公共卫生研究摘要 (2025-09-16)
共收录 52 篇研究文章
1. Risk of Epilepsy and Factors Associated With Time to Seizure Remission in Anti-LGI1 Encephalitis: Long-Term Outcome in 236 Patients.
期刊: Neurology(R) neuroimmunology & neuroinflammation 发表日期: 2025-Nov 链接: PubMed
摘要
Autoimmune encephalitis (AIE) with anti-leucine-rich glioma-inactivated 1 (LGI1) antibodies typically manifests with subacute cognitive deficits, seizures, and psychiatric symptoms, mostly in older adults. Immunotherapy (IT) leads to the cessation of seizures in most patients, yet some develop AIE-associated epilepsy (AEAE) and persistent cognitive deficits. The aim of this large multicentric retrospective observational cohort study was to assess long-term outcomes of patients with anti-LGI1 encephalitis regarding seizures and AEAE and to identify associated factors. We included patients with anti-LGI1 encephalitis from 3 national referral centers/consortia meeting the following inclusion criteria: (I) definite LGI1 limbic encephalitis (Graus criteria); (II) occurrence of seizures; and (III) follow-up period ≥24 months. We aimed to (1) determine the risk of seizure recurrence (ROSR) on remission, (2) investigate clinical and paraclinical biomarkers for an effect on time to seizure remission using Cox proportional hazard modeling (n = 188), and (3) assess the risk of AEAE and determine associated factors (n = 236). AEAE was observed in 5.9% (16/271) of the full cohort. Both AEAE (16/16 vs 129/215, p = 0.001) and longer time to seizure remission (OR 1.36 per year, p = 0.025) were associated with persistent cognitive impairment. Patients with pilomotor seizures had a lower rate of seizure remission (hazard ratio [HR] 0.58, 95% CI 0.55-0.60, p < 0.001) while patients under IT administration had a higher rate of seizure remission over time (HR 12.4, 95% CI 9.67-16.0, p < 0.001). In addition, patients receiving second-line IT tended to achieve earlier seizure remission (log-rank test, p = 0.019). The ROSR at 12, 60, and 120 months on seizure remission was 9% (95% CI 4.5%-13%), 20% (95% CI 11%-28%), and 53% (95% CI 14%-74%), respectively. In conclusion, our results demonstrate that AEAE in anti-LGI1 encephalitis is rare and suggest that the diagnosis of epilepsy is inappropriate in patients reaching seizure remission because of a relatively low ROSR. Accordingly, on seizure remission, the diagnosis of acute symptomatic seizures would be appropriate. Moreover, we validate and quantify the importance of IT for seizure remission and identify biomarkers associated with lower rates of seizure remission. Late remission of seizures and AEAE were associated with persistent cognitive impairment.
2. Pearls & Oy-sters: Adult-Onset Coats Plus: A Case of Leukoencephalopathy With Calcifications, a Tumefactive Brain Lesion, and a Presumed Autoimmune Disease.
期刊: Neurology 发表日期: 2025-Oct-07 链接: PubMed
摘要
Coats plus (Cp) is a pleiotropic disorder with multisystemic manifestations including retinal vascular disease and leukoencephalopathy with intracranial calcifications and cysts. It is an autosomal recessive telomere biology disorder mostly associated with compound heterozygous defects in CTC1 gene. Cp typically presents in early childhood with poor long-term prognosis. In this study, we describe the case of a 46-year-old woman presenting with a first unprovoked seizure in the setting of 2 years of progressive behavioral and cognitive deterioration. Her medical history was notable for retinal vascular disease, anemia, restrictive lung disease under consideration for transplantation, osteoporosis, and infertility, with persistently elevated antinuclear antibodies concerning for a possible systemic autoimmune disease. She had been treated with chronic immunosuppression for the previous 9 years without a clear response, although with poor compliance. Her family history was unremarkable. Brain MRI revealed an asymmetric leukoencephalopathy with a gadolinium-enhancing tumefactive lesion and intracranial calcifications. Acquired etiologies such as malignancy, inflammatory, and infectious diseases were excluded. Despite adult onset, absence of family history, and asymmetrical MRI brain findings, we then considered a genetic autoinflammatory or neurovascular syndrome. Sanger sequencing of the TREX1 gene excluded retinal vasculopathy with leukoencephalopathy and systemic manifestations (RVCL-S). A large multigene panel for neurologic diseases identified a homozygous pathogenic in-frame deletion in the CTC1 gene (NM_025099.6:c.2954_2956del), establishing the diagnosis of Cp. This case broadens the clinical spectrum of Cp to include a milder adult-onset phenotype. Moreover, it highlights Cp as a potential mimic of autoimmunity, with the need to question previously presumed diagnoses.
3. Circadian-informed modeling predicts regional variation in obesity and stroke outcomes under different permanent US time policies.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Sep-23 链接: PubMed
摘要
Seasonal changes in time policy, such as switching between Standard Time (SDT) and Daylight Saving Time (DST), have been adopted by many countries, including the United States. While transitioning between SDT and DST has notable acute negative population health impacts, the chronic impact of these time policies on health has not been well evaluated. To estimate the impact of permanent SDT or DST on health, we modeled the circadian impact of SDT, DST, and Biannual Shifting (BAS) across a year in the contiguous, continental United States. We find that BAS produces a greater burden on the circadian system as compared to either permanent SDT or DST. Chronotype as well as location (latitude and location within time zones) impact this burden. Analyzing these data relative to county-level health data (Centers for Disease Control and Prevention Places dataset), we find that, under idealized light exposure conditions and after controlling for health and socioeconomic factors, there would be a decrease in the prevalence of both obesity [[Formula: see text]0.78% ([Formula: see text]0.06% to [Formula: see text]1.49%)] and stroke [[Formula: see text]0.09% ([Formula: see text]0.04% to [Formula: see text]0.14%)] under SDT compared with the current policy. The prevalence of both obesity [[Formula: see text]0.51% ([Formula: see text]0.09% to [Formula: see text]0.93%)] and stroke [[Formula: see text]0.07% ([Formula: see text]0.04% to [Formula: see text]0.09%)] would also decrease under permanent DST, though to a lesser degree. Our data, reflecting the impact of time policy on circadian burden and subsequent health benefits, support the cessation of BAS.
4. Earliest evidence of smoke-dried mummification: More than 10,000 years ago in southern China and Southeast Asia.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Sep-23 链接: PubMed
摘要
In southern China and Southeast Asia (collectively, Southeastern Asia), Terminal Pleistocene and Early to Middle Holocene (ca. 12,000 to 4,000 cal. BP) hunter-gatherer burials feature tightly crouched or squatting postures, sometimes with indications of post-mortem dismemberment. Such burials contrast strongly with the extended supine burial postures typical of subsequent Neolithic inhumations in these regions. Their contorted postures, often with traces of burning, present interpretive challenges. This study uses multiple techniques, including X-ray diffraction and Fourier-transform infrared spectroscopy, to investigate 54 pre-Neolithic burials from 11 archaeological sites located across Southeastern Asia. The findings confirm that many of these pre-Neolithic flexed and squatting burials were treated by an extended period of smoke-drying over fire, a process of mummification similar to that recorded ethnographically in some Australian and Highland New Guinea societies. Some of the analyzed archaeological samples represent the oldest known instances of such artificial mummification in the world.
5. Obesity, Weight Loss, and Knee Osteoarthritis: The Role of Glucagon-Like Peptide-1 Receptor Agonists.
期刊: Annals of internal medicine 发表日期: 2025-Sep-16 链接: PubMed
摘要
6. The Cost-Effectiveness of Semaglutide and Tirzepatide for Patients With Knee Osteoarthritis and Obesity.
期刊: Annals of internal medicine 发表日期: 2025-Sep-16 链接: PubMed
摘要
Glucagon-like peptide-1 receptor agonists (GLP1RAs) lead to substantial weight loss and pain reduction in persons with knee osteoarthritis and obesity. To evaluate the cost-effectiveness of 2 GLP1RAs, semaglutide and tirzepatide, for patients with osteoarthritis and obesity. Osteoarthritis Policy Model, a validated microsimulation model of knee osteoarthritis, to estimate lifetime benefits and costs of weight loss strategies. Published data to derive treatment-related weight loss, pain reduction, and costs of GLP1RAs from the U.S. Office of Health Policy. Persons with knee osteoarthritis and obesity in the United States. The base-case cohort had a Western Ontario and McMaster Universities Osteoarthritis Index pain score of 71 (0 to 100, 100 worst) and a mean body mass index (BMI) of 40 kg/m2. Lifetime. Health care, societal. Semaglutide, tirzepatide, laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and diet and exercise. Quality-adjusted life-years (QALYs), cost, and incremental cost-effectiveness ratios (ICERs). Tirzepatide provided greater health benefits at lower costs than semaglutide and yielded a $57 400 per QALY ICER versus diet and exercise. For those eligible, RYGB provided greater health benefits at lower costs than the 2 GLP1RAs and had a $30 700 per QALY ICER versus LSG. Tirzepatide’s ICER was most sensitive to changes in medication costs, treatment efficacy, and cohort baseline BMI. Tirzepatide had a 64% and semaglutide had a 34% probability of being cost-effective at a $100 000 per QALY threshold. Data from multiple sources. Both tirzepatide and semaglutide would be widely considered cost-effective when compared directly with usual care. Tirzepatide would offer the most favorable return on investment to decision makers whose cost-effectiveness thresholds exceed $57 400 per QALY. The Arthritis Foundation and National Institute of Arthritis and Musculoskeletal and Skin Diseases.
7. Identifying Core Clinical Topics and Recommending Core Performance Measures for Internal Medicine Physicians: A Position Paper From the American College of Physicians.
