公共卫生研究摘要 (2025-09-18)
共收录 57 篇研究文章
1. Association of Frailty With Dementia and the Mediating Role of Brain Structure and Immunometabolic Signatures.
期刊: Neurology 发表日期: 2025-Oct-21 链接: PubMed
摘要
Physical frailty is associated with a higher risk of developing dementia, but it remains unclear whether this relationship is causal and whether the biological biomarkers and neurologic underlying mechanisms are involved. We aimed to elucidate the link between physical frailty and dementia, establish their causal relationship, and investigate the underlying biological mechanisms. This prospective cohort study was based on UK Biobank participants without dementia at enrollment (between 2006 and 2010). Physical frailty was defined by 5 criteria (weight loss, exhaustion, physical inactivity, slow walking speed, and low grip strength). Incident dementia was tracked through linked hospital admission records and death registries, using the International Classification of Diseases, Tenth Revision (ICD-10) codes. Cox proportional hazard regression models and bidirectional Mendelian randomization (MR) analyses were used to evaluate the causal association of physical frailty with incident dementia. In addition, the potential roles of genetic background, brain structures, and biological biomarkers in the association were evaluated using structural equation modeling. Among 489,573 participants (mean age 57.03 years, 54.4% female), 8,900 dementia cases were documented over a median follow-up of 13.58 years. Compared with nonfrail individuals, the risk of dementia was 50% higher in those with prefrailty (hazard ratio [HR]:1.50, 95% CI 1.44-1.57) and 182% higher in those with frailty (HR: 2.82, 95% CI 2.61-3.04). Participants with frailty and high genetic risk had the highest risk of dementia compared with those with low genetic risk and nonfrailty (HR: 3.87, 95% CI 3.30-4.55 for high polygenic risk score; HR: 8.45, 95% CI 7.51-9.51 for APOE-ε4 carriers). The forward MR analysis indicated a potential causal relationship between physical frailty and dementia (odds ratio [OR]:1.79, 95% CI 1.03-3.12) while the reverse MR suggested a null causal association (OR: 1.00, 95% CI 0.98-1.01). Structural equation modeling points to genetic background and neurologic and immunometabolic function as potential underlying mechanisms linking physical frailty to dementia. Our findings support the causal association between physical frailty and dementia, which is possibly mediated through genetic background and neurologic and immunometabolic function. However, this association deserves close consideration because frailty may also be a correlative marker of dementia vulnerability.
2. Soccer Heading Exposure-Dependent Microstructural Injury at Depths of Sulci in Adult Amateur Players.
期刊: Neurology 发表日期: 2025-Oct-07 链接: PubMed
摘要
Repetitive head impacts (RHIs) in sports are associated with adverse clinical and neuropathologic outcomes, but there is limited evidence from in vivo human imaging studies to inform risk assessment, exposure standards, and interventions. We tested the association of RHI with in vivo microstructural disruption at the depths of cerebral sulci, a region vulnerable to trauma. We examined the relationship between soccer-related RHI exposure over 12 months and imaging measures. Participants included amateur soccer players and noncollision sport athletes aged 18-55 years from the Greater New York City area. We analyzed diffusion MRI measures specifically within the juxtacortical white matter at the depths of cortical sulci and crests of gyri, as well as within deep white matter. Cognitive function was assessed using components of the CogState computerized battery, focusing on verbal learning and memory performance. A total of 352 soccer players (mean [SD] age, 25.6 [7.5] years; 245 men [70%]) and 77 controls (22.8 [5.1] years; 30 men [39%]) were included. In multivariable regression, greater RHI was associated with lower fractional anisotropy (FA) (standardized β = -0.234; p < 0.001) and higher orientation dispersion index (ODI) (β = 0.156; p = 0.008), averaged over depths of cerebral sulci, in an RHI exposure-dependent manner. Worse cognitive performance on verbal learning and memory tests was associated with lower FA (Pearson r = 0.16 to 0.24, p < 0.001) and higher ODI (r = -0.25 to -0.17, p < 0.001) at depths of sulci in the orbitofrontal region. Diffusion measures from deep white matter were not associated with RHI or cognitive measures. Mediation analyses revealed that orbitofrontal depths of sulci microstructural disruption (lower FA and higher ODI) partially mediated the relationship between RHI exposure and poorer performance on verbal learning (indirect effects = -0.26 to -0.25, p < 0.001), weighted verbal learning (-0.51 to -0.48, p < 0.001), and verbal memory (-0.05 to -0.04, p = 0.04). Higher RHI exposure was associated with MRI measures of microstructural disruption at the depths of sulci in an exposure-dependent manner. By contrast, deep white matter regions were relatively insensitive to RHI effects. Diffusion MRI at the depths of sulci may serve as a more specific marker of RHI-related brain injury.
3. Reply to Verbrugghe et al.
期刊: Pain 发表日期: 2025-Oct-01 链接: PubMed
摘要
4. Low-Dose Aspirin for PI3K-Altered Localized Colorectal Cancer.
期刊: The New England journal of medicine 发表日期: 2025-Sep-18 链接: PubMed
摘要
Aspirin reduces the incidence of colorectal adenoma and colorectal cancer among high-risk persons. Observational studies suggest that aspirin may also improve disease-free survival after diagnosis, particularly among patients with tumors harboring somatic PIK3CA mutations. However, data from randomized trials are lacking. We conducted a double-blind, randomized, placebo-controlled trial involving patients with stage I, II, or III rectal cancer or stage II or III colon cancer with somatic alterations in PI3K pathway genes. The patients were assigned in a 1:1 ratio to receive 160 mg of aspirin or matched placebo once daily for 3 years. Patients with prespecified PIK3CA hotspot mutations in exon 9 or 20 (group A alterations) and those with other moderate- or high-impact somatic variants in PIK3CA, PIK3R1, or PTEN (group B alterations) were eligible for randomization. The primary end point was colorectal cancer recurrence, assessed in a time-to-event analysis, in patients with group A alterations. Secondary end points included colorectal cancer recurrence in patients with group B alterations, disease-free survival, and safety. Alterations in PI3K pathway genes were detected in 1103 of 2980 patients (37.0%) with complete genomic data. Of 515 patients with group A alterations and 588 patients with group B alterations, 314 and 312, respectively, were assigned to receive aspirin or placebo. The estimated 3-year cumulative incidence of recurrence was 7.7% with aspirin and 14.1% with placebo (hazard ratio, 0.49; 95% confidence interval [CI], 0.24 to 0.98; P = 0.04) among patients with group A alterations and 7.7% and 16.8%, respectively (hazard ratio, 0.42; 95% CI, 0.21 to 0.83), among those with group B alterations. The estimated 3-year disease-free survival was 88.5% with aspirin and 81.4% with placebo (hazard ratio, 0.61; 95% CI, 0.34 to 1.08) among patients with group A alterations and 89.1% and 78.7%, respectively (hazard ratio, 0.51; 95% CI, 0.29 to 0.88), among those with group B alterations. Severe adverse events occurred in 16.8% of aspirin recipients and 11.6% of placebo recipients. Aspirin led to a significantly lower incidence of colorectal cancer recurrence than placebo among patients with PIK3CA hotspot mutations in exon 9 or 20 and appeared to have a similar benefit among those with other somatic alterations in PI3K pathway genes. (Funded by the Swedish Research Council and others; ALASCCA ClinicalTrials.gov number, NCT02647099; EudraCT number, 2015-004240-19.).
5. Prevalence and Associated Risk Factors of Self-Harm Among Health Care Workers: Protocol for Systematic Review and Meta-Analysis.
期刊: JMIR research protocols 发表日期: 2025-Sep-17 链接: PubMed
摘要
Self-harm is a major public health concern, with prevalence increasing worldwide, particularly after the COVID-19 pandemic and associated lockdown restrictions. Health care workers (HCWs) face various challenges, such as pressures of social and familial responsibilities, a lack of integration within the profession, heavier workload, bullying at the workplace, and limited support in the workplace, that impact their mental health and often lead to self-harm. We aim to synthesize the evidence on the pooled prevalence of self-harm worldwide and identify risk factors for self-harm among HCWs. We will conduct a systematic review of observational and experimental studies that investigated the overall prevalence of self-harm among HCWs. We will search the PubMed, PsycINFO, Embase, and CINAHL databases for eligible articles from inception until March 2025 using specific search terms developed using the population, exposure, comparison, and outcome framework. Study selection and reporting will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the Meta-Analysis of Observational Studies in Epidemiology guidelines. We will contact the corresponding author via email if the required data are not available in the article. After completing the article search, duplicate records will be removed. Titles and abstracts will then be screened according to the inclusion and exclusion criteria, followed by retrieval of the full texts for detailed screening. All the required data for the review, such as names of authors, publication year, prevalence of self-harm, type of profession, associated risk factors to self-harm, and others, will be extracted using a standardized data extraction form. The quality of the studies will be assessed using the Joanna Briggs Institute guidelines based on the study design. Random-effects meta-analysis will be used to derive the pooled prevalence using Stata (version 17.0) software. We will conduct a subgroup meta-analysis on sex, regions, and the type of profession (physicians or nurses). We will also examine the association of risk factors of self-harm with sociodemographic factors to observe their relationship. Both analyses will be performed using RevMan software. Publication bias will be examined using the funnel plot and Egger test. Data analysis is expected to be completed by August 2025, and manuscript preparation is expected to be completed by October 2025. This review is expected to be completed and published by January 2026. We will provide a comprehensive synthesis of the overall prevalence of self-harm among HCWs. We will also provide important information to develop effective strategies for preventing and managing self-harm among HCWs. PROSPERO CRD42024581791; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024581791. PRR1-10.2196/67059.
