the population cannot be ignored. At the county scale in Yunnan Province, there is a significant positive correlation between ω(Sn) and longevity index, which may be related to the exposure of Sn in the natural environmental background into the human body and thus affecting the incidence of cancer, but the biogeochemical cycling mechanism of its association with longevity still needs to be further investigated.
57. The increase in varus tilt of the joint line convergence angle under weight-bearing is correlated with medial meniscus extrusion in patients with knee osteoarthrosis.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Increased medial meniscus extrusion (MME) in weight-bearing conditions is a critical factor associated with knee osteoarthritis (OA) progression and is not an alternative indicator in nonweight-bearing. This feature is related to mechanical stress. However, its correlation with varus knee alignment, reflecting the loading stress on the medial compartment, is still unknown. This study aimed to determine whether increased MME is associated with varus limb alignment. Seventy patients with knee OA were recruited for this cross-sectional study. The MME was assessed using ultrasonography. Knee alignments were determined by whole-leg radiography in the standing position, and factors related to the loading stress on the medial compartment of the knee joint were detected, such as the hip-knee-ankle angle, percentage of the mechanical axis, medial proximal tibial angle, and joint line convergence angle (JLCA). MME and JLCA were evaluated under two conditions: nonweight-bearing and weight-bearing, and the increased values were determined as the difference between the conditions (Δ values). MME and JLCA were significantly higher in the weight-bearing condition than in the nonweight-bearing. The described alignment for MME under nonweight-bearing in the liner model was HKAA, where the ΔMME was ΔJLCA. The factors of increased MME in weight-bearing conditions differed from those of MME in nonweight-bearing conditions, as shown by the amount of change in JLCA under loading stress.
58. Pulsed electric field (PEF)-processed 6-shogaol-rich ginger extract protects β-Thalassemic red blood cells from iron-induced oxidative stress and hemolysis.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
β- thalassemia is the genetic blood disorder characterized by ineffective beta-globin chain synthesis. The increased iron absorption and frequently blood transfusion result in iron overload and the production of reactive oxygen species (ROS). ROS causes lipid peroxidation and membrane damage in red blood cells (RBCs), culminating in hemolysis and anemia. This study investigated the protective effects of ginger extract against iron induced oxidative damage in thalassemic RBCs. The pulsed electric field (PEF) technique with high-voltage electric pulses, was used for ginger extraction. The PEF significantly enhanced the yield of bioactive compounds, 6-shogaol and total phenolic content compared to conventional maceration technique. The 6-shogaol-rich ginger extract possessed a potent antioxidant activity by scavenging free radicals (ABTS•+ and DPPH•), and inhibiting of AAPH-induced RBC hemolysis in both healthy and β-thalassemic RBCs. Additionally, the extract exhibited iron-chelating properties by decreasing non-heme iron levels on the RBC membrane, thereby reducing lipid peroxidation reaction. These findings suggest that 6-shogaol-rich ginger extract processed with PEF could serve as a potential therapeutic agent, exhibiting powerful antioxidant and red blood cell membrane iron-chelating properties to protect against oxidative damage and hemolysis in iron-overloaded β-thalassemia patients.
59. A multi-group path analysis of medication documentation quality using cross-sectional survey data: Impact of leadership, job satisfaction, patient-related burnout, and patient safety culture.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Medication-related adverse events are a major problem for patient safety and quality of care. This study explored the effects of leadership, job satisfaction, patient-related burnout and patient safety culture, measured through surveys of frontline workers, on documentation quality. Perceptions of physicians and nurses were surveyed using established instruments including the Transformational Leadership Inventory, the Copenhagen Psychosocial Questionnaire, the Copenhagen Burnout Inventory, and the Hospital Survey on Patient Safety Culture. Documentation quality was evaluated using retrospective review of patient records with the MediDoq instrument. Data from 24 departments, covering 282 physicians, 417 nurses, and 802 patient records, were analysed through a multi-group (physicians and nurses) path analysis to evaluate the theoretical model. The theoretical model revealed satisfactory fit, explaining about 76-80% of the variance in Documentation Quality for physicians and nurses. Perceived Patient Safety had a significant effect on Documentation Quality only for nurses. The analyses revealed differences between professional groups. Based on these results, (i) medication documentation quality may be affected by various organizational factors; (ii) perceived Patient Safety reported by the nurses may mediate some of these effects; (iii) the effects of various organizational factors on documentation quality may vary significantly across professional groups.