期刊: Annals of internal medicine 发表日期: 2025-Sep-16 链接: PubMed
摘要
Internal medicine physicians are specialists who promote health, emphasize disease prevention, manage complex acute and chronic conditions in adults, and receive extensive training in the diagnosis and treatment of diseases affecting all systems of the human body. As a result, internal medicine performance measures (PMs) target several topics. Many PMs are not based on high-certainty evidence of at least moderate net benefit and are burdensome, with low or no value to patient care. The American College of Physicians (ACP) wants to provide a national focus to improve the quality of health care in the United States. The ACP is a leader in the evidence-based world, being the only physician organization designated as a GRADE (Grading of Recommendations Assessment, Development and Evaluation) Center, an Appraisal of Guidelines for Research and Evaluation (AGREE) Center, and a member of the Cochrane U.S. Network. Using a structured, stepwise, evidence-based approach, ACP identified the most important clinical topics evaluated and treated by internal medicine physicians. The ACP is also actively working toward recommending essential PMs for each core clinical topic that can be used to evaluate and improve patient care. This position paper describes ACP’s method and results of identifying core clinical topics. It also offers a blueprint for defining core PMs and illustrating the principals through application to 2 core clinical topics. The ACP plans to apply this method on PMs for other core clinical topics.
8. Unhealthy Alcohol Use Among Gay, Bisexual, and Other Men Who Have Sex with Men (GBMSM): A Concept Clarification.
期刊: Issues in mental health nursing 发表日期: 2025-Sep-15 链接: PubMed
摘要
Unhealthy alcohol use includes a range of drinking behaviors that pose health risks. Among gay, bisexual, and other men who have sex with men (GBMSM), factors including minority stress exacerbate these risks. However, inconsistencies in defining unhealthy alcohol use in research hinder effective screening and intervention. A clearer conceptual understanding is essential for improving nursing care and public health strategies. This article aims to clarify the concept of unhealthy alcohol use among GBMSM using the Norris method of concept clarification. A selective literature review identified 20 sources. The Norris framework was applied to examine unhealthy alcohol use through its antecedents, attributes, and consequences. Findings were synthesized to develop an operational definition and a conceptual model. Unhealthy alcohol use among GBMSM is defined as a pattern of drinking that exceeds established low-risk guidelines and/or causes harm, often influenced by stigma, discrimination, and permissive social norms, thereby increasing vulnerability to adverse health outcomes, including co-occurring substance use, HIV risk, and chronic conditions. Nurses are well-positioned to address unhealthy alcohol use in GBMSM communities through culturally competent screening, education, and interventions. Conceptual clarity supports research, policy, and practice by integrating quantitative thresholds with sociocultural influences and guiding targeted strategies to improve GBMSM health outcomes.
9. Securing the Future of NMR Metabolomics Reproducibility: A Call for Standardized Reporting.
期刊: Analytical chemistry 发表日期: 2025-Sep-15 链接: PubMed
摘要
Metabolomics is a rapidly growing multidisciplinary field with ever increasing demand and usability, which is attracting a surge of new researchers. While their varied skill sets, scientific questions, and approaches enrich the field with fresh perspectives and innovation, individual investigators also bring wide-ranging levels of metabolomics-specific experience and diverse areas of interest. These factors introduce considerable variability and inconsistency in both the methodology and reporting. A recent comparative literature review of nuclear magnetic resonance (NMR) metabolomics from studies published in 2010 and 2020 revealed significant shortcomings in the reporting of experimental details necessary for evaluating both the scientific rigor and the reproducibility of NMR-based metabolomics experiments. Each stage of metabolomics research contains multiple methodological choices and various optimization parameters, all of which can introduce experimental bias and alter the study results. This emphasizes the need for proper reporting to enhance reproducibility, data reusability, and study comparability. To address these concerns, the NMR Special Interest Group within the Metabolomics Association of North America presents reporting recommendations focused on fundamental aspects of NMR metabolomics research identified from the detailed literature review report. These include specifics with respect to study design, sample preparation, data acquisition, data processing and analysis, data accessibility, and comparability to previous studies. Also presented is a complementary list of seminal papers in the field to guide the study design and implementation of NMR metabolomics experiments. This initiative seeks to enhance the long-term impact of NMR metabolomics by supporting high-quality, reproducible, and impactful data collected from well-executed and thoroughly reported studies.
10. Viewpoint on the Intersection Among Health Information, Misinformation, and Generative AI Technologies.
期刊: JMIR infodemiology 发表日期: 2025-Sep-15 链接: PubMed
摘要
In recent years, artificial intelligence (AI) has seen rapid advancements, with innovations such as large language models and generative AI evolving at a rapid pace. While this progress offers tremendous opportunities, it also presents risks, particularly in the creation, consumption, and amplification of information and its impact on population health and health program delivery. Thoughtful approaches are necessary to navigate the consequences of advances in AI for different health care professionals and patient populations and from a policy and governance perspective. Through a collaboration between the World Federation of Public Health Associations working groups, this Viewpoint article brings together perspectives, concerns, and aspirations from young adult professionals across 5 continents and from diverse backgrounds to explore the future of public health and AI in the context of the changing health information environment. Our discussion is divided into 2 parts, specifically examining aspects of disinformation and AI, and also the role of public health and medical professionals in a growing AI-driven health information ecosystem. This Viewpoint concludes with 5 key recommendations on how to potentially address issues such as information and disinformation overload; misinformation propagation; and resultant changes in health practices, research, ethics, and the need for robust policies that can dynamically address current and future challenges.
11. Integration of Screening and Referral Tools for Social Determinants of Health and Modifiable Lifestyle Factors in the Epic Electronic Health Record System: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-15 链接: PubMed
摘要
Recent health behavior interventions combine social determinants of health (SDOH) and biosocial perspectives, refocusing from the individual to broader societal contexts under the SDOH approach. Targeting modifiable health behaviors can significantly reduce disease risk and save up to 30% of health care costs. Screening tools individual and societal factors are being increasingly integrated into electronic health record (EHR) systems. Epic Systems is a leading, most adopted EHRs worldwide, with modules on SDOH and modifiable risk factors. Literature on integration and use of screening tools for SDOH and modifiable risk factors is lacking. This review aimed to (1) summarize evidence integrating screening and referral tools for SDOH and modifiable risk factors including tobacco/alcohol use and physical inactivity in the Epic EHR; (2) synthesize findings on implementation methods, processes, clinical workflow modifications, and outcomes from integrating SDOH screening and referral tools in EHR systems; and (3) capture the major barriers, facilitators, and lessons learned across the included implementation studies. We followed Joanna Briggs Institute’s guidelines, Arksey and O’Malley’s framework, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We included 3 peer-reviewed databases, 2 gray literature sources, and citation chaining from related reviews and articles. All included studies (n=43) were from 24 US states; 26 reported quantitative methods, 12 reported mixed methods, and 6 were qualitative studies across various health settings. Most studies focused on adults, with the top 3 SDOH domains being housing, food and transportation, while physical activity, alcohol and tobacco were the most common modifiable risk factors. The top 3 SDOH domains were housing, food, and transportation, while physical activity, alcohol, and tobacco use were the most common risk factors targeted. Various screening tools were used, with the Protocol for Responding to & Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) being used the most across 6 studies. Most integrations used enhanced support or optimized workflows, with MyChart and Best Practice Advisories being the most used Epic modules and functions. MyChart was the most patient-accepted module. Screening and referral patient outcomes varied, with many studies presenting a significant impact. The most important integration facilitators included leadership support, dedicated clinical champions, and well-defined roles; barriers included clinician time, inefficient workflows, and the availability of devices and staff to ensure integrated tools’ usage. Integration of SDOH and modifiable risk factors in the Epic EHR is being increasingly adopted to capture and target equitable health services. While Epic is among the most globally adopted EHRs, studies are primarily from the United States. Epic’s SDOH wheel module is insufficient in capturing context-based SDOH and behavioral domains. Need for contextual standardization of SDOH and modifiable risk factor domains and EHR tools is being increasingly felt. Future research is needed for enhanced learning, improvement and use of built-in and customized tools, standardization, and processes for integrating targeted patient-centered interventions.
12. Measuring 24-hour Movement Profiles During Pregnancy: Protocol for the 24MOVE Prospective Cohort Study.
期刊: JMIR research protocols 发表日期: 2025-Sep-15 链接: PubMed
摘要
Physical activity (PA) during the waking period and sleep during pregnancy may mitigate the increased risk for adverse pregnancy outcomes posed by gestational diabetes mellitus (GDM) and excessive gestational weight gain (GWG) in pregnant individuals with pre-pregnancy overweight and obesity. Recent studies have conceptualized PA, sedentary behavior, and sleep as part of a 24-hour movement framework; however, there is a gap in the knowledge about the relationship between 24-hour movement and pregnancy outcomes. This paper describes the study protocol for the 24MOVE study, a prospective cohort study that examines associations between 24-hour movement profiles across pregnancy and maternal glucose tolerance, GWG, and infant birthweight. Participants (N=306) were recruited from a large, integrated health care delivery system at 10 weeks’ gestation. In early (10-12 weeks), mid- (20-22 weeks), and late (33-35 weeks) pregnancy, all eligible individuals with a pre-pregnancy BMI of ≥25 kg/m2 completed online surveys collecting information about sociodemographic characteristics and pregnancy symptoms and behaviors, including sleep quality. Participants concurrently wore a research-grade accelerometer for 24 hours per day for 7 consecutive days to capture movement, sedentary behavior, and sleep data. Data from accelerometry will be processed to create 24-hour movement profiles. Pregnancy outcomes will be ascertained from electronic health records (EHRs). We will use compositional data analysis (CoDA) methods, modeling associations of reallocations of time from one component behavior to another at various timepoints with outcomes. Recruitment began on March 19, 2023, and ended on September 11, 2024. Enrollment was completed on September 19, 2024. Data collection was completed in April 2025. Over an 18-month recruitment period, 2035 individuals were invited to participate, and of those, 306 (15%) eligible participants were enrolled in this study. The enrolled cohort had a median age of 33 (quintile 1 [Q1]-quintile 3 [Q3] 30-36) years and a median BMI of 28.8 (Q1-Q3 26.9-32.7) kg/m². Most participants had private insurance (n=266, 86.9%) and were multiparous (n=232, 75.8%). Analyses are in progress. The 24MOVE study is designed to address gaps in our knowledge of the impact of 24-hour movement during pregnancy on maternal glucose metabolism, GWG, and other risk factors for childhood obesity, such as a high birthweight. Data from this study will also serve as a rich resource for future investigations of 24-hour movement profiles and behavior substitutions and other perinatal mental and physical health outcomes. DERR1-10.2196/72828.