6. Bridging Technology and Pretest Genetic Services: Quantitative Study of Chatbot Interaction Patterns, User Characteristics, and Genetic Testing Decisions.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-17 链接: PubMed
摘要
Among the alternative solutions being tested to improve access to genetic services, chatbots (or conversational agents) are being increasingly used for service delivery. Despite the growing number of studies on the accessibility and feasibility of chatbot genetic service delivery, limited attention has been paid to user interactions with chatbots in a real-world health care context. We examined users’ interaction patterns with a pretest cancer genetics education chatbot as well as the associations between users’ clinical and sociodemographic characteristics, chatbot interaction patterns, and genetic testing decisions. We analyzed data from the experimental arm of Broadening the Reach, Impact, and Delivery of Genetic Services, a multisite genetic services pragmatic trial in which participants eligible for hereditary cancer genetic testing based on family history were randomized to receive a chatbot intervention or standard care. In the experimental chatbot arm, participants were offered access to core educational content delivered by the chatbot with the option to select up to 9 supplementary informational prompts and ask open-ended questions. We computed descriptive statistics for the following interaction patterns: prompt selections, open-ended questions, completion status, dropout points, and postchat decisions regarding genetic testing. Logistic regression models were used to examine the relationships between clinical and sociodemographic factors and chatbot interaction variables, examining how these factors affected genetic testing decisions. Of the 468 participants who initiated a chat, 391 (83.5%) completed it, with 315 (80.6%) of the completers expressing a willingness to pursue genetic testing. Of the 391 completers, 336 (85.9%) selected at least one informational prompt, 41 (10.5%) asked open-ended questions, and 3 (0.8%) opted for extra examples of risk information. Of the 77 noncompleters, 57 (74%) dropped out before accessing any informational content. Interaction patterns were not associated with clinical and sociodemographic factors except for prompt selection (varied by study site) and completion status (varied by family cancer history type). Participants who selected ≥3 prompts (odds ratio 0.33, 95% CI 0.12-0.91; P=.03) or asked open-ended questions (odds ratio 0.46, 95% CI 0.22-0.96; P=.04) were less likely to opt for genetic testing. Findings highlight the chatbot’s effectiveness in engaging users and its high acceptability, with most participants completing the chat, opting for additional information, and showing a high willingness to pursue genetic testing. Sociodemographic factors were not associated with interaction patterns, potentially indicating the chatbot’s scalability across diverse populations provided they have internet access. Future efforts should address the concerns of users with high information needs and integrate them into chatbot design to better support informed genetic decision-making.
7. Evaluating and Optimizing Just-in-Time Adaptive Interventions in a Digital Mental Health Intervention (Wysa for Chronic Pain) for Middle-Aged and Older Adults With Chronic Pain: Protocol for a Series of Randomized Trials.
期刊: JMIR research protocols 发表日期: 2025-Sep-17 链接: PubMed
摘要
On a population level, digital mental health interventions effectively reduce depression and anxiety symptoms. However, middle-aged and older adults with chronic pain and coexisting depression or anxiety have not been adequately represented in digital mental health studies. The goal of this study is to refine an existing mobile, digital mental health intervention (Wysa for Chronic Pain) that addresses symptoms of depression, anxiety, and coexisting chronic pain for the unique challenges and technology use patterns of middle-aged and older adults. Using a mixed methods, human-centered design approach and a series of randomized trials, we will test and iteratively refine just-in-time adaptive interventions (JITAIs) that are designed to increase engagement with a digital mental health intervention. Participants will be aged 45 years or older, endorse at least moderately severe depression or anxiety symptoms (Patient Health Questionnaire-9 or Generalized Anxiety Disorder-7 score ≥10), and have coexisting chronic pain (ie, pain on most days or every day in the past 3 months), and live in the United States. In this open, web-based trial, participants will all receive Wysa for Chronic Pain (by Wysa), which uses a behavioral activation framework and encourages users to work toward pain acceptance. The fully automated intervention also includes cognitive behavioral therapy, mindfulness, and sleep tools, among others. In each trial, participants will be randomized during a maximum 12-week study period to receive versus not receive novel JITAIs that are intended to reduce navigation burden and improve usability (and subsequent engagement and clinical effectiveness). The JITAIs are being designed with iterative user feedback, guided by the Discover, Design/Build, and Test framework and the Behavioral Intervention Technology model. The proximal outcome for each JITAI is related to engagement with Wysa for Chronic Pain after JITAI delivery (compared to when no JITAI is delivered). The primary distal clinical outcome is the Patient Health Questionnaire Anxiety and Depression Scale. Based on statistical analysis that is triangulated with qualitative feedback from a subsample of trial participants, the JITAIs will be iteratively refined and retested in subsequent microrandomized trials until retesting of refined adaptations no longer yields meaningful improvement in immediate engagement or a maximum of 5 total trials have been completed. Institutional review board approval was obtained on April 11, 2025. The first participant was enrolled on June 2, 2025, and recruitment is expected to conclude in 2026. Completion of this project will result in iteratively refined JITAIs that are designed to improve usability and engagement with a digital mental health intervention by middle-aged and older adults with depression or anxiety and coexisting chronic pain. ClinicalTrials.gov NCT06978166; https://clinicaltrials.gov/study/NCT06978166. PRR1-10.2196/77532.
8. Introducing Public Health Vending Machines in Rural Communities: Protocol for a Study Using a Community-Based Participatory Approach.
期刊: JMIR research protocols 发表日期: 2025-Sep-17 链接: PubMed
摘要
Drug-related overdoses impact communities all over the United States. In the past 2 decades, over 28,000 people have died of a drug overdose in North Carolina (NC). Research has shown that there has been an increase in overdose deaths throughout NC, particularly in rural areas. To reduce overdose rates, health care interventions should be expanded. Naloxone distribution is one intervention to combat overdose rates. Naloxone is a medication designed to reverse an opioid overdose rapidly. Public health vending machines (PHVMs) are a strategy recently implemented in some US communities to expand access to harm reduction supplies. Examples of locations where PHVMs have been installed include public health departments, libraries, county detention centers, and law enforcement offices. This protocol aims to develop a community-engaged approach to implementing PHVMs as a health care delivery option for harm reduction supplies in 5 rural counties in NC. This study will use a community-based participatory approach in which we partnered with the NC Harm Reduction Coalition and Community Impact NC to engage with substance use prevention providers and community members in 5 rural counties in NC to improve naloxone access. We will collect qualitative interview data from people with lived experience of substance use to identify the optimal placement of PHVMs and items to be stocked in PHVMs. To do this, we will hire 1 local community member with lived experience of substance use from each county to be an interviewer who will recruit, conduct interviews, and collect data from other community members with lived experience of substance use. Interviewers will be trained to recruit participants, conduct interviews, and collect and analyze data. Developing a protocol for training interviewers includes an interview training presentation with an adapted collaborative institutional training initiative portion. Data will be collected from 2024 to 2025. The findings will inform the implementation of PHVMs to improve harm reduction access and assist in decreasing overdose deaths. This study will use in a community-based participatory approach to improve naloxone access in rural communities. Community partners will assist the academic team in developing a sustainability plan for each county and an implementation toolkit for other communities to use. PRR1-10.2196/64913.
9. Collecting and Sharing Person-Centered AI Clinical Summaries Across Frailty Services Provided by the National Health Service and Voluntary, Community, and Social Enterprise: Protocol for a Co-Design and Feasibility Study.
期刊: JMIR research protocols 发表日期: 2025-Sep-17 链接: PubMed
摘要
Due to its association with multimorbidity, frailty gives rise to multidimensional needs for different services. Too often, patient preferences and service encounter information are not adequately shared. This developmental study aims to co-design, collect, and analyze encounter data from multiple community and primary-based multidisciplinary teams (MDTs) providing services for people with frailty to develop prototype large language models that can generate clinical and person-centered care summaries. Engaging stakeholders in 2 primary care networks, we will co-design the large language model to ensure it meets local needs and preferences as well as infrastructure, information governance, and regulation requirements. General practitioners will identify 50 patients with frailty requiring MDT engagement. Three consecutive encounters between the patients and different members of MDTs will then be audio-recorded. Recordings will be transcribed into text for concept design and model pretraining. These data combine stakeholder engagement insights to develop sensitive artificial intelligence (AI) models responding to stakeholders’ needs, workflows, and preferences. To generate the person-centered summaries, we will test 2 approaches to modeling the encounter data: graph-based modeling and hierarchical transformers. The AI-generated summaries will be compared to human-written summaries of the same encounter data and assessed for accuracy, quality, fluency, and person-centeredness. They will also be shared with the original MDT members for validation. We will capture inputs, processes, and outcomes across all key phases of the implementation journey to identify capability requirements, determinants of implementation (including key challenges and best practices to overcome them), and the value added by the technology. This protocol aims to review implementation evidence and engage stakeholders in co-design. This work package will aid the development of contextually sensitive, longitudinal, and AI-generated person-centered summarization tools. Model development will aim to achieve longitudinal person-centered summaries tested against MDT standards. If deemed suitable for deployment, optimum ways of integrating these summaries into shared care records will be explored with local key system leaders. Model evaluations will provide conclusive insights into such technologies’ benefits and risks. As of August 2025, this study has not yet been funded, nor has ethical approval for the project been obtained. Consequently, dates of data collection and numbers of recruited participants are not applicable at this time. Our protocol provides a robust method of co-designing, evaluating, and implementing a longitudinal AI medical summary tool. Including key stakeholders at multiple stages facilitates an iterative development strategy that is designed to solve implementation challenges as they emerge. This project fits within our long-term vision to deliver a multimodal AI tool that saves clinicians time and deepens the health care professional-patient relationship. Future studies should include a larger patient sample, video-recorded health care professional-patient encounters, and a more extensive longitudinal evaluation. PRR1-10.2196/68511.
10. Psychotherapists' Ethical Dilemmas Regarding Online and Face-to-Face Psychotherapy During the COVID-19 Pandemic: Survey Study.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-17 链接: PubMed
摘要
During the COVID-19 pandemic, mental health professionals were forced to find an appropriate way of working with patients that would ensure the continuity of therapy while considering the restrictions aimed at counteracting the spread of the virus. Online therapy has become an increasingly popular and common form of psychotherapeutic work. Emerging scientific studies have confirmed the positive effects of remote psychotherapeutic work. Nevertheless, modifying traditional and well-known forms of therapy or introducing completely new forms of remote therapy have been associated with several ethical concerns and challenges for psychotherapists. Due to the COVID-19 pandemic and the emerging epidemiological restrictions and recommendations, as well as new recommendations from psychotherapeutic associations, this study aimed to investigate the following: (1) Have psychotherapists experienced ethical dilemmas related to working online and face-to-face during the COVID-19 pandemic? (2) Was the occurrence of these dilemmas related to the therapists’ personal characteristics, such as age, sex, professional experience, or therapeutic approach? (3) What specific ethical dilemmas do psychotherapists point to in conducting online and face-to-face therapy during the COVID-19 pandemic? We conducted an international study with 177 psychotherapists from 4 European countries (Sweden, Poland, Germany, and Portugal) using a web-based survey. The psychotherapeutic approaches represented in the sample were cognitive-behavioral, integrative, psychodynamic-psychoanalytic, systemic, existential and gestalt, and Ericksonian therapy, among others. An interview comprising closed and open questions was used to collect data on psychotherapists’ personal characteristics, professional functioning, and ethical dilemmas encountered during online and face-to-face therapy. Ethical dilemmas related to online therapy were reported by 58.7% (104/177) of therapists, while dilemmas related to face-to-face therapy were reported by 61% (108/177). The study showed that these dilemmas were independent of the personal and professional characteristics of therapists. Dilemmas related to online therapy were concern about online therapy, the issue of privacy and confidentiality of sessions, the effectiveness of online therapy, the issue of limitations that may hinder clinical work, and concerns related to the broader systemic and institutional context. In contrast, for the face-to-face form, ethical dilemmas mainly concerned health and safety, limitations in communication and quality of relationships due to wearing masks, and technical and logistical limitations. The issues considered here have not lost their relevance, because despite the lifting of restrictions related to the pandemic, some of the described dilemmas are similar to those related to coping with the risk and transmission of infection during face-to-face meetings. Moreover, the spread of online therapy means that the related ethical dilemmas are still relevant. The results indicate the direction of further consideration, the outcome of which should be specific ethical and legal guidelines that consider the concerns and dilemmas reported.
11. Optimizing Digital Solutions to Improve Access to Comprehensive Primary Health Care Services in Remote Indigenous Communities: Protocol for a Participatory Action Research Project.
期刊: JMIR research protocols 发表日期: 2025-Sep-17 链接: PubMed
摘要
Aboriginal and Torres Strait Islander (Indigenous) peoples living in remote Australia experience a heavy burden of ill health and multiple barriers to accessing health care. Digital health technologies (DHTs) have the potential to help overcome some of these challenges and increase access to comprehensive primary health care (CPHC), thereby improving equity of health outcomes. However, little is known about the community and provider preferences for the use of digital technologies for improving health and wellness. The study aims to co-design, implement, and evaluate how DHTs can improve access to CPHC in remote Indigenous communities in the Northern Territory (NT), Australia. This multiphased project will take a participatory action research approach to co-design and optimize digital health solutions with local community members and health service staff in 2 communities. Our mixed methods approach will include pre- and postimplementation focus group discussions, interviews, quantitative analysis of CPHC utilization administrative data, and surveys administered by Indigenous community-based researchers to understand the use of digital devices and connectivity, eHealth literacy, preferences for different attributes of DHTs using best-worst scaling, and consumer satisfaction and experiences with DHT interventions. Priority DHTs will be selected for implementation based on consumer and health staff preferences. Focus group discussions and interview data will explore community and health service staff preferences, experiences, and satisfaction with implemented DHTs. A realist approach will be taken to identify how DHT interventions work, for whom, and in what circumstances, so that the understanding of why some interventions work while others do not is expanded. Economic analyses will be conducted to calculate the incremental costs and benefits of implemented DHT interventions. The scalability of digital health solutions will be tested in two additional communities. Project partners include key funding, service, and support agencies in the NT and nationally. As of November 2024, we have selected two implementation sites. Digital health initiatives are underway at the implementation sites, and evaluation activities are progressing. The initial findings from these sites have informed our scalability assessment in an additional two sites. Knowledge translation is integral to the study design, which involves partnering with consumers, CPHC service providers, and a range of key stakeholders to inform health service providers and policy makers about which DHTs work for which groups of consumers, and under what circumstances, to improve access to CPHC. This unique study will accommodate consumer and provider preferences regarding the use of DHTs to improve CPHC access and address the lack of knowledge about how to deploy digital solutions to best support CPHC in remote Indigenous Australia. DERR1-10.2196/68892.
12. Coronary Artery Disease Prevalence in an Executive Population at a Tertiary Medical Center: Protocol for a Retrospective Cohort Study.
期刊: JMIR research protocols 发表日期: 2025-Sep-17 链接: PubMed
摘要
Coronary artery disease (CAD) is a leading cause of global morbidity and mortality. Although CAD prevalence in the general population is well-documented, its occurrence among executive patients remains largely unexplored. An executive is an individual in a major leadership role, such as a C-suite officer, senior manager, board member, trustee, founder, or business owner, responsible for high-level decision-making and strategic direction. These roles often involve demanding schedules and significant stress. Despite their influence and better access to health care, this demographic faces unique challenges such as demanding work schedules, chronic stress, frequent travel, and reduced control over lifestyle. To address executives’ unique health needs, many health care organizations offer specialized programs emphasizing preventive cardiovascular care, using advanced tools such as lipid panels, stress tests, and coronary calcium scans not typically included in primary care, to detect risks early and to promote long-term wellness. This protocol aims to design a study to determine the prevalence of CAD in executive patients and compare it to the established prevalence in the US general population with the overarching goal of improving screening and care of CAD among executive patients. This protocol proposes a retrospective review of medical records for patients with CAD seen at the Mayo Clinic’s Executive Health Program from January 1, 2020, to December 31, 2023, with the aim of determining the prevalence of CAD in executive patients. The primary outcome is CAD prevalence, which will be identified through clinical diagnoses in the electronic medical records. Secondary outcomes include demographics, cardiovascular medications, social determinants of health, laboratory and diagnostic results, coronary calcium scores, and treatment interventions. The prevalence of CAD will be calculated as the proportion of patients with a documented CAD diagnosis relative to the total number of patients in the study cohort. A total of 24,272 patients were seen in the executive health clinic between January 1, 2020, and December 31, 2023. After applying the inclusion criteria, 6466 executive patients were eligible, with 3290 identified as having a potential CAD diagnosis pending confirmation through a detailed chart review. In this protocol, we outline a research design and methodology to address a critical gap in understanding the prevalence of CAD among executive patients. This demographic is often overlooked despite their unique risk factors such as high stress and lifestyle choices. DERR1-10.2196/72451.
13. Medical Imaging and Pediatric and Adolescent Hematologic Cancer Risk.
期刊: The New England journal of medicine 发表日期: 2025-Sep-17 链接: PubMed
摘要
Assessing the risk of radiation-induced hematologic cancer from medical imaging in children and adolescents might support informed decisions on the use of imaging. We followed a retrospective cohort of 3,724,623 children born between 1996 and 2016 in six U.S. health care systems and Ontario, Canada, until the earliest of cancer or benign-tumor diagnosis, death, end of health care coverage, an age of 21 years, or December 31, 2017. Radiation doses to active bone marrow from medical imaging were quantified. Associations between hematologic cancers and cumulative radiation exposure (vs. no exposure), with a lag of 6 months, were estimated with the use of continuous-time hazards models. During 35,715,325 person-years of follow-up (mean, 10.1 years per person), 2961 hematologic cancers were diagnosed, primarily lymphoid cancers (2349 [79.3%]), myeloid cancers or acute leukemia (460 [15.5%]), and histiocytic- or dendritic-cell cancers (129 [4.4%]). The mean (±SD) exposure among children exposed to at least 1 mGy was 14.0±23.1 mGy overall (for comparison, 13.7 mGy was the exposure from one computed tomographic [CT] scan of the head) and 24.5±36.4 mGy among children with hematologic cancer. Cancer risk increased with cumulative dose, with a relative risk (vs. no exposure) of 1.41 (95% confidence interval [CI], 1.11 to 1.78) for 1 to less than 5 mGy, 1.82 (95% CI, 1.33 to 2.43) for 15 to less than 20 mGy, and 3.59 (95% CI, 2.22 to 5.44) for 50 to less than 100 mGy. The cumulative radiation dose to bone marrow was associated with an increased risk of all hematologic cancers (excess relative risk per 100 mGy, 2.54 [95% CI, 1.70 to 3.51; P<0.001]; relative risk for 30 vs. 0 mGy, 1.76 [95% CI, 1.51 to 2.05]) and most tumor subtypes. The excess cumulative incidence of hematologic cancers by 21 years of age among children exposed to at least 30 mGy (mean, 57 mGy) was 25.6 per 10,000. We estimated that, in our cohort, 10.1% (95% CI, 5.8 to 14.2) of hematologic cancers may have been attributable to radiation exposure from medical imaging, with higher risks from the higher-dose medical-imaging tests such as CT. Our study suggests an association between exposure to radiation from medical imaging and a small but significantly increased risk of hematologic cancer among children and adolescents. (Funded by the National Cancer Institute and others.).
14. Studying Cancer Risks Associated with Diagnostic Procedures - Interpret Wisely.
期刊: The New England journal of medicine 发表日期: 2025-Sep-17 链接: PubMed
摘要
15. To Talk or Not to Talk About Sexual Orientation? That Is the Question: Experiences of Sexual Minority Women With Cancer in Brazil and United Kingdom.