13. Virtual Health Assistants in Preventive Cancer Care Communication: Systematic Review.
期刊: JMIR cancer 发表日期: 2025-Sep-15 链接: PubMed
摘要
Virtual health assistants (VHAs), interactive digital programs that emulate human communication, are being increasingly used in health care to improve patient education and care and to reduce the burden on health care providers. VHAs have the potential to promote cancer equity through facilitating patient engagement, providing round-the-clock access to information, and reducing language barriers. However, it is unclear to what extent audience-centeredness is being considered in the development of cancer-related applications. This systematic review identifies and synthesizes strategies used to make VHA-based cancer prevention and screening interventions audience-centered. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, we searched 4 databases (PubMed, Embase, Web of Science, and EBSCOhost) for peer-reviewed studies on VHA interventions promoting cancer screening (January 2022). Included studies focused on adult populations in primary care settings, with interventions emphasizing interactivity and immediacy (key VHA features). Excluded studies were on cancer treatment, noninteractive decision aids, or technical VHA development. Screening, data extraction, and quality assessment (Mixed Methods Appraisal Tool) were performed independently by multiple reviewers. Thematic synthesis was used to analyze audience-centered strategies. Of 1055 records screened, 17 studies met inclusion criteria. Most (n=11) targeted colorectal cancer, with others addressing prostate, breast, cervical, or lung cancer. A total of 16 studies were US-based; 1 study focused on Uganda. Key strategies for audience-centered design included: (1) Demographic Concordance: Race or gender alignment between VHA and users (eg, African American participants interacting with Black-coded avatars); (2) User Feedback: Iterative testing via interviews, think-aloud protocols, or pilot studies to refine interventions; (3) Preintervention Needs Assessment: Identifying cultural, linguistic, or literacy barriers (eg, myths about screening in Ugandan communities); (4) Theoretical Frameworks: The Health Belief Model (most common), the Modality, Agency, Interactivity, and Navigability (MAIN) model, or tailored messaging theories guided design; (5) Information Customization: Culturally adapted content (eg, Spanish-language interfaces, narratives addressing racial disparities); and (6) Feature Customization: Adjusting VHA appearance (eg, animations and fonts) based on user preferences. Notably, 7/17 studies focused on racially minoritized groups (eg, African Americans, Hispanic farmworkers), addressing systemic barriers like mistrust in health care. However, gaps persisted in intersectional tailoring (eg, rurality and income) and non-English languages (only 2/17 studies). Recruitment methods influenced diversity; community-based strategies yielded more representative samples than solely internet-based recruitment approaches. The systematic review identified the audience-centered development practices currently being used for VHA-based interventions in preventive cancer care. The majority of the studies included processes to diversify and segment the intended audience, focused on medically underrepresented population groups, and implemented strategies to be culturally sensitive to the population of interest. However, opportunities remain to address multidimensional inequities (eg, rural access and low literacy). Future interventions should integrate intersectional frameworks, expand language diversity, and measure social presence to enhance engagement. This review provides a roadmap for developing equity-focused eHealth tools in cancer prevention.
14. Assessing Internet Quality Across Public Health Centers in Indonesia: Cross-Sectional Evaluation Study.
期刊: JMIR medical informatics 发表日期: 2025-Sep-15 链接: PubMed
摘要
Primary health care centers (Puskesmas) serve as the cornerstone of Indonesia’s health care system, providing integrated services aimed at improving individual health through prevention, treatment, and health promotion. To fulfill these roles effectively, robust technological infrastructure, particularly reliable internet connectivity, is increasingly essential. Assessing the availability and quality of internet access in Puskesmas is therefore a critical step in understanding their readiness to implement digital health initiatives and fulfill their responsibilities in delivering accessible and effective healthcare services. This study provides a national baseline assessment of internet quality and its relevant IT infrastructure in more than 10,000 Puskesmas across Indonesia. A cross-sectional survey was conducted throughout all Puskesmas (10,382) in 34 provinces in Indonesia, using an online questionnaire. Categorization was done to analyze internet quality level results. A total of 10,378 out of 10,382 public health centers (99.96%) participated in this study. Overall, 745 of 10,382 (7.18%) did not have internet access, 1487 (14.33%) had limited internet access, 5567 (53.64%) had sufficient internet access, and 2579 (24.85%) had sufficient and fast internet access. Moreover, 832 of 10,382 Puskesmas (8.02%) did not have 24-hour electricity, 44,196 (43.7%) had a central processing unit (CPU) with i3 specifications, 43,044 (42.56%) had 512 GB hard disk capacity, and 67,272 (66.5%) used antivirus. Although 79% (8201/10,382) of Puskesmas in Indonesia already had sufficient internet access, 21% (2180/10,382) still have limited and insufficient access. To ensure universal internet availability, it is essential to build collaborative support among internet providers and government to foster the availability and use of internet satellites, high-quality computers, and electrical power to support internet connectivity.
15. Metabolic profiling of Polyporus umbellatus (Pers.) Fr.
期刊: Natural product research 发表日期: 2025-Sep-15 链接: PubMed
摘要
Polyporus umbellatus (Pers.) Fr. (Sin. Dendropolyporus umbellatus (Pers.) Jülich) is an edible and medicinal mushroom in the family Polyporaceae (phylum Basidiomycota). Widely distributed in the Northern hemisphere, it is reported for the first time its presence in central Italy, Lazio. Even though the known history of usage in traditional medicine of Polyporus umbellatus, the entire phytochemical profile of both the aqueous and organic extract has not been yet analysed, also specifically from sample of non-Asian origin. In this perspective, it is important to evaluate the presence of other possible bioactive compounds and investigate the quantities of metabolites with a nutraceutical impact. High resolution NMR spectroscopy with 1H-NMR,1H-1H TOCSY, and 1H-13C HSQC was employed, finding 45 metabolites in both aqueous and organic extract, identifying and quantifying compounds of interest for nutrition and human health.
16. Continuity of care among people with hypertension and disabilities.
期刊: Chronic illness 发表日期: 2025-Sep-15 链接: PubMed
摘要
ObjectivesContinuity of care is a critical component of successful hypertension management. With the growing prevalence of people living with both hypertension and disabilities, it is essential to explore how disability impacts continuity of care. This study aimed to investigate whether disability is associated with continuity of care among people with hypertension.MethodsThis study was a retrospective observational cross-sectional analysis using the 2019 Korea National Health Insurance Service-National Sample Cohort database. A total of 104,280 individuals diagnosed with hypertension aged 30 years and older were included. Multivariate logistic regression was used to examine the impact of disability on the odds of having higher continuity of care, measured using the Bice-Boxerman index, adjusting for sociodemographic factors.ResultsPeople with hypertension who also have physical disabilities were 6.6% less likely to achieve optimal COC compared to those without disabilities (Odds ratio = 0.934; 95% confidence interval = 0.875, 0.998).ConclusionPhysical disability significantly reduces the likelihood of achieving optimal COC in hypertension management. Targeted interventions addressing barriers faced by people with disabilities and hypertension are critical for improving care coordination and health outcomes.DiscussionThis study highlights the need for disability-inclusive healthcare policies and practices to reduce disparities in hypertension care.
17. A Qualitative Exploration of Experiences of Accessing Services Among Patients with Mental Health and Addiction Disorders.
期刊: Issues in mental health nursing 发表日期: 2025-Sep-15 链接: PubMed
摘要
The mental health crisis in Canada is escalating rapidly, placing immense pressure on the healthcare system. This is particularly concerning for individuals with mental health and addiction disorders, who depend on primary and community-based healthcare services to manage their conditions. Inadequate and delayed care for these populations can result in worsening symptoms, higher mortality rates, and excessive reliance on emergency services. This study explores patients’ experiences with accessing primary and community-based healthcare service to enhance service accessibility and utilization, and address excessive use of emergency services, which are often poorly equipped to provide long-term mental health and addiction care. Interviews with 22 individuals living with mental health and/or addiction disorders highlight the significance of positive relationships with healthcare providers, the impact of systemic barriers on help-seeking behaviors, and the coping strategies developed to navigate these challenges. The paper concludes with actionable policy recommendations aimed at addressing barriers and strengthening facilitators to improve healthcare delivery to those with mental health and/or addiction disorders.
18. Authors' Reply: Reconsidering Biomarker Interpretation and Clinical Applicability in High-Intensity Interval Training and Kidney Function Trials.
期刊: Journal of the American Society of Nephrology : JASN 发表日期: 2025-Sep-15 链接: PubMed
摘要
19. Impact of a Free Influenza Vaccination Policy on Older Adults in Zhejiang, China: Cross-Sectional Survey of Vaccination Willingness and Determinants.