期刊: Journal of homosexuality 发表日期: 2025-Sep-17 链接: PubMed
摘要
This study aims to understand how Brazilian and British sexual minority women who have had cancer make the decision whether or not to disclose their sexual orientation to health professionals. This is a qualitative, interpretative and cross-sectional study. Four Brazilian and three British sexual minority women who were diagnosed with cancer participated in the research. To build the corpus for analysis, individual face-to-face interviews were conducted. The interviews were digitally recorded with the participants’ consent, and the audio-recorded content was transcribed verbatim and in full. Subsequently, the data were analyzed using reflexive thematic analysis. Four main themes were generated: (1) structural aspects of health services; (2) professionals’ characteristics; (3) professionals’ attitudes/behaviors during appointments; (4) how the topic of sexual orientation (dis)appears at appointments. We found some convergences between the experiences of Brazilian and English sexual minority women. Participants wanted to be able to present with their partner at health services and feel safe that they would be respected and included. Barriers to disclosure included professionals’ personal characteristics that might be suggestive of prejudice or lack of understanding, overt political and/or right-wing attitudes, and a feeling that sexual orientation would be ignored by the health provider even if disclosed.
16. A Social-Ecological Systems Understanding of Risk & Protective Factors for Loneliness in LGBTQ+ Adults: A Scoping Review.
期刊: Journal of homosexuality 发表日期: 2025-Sep-17 链接: PubMed
摘要
LGBTQ+ adults are a marginalized population that often experiences high levels of loneliness associated with poor mental and physical health outcomes. However, designing effective interventions can be hindered by the complexity and interdependence of loneliness risk and protective factors. A scoping review was conducted to map the scientific understanding of loneliness risk and protective factors for LGBTQ+ adults to theoretical frameworks that propose a causal mechanism for how social connection as a human basic need can directly impact health outcomes. The review identified relevant research literature (1983-2024) in seven clinical and social science databases. A total of 44 articles were included in the review, resulting in four distinct categories of risk or protective social environment systems. These categories summarized the relationship of 113 social environment factors with loneliness outcomes as forms of social isolation, geographic isolation, social support, or distal stressors. This may ease the burden of understanding how to intervene on the deficiency of quality in social environments that drive loneliness in LGBTQ+ adults.
17. Potential Contributions of Edible Oil and Wheat Flour Fortification on Reducing Inadequate Micronutrient Intake in Ethiopia.
期刊: Annals of the New York Academy of Sciences 发表日期: 2025-Sep-17 链接: PubMed
摘要
In 2022, Ethiopia enacted the mandatory fortification of wheat flour and edible oil to counter inadequate micronutrient intake as a risk factor for micronutrient deficiencies. This study aimed to model the potential contributions of fortifying wheat flour and edible oil to reducing the risk of micronutrient inadequacy. The 2015/16 Ethiopian Household Consumption-Expenditure Survey was used to estimate apparent micronutrient intakes of nine micronutrients and triangulated to existing food consumption and micronutrient surveys. Population risk for inadequate micronutrient intake was assessed overall using a mean adequacy ratio and for individual micronutrients included in the fortification standards. Potential contributions of fortification were assessed by comparing two scenarios across subpopulations: assuming no fortification and full compliance with the fortification policy. The reach of fortifiable wheat flour (39%) and edible oil (70%) suggests that fortifying these vehicles could reduce the risk of inadequate micronutrient intake by 44%, with variation between micronutrients, geographies, urban/rural residence, and socioeconomic status. Even under optimistic fortification scenarios, however, micronutrient gaps would remain for the rural poor. Sustained efforts are needed to drive the implementation of Ethiopia’s fortification policy and to coordinate fortification with other interventions targeting populations beyond the reach of fortified foods.
18. Digital Health Intervention in Snakebite Management: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-17 链接: PubMed
摘要
Snakebite envenoming is a neglected tropical disease that causes significant morbidity and mortality, with an estimated 81,410-137,880 deaths annually, primarily in rural, low-resource settings. Digital health interventions, particularly mobile apps (mobile-based health apps), offer innovative solutions to improve snakebite management through real-time guidance, antivenom stock tracking, and telemedicine. This scoping review aims to (1) systematically map existing digital mobile-based health interventions for snakebite management and (2) evaluate their key functionalities, accessibility, and geographical distribution. We conducted a systematic search (January 2024) across PubMed, Google Scholar, ResearchGate, Google Search, and the Google Play Store. The results were screened using the following criteria: mobile-based health apps providing structured guidance for snakebite management (first aid, treatment protocols, antivenom mapping) were included while studies not in the English language and studies on apps lacking clinical guidance were excluded. Data extraction focused on app features (snake identification, first aid protocols), accessibility (operating system compatibility, cost), multilingual support, and user feedback. Regional app availability was verified via VPN for country-specific stores (eg, India, Nigeria). Narrative synthesis was used to categorize findings by functionality, regional distribution, and implementation challenges. The results were presented using a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart to illustrate the screening process, complemented by summary tables for a clear and detailed overview of the findings. The search resulted in a total of 237 records, of which 227 underwent primary screening after removing duplicates. After full-text review, 135 reports were excluded, resulting in the inclusion of a total of 16 apps. All 16 apps provided first aid protocols, with most including snake identification tools (n=14, 88%) such as artificial intelligence-driven photo recognition. Additionally, over half mapped antivenom stocks (n=9, 56%) and a majority integrated emergency contacts (n=11, 69%). A total of 15 apps (94%) were free to access, and 10 (62%) supported Android. Most of the apps were available in India (n=11, 69%), while South Africa had very few, despite the burden, highlighting a clear geographical disparity. Urban users praised real-time guidance (85% positive reviews), but rural usability was hindered due to internet dependency (40% of rural users) and language barriers (65% misinterpretation was noted in regions where English was not the primary language). Digital health apps have demonstrated the potential to reduce snakebite mortality through education and emergency support. However, scalability can only be achieved by taking into consideration several factors. First, infrastructural adaptations including offline functionality and low-data interfaces are needed. Second, they must have equity-driven designs, allowing regional customization (eg, sub-Saharan African snake species) and hyperlocal language integration. Third, there must be policy actions taken including standardized development guidelines, subsidized smartphone access, and digital literacy programs. These steps are critical to achieving the World Health Organization’s 2030 targets and ensuring equitable global impact.
19. Competitive Food Policy and Food Behavior and Health Metrics in K-12 Students: A Scoping Review.
期刊: The Journal of school nursing : the official publication of the National Association of School Nurses 发表日期: 2025-Sep-17 链接: PubMed
摘要
School meals provide nearly half of children’s daily calories, making them critical to childhood health. School food policies aim to improve student health by shaping the school food environment. While this environmental influence is known, the impact of these policies, especially following the Healthy Hunger-Free Kids Act of 2010, has not recently been synthesized. This review searched PubMed, EMBASE, ERIC, and Cochrane databases, identifying 28 studies assessing school food policy on student health. Of these, 23 found positive health effects from competitive food policies, and 5 found mixed positive and neutral effects. No studies reported negative impacts. These findings suggest that competitive food policies are an effective and equitable strategy for improving health that school nurses can support. This review synthesizes the current evidence on competitive food policy to establish baseline evidence for the function of such policies to promote population health and find areas where further research would be useful.
20. Longitudinal antibody titers measured after COVID-19 mRNA vaccination can identify individuals at risk for subsequent infection.
期刊: Science translational medicine 发表日期: 2025-Sep-17 链接: PubMed
摘要
A key issue in the post-COVID-19 pandemic era is the ongoing administration of COVID-19 vaccines. Repeated vaccination is essential for preparing against currently circulating and newly emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. However, optimizing vaccination strategies is crucial to efficiently manage medical resources and establish an effective vaccination framework. Therefore, a strategy to identify poor responders with lower sustained antibody titers would be beneficial because these individuals should be considered high priority for revaccination. We investigated longitudinal antibody titer data in a cohort of 2526 people in Fukushima, Japan, collected between April 2021 and November 2022. Using mathematical modeling and machine learning, we stratified the time-course patterns of antibody titers after two primary doses and one booster dose of COVID-19 messenger RNA vaccines. We identified three populations, which we refer to as the durable, the vulnerable, and the rapid-decliner populations, and approximately half of the participants remained in the same population after the booster dose. The rapid-decliner population experienced earlier infections than the others. Furthermore, when comparing spike protein-specific immunoglobulin G (IgG) titers, spike protein-specific IgA titers, and SARS-CoV-2-specific T cell responses between participants who experienced subsequent infections after booster vaccination and those who did not, we found that spike protein-specific IgA titers were lower during the early stage after booster vaccination in participants who went on to become infected with SARS-CoV-2. This approach could be used to inform policy decisions on vaccine distribution to maximize population-level immunity both in future pandemics and in the post-COVID-19 pandemic era.
21. Online Yoga Pilot Intervention for Black Women at High Cardiovascular Risk: Internet-Based Recruitment and Engagement.