期刊: JMIR human factors 发表日期: 2025-Sep-15 链接: PubMed
摘要
In 2024, Zhejiang Province introduced a new policy offering free influenza vaccinations to individuals aged 60 years and older. However, the vaccination willingness among the newly eligible 60-69 years age group remains ambiguous in comparison to those aged 70 years and older. This study aimed to evaluate the willingness of individuals aged ≥60 years in Zhejiang Province, China, to receive free influenza vaccines under a newly implemented policy. It further explored their sources of influenza-related health information and identified key determinants of vaccination hesitancy across age subgroups. A cross-sectional survey was conducted using multistage convenience sampling via on-site questionnaires. Structured questionnaires were administered to 7162 eligible participants aged ≥60 years from March to May 2024. Valid responses (n=7103; response rate: 99.18%) were analyzed via logistic regression and Kruskal-Wallis tests. Overall vaccination willingness was 73.15% (5196/7103), with 11.71% (832/7103) refusal and 15.14% (1075/7103) hesitancy. Key predictors of hesitancy included male gender (odds ratio [OR] 1.27, 95% CI 1.05-1.54), ages 60-69 years (OR 1.46, 95% CI 1.06-2.02), corporate employment (OR 0.75, 95% CI 0.58-0.98), and absence of chronic diseases (OR 2.06, 95% CI 1.44-2.96). The 60-69 year age group demonstrated lower awareness of the free policy (61.9% vs 73.72% in the ≥70 years group; H=61.25, P<.001) but higher engagement with social media (WeChat [Tencent Holdings Limited]: H=345.44; TikTok [ByteDance Ltd]: H=294.66; P<.001) for health information. Despite high willingness, knowledge gaps persist, particularly among adults aged 60-69 years. Targeted dissemination of policy information via social media platforms (eg, WeChat and TikTok) and community-driven campaigns is recommended to enhance vaccination uptake. This approach may serve as a model for regions implementing similar policies. Future studies should track actual vaccination uptake postpolicy and explore artificial intelligence-driven social media interventions to boost engagement.
20. Classes of Racism and Suicide Risk Among Black Emerging Adults.
期刊: Social work in public health 发表日期: 2025-Sep-15 链接: PubMed
摘要
This cross-sectional study investigates the relationship between three distinct types of racism-based experiences (i.e. hostile, aversive-hostile, and avoidant) and suicide risk among Black emerging adults. Computer assisted surveys were administered to a sample of 300 Black emerging adult college students. Increased exposure to hostile racism was linked to higher risk of suicidal ideation and attempts, whereas an increase in exposure to aversive-hostile racism was associated with a decreased likelihood of experiencing suicidal ideation. These findings underscore the complex and multifaceted nature of the relationship between racism-based experiences and suicide risk for Black emerging adults. Implications for research, practice, and policy are discussed.
21. Feasibility of the aktivplan Digital Health Intervention for Regular Physical Activity Following Phase II Rehabilitation: Protocol for a Mixed Method Randomized Controlled Pilot Study (ACTIVE-CaRe Pilot).
期刊: JMIR research protocols 发表日期: 2025-Sep-15 链接: PubMed
摘要
Patients with cardiovascular disease (CVD) often encounter challenges in establishing and maintaining heart-healthy physical activity habits, even after successfully completing a cardiac rehabilitation program. Digital health technologies hold promise to support long-term habit formation in the secondary prevention of CVD. The aktivplan digital health intervention has been developed to support patients with CVD in establishing long-term heart-healthy physical activity habits. The primary study aim is to pilot and assess the feasibility of a future randomized controlled trial design to investigate the effectiveness of the aktivplan intervention and to assess the usability, user experience, and acceptance of the aktivplan app. The secondary objective is to collect clinical and safety outcomes. This multicenter, mixed method, randomized controlled pilot study aims to recruit 40 patients with an established diagnosis of CVD or with increased risk of CVD (physically inactive along with 1 further CVD risk factor) who are undergoing phase II rehabilitation at 2 rehabilitation centers in Austria. Participants will be allocated to the intervention or standard care control group by stratified randomization and will be monitored for 10 weeks after discharge from phase II rehabilitation. Participants, health care professionals, and outcome assessors are not masked (blinded) to group allocation. Data collection will include recruitment and drop-out rate; data completeness; adherence to the intervention; usability, user experience, and user acceptance questionnaires; technical reliability of the intervention; clinical assessments (exercise capacity, physical activity behavior, and CVD risk factors); adverse events; self-reported outcome measures (health-related quality of life, exercise self-efficacy, depression and anxiety, and kinesiophobia); patient interviews, and focus groups with health care professionals. Quantitative data will be analyzed descriptively, and 95% CIs will be calculated for recruitment and drop-out rates and for data completeness. No confirmatory inferential statistical analysis or hypothesis testing will be conducted. Qualitative data will be analyzed thematically by framework analysis. A total of 34 participants were recruited between October 2023 and May 2024. Data collection was completed in August 2024. Currently, the data are being analyzed and prepared for publication. The first publication of feasibility results is expected by summer 2025. This pilot study is expected to generate valuable and comprehensive insights to inform the study design of a future definitive effectiveness trial of the aktivplan intervention, guide the need for further iteration of the aktivplan app before entering a definitive trial, and inform future implementation strategies for the intervention. ClinicalTrials.gov NCT06025526; https://clinicaltrials.gov/study/NCT06025526. DERR1-10.2196/73704.
22. Photo-Cross-Linked and Photothermal Flammulina velutipes Polysaccharide Hydrogel Loaded with Caffeic Acid-Copper Nanozyme for Diabetic Wound Healing.
期刊: ACS applied materials & interfaces 发表日期: 2025-Sep-15 链接: PubMed
摘要
Diabetic ulcers remain a persistent global health challenge. Developing therapeutic systems with antibacterial, antioxidant, anti-inflammatory, and pro-angiogenic properties presents a promising strategy for effectively and rapidly treating diabetic wounds and preventing the development of diabetic ulcers. Herein, a photo-cross-linked Flammulina velutipes polysaccharide (FVP) containing double bonds was obtained through extraction and purification of FVP, and a facile reaction using methacrylic anhydride. The FVP was further combined with caffeic acid-copper nanozyme (CCN) to fabricate a series of multifunctional photo-cross-linked hydrogels (FVP@CCN) for diabetic wound healing. The FVP@CCN demonstrated rapid degradability, tunable mechanical properties, considerable intrinsic antimicrobial activity, and excellent biocompatibility. Additionally, the incorporated CCN, possessing peroxidase-like nanozyme activity, further endowed FVP@CCN with strong photothermal-induced antimicrobial ability, reactive oxygen species (ROS) scavenging capability, angiogenesis promotion activities, and pH-responsive release of CA and Cu2+. In vivo studies confirmed that FVP@CCN provided synergistic treatment against multiple healing impairments associated with diabetic wounds, exhibiting hemostasis, sustainable antibacterial, antioxidant, anti-inflammatory, angiogenesis-promotion, cell-proliferation, and hair follicle-regeneration, ultimately resulting in a diabetic wound closure rate exceeding 90% within 7 days. The multifunctional FVP@CCN hydrogel holds significant potential for diabetic wound healing, and its fabrication strategy can be extended to other plant-based polysaccharide hydrogels.
23. Technology-Assisted Physical Activity Interventions for Older People in Their Home-Based Environment: Scoping Review.
期刊: JMIR aging 发表日期: 2025-Sep-15 链接: PubMed
摘要
Technology-assisted physical activity interventions for older adults in their home-based environment have been used to promote physical activity. Previous research has reported that such interventions benefit body composition, aerobic fitness, cognitive abilities, and postural control, reducing the risk of falls and maintaining regular physical activity among the older population. While previous reviews on technology-assisted physical activity interventions focused on health-related outcomes, this scoping review explores the characteristics of the technology in relation to the characteristics of populations, purpose of the activity, and usability in terms of adverse events, drop-outs, adherence, and user experience. A full search was performed in Medline, Embase, CINAHL, SportDiscus, and Web of Science. Sources were considered for inclusion if the participants aged on average 60 years and older, if the physical activity intervention was assisted by technology, and if performed within home-based environments. We identified 8496 sources. After title and abstract screening, 455 full texts were assessed, and 148 were included, representing 12,717 participants aged 74 (SD 6) years. In total, 63% (93/148) of the sources reported on the population’s health status. The main purpose of the interventions was balance (75/148, 51%), and strength and power (64/148, 43%) and the intervention purposes were not related to the embedded technology. In studies where the participant’s health status was reported as healthy, 53% (78/148) implemented exergames compared to only 27% (40/148) in studies with participants with a clinical condition. Mobile apps (30/148, 20%) and trackers (16/148, 11%) were implemented likewise in both groups. The technology was embedded to provide continuous exercise information (40/148, 27%) and exercise feedback (40/148, 27%) or to record real-time movement data (38/148, 26%). Adverse events were reported in 46% (68/148) of the sources with three quarters (49/68) reporting no adverse events. Only two mild events were related to technology. Dropout rates were reported in 68% (100/148) of the sources, with no differences between intervention (16 SD 16%) and control (14 SD 12%) groups. Dropout reasons related to technology are only 3% (3/100). Adherence was reported in 53% (79/148) sources and was slightly higher in the intervention group (80 SD 18%) compared to the control group (71 SD 25%). A significantly higher adherence was found between interventions that were tailored (83 SD 15%) versus those that were not (75 SD 21%). General enjoyment of the technology was captured in 37% (55/148) of the sources. Within those sources, 91% rated positive (91/100), 7% neutral (7/100), and 2% negative (2/100). Occasionally reported wishes were related to goal setting, feedback, technical support, exercise variation, and social setting. Various technologies were successfully used in healthy and clinical older populations, though evidence regarding their implementation in physical activity interventions in hospital settings remains limited. The embedded technology was not a reason for additional dropouts, led to slightly better adherence, and adverse events were rarely related to technology. When assessed, the technology was well accepted and positively enjoyed.
24. Experiences with Rough Sex Among Autistic University Students: Descriptive Findings from a Campus Probability-Based Survey.
期刊: Journal of sex research 发表日期: 2025-Sep-15 链接: PubMed
摘要
There is little research on autistic adults’ rough sex experiences - even though rough sex has become prevalent among young adults. We aimed to explore lifetime sexual experiences, including consensual and non-consensual rough sex, among autistic university students in the U.S. and their perceptions and subjective experiences of rough sex. The study sample consisted of 46 autistic undergraduate and graduate students from a large public Midwestern U.S. university. Participants had engaged in a broad range of solo and consensual partnered sexual experiences, including rough sex, such as having their hair pulled (54.7%), being spanked lightly (51.3%), being choked by a partner (42.5%), consensual non-consent (12.5%) and having choked themselves while masturbating (19.6%) Most indicated their rough sex experiences had felt pleasurable, joyful, exciting, intimate, loving, or liberating; however, some reported they had felt them to be upsetting (60.0%), scary (30.0%), or traumatic (15.0%). About one-fifth had experienced non-consensual rough sex. Study findings underscore the need for sexuality education curricula to address diverse sexual practices for all students, including autistic university students. As autistic students in this sample reported some higher-risk practices (e.g. choking) and non-consensual rough sex, the timely and proactive integration of autism-specific findings on rough sex into sexuality education curricula is critical.
25. Sacral hydatid cyst: illustrative case.
期刊: Journal of neurosurgery. Case lessons 发表日期: 2025-Sep-15 链接: PubMed
摘要
Echinococcus species causes hydatid cyst (HC) disease, primarily affecting the liver and lungs. Bone involvement is rare (0.5%-2% of cases), with half occurring in the vertebral system. Sacral spine involvement is particularly uncommon and poses diagnostic challenges. A 17-year-old male with a history of HC disease presented with low back pain radiating to both lower limbs, claudication, and chronic constipation for 5 years. Imaging revealed a large, multiloculated sacral cyst extending retrorectally and presacrally from S3 to S5, involving the spinal canal, compressing the rectum, and causing sacral erosion. A diagnosis of sacral hydatidosis was made, and the patient was started on albendazole, with surgical excision planned. HC disease should be considered in the differential diagnosis of low back pain and constipation, especially in endemic regions. Because of its invasive nature and high recurrence rate, early diagnosis, antiparasitic therapy, and surgical intervention are essential. Proper follow-up is necessary to prevent complications, particularly in atypical presentations. https://thejns.org/doi/10.3171/CASE25109.
26. Knowledge levels of final year medical students before and after occupational health and occupational diseases training sessions: An interventional study.
期刊: Archives of environmental & occupational health 发表日期: 2025-Sep-15 链接: PubMed
摘要
Many occupational diseases can be prevented or at least mitigated, highlighting the importance of including occupational health education in medical curricula. We aimed to evaluate the knowledge levels of sixth-year students before and after occupational health courses, assess the effectiveness of teaching sessions, and identify necessary improvements in the presentations as part of our self-criticism. Pre- and post-training tests covering key aspects of occupational safety and health and occupational diseases, along with questions regarding students’ opinions about the courses, were administered using the Kahoot application. Of 207 students, 191 (92.2%) participated in the study over six months within one academic year. An increase was observed in the number of students who answered all questions correctly after lectures. Additionally, 72.2% found the lecture duration sufficient, while 83.3% reported increased awareness. The study pinpointed the topics where mistakes were most frequent and highlighted these more effectively in future presentations.
27. Redox Cascade in Chicken Skeletal Muscle: SELENOT Suppression in Selenium Deficiency Triggers Disulfidptosis via mtROS-NADPH Dysregulation.
期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2025-Sep-15 链接: PubMed
摘要
Skeletal muscle atrophy in poultry is characterized by reduced muscle mass and fiber quantity, leading to substantial economic losses in poultry production worldwide. Selenium is an essential trace element that maintains muscle integrity; however, the mechanisms linking Se deficiency to muscle injury remain unclear. Selenoprotein T (SELENOT) is a key regulator of cellular redox homeostasis that has not been fully characterized in skeletal muscles. Se deficiency downregulates SELENOT expression, increases oxidative stress, and induces skeletal muscle atrophy via disulfidase pathways. SELENOT deficiency impaired mitochondrial respiratory chain function, causing mitochondrial reactive oxygen species (mtROS) overproduction, glucose metabolism reprogramming, and Nicotinamide Adenine Dinucleotide Phosphate (NADPH) metabolism disruption. These changes result in cysteine accumulation and disulfidptosis, which lead to abnormal actin disulfide bonding. TEMPO-mediated mtROS inhibition or NADPH supplementation partially rescues Se-deficiency-induced muscle atrophy. SELENOT overexpression alleviates the redox imbalance, NADPH dysfunction, disulfidptosis, and myotube atrophy in Se-deficient cells, whereas rotenone-induced mtROS activation or BAY-876-mediated NADPH inhibition reverses these protective effects. The SELENOT/mtROS/NADPH axis is crucial for Se-deficiency-induced muscle atrophy. This study provides mechanistic insights into muscle-wasting disorders and potential therapeutic targets.
28. Geospatial distribution of natural radionuclides and radiological assessments in Asia's largest coastal lagoon sediment, Chilika, India.
期刊: Isotopes in environmental and health studies 发表日期: 2025-Sep-15 链接: PubMed
摘要
The pioneer work on the measurement and distribution of natural radioactivity levels was carried out in the sediment samples of Asia’s largest coastal lagoon, Chilika, India. The activity concentrations of radionuclides in the sediment samples measured by using a high-resolution HPGe semiconductor detector gamma-ray spectroscopy system, and the average activity concentration of 226Ra, 232Th, and 40K were found to be 28.25 ± 7.85, 84.27 ± 30.93 and 610.57 ± 89.74 Bq kg-1. The contour map, drawn using the Kriging method, illustrates the geospatial distribution of each radionuclide in Chilika. The results show the distribution of radionuclides and are compared with similar results from different locations in the worldwide. The activity concentrations are also compared with the average values of the world and India. The radiological indices for the lagoonal system were calculated, and the mean values are 195.77 Bq kg-1 for radium equivalent (Raeq), 167.53 nGy h-1 for absorbed gamma dose rate (DR), 0.21 mSv y-1 for annual effective dose equivalent (AEDE), 631.27 µSv y-1 for Annual gonadal dose equivalent (AGDE), 0.53 for external hazard index (Hex), 0.61 for internal hazard index (Hin), 0.72 for gamma representative level index (Iγr), and 0.14 for alpha index (Iα). The mean value of the Raeq obtained from the study area was less than the international value of 370 Bq kg-1. All the radiological assessment indices indicated that the observed values are below the threshold values.
29. Meaningful Movement: Understanding and Accessing Physical Activity Among People with Severe Mental Illness - A Photovoice Study.
期刊: Issues in mental health nursing 发表日期: 2025-Sep-15 链接: PubMed
摘要
People with severe mental illness are less physically active than the general population and face higher risks of cardiovascular disease, obesity and diabetes. The aim of this study was to explore how people with severe mental illness understand physical activity and what barriers and facilitators they experience. Using the methods of photovoice and co-creation, we engaged people with severe mental illness as co-researchers. The data was analysed using reflexive thematic analysis. The method enabled participants to reconceptualise physical activity, thereby highlighting it as a socially embedded practice. A photovoice exhibition showcased our result and gave voice to the target group. The overarching theme of ‘Meaningful Movement’ described the ways in which physical activity is part of daily life, emotional well-being, embodied experience, social belonging and identity. Two themes, ‘Interaction with Other People’ and ‘Interaction with Nature and Animals’, showed the ways in which access to physical activity is shaped by complex environmental interactions. The participants described limited access to nature, animals, and nuanced understandings of physical activity during psychiatric hospitalisation. These structural barriers limit opportunities for people with severe mental illness to engage in physical activity and constrain professionals in providing person-centred care.
30. Prevalence of Mercury aka. "Sekete" consumption during pregnancy and its effect on nutrition: A cross-sectional study.
期刊: Nutrition and health 发表日期: 2025-Sep-15 链接: PubMed
摘要
BackgroundConsumption of mercury during pregnancy is detrimental to life and results in neurodevelopmental delays, foetal development, premature birth, low birth weight, and spontaneous miscarriages. Socio-cultural norms and practices play a critical role in shaping dietary habits and food choices among pregnant women.AimTo assess the prevalence of mercury consumption, its socio-cultural drivers, and its nutritional implications among pregnant women in urban Mafeteng District, Lesotho.MethodUsing a cross-sectional design, quantitative and qualitative approaches, the study sampled 72 participants (50 pregnant women and 22 traditional healers), drawn from an estimated population of 16,682 using Epi Info software. Data was analyzed using SPSS version 20.ResultsThe mean age of pregnant women was 25 years (± 4.7 SD), more than 60% had a high school education, and more than 62% were not married. 48% reported obtaining mercury from the local chemist, with over 60% consuming it for more than 2 months. Mercury was consumed by 36% to reduce pain during childbirth, 24% to protect their unborn child against witchcraft, 28% a cultural practice. Among traditional healers, 95% were males, with a mean age of 34 years (± 12.4 SD). Of these 38% administered mercury to counter witchcraft, 53% to reduce labor pain, and ensure safe and timely delivery.ConclusionA high prevalence of mercury consumption among pregnant women existed and was largely influenced by socio-cultural norms and beliefs. Duration of exposure to mercury could affect early fetal development. Furthermore, side effects like nausea and vomiting may compromise maternal nutrition, adding to health risks during pregnancy. Need for urgent public health interventions to address these cultural practices and prevent mercury exposure.