期刊: JMIR formative research 发表日期: 2025-Sep-17 链接: PubMed
摘要
Disproportionately adverse heart health outcomes in Black women, characterized by high metabolic syndrome prevalence, underscore the need for innovative, accessible interventions. Digital health strategies, particularly web-based yoga videos, show promise for engaging this high-risk group in health-promoting behaviors. This study aimed to evaluate the feasibility and acceptability of a web-based yoga intervention for community-dwelling Black women, providing preliminary data to inform a larger, mixed methods study on reducing cardiometabolic risks. In this 4-week pilot study, grounded in Pender’s Health Promotion Model, 28 participants engaged in daily online health education and yoga activities through YouTube videos. Using Fitbit trackers, electronic blood pressure monitors, and web-based logs, the study measured metabolic syndrome risk factors and sedentary behavior. Participant experiences were further explored through postintervention focus groups aiming to contextualize the intervention’s impact. We enrolled 28 women, with a completion rate of 79% (22/28), demonstrating successful recruitment and retention. Participants were an average age of 43.3 years with a mean BMI of 40.9 kg/m2, indicating a high-risk group for metabolic syndrome. Engagement with 2 or more intervention components were significantly correlated with study completion (χ21=7.14, P=.008). Specifically, viewing over one-half of the instructional videos (χ21=4.39, P=.04) and daily blood pressure monitoring (χ21=5.67, P=.02) were key to participant adherence. The intervention was well-received, with 95% (19/20) of survey respondents finding it satisfactory and suitable. Technology use was high, with all participants having access to the internet, 96% (27/28) owning smartphones, and 53% (15/28) having a YouTube account prior to the study. Recruitment was effectively conducted online, primarily via Facebook and a university newsletter, each accounting for 39.3% (11/28) of participants. The qualitative focus group data unveiled 4 major themes: (1) accountability, emphasizing the shift toward self-prioritization and collective health responsibility; (2) increased awareness, highlighting enhanced understanding of health behaviors and metabolic syndrome risks; (3) health benefits, noting observed improvements in blood pressure and stress levels; and (4) unanticipated stressors, identifying external factors that challenged engagement. These insights underscore the intervention’s multifaceted impact, from fostering health awareness to navigating external stressors. This pilot study demonstrated the feasibility and acceptability of a culturally tailored, online yoga intervention among community-based, Black women at high risk for metabolic syndrome, showing promising engagement and potential health benefits. The high rates of participation and completion highlight the intervention’s acceptability and the potential for digital platforms to facilitate health behavior changes in high-risk populations. The qualitative findings reveal critical insights into the psychological and social dynamics influencing health behavior change, suggesting the importance of addressing both individual and communal barriers to improve intervention efficacy. Future research should further explore these dynamics in larger, more diverse cohorts to substantiate the intervention’s potential in reducing cardiometabolic risks.
22. Fiber for improvement of behavior, eating, and risk: Protocol for a randomized controlled trial examining a behavioral intervention focused on facilitating improved dietary fiber consumption, eating behavior, and cardiometabolic risk in adults with obesity.
期刊: Nutrition and health 发表日期: 2025-Sep-17 链接: PubMed
摘要
Background: Despite a long-standing appreciation for the benefits of dietary fiber consumption, there is a lack of interventions focused exclusively on improving dietary fiber intake. Aim: The aim of this study is to determine the effects of an intervention focused singularly on improving dietary fiber on weight, eating behavior, and markers of cardiometabolic risk. Methods: This pilot study will employ a three-arm, factorial design to examine effects of a novel dietary fiber-focused intervention: Fiber for Improvement of Behavior, Eating, and Risk (FIBER), compared to standard weight loss education alone or in combination with FIBER. FIBER is 3 months long, including group-based educational sessions and remote counseling using motivational interviewing. Intervention content is focused on dietary fiber. This includes what dietary fiber is, where to find it, why to consume it, and how to consume it via theory-driven behavior change techniques and strategies (e.g. observational learning). Adults consuming ≤25 g of dietary fiber/day and a body mass index ≥30 kg/m2 will be recruited using online advertisements. Participants will complete in-person data collection visits at baseline and 1 and 2 years post-FIBER to measure body mass (primary outcome), blood lipids, dietary fiber intake, behavior and cognitive measures, stool samples, and body composition (secondary outcomes). One remote data collection session will occur directly after FIBER to assess dietary fiber intake and behavior and cognitive measures. Summary: This study will provide data regarding effects of a dietary fiber-focused intervention on diet and eating-related behavior, body weight, and cardiometabolic risk factors in adults with obesity.
23. Exploring the Confidence and Attitudes of Physiotherapy Students Working With People Experiencing Mental Ill Health: A Mixed-Methods Study.
期刊: Journal, physical therapy education 发表日期: 2025-Sep-17 链接: PubMed
摘要
Due to the rising prevalence of mental illness (MI), physiotherapists are likely to work with this population with increasing frequency. This study aimed to explore the confidence, attitudes, and curriculum perceptions of physiotherapy students in the United Kingdom to work with people experiencing MI. Although studies have explored attitudes of physiotherapy and health care students working with people experiencing MI, few have examined the impact of these attitudes on confidence in practice and curriculum development. Preregistration physiotherapy students from across the United Kingdom (n = 141) completed a web-based survey, with 21 students participating in semi-structured interviews. A sequential mixed-methods study was conducted, including a web-based survey and 1:1 semi-structured interviews to explore the confidence and attitudes of physiotherapy students around working with people experiencing MI. Overall confidence levels (0-100 scale) to work with people experiencing MI was 35.6 (±21.9). There was a significant relationship between confidence working with people experiencing MI and time covering mental health within the curriculum so far, and overall perceived curriculum coverage of mental health and illness. Analysis of qualitative interviews identified 5 major themes: 1) A current lack of confidence and preparedness to address mental health; 2) Gaining competence from experience (placement and life); 3) Integrating the physical and the psychological; 4) Lack of role clarity; 5) A need to educate the workforce. Preregistration physiotherapy students demonstrate a lack of confidence in working with people experiencing MI. Increased exposure within teaching and clinical experience was identified both quantitatively and qualitatively to increase confidence levels. Although attitudes to working with people experiencing MI are positive, recommendations to increase physiotherapy student confidence include increasing curriculum coverage through directed teaching, case-based learning, an integrated approach to physical and mental health, and simulation experiences.
24. Choking on TikTok: Memetic Content and CRAAP Analysis of Educative and Entertaining #Chokekink Videos.
期刊: Journal of sex research 发表日期: 2025-Sep-17 链接: PubMed
摘要
Sexual choking is prevalent among adolescents and young adults (AYA), some of whom report having learned about this sexual practice from social media. This study reports on sexual choking related #chokekink TikTok videos collected over 2 days in 2023-2024. We analyzed 96 entertaining and/or educative videos thematically and categorically using Memetic Content Analysis. The CRAAP (Currency, Relevance, Authority, Accuracy, Purpose) test was applied to all educative content (n = 6). Videos were primarily brief, one-sided, and framed as entertainment skits utilizing sampled sounds with text annotation. They contained more content around desiring choking than potential health risks. Most people present appeared to be traditionally cisgender female AYAs. While we primarily observed videos about consensual choking, we also witnessed choking in the context of dating violence. We identified 11 themes: (1) rough sex as pleasurable, (2) choking as not rough enough, (3) ideal masculine partners choke, (4) choking is “vanilla,” (5) choking is introductory to rougher kinks, (6) consensual choking boundaries are unclear, (7) loss of consciousness: concerns and experiences, (8) being choked increases feminine attractiveness, (9) choking is intimidating for the choker, (10) kink origins related to trauma, (11) engagement of sexual choking to uphold sexual norms. All the educative content (n = 6) included misinformation comprised statements that there is a right way to choke based on pressure location and/or intensity or that consciousness implies safety. Based on our findings, we provide suggestions for educators, policymakers, and technology companies.
25. Effects of 8-week ischemic preconditioning on swimming performance and power output in male 100-m freestyle swimmers: a randomized controlled trial.
期刊: European journal of applied physiology 发表日期: 2025-Sep-17 链接: PubMed
摘要
This study aimed to investigate the long-term effects of an 8-week ischemic preconditioning (IPC) intervention on the athletic performance of male freestyle swimmers. Eighteen male 100-m freestyle swimmers were randomly assigned to either the IPC group (n = 9) or the sham operation group (n = 9), with interventions administered three times per week over the course of 8 weeks. Athletic performance was evaluated through 100-m freestyle race tests and Wingate 30-s tests at baseline, at the 4th week, and at the 9th week. The data were analyzed via two-way repeated-measures ANOVA. After 8 weeks of intervention, the IPC group demonstrated significantly improved performance in the 100-m race compared with the placebo group (57.57 ± 2.30 vs. 59.90 ± 2.30, p = 0.048, d = 1.01). The enhancement in the second half of the 100-m performance was more pronounced in the IPC group than in the placebo group (30.15 ± 1.00 vs. 32.32 ± 1.97, p = 0.009, d = 1.39). Significant increases in peak power (817.27 ± 144.77 vs. 674.93 ± 54.75, p = 0.014, d = 1.30), mean power (679.60 ± 85.12 vs. 541.64 ± 78.33, p = 0.003, d = 1.69), and blood lactate levels (16.07 ± 1.22 vs. 14.7 ± 0.97, p = 0.018, d = 1.24) were detected. Conversely, a significant decrease was noted in the fatigue index (51.28 ± 6.20 vs. 60.34 ± 10.60, p = 0.042, d = 1.04) and time to peak (2942.67 ± 1782.08 vs. 4758.00 ± 1830.71, p = 0.049, d = 1.00). An 8-week IPC intervention can effectively enhance the athletic performance of freestyle swimmers, potentially by improving anaerobic power output and delaying fatigue, as measured by the Wingate 30 s test. This finding suggests a novel intervention strategy for swim training.
26. Community Agency Health Promotion Capacity for Ethno-Culturally Diverse Immigrant Women: Qualitative Interviews.
期刊: Journal of immigrant and minority health 发表日期: 2025-Sep-17 链接: PubMed
摘要
High rates of international migration must be addressed by healthcare systems. In particular, immigrant women lack access to and quality of care. Community-based health promotion may be one way to reach immigrant women. The aim of this study was to explore the capacity of immigrant settlement agencies for health promotion to immigrant women. We conducted semi-structured telephone interviews with immigrant women and community agency managers to discuss current and required health promotion capacity based on the New South Wales Framework, and identified themes using content analysis. We interviewed 24 immigrant women and 22 staff from 20 immigrant settlement agencies across Canada. Women and agency staff largely agreed on the need to develop the workforce (staff type and qualifications), acquire resources (human, physical, financial) dedicated to health promotion, establish external partnerships with academic, healthcare and other community organizations, create policies and strategies specific to health promotion, and choose and train leaders with interpersonal and technical skills. In addition, women underscored the need to tailor health promotion programs and services to women, and to enhance access to community-based health promotion by raising awareness via diverse media and government settlement agencies, and supporting participation by paying for transportation to community agencies or providing programs and services virtually or in multiple convenient locations. Action is needed to integrate these findings into policy that supports community-based health promotion, and into community agency policies and strategies. Ongoing research is needed to establish optimal community agency health promotion models and impact. Ultimately, community agency health promotion may reduce healthcare inequities, and lead to improved health and wellness among immigrant women.