31. An integrated analysis of mammalophilic blackflies in the Simulium variegatum group in Laos.
期刊: Medical and veterinary entomology 发表日期: 2025-Sep-15 链接: PubMed
摘要
The simuliid fauna of Laos is among the most poorly known of any country in the world, only seven species having been recorded. We explored the Laotian simuliid fauna as an opportunity to test reproductive isolation and the minute morphological differences between two of the country’s common isomorphic nominal species-Simulium chamlongi Takaoka & Suzuki (Diptera: Simuliidae) and Simulium luculentum Takaoka, Srisuka & Saeung (Diptera: Simuliidae). Both are members of the widespread Simulium variegatum group. Using the band patterns of the giant chromosomes in the larval silk glands, we showed that S. chamlongi and S. luculentum are reproductively isolated, no hybrids having been found. Molecular analyses indicated that the two species are genetically distinct, with a minimum genetic divergence of 2.91%. Analysis of a fragment of the vertebrate cytochrome b gene revealed that the blood hosts of S. chamlongi and S. luculentum in Laos include humans and water buffaloes (Bubalus bubalis Linnaeus) (Artiodactyla: Bovidae), respectively. Diagnostic morphological characters provided in the original species descriptions were substantiated for pupae and females but not for larvae or males. Our chromosomal analyses also revealed a third reproductively isolated species, possibly new, with a unique IIS chromosomal sequence. The absence of a uniquely shared inversion among the three species indicates that the S. variegatum group lacks a defining chromosomal synapomorphy.
32. Enhancing Empathy: A Mixed Methods Exploration of Dementia Simulation in Occupational Therapy and Nursing Education.
期刊: Journal of gerontological nursing 发表日期: 2025-Sep-15 链接: PubMed
摘要
Dementia, including Alzheimer’s disease, poses complex challenges requiring health care providers to respond with empathy and skill. The current study examined whether a simulation-based dementia education intervention could enhance empathy in health care students. Using embedded mixed methods, one-group quasi-experimental design, empathy levels in 125 prelicensure nursing and graduate occupational therapy students were measured via the Kiersma-Chen Empathy Scale-Revised (KCES-R) before, immediately after, and 6 weeks post-simulation. In addition, 36 post-debriefing focus groups explored student experiences qualitatively. Findings showed significant empathy score increases across all time points (F[2,124] = 17.02, p < 0.001). Thematic analysis revealed five themes: The Illusion of Empathy, Developing Empathetic Skills, Confronting Uncomfortable Truths, The Eureka Moment: Transformative Realizations, and Empathy and Power Dynamics. Findings suggest that simulation-based dementia experience improves empathy and motivates students to provide better care. Experiential learning is critical to preparing future health care professionals to meet the growing demands of dementia care.
33. Ensuring correct fit and sustainability of assistive technology recommendations in schools.
期刊: Disability and rehabilitation. Assistive technology 发表日期: 2025-Sep-15 链接: PubMed
摘要
Our aim was to identify the frameworks used when considering AT and to identify the key elements that support its recommendation, implementation, and sustainability in schools. A mixed-methods approach was taken, using surveys and semi-structured interviews with clinicians and education staff. Survey data were analysed descriptively, while framework analysis was applied to the interview data. Quantitative and qualitative data were integrated through a mapping exercise. Participants included 22 clinicians and 16 educators, with follow-up interviews conducted with 8 clinicians and 3 education staff. Findings revealed that clinicians and educators believed that site-specific guiding frameworks could aid in successful AT implementation. However, there was variation in awareness of available frameworks and limited use of their structures. Consistent themes emerged from interviews: maintaining a focus on the child, considering multiple aspects of the school context, and encouraging collaboration between educators and clinicians. Key ingredients for AT success in schools were threaded throughout each theme. Abandonment of AT in schools is costly and undermines children’s academic success. Best practices for AT recommendation, implementation, and sustainability necessitate a simplified guiding framework that incorporates key ingredients related to child focus, school context, and collaboration. The framework structure should be flexible such that it can be tailored to the organisational systems and processes within individual schools. Best practice to support success of AT recommendation, implementation, and sustainability requires a guiding framework which facilitates collaboration and ensures accountability.Consideration of school context, existing technology, and embedding recommendations into school processes such as individual education plans (IEP’s) minimise AT abandonment.Ensuring child-focused goals, pertinent to the curriculum assists AT sustainability.
34. Instructional Insights: From Classroom to Community-Interprofessional Learning Through Fall Prevention Screening.
期刊: Occupational therapy in health care 发表日期: 2025-Sep-15 链接: PubMed
摘要
This article describes an interprofessional, community-based fall prevention screening program informed by Kolb’s Experiential Learning Theory and the Interprofessional Education Collaborative (IPEC) core competencies, which connects entry-level occupational therapy and physical therapy doctoral students with community-dwelling older adults using the Centers for Disease Control and Prevention (CDC) STEADI toolkit. Students work alongside healthcare professionals to assess fall risk, provide education, and offer personalized recommendations. Students reported an enhanced understanding of interprofessional collaboration and fall prevention strategies. The program bridges classroom learning with real-world applications, highlighting the value of experiential education, interprofessional teamwork, and community partnerships in addressing falls among older adults, a critical public health concern.
35. Predicting walking capacity, walking performance, and life space mobility using socket comfort in lower-limb prosthesis users.
期刊: Clinical rehabilitation 发表日期: 2025-Sep-15 链接: PubMed
摘要
ObjectiveTo determine if socket comfort predicts walking capacity, walking performance, and life-space mobility.DesignObservational exploratory study involving a secondary cross-sectional analysis using multiple regression of data collected from an exercise intervention trial.SettingLaboratory setting for clinical assessments; community setting for walking performance.ParticipantsCommunity-dwelling lower-limb prosthesis users over 50 years old (n = 72).Main measuresSocket Comfort Score, 2-Minute Walk Test, step count, Life Space Assessment, and control variables including demographics, Short Physical Performance Battery, Four Square Step Test, and Walking While Talking.ResultsRegression modeling showed Socket Comfort Score as a statistically significant predictor of 2-Minute Walk Test (B = 6.9 m, 95% CI [2.7, 11.1] m) alongside amputation level, Walking While Talking test, and Short Physical Performance Battery (greatest contribution to the model); the model accounted for 61% of the variance. Socket Comfort Score was not a statistically significant predictor of step count. Socket Comfort Score was the only statistically significant predictor of Life Space Assessment (B = 4.9, 95% CI [1.1, 8.8]); the model accounted for 12% of the variance.ConclusionsSocket comfort played a notable role in predicting walking capacity and life space mobility, but not in walking performance. Improving lower extremity function may have greater impact on walking overall. While this study provides context regarding socket comfort that clinicians may consider when planning holistic prosthetic rehabilitation, mixed findings in the literature suggest that further research on how socket comfort relates to walking outcomes in the community is warranted.
36. Predictive influence of non-dominant hand performance on work-related dominant hand function using the Jebsen-Taylor hand function test.
期刊: Work (Reading, Mass.) 发表日期: 2025-Sep-15 链接: PubMed
摘要
BackgroundHand dominance significantly influences motor skills, with the dominant hand excelling due to better neurological control. Limited knowledge of the non-dominant hand’s role highlights the need for on its functional contributions.ObjectiveThis study aims to evaluate how effectively non-dominant hand performance can predict dominant hand performance in healthy individuals using the Jebsen-Taylor Hand Function Test (JTHFT), offering valuable implications for vocational assessment, rehabilitation planning, and return-to-work (RTW) decision-making.MethodsThis cross-sectional study included 307 healthy adults aged 18-65. Hand performance was evaluated using six JTHFT subtests, excluding sentence writing. Task completion times were recorded in seconds. Paired sample t-tests compared dominant and non-dominant hand performances, while multiple linear regression analyses assessed the predictive value of non-dominant hand performance.ResultsRegression analysis revealed that non-dominant hand performance was a significant predictor of dominant hand performance across all subtests (p < 0.001). Strong predictive relationships were identified in gross motor tasks, such as lifting large light objects (adjusted R2 = 0.642) and heavy objects (adjusted R2 = 0.674). Adjusted R2 ranged from 0.268 (feeding) to 0.681 (lifting heavy objects). Non-dominant hand performance significantly predicted dominant hand performance across all subtests (β = 0.51-0.82; p < 0.001). Age, sex, and handedness showed task-specific effects, but non-dominant hand performance remained the strongest predictor.ConclusionsThe study highlights that non-dominant hand performance significantly predicts dominant hand performance across JTHFT tasks, particularly in gross motor activities requiring strength and coordination. These findings underscore the importance of evaluating non-dominant hand function in occupational assessments and return-to-work programs.
37. Association between essential metal elements in the blood of pregnant women in the first trimester and gestational diabetes mellitus and the mediating role of inflammatory indicators.
期刊: International journal of hygiene and environmental health 发表日期: 2025-Sep-14 链接: PubMed
摘要
To evaluate the potential association between essential metal elements and gestational diabetes mellitus (GDM), and to explore whether inflammatory indicators play an intermediary role in the association between essential metal elements and GDM. This study included 4833 pregnant women who underwent early pregnancy examinations at Guangdong Women and Children Hospital between 2015 and 2022. Basic demographic information and peripheral blood samples were collected. Atomic absorption spectrometry was utilized to measure five essential metal elements, including iron (Fe), calcium (Ca), zinc (Zn), copper (Cu), and magnesium (Mg) in whole blood samples of pregnant women. Routine blood tests, including white blood cell (WBC), lymphocyte (Lym), neutrophil (Neu), monocyte (Mono), and platelet (PLT), were conducted using an automated hematology analyzer. The generalized linear regression model (GLM) was employed to analyze the relationship between essential metal elements, inflammatory indicators, and GDM. Mediation analysis was used to explore the potential mediating role of inflammatory indicators in the association between essential metal elements and GDM. Fe was positively correlated with WBC, NEU, LYM and MONO levels, and negatively correlated with PLT levels (P < 0.05). Ca was negatively correlated with WBC, NEU and MONO levels, and positively correlated with PLT levels (P < 0.05). Zn was positively correlated with WBC, NEU, LYM and PLT levels (P < 0.05). Cu was positively correlated with WBC, NEU and PLT levels (P < 0.05). Mg was positively correlated with WBC, NEU, LYM, MONO and PLT levels (P < 0.05). Compared with the first quantile concentration level, the fourth quantile level of Fe (OR = 1.282, 95 %CI: 1.043-1.578) and the fourth quantile level of Zn (OR = 1.267, 95 %CI: 1.032-1.559) were significantly positively correlated with GDM. WBC, NEU, LYM, MONO and PLT were all positively correlated with GDM risk (P < 0.05), and the correlation between five inflammatory indicators and GDM risk was positively linear by RCS (Poverall < 0.05 and Pnonlinear > 0.05). All five inflammatory indicators had significant mediating effects in the association between essential metal elements and GDM. Among them, the percentage of mediating effect of WBC was 29.18 % (OR = 1.043, 95 %CI: 1.027-1.061); The percentage of NEU mediating effect was 26.97 % (OR = 1.039, 95 %CI: 1.025-1.058); The percentage of LYM mediating effect was 8.30 % (OR = 1.012, 95 % CI: 1.004-1.023); The percentage of MONO mediation effect was 6.84 % (OR = 1.010, 95 % CI: 1.004-1.021); The percentage of PLT mediating effect was 8.87 % (OR = 0.987, 95 %CI: 0.976-0.995). The study found a significant association between essential metal elements and GDM. Specifically, higher levels of Fe and Zn in pregnant women were positively associated with GDM. Furthermore, inflammatory indicators were identified to play a mediating role in the association between Fe levels and GDM. These suggested the imbalance of essential metal elements may increase the risk of GDM by influencing the levels of inflammatory indicators.
38. Out in the Cold: The ignored influence of glacial melting on Rhincalanus gigas and R. nasutus (Copepoda, Calanoida) morphology in Antarctic waters.
期刊: Marine environmental research 发表日期: 2025-Sep-12 链接: PubMed
摘要
Environmental variability causes variations in the biological traits of marine organisms, affecting their abundance, distribution, and morphology. By using two bio-oceanographic surveys in Maxwell Bay, King George Island (summer 2023), and South Bay, Doumer Island, Palmer Archipelago (summer 2022), West Antarctica, the influence of glacial meltwater was quantified on biological traits of the neritic calanoid copepods, Rhincalanus gigas and R. nasutus. Stations were categorized as glacial-influenced (GI) when the mean temperature and salinity were <1 °C and <33.9 g kg-1 (2022), and <2.2 °C and <33.9 g kg-1 (2023), respectively. Stations with warmer and saltier waters were considered as non-glacial influenced (NGI) zones. The abundance of adult females was similar for both species in the GI and NGI areas. Morphologically, both species were similar, varying from specimens with shorter urosome, and wider 2nd somite of the prosome, to specimens with larger urosome, and narrower 2nd somite of the prosome (PC1, 31 % of the variance). Also, copepods varied from specimens with a narrower body and a pointed urosome to individuals with a wider body and an expanded urosome (PC2, 27 %). The allometry was low but significant for R. gigas (3.46 %), and larger for R. nasutus (13.56 %), associated with a widening of the base of the cephalosome and a change of the urosome’s direction. Discriminant Function Analysis detected significant shape differences between GI and NGI areas for the endemic R. gigas, but not for circumglobal R. nasutus. A Partial Least Squares analysis detected covariance between shape variations in Rhincalanus gigas females and hydrographic conditions, showing that individuals with larger (shorter) urosome were associated with warmer (colder) and less (more) oxygenated waters. These morphological variations may pose constraints on the relevant ecological traits of local populations or represent an expression of phenotypic plasticity in endemic Antarctic species.
39. Optimizing passive exoskeleton torque for dynamic overhead work: Phase-specific analysis on muscle activity and perceived exertion.
期刊: Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology 发表日期: 2025-Sep-10 链接: PubMed
摘要
This study investigated how different levels of torque provided by a passive arm-support exoskeleton (ASE) influence upper extremity muscle activity, perceived exertion, and fatigue during arm ascent and descent phases of a Dynamic Overhead (DO) task. The DO task involved 20 cycles of simulated drilling and was completed by 20 individuals by using a light-duty drill in four conditions: without supporting torque (no ASE) and with three increasing levels of ASE torque (i.e., 50, 75, and 100% of the torque required to support the arm in 90° of flexion). Surface electromyography was measured bilaterally over six shoulder muscles. Moreover, participants indicated torque preference, ratings of perceived exertion (RPE), and fatigue in the shoulder. Increasing torque levels caused significant reductions in shoulder agonist muscle activity (up to 47%) and significant decreases in RPE and fatigue during the ascent phase. In contrast, higher levels of torque increased muscular activity for some antagonist muscles during the descent phase. While torque levels of 75% and 100% received the most positive ratings, we suggest that 75% torque could be an effective supporting condition, by reducing shoulder muscle flexor activity during arm ascent and minimizing antagonist muscle activity during arm descent.
40. Frequency of misdiagnoses and associated risk factors in Macular Telangiectasia Type 2.
期刊: Retina (Philadelphia, Pa.) 发表日期: 2025-Sep-10 链接: PubMed
摘要
To analyze the frequency of misdiagnoses in Macular Telangiectasia Type 2 (MacTel) and to investigate factors influencing the probability of receiving an incorrect diagnosis. A retrospective analysis of 288 patients with confirmed diagnosis of MacTel from the Natural History Observation Registry at the University Eye Hospital Bonn was performed. Patients were grouped as follows: Correct diagnosis of MacTel, misdiagnosis, incidental finding. Clinical and demographic data, including best-corrected visual acuity, symptoms, prior treatments, were recorded. Misdiagnoses were categorized, and predictors were analyzed using mixed effect models. Of 288 patients, 174 (60.4%) were correctly diagnosed, 103 (35.8%) were misdiagnosed, and 11 (3.8%) diagnosed incidentally. Misdiagnoses included macular hole (17.3%), maculopathy (12.5%), and AMD (12.5%). Mean age at symptom onset was 54.7 (± 9.8 years); mean time to correct diagnosis was 38.5 ± 50.3 months, decreasing from 115 months (2000-2005) to 5.9 months (after 2020). Younger age at symptom onset reduced the probability of misdiagnosis (odds-ratio 0.96, 95% CI: 0.94-0.98), subjective glare sensitivity increased misdiagnosis probability (OR 2.01, 95% CI: 1.14-3.55). Misdiagnoses of MacTel are common and may delay care. Improved awareness and imaging have shortened these delays. Early multimodal imaging and clinician education remain key to timely diagnosis and better management.
41. Excision of extensive subretinal fibrosis associated with rhegmatogenous retinal detachments in patients with familial exudative vitreoretinopathy.
期刊: Retina (Philadelphia, Pa.) 发表日期: 2025-Sep-10 链接: PubMed
摘要
To determine the characteristics and treatment of the extensive subretinal fibrosis (ESF) in eyes with rhegmatogenous retinal detachment (RRD) but without a tractional retinal detachment in patients with familial exudative vitreoretinopathy (FEVR). Ten eyes of 9 men and 1 woman with ESF in patients with RRD-FEVR were studied. The characteristics, surgical procedures, and the outcomes after the removal of the ESF were determined. The ESF was excised by either stripping the ESF from small retinotomies or by en bloc excision through a >180° retinotomy or retinectomy at the ora serrata. The median age of the patients was 12.5-years. All cases had a unilateral macula-off retinal detachment with a total detachment in 4 eyes and detachment over 2 quadrants in 6 eyes. The first case underwent ESF stripping through small retinotomies that required 7 additional surgeries with a final visual acuity (VA) of hand motion. The subsequent 9 cases underwent en bloc excision resulting in a retinal reattachment with silicone oil tamponade. The silicone oil was removed without a recurrence of the RD during a median follow-up period of 7 years. The median final VA was 20/66 with a range of 20/17 to 20/500. ESF can be found in FEVR eyes with a slowly progressive RRD. We conclude that the en bloc excision of the ESF is an effective and safe procedure to reattach the retina and thus improve the visual acuity.
42. Abortion.
期刊: Annals of internal medicine 发表日期: 2025-Sep 链接: PubMed
摘要
43. Ensuring Safe Practice by Late Career Physicians.
期刊: Annals of internal medicine 发表日期: 2025-Sep 链接: PubMed
摘要
44. Optimizing Surgical Strategies for Elderly Patients With Femoral Neck Fracture: The Critical Role of Comorbidities.
期刊: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews 发表日期: 2025-Sep-01 链接: PubMed
摘要
Femoral neck fractures (FNFs) pose a notable challenge in the elderly population, given the high associated mortality rates and costs. The choice between internal fixation (IF) and hip arthroplasty (HA) has long been debated, yet existing guidelines often overlooked the crucial influence of comorbidities. With the increasing number of hip fracture cases globally and the complexity of patient conditions, it is essential to identify the key factors that truly affect surgical outcomes. We conducted a large-scale retrospective study across 152 Beijing hospitals, including 25,764 patients aged 60+ years with FNF. After excluding those with severe preexisting conditions, we collected data on patient characteristics and used advanced statistical methods for analysis. Among the patients, 4568 received IF and 21,196 received HA. IF decreased 1-year mortality in patients with fewer than four comorbidities, whereas HA was more beneficial for those with four or more comorbidities. Mortality predicted by comorbidities was notably lower than that by age and sex (2.379% versus 2.790%, P < 0.001), and age had no marked influence on outcomes. In summary, for elderly patients with FNF, comorbidity profile, rather than age or sex, should be the key determinant in surgical choices to reduce all-cause mortality. These findings support the refinement of surgical guidelines and have implications for geriatric care. Future research should focus on enhancing comorbidity assessment in surgical planning.