27. Spirulina supplementation and rheumatoid arthritis: A systematic review of current research and molecular mechanisms.
期刊: Molecular biology reports 发表日期: 2025-Sep-17 链接: PubMed
摘要
28. Triterpenes From Lagerstroemia indica L. Bark With Anti-ZIKV Activity.
期刊: Chemistry & biodiversity 发表日期: 2025-Sep-17 链接: PubMed
摘要
Two previously undescribed triterpenes, 2S,3R,23-trihydroxy-1-oxo-olean-12-en-28-oic acid (1) and 2S,3R-dihydroxy-1-oxo-olean-12-en-28-oic acid (2), along with 19 known triterpenes (3-21), were isolated from the bark of Lagerstroemia indica L. Their structures were determined by comprehensive spectroscopic analysis, including NMR, HR-ESI-MS, UV, and IR measurements. The absolute configurations were established through ECD calculations. Compound 4 demonstrated potent anti-ZIKV activity with an EC50 value of 6.05 ± 0.51 µM. Notably, Compound 4 was shown to inhibit ZIKV envelope (E) protein expression and viral replication in a dose-dependent manner.
29. Clesrovimab for Prevention of RSV Disease in Healthy Infants.
期刊: The New England journal of medicine 发表日期: 2025-Sep-17 链接: PubMed
摘要
Clesrovimab is a long-acting investigational monoclonal antibody against site IV of the respiratory syncytial virus (RSV) fusion protein. Data regarding the safety and efficacy of clesrovimab in healthy infants are needed. We randomly assigned healthy preterm and full-term infants entering their first RSV season in a 2:1 ratio to receive one intramuscular 105-mg dose of clesrovimab or placebo. The primary efficacy end point was RSV-associated medically attended lower respiratory infection (including at least one indicator of lower respiratory infection or disease severity) through 150 days after injection. A key secondary efficacy end point was RSV-associated hospitalization during the same period. A total of 3614 infants received an injection: 2412 infants received clesrovimab, and 1202 infants received placebo. Through day 150 after injection, RSV-associated medically attended lower respiratory infection occurred in 60 of 2398 infants in the clesrovimab group (incidence rate over 5-month period, 2.6%) and in 74 of 1201 infants in the placebo group (incidence rate over 5-month period, 6.5%), for an efficacy of 60.4% (95% confidence interval [CI], 44.1 to 71.9; P<0.001). RSV-associated hospitalization within 150 days was reported in 9 of 2398 infants in the clesrovimab group and in 28 of 1201 infants in the placebo group, for an efficacy of 84.2% (95% CI, 66.6 to 92.6; P<0.001). Serious adverse events were reported in 278 of 2409 infants (11.5%) in the clesrovimab group and 149 of 1202 infants (12.4%) in the placebo group. In healthy preterm and full-term infants, a single dose of clesrovimab reduced the incidence of RSV-associated medically attended lower respiratory infection and RSV-associated hospitalization, with a safety profile similar to that of placebo. (Funded by Merck Sharp and Dohme; CLEVER ClinicalTrials.gov number, NCT04767373.).
30. Comparing COVID-19 Acute And Postacute Medical Spending By Vaccination Status For Child And Adult Medicaid Enrollees.
期刊: Health affairs (Project Hope) 发表日期: 2025-Sep-17 链接: PubMed
摘要
Although COVID-19 vaccines have been shown to be highly effective in preventing severe illness, hospitalization, and death, information on the economic benefits of COVID-19 vaccination is lacking. Using data from a comprehensive, integrated health system, we linked health plan data and electronic health records to vaccination data to compare the average medical expenditures of vaccinated versus unvaccinated patients diagnosed with COVID-19. We examined expenditures during acute (within thirty days after diagnosis) and postacute (at least thirty days after diagnosis) periods from April 2021 through July 2022. Among children, average acute medical expenditures were $194 less for vaccinated than unvaccinated cases and among adults, $1,743 less for vaccinated than unvaccinated cases. Medical expenditures in the postacute period were not statistically different by vaccination status. The findings suggest that COVID-19 vaccination is associated with lower medical expenditures in the acute period. Vaccination continues to be important for reducing the economic impact of COVID-19.
31. Accurate and Early Diagnosis of NSCLC Using Aberrant Fragmentomic Features of Circulating Cell-Free Mitochondrial DNA.
期刊: American journal of respiratory and critical care medicine 发表日期: 2025-Sep-17 链接: PubMed
摘要
Early differential diagnosis of benign and malignant lung diseases is a critical challenge in the clinical oncology of non-small cell lung cancer (NSCLC). We aim to develop a novel strategy utilizing circulating cell free mtDNA (ccf-mtDNA) fragmentomics for accurate and early diagnosis of NSCLC. We analyzed capture-based ccf-mtDNA sequencing data of 2,306 plasma samples from 1,357 NSCLC patients, 432 benign lung diseases (BLD) patients, and 517 healthy controls (HCs) obtained from three hospitals. Subsequently, using ccf-mtDNA fragmentomic features, we developed models for Differential diagnosis of Benign and Malignant lung diseases (DBM) and Early Diagnosis of NSCLC (EDL). Our analysis revealed significantly aberrant fragmentomic features of ccf-mtDNA in NSCLC patients compared with those in BLD patients and HCs. Remarkably, the DBM model demonstrated remarkable capability to distinguish NSCLC from BLD, outperforming serum biomarkers with an AUC exceeding 0.9551 in three validation cohorts. Still, the DBM model exhibited superior diagnostic performance even for small nodules (< 1 cm), achieving an AUC of 0.9151. Moreover, the DBM model demonstrated precise clinical management ability of pulmonary lesions, thereby avoiding unnecessary invasive procedures in BLD patients and preventing delayed treatment in NSCLC patients. Furthermore, the EDL model demonstrated outstanding performance in detecting stage 0 - Ⅰ NSCLC, with an AUC exceeding 0.9759. Our multicenter study provides a novel non-invasive approach using ccf-mtDNA fragmentomics for the differential diagnosis of benign and malignant lung diseases and early diagnosis of NSCLC, with potential applications in clinical decision-making in the management of NSCLC.
32. Effect of Ozone Autohemotherapy on Inflammatory Response and Postoperative Cognitive Function in Patients Undergoing Valve Replacement with Cardiopulmonary Bypass.
期刊: Brazilian journal of cardiovascular surgery 发表日期: 2025-Sep-17 链接: PubMed
摘要
We herein probed the effects of ozone autohemotherapy (O3-AHT) on inflammatory response and postoperative cognitive function in patients undergoing valve replacement with cardiopulmonary bypass (CPB). Totally, 130 patients undergoing valve replacement with CPB were included in the study (O3-AHT) and control (banked blood transfusion) groups. Blood samples were taken for blood gas analysis, with arterial oxygen saturation, jugular venous oxygen saturation, partial pressure of arterial oxygen and jugular venous PO₂, hemoglobin, and cerebral oxygen extraction rate documented. Interleukin (IL)-6, tumor necrosis factor alpha (TNF-α), and IL-1β levels and serum S100β and neuron-specific enolase (NSE) concentrations were measured by enzyme-linked immunosorbent assay, followed by cognitive function assessment by Mini-Mental State Examination and Montreal Cognitive Assessment scales. The research group exhibited elevated thrombin time, activated partial thromboplastin time, and prothrombin time and decreased fibrinogen level immediately after surgery; it also presented reduced 24-hour postoperative serum IL-6, TNF-α, IL-1β, S100β, and NSE levels. Intraoperative cerebral oxygen metabolism was improved, and cognitive dysfunction was alleviated in the research group. The comparison of transfusion complication incidence between the two groups showed no significant difference. The application of O3-AHT in patients undergoing valve replacement with CPB enhanced intraoperative brain oxygen metabolism and reduced postoperative 24-hour inflammatory response and cognitive dysfunction.
33. High-elevation adaptation and gestational hypoxia jointly shape vascular development in a rodent placenta.
期刊: The Journal of physiology 发表日期: 2025-Sep-17 链接: PubMed
摘要
Gestational hypoxia reduces fetal growth and birth weight across mammals, including humans. Evolutionary adaptation to high-elevation hypoxia mitigates these negative effects, and identifying these protective mechanisms may offer insight into how environmental factors interact with gestational physiology to influence health outcomes. We know that gestational hypoxia modifies development of the placenta, which mediates maternal-fetal exchange, but little is known about how high-altitude adaptation interacts with this developmental plasticity to influence placental exchange capacity. We tested the hypothesis that hypoxia-dependent remodelling of the placental exchange surface is protective for fetal growth and thus will be exaggerated in highland-adapted individuals by using a model rodent system, the North American deer mouse. We acclimated lowland- and highland-ancestry deer mice to normoxia or hypoxia (12.3% O2) during gestation and found that lowland-ancestry deer mice expand their placenta and maternal blood spaces in the placenta in response to environmental hypoxia. Highland-ancestry deer mice produce even larger placentas and maternal blood spaces, suggesting that these hypoxia-driven responses may benefit fetal growth by increasing total exchange capacity. Notably, we also found that the fetal blood spaces in highland-ancestry placentas have increased perimeter (a proxy for surface area) per unit area occupied by blood. Similar changes to fetal vasculature have been observed in high-elevation-adapted human populations, which is suggestive of convergent adaptation. Our results demonstrate that the hypoxia-sensitive development of placental vasculature is remodelled by adaptation to environmental hypoxia and that some of these processes may be points for convergent adaptation across species despite distinct placental architectures. KEY POINTS: Evolutionary adaptation to high elevations provides protection against hypoxia-dependent fetal growth restriction. The placenta is a key determinant of fetal growth because it defines the total surface area available for nutrient and gas exchange between the gestational parent and offspring. We tested the hypothesis that evolutionary adaptation to high elevations protects fetal growth by increasing placental surface area for exchange using acclimation experiments in a model rodent system, the North American deer mouse. As we predicted, high-elevation ancestry increased the size of maternal blood spaces in the placenta, especially under gestational hypoxia; however, highland ancestry was also associated with narrower fetal blood spaces, which could increase exchange efficiency. The patterns observed in deer mice resemble developmental plasticity observed in placentas from humans with high-elevation ancestry, pointing to potential for convergent adaptation across species with distinct placental architectures.