45. Longitudinal Nephrotoxic Metal Exposure in a Cohort of Farm Workers in Sonora, Mexico.
期刊: Journal of occupational and environmental medicine 发表日期: 2025-Aug-19 链接: PubMed
摘要
Metal exposure among farmworkers along the US-Mexico border is understudied, despite links between certain metals and kidney injury or disease. We assessed seasonal metal exposure in agricultural workers in Sonora, Mexico, compared to office workers and other populations. Adult male agricultural and office workers provided urine samples and demographic data at the start and end of the work season. Urine was analyzed for specific gravity, creatinine, and metal(loid) concentrations. Agricultural workers had significantly higher urinary arsenic, lead, nickel, and uranium than office workers. Uranium increased over time, while arsenic, lead, and nickel declined. Urinary metal levels exceeded those in NHANES Mexican Americans, with cadmium levels similar to other farmworker populations but higher arsenic and uranium. Findings enhance understanding of regional exposure, support global farmworker comparisons, and inform exposure modeling, mitigation strategies, and policy.
46. Microbiota of the Lung Tuberculoma: Paucibacillary Bacterial Community.
期刊: International journal of mycobacteriology 发表日期: 2025-Jul-01 链接: PubMed
摘要
Caseum, the central necrotic material of tuberculous lesions, is a reservoir of drug-resistant persisting Mycobacterium tuberculosis (MTB). However, tubercle bacilli are not the only bacterial inhabitants of this necrosis. We discuss the available data on metagenomic and amplicon sequencing of 16S rRNA of caseous necrosis from surgically excised tuberculosis (TB) foci. This approach facilitated the characterization of the biodiversity and the potential biochemical pathways of these bacterial communities. We postulate that in terms of MTB content relative to satellite anaerobic lipophilic bacteria, caseum may present two distinct terminal states. “True” TB necrosis, containing 99.9% tubercle bacilli, and a polymicrobial community wherein anaerobic lipophilic bacteria predominate over MTB. Isolation from caseum and genomic characterization of several Corynebacterium and Staphylococcus species support this concept.
47. An Eye for an Eye, An Ear for an Ear: A Midwestern Case Report of Vogt-Koyanagi-Harada Disease.
期刊: WMJ : official publication of the State Medical Society of Wisconsin 发表日期: 2025 链接: PubMed
摘要
Vogt-Koyanagi-Harada (VKH) disease is an autoimmune condition affecting both ocular and extraocular systems. This case highlights the need for research into the epidemiology and pathophysiology of VKH. A 23-year-old cisgender Hispanic female presented to our tertiary care center with severe headache, eye pain, vision changes, photophobia, hearing loss with tinnitus, phonophobia, nausea, vomiting, and vertigo. She was diagnosed with VKH disease. This report shares a case of VKH disease in the Midwestern United States. A 2023 Northwestern University study highlights the orphan nature of the disease; even with a small sample size, that study proved to be a larger cohort in studies of VKH. This report contributes to the growing literature documenting VKH disease. Especially in diagnoses associated with certain racial groups, a broad differential diagnosis is essential, as delay in diagnosis may result in irreversible sequelae. Prompt coordination with colleagues may reduce subsequent morbidity and mortality.
48. A Novel Coach-Approach to Clinical Faculty Mentoring and the UW Department of Medicine Clinical Faculty Development Program.
期刊: WMJ : official publication of the State Medical Society of Wisconsin 发表日期: 2025 链接: PubMed
摘要
Clinical faculty at academic health centers may benefit from specific mentorship and proficiencies that are distinct from those on research tracks. We describe the creation, activities, and 1-year impact of a faculty development program that included novel professional coaching training (the Clinical Faculty Mentoring Program), which was supplemented by skills- and knowledge-building activities (the Clinical Faculty Development Series). The goals and components of the Clinical Faculty Mentoring Program and Clinical Faculty Development Series are described in detail. A mixed methods evaluation plan guided collection of confidential survey and interview data before and after the first year of these activities. We used paired t tests to identify statistically significant changes. The 43 clinical mentors reported significant gains in job satisfaction, teaching attitudes, knowledge of mentorship competencies, and confidence with coaching skills for mentorship (all P < 0.05). Of mentor respondents, 88% found the coach approach to mentoring program to be “very” or “somewhat” helpful. Coaching behavioral domains with the greatest evidence of improvement were supporting the mentee to integrate new awareness, insight, and learning into their worldview and behaviors (P = 0.0503) and managing time and focus of mentoring sessions (P = 0.022). All 37 mentees had at least 1 meeting with a mentor (100%). Over 9 months, 39 virtual Clinical Faculty Development Series sessions had an average participation of 38 participants (range 22-59). A majority of surveyed faculty (>55%) agreed or strongly agreed the sessions provided valuable opportunities for skills development with teaching, leadership, wellness, diversity, equity, inclusion, and promotion. Among clinical mentors, our novel coach approach to clinical faculty mentoring and skill-building had favorable effects on job satisfaction, knowledge of mentorship competencies, and confidence in coaching skills. Outcomes from the Clinical Faculty Development series supported the mentoring program outcomes. Longitudinal follow-up is needed to determine how this program will impact mentees.
49. Study protocol for the Health Outcomes in Pregnancy and Early Childhood (HOPE) Study: A mother-infant study in American Samoa.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Pacific Islanders, including those in American Samoa, face a disproportionately high burden of gestational diabetes mellitus (GDM) and related sequalae of metabolic conditions. The CREBRF rs373863828 genetic variant, which is uniquely common among Pacific Islanders, has been paradoxically associated with higher body mass index (BMI) but lower risk of type 2 diabetes. While emerging evidence suggests this variant may influence both maternal metabolic outcomes and infant growth, studies in pregnancy and early life remain limited. The purpose of this paper is to describe the protocol for a study designed to address these gaps. The Health Outcomes in Pregnancy and Early Childhood (HOPE) Study is an observational, longitudinal cohort study that will enroll up to 180 Samoan pregnant women and their infants (target n = 150 dyads completing study protocols) in American Samoa, with follow-up through six months postpartum/postnatal. The study includes questionnaires, anthropometric measurements, and biospecimen collection. Genetic and epigenetic analyses will examine associations between maternal and infant CREBRF rs373863828 genotype, gestational diabetes status, infant body size, and cord blood DNA methylation. The study is approved by the Institutional Review Boards at the University of Pittsburgh, Yale University, and the American Samoa Department of Health, as well as the Lyndon B. Johnson Tropical Medical Center (American Samoa) Research Oversight Committee. Findings will be disseminated through peer-reviewed publications, conference presentations, and community reports.
50. Candida Auris Total Knee Arthroplasty Infection in an Immunocompetent Individual: Case Report and Literature Review.
期刊: WMJ : official publication of the State Medical Society of Wisconsin 发表日期: 2025 链接: PubMed
摘要
Candida auris (C auris), a multidrug-resistant fungus, was declared by the Centers for Disease Control and Prevention as a serious global health threat in 2016. It is hard to identify, resistant to standard antifungal treatments, and spreads within health care settings, resulting in high morbidity and mortality in critically ill patients. We report the case of a 60-year-old immunocompetent male with a protracted course of prosthetic knee joint infections. He received medical care at several health care facilities across 2 Midwestern states culminating in wound dehiscence and C auris infection necessitating prolonged antimicrobial treatment. C auris has been a pathogen of increasing nosocomial transmission with particular concern for multidrug resistance. Treatment is with prompt irrigation and debridement and polyethylene exchange and systemic antifungal treatment. Local treatment with antimicrobial impregnated cement can be used to reduce treatment duration and mitigate resistance. With emerging concerns and the prevalence of infection with C auris, there should be greater vigilance in evaluating patients with repeat surgeries and health care contacts for fungal infection.
51. A Silent Wave: Increases in Wisconsin's Alcohol- Related Mortality During the COVID-19 Pandemic.
期刊: WMJ : official publication of the State Medical Society of Wisconsin 发表日期: 2025 链接: PubMed
摘要
Alcohol-related mortality is an increasing public health concern in the United States. To date, no study has considered trends in alcohol-related deaths during the full COVID-19 pandemic period. We analyzed deaths from Wisconsin vital statistics to explore the relationship between the pandemic period and any changes in alcohol-related mortality. In Wisconsin, the pandemic period was associated with additional alcohol-related mortality above and beyond a previously reported upward trend. We show that the COVID-19 pandemic was associated with exacerbated alcohol-related mortality in Wisconsin. Alcohol use may need to be considered as an additional public health risk in future pandemic scenarios.
52. An exploratory assessment of GPT-4o and GPT-4 performance on the Japanese National Dental Examination.
期刊: The Saudi dental journal 发表日期: 2024-Dec 链接: PubMed
摘要
Multiple large language models (LLMs) have been released since 2022, including OpenAI’s GPT-3.5 and GPT-4. The latest model, GPT-4o, introduced on May 13, 2024, significantly improves GPT-4. Previous studies have shown the potential of LLMs as educational tools in medical and dental exams. This study evaluates the accuracy of GPT-4 and GPT-4o responses for the Japanese National Dental Examination (JNDE) to assess their potential as educational tools for dental education. We obtained the dataset of the 117th JNDE, administered in January 2024, consisting of 360 questions. After excluding questions with images and inappropriate ones, 202 questions were selected. GPT-4 and GPT-4o were used to generate responses. Standardized prompts ensured consistent input. Data analysis used Qlik Sense® and GraphPad Prism, employing Fisher’s exact test. GPT-4o showed a significantly higher correct response rate (73.8%) than GPT-4 (63.3%). In the compulsory section, GPT-4o achieved 88.6% accuracy, significantly higher than GPT-4’s 74.3%. Though not statistically significant, the general section saw an improvement with GPT-4o (66.4%) over GPT-4 (58.0%). GPT-4o significantly outperformed GPT-4 in accuracy for JNDE questions, suggesting its improved potential as an educational tool in dental education. Further studies are needed to evaluate GPT-4o’s capabilities with visual materials and in diverse question sets to fully ascertain its utility in educational settings.