34. Respiratory Injuries among California Career Firefighters, 2000-2019.
期刊: Annals of the American Thoracic Society 发表日期: 2025-Sep-17 链接: PubMed
摘要
The association between firefighting exposure and respiratory injuries remains poorly quantified, despite the inhalational hazards of firefighting. To describe respiratory injury rates among California firefighters between 2000 to 2019 demographically, temporally, and geographically. Using data from the California Workers’ Compensation Information System from 2000 to 2019, we analyzed California firefighter workers’ compensation claims for respiratory injuries from 2000 to 2019. We identified firefighter respiratory claims using nature of injury codes, injury description keywords, and International Classification of Diseases Ninth or Tenth revision codes. We estimated California firefighter employment totals using the American Community Survey. We calculated respiratory injury rates, rate ratios, and their associated confidence intervals by age and injury date and location. We identified 3,431 respiratory injury claims between 2000 to 2019 (478 respiratory claims/100,000 California career firefighters, 90% CI: 432-534) and the respiratory injury rate remained unchanged. Firefighters aged 50 to 59 years had a higher risk of respiratory injuries compared to those aged 18 to 29 years (rate ratio=1.7, 90% CI: 1.6-1.8). Firefighters during wildfire season months had significantly more respiratory injuries than during non-wildfire season months. From 2000 to 2019, firefighter’s respiratory injury rate in rural and small/medium metro counties increased significantly, while firefighter’s respiratory injury rate in large metro counties decreased significantly. Older firefighters, firefighters during wildfire season, and those in rural and small/medium metro counties may be at higher risk of respiratory injury, based on our large-scale, multi-year surveillance study among career California firefighters.
35. Estimating the effectiveness of non-pharmaceutical interventions against COVID-19 transmission in the Netherlands.
期刊: PLoS computational biology 发表日期: 2025-Sep-17 链接: PubMed
摘要
During the COVID-19 pandemic non-pharmaceutical interventions (NPIs) were taken to mitigate virus spread. Assessing their effectiveness is essential in policy support but often challenging, due to interactions between measures, the increase of immunity, variant emergence and seasonal effects. These factors make results difficult to interpret over a long period of time. Using a mechanistic approach, we estimate the overall effectiveness of sets of NPIs in reducing transmission over time. Our approach quantifies the effectiveness by comparing the observed effective reproduction number, which is the number of secondary infections caused by a typical infected person, to a counterfactual reproduction number if no NPIs were taken. The counterfactual reproduction number accounts for seasonal variations in transmissibility, for emergence of more transmissible variants, and for changes in immunity in the population. The immune fraction is reconstructed from age-specific data of longitudinal serological surveys and vaccination coverage, taking immunity loss due to waning into account. We estimate the effectiveness of NPIs in the Netherlands from the start of the pandemic in March 2020 until the emergence of the Omicron variant in November 2021. We find that the effectiveness of NPIs was high in March and April 2020 during the first pandemic wave and in January and February 2021, coinciding with the two periods with the most stringent measures. For both periods the effectiveness was estimated at approximately 50%, i.e., without any measures the reproduction number would have been twice as high as observed. The proposed approach synthesises available epidemiological data from different sources to reconstruct the population-level immunity. With sufficient data, it can be applied not only to COVID-19 but also to other directly transmitted diseases, such as influenza. This method provides a near real-time assessment of the effectiveness of control measures when the required data are available.
36. Universal Trauma Screening in Preschool Speech and Language Services: Screening Process and Client Profiles.
期刊: Language, speech, and hearing services in schools 发表日期: 2025-Sep-17 链接: PubMed
摘要
The purpose of this study was to investigate the implementation of universal trauma screening in publicly funded preschool speech and language (PSL) services. This article presents the results pertaining to the screening process and the client profiles of research participants (including trauma exposures and potential responses). As part of a larger study, a clinical pilot and research study were undertaken. The clinical pilot included the design and implementation of a screening protocol where speech-language pathologists prescreened clients for potential trauma exposure during initial assessment, and then offered families a full trauma screening with a mental health professional. Data were collected from 193 speech-language pathologist-completed questionnaires following initial assessment and from the full trauma screenings of 57 children aged 9-50 months (which comprised the research study). During PSL initial assessments, 30% of clients disclosed potential trauma exposure. The highest reported exposures included public health or environmental crises (33%), major family moves (30%), and significant separations from parents/caregivers or close family members (26%). Of the top seven reported exposures, four were characterized as interpersonal trauma, and 35% of clients reported at least three trauma exposures. A significant correlation was observed between the number of reported trauma exposures and potential trauma responses, which are commonly seen in PSL services, r(55) = .28, p = .037. The findings highlight the importance of integrating trauma-informed care universally in PSL services, including collaborative speech-language pathology and mental health services. Universal trauma screening in PSL services can identify at-risk children early, allowing for tailored interventions and better support for families. The study underscores the need for integrated services to address the complex needs of children exposed to trauma.
37. The feasibility, acceptability, and effects of the adapted 6-month Otago exercise program on cognitive, physical, and psychological function in people living with dementia in residential care facilities: The ENABLED randomized controlled trial.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Sep-17 链接: PubMed
摘要
BackgroundPeople living with dementia (PWD) have poor executive function, which impacts their independence and fall risk. Exercise is a promising strategy but needs to be adapted for PWD in residential care settings. Thus, the feasibility, acceptability, and efficacy of adapted exercise on executive function need to be established.ObjectiveThe purpose of the 6-month assessor-blinded strENgth And BaLance exercise on Executive function in people living with Dementia (ENABLED) randomized controlled trial was to determine 1) the feasibility and acceptability, and 2) if the adapted physical therapist-led Otago Exercise Program (OEP) plus usual care would improve executive function (primary) and secondary cognitive, physical, and psychological function measures as well as falls compared to usual care only in PWD in residential care facilities.MethodsWe randomized PWD to the exercise (n = 21) or usual care group (n = 21) at two residential care facilities in our parallel, assessor-blinded RCT (1:1) [NCT05488951]. A physical therapist delivered our adapted OEP 3x/week over 6 months. We examined feasibility and acceptability. Participants completed a battery of assessments, with the Color-Word Stroop as our primary outcome.ResultsAttrition (19.0%), exercise adherence (60.2 ± 34.5%; 47/78 sessions), and satisfaction were acceptable (4.2/5 points). We found no differences in the Color-Word Stroop, but better working memory, leg strength, and quality of life following exercise relative to usual care (p < 0.05). No differences in falls emerged.ConclusionsThis feasible and acceptable RCT indicates that exercise improves working memory, leg strength, and quality of life and has implications for the design of therapeutic intervention in PWD.
38. Shift work and metabolic dysfunction-associated steatotic liver disease: a systematic review of observational studies.
期刊: International archives of occupational and environmental health 发表日期: 2025-Sep-17 链接: PubMed
摘要
Shift work disrupts the circadian rhythm and may increase the risk of metabolic disorders, including nonalcoholic fatty liver disease, recently redefined as metabolic dysfunction-associated steatotic liver disease (MASLD), and its progressive form, metabolic dysfunction-associated steatohepatitis. This systematic review aimed to synthesize observational studies on the association between shift work and MASLD. A comprehensive literature search was conducted in the PubMed, Scopus, and Web of Science databases up to November 25, 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted and summarized based on pre-specified inclusion and exclusion criteria. The National Institutes of Health quality assessment tool was used to evaluate the quality of the included studies. Both data extraction and quality assessment were conducted independently by two authors, with disagreements resolved through consensus. Nine studies met the criteria and were included in the review, including various occupational groups. Most studies reported a positive association between shift work and MASLD, with stronger effects observed in workers exposed to long-term or frequent shift work. Subgroup and interaction analyses suggested that gender, age, lifestyle, chronotype, and occupational factors may modify this association, while body mass index was identified as a potential mediator of the relationship between shift work and MASLD. However, methodological issues, such as imprecise exposure and outcome measurements and a lack of time-varying analysis, limit causal interpretation. The systematic review supports an association between shift work and increased MASLD risk. Further prospective studies with rigorous designs and diverse populations, as well as stronger mechanistic evidence, are needed to establish a causal link between shift work and MASLD.
39. Plasma Metabolite N-Formylmethionine Is Associated With Higher Blood Pressure in the Multiethnic HELIUS Cohort and Triggers Vascular Dysfunction.
期刊: Hypertension (Dallas, Tex. : 1979) 发表日期: 2025-Sep-17 链接: PubMed
摘要
Since the existing literature on plasma metabolites and blood pressure (BP) is predominantly focused on populations of European ancestry, we aimed to study associations between metabolite profiles and BP in a multiethnic cohort. From the HELIUS study (Healthy Life in an Urban Setting), 369 individuals of Dutch, Ghanaian, African Surinamese, and South-Asian Surinamese ethnicity were included for a cross-sectional analysis. Office BP was recorded, and plasma metabolites were measured using untargeted LC-MS/MS. Associations between metabolite profiles and BP were assessed with XGBoost machine learning prediction models, followed by linear regression models. The associations with the highest-ranked metabolite were validated in 2 cohorts, and its effects were investigated in human aortic endothelial and vascular smooth muscle cells. The plasma metabolite N-formylmethionine (fMet) showed the most consistent associations with BP across age, sex, and ethnicity. Notably, fMet was associated with higher systolic (+4.14 mm Hg, 95% CI, 2.11-6.17 per SD increase) and diastolic BP (+2.61 mm Hg, 1.41-3.82), and these associations were validated in 2 independent cohorts. Mechanistically, we found that fMet likely contributes to elevated BP by suppressing endothelial nitric oxide synthase expression, and inducing oxidative stress and mitochondrial dysfunction in endothelial cells. In addition, fMet elicited an early inflammatory response, disrupted the endothelial barrier and upregulated myosin light chain expression in vascular smooth muscle. We identified the metabolite fMet as a novel independent factor associated with BP in an ethnically diverse population. It likely contributes to higher BP by triggering endothelial cell dysfunction, while augmenting contractile proteins in vascular smooth muscle cells.
40. Impact of systemic SARS-CoV-2 vaccination on mucosal IgA responses to subsequent breakthrough infection.
期刊: EBioMedicine 发表日期: 2025-Sep-16 链接: PubMed
摘要
Mucosal IgA responses are central to protection against SARS-CoV-2 infection and viral transmission. While systemic immunity following SARS-CoV-2 infection and vaccination is thoroughly investigated, we have limited understanding of factors affecting the generation and boosting of mucosal IgA. In this cohort study, we investigated factors influencing mucosal SARS-CoV-2 IgA responses among 879 healthcare workers enrolled in the longitudinal COMMUNITY study. Blood samples and clinical data were collected from all participants every four months since April 2020. SARS-CoV-2 immune histories are well characterized through national vaccine and infection registries along with regular monitoring of seroconversion of spike and/or nucleocapsid antigen. Regression models were developed to assess the influence of vaccinations and prior infections on the magnitude of SARS-CoV-2 spike-specific IgA in nasal secretions collected from the cohort in October 2022. Mucosal SARS-CoV-2 spike-specific IgA was detected in 81% of participants, with a positive association with number of prior infections, indicating a booster effect by reinfection. The increased odds ratio of detectable mucosal IgA remained for at least 22 months post infection. There was a strong association between repeated systemic vaccinations and a lower magnitude of mucosal IgA responses. Moreover, the temporal sequence of infection and vaccination influenced mucosal IgA responses, with higher levels among participants with infection prior to systemic vaccination as compared to those with breakthrough infection as the first viral encounter. The observation that repeated mucosal exposures elicit enhanced and long-lasting mucosal IgA responses strengthens the rationale for developing effective mucosal vaccines. While systemic vaccination remains essential for preventing severe disease, our findings suggest that it may influence subsequent generation of mucosal IgA trough a reduction of viral load and inflammation in the mucosa. This is highly relevant for both understanding the development of population immunity and for optimizing the timing of a sequential systemic and mucosal vaccination approach. This study was supported by grants from Region Stockholm, and SciLifeLab and the Knut and Alice Wallenberg Foundation, SSMF and European Research Council. We thank the Public Health Agency of Sweden for support.
41. Forensic analysis of psychiatric disorder-related deaths: A retrospective study in southern China.
期刊: Journal of forensic and legal medicine 发表日期: 2025-Sep-16 链接: PubMed
摘要
Mental health issues have become increasingly severe globally over the last decade. The aim of the present study is to explore the characteristics of psychiatric disorder-related deaths in southern China and to provide a reference for forensic practice. Upon examining forensic autopsy cases from the Faculty of Forensic Medicine at Zhongshan School of Medicine, Sun Yat-sen University, spanning from 2014 to 2023, we identified cases of death related to psychiatric disorders. We then analyzed pertinent data, including age, gender, forensic autopsy details, and medication records.Our findings indicated that out of 6013 forensic autopsies conducted, 63 deaths were associated with psychiatric disorders. Cardiovascular disease emerged as the primary cause of death. Notably, individuals who had died from psychiatric disorders exhibited heavier heart weights and smaller perivalvular diameters of the pulmonary artery, as well as coronary artery disease. Antipsychotic drug therapy was prevalent, with most patients being prescribed more than two medications. Cardiovascular disease is the leading cause of death in psychiatric disorders, deaths related to psychiatric disorders are emerging as a challenge in forensic practice and require the concerted efforts of forensic scientists worldwide.
42. Typology and Ethical Considerations of Digital Health Promotion Tools for Youth in Sub-Saharan Africa: Review of Examples From Ghana, Kenya, and South Africa.
期刊: JMIR formative research 发表日期: 2025-Sep-15 链接: PubMed
摘要
Digital technologies for health promotion have proliferated over the past decade, with uptake increasing steadily among young people, including those in low- and middle-income countries (LMICs). Youth increasingly rely on digital tools for health information, and the early influence of this digital technology can have an impact throughout the lifespan. While there is a growing body of literature on the opportunities and challenges of digital health promotion (DHP) for young people, a gap remains in research that closely examines the characteristics of digital health strategies developed specifically for youth in LMICs. In this paper, we investigate and compare selected examples of DHP tools from 3 countries in Sub-Saharan Africa, namely Ghana, Kenya, and South Africa. Our aim is to create a multidimensional descriptive typology of DHP tools developed specifically to promote the health of adolescents and young adults in these countries. To select the tools, we conducted systematic internet-based searches using relevant keywords, incorporating the expertise of local professionals to ensure a thorough search. Included solutions originated from one of the 3 countries of focus and could take any number of forms such as apps, websites, chatbots, or social media initiatives. We thereafter deductively created a typology describing selected features of each tool, including the health area of focus, key stakeholders, type of service, and ethical values explicitly referenced within the tool. While such high-level features of interest were selected based on the existing literature in the field, the detailed descriptive categories were identified through an inductive analysis of the tools. A total of 31 DHP tools were identified. Sexual and reproductive health was the most common health area of focus for DHP services, which were primarily funded and supported by local non-governmental organizations, foundations, and international organizations. The assessed tools were predominantly web-based and social media-based, with the overarching goal and core value of expanding health knowledge and offering access to health promotion services to young people. With sustained investment, DHP can improve the health of young people while relieving pressure on health care services. The areas of mental health, as well as substance use prevention and nutrition, stand out with clear potential for health gains through investment in DHP. Addressing ethical concerns such as privacy, transparency, equity, and inclusiveness is essential to the safety, usefulness, and fairness of DHP. To achieve the greatest benefit, local youth perspectives and priorities should be included in DHP development. Local initiatives have the potential to be the most agile, flexible, and relevant for the target audience of young people, with the overall goal of early intervention and greater health quality throughout the lifespan, and more efficient use of health care resources.
43. Association of dietary fibre with type 2 diabetes risk is modified by transcription factor 7 like 2 genotype in men with impaired fasting glucose: The T2D-GENE study.
期刊: Clinical nutrition (Edinburgh, Scotland) 发表日期: 2025-Sep-09 链接: PubMed
摘要
Dietary fibre helps prevent type 2 diabetes (T2D), but the effect could be affected by a risk allele T of the transcription factor 7 like 2 (TCF7L2) gene. We investigated the effects of a group-based, 3-year T2D-GENE diet and exercise intervention on dietary fibre intake and if fibre intake was associated with T2D risk and plasma glucose parameters. We also investigated if the TCF7L2 rs7903146 genotype modified the effects of fibre. A 3-year lifestyle intervention with Finnish men having impaired fasting glucose, aged 50-75 years. We measured fibre intake with 4-day food records (FR) and used plasma alkylresorcinol measurements for fibre intake validation. The participants (n = 558) were categorised into low (<3 g/MJ) and high (≥3 g/MJ) fibre intake group. We measured glucose parameters with a 2-h oral glucose tolerance test and stratified participants by the TCF7L2 genotype. The intervention increased the proportion of participants with fibre intake ≥3 g/MJ (45 % at baseline vs. 64 % at the end of the intervention, p < 0.001). Higher fibre intake associated with lower risk for T2D in all participants (hazard ratio [HR] 0.46 (95 % confidence interval [CI] 0.23; 0.94), adjusted with age, body mass index, exercise, smoking, alcohol consumption, saturated fatty acid, monounsaturated fatty acid, and polyunsaturated fatty acid intake), especially in the TCF7L2 rs7903146 risk allele carriers (HR 0.06 (95 % CI 0.01; 0.36), the adjusted model). The increase of fasting plasma glucose and glucose area under the curve and the decrease of disposition index were attenuated in the T allele carriers with fibre intake of ≥3 g/MJ as compared to the participants not reaching the fibre target (p = 0.01, p = 0.012, p = 0.013, respectively). Group-based lifestyle intervention increased dietary fibre intake. Higher fibre intake benefited especially the risk allele carriers in TCF7L2 rs7903146 gene. T2D-GENE study was registered at clinicaltrials.gov as NCT02709057.
44. Rare Variants Associated With Pediatric Cancer Treatment-Related Second Malignant Neoplasm Risk.
期刊: JCO precision oncology 发表日期: 2025-Sep 链接: PubMed
摘要
Survivors of childhood cancers are at risk of second malignant neoplasms (SMNs). Exposure to radiation therapy and different chemotherapy agents are known risk factors for SMN development. However, there remains interindividual variability that could be attributed to genetic variations. Our study aims to identify rare genetic variants associated with SMN risk and assess the influence of treatment on the associated risk of these variants. We conducted a whole-exome sequencing in a nested case-control study within the French Childhood Cancer Survivors Study for 450 survivors including 163 cases and 287 controls. Rare variants in genes within replication, recombination, and repair pathways were selected. Gene-based association tests were conducted and a logistic regression analysis was used to estimate the effect of selected genes on SMN risk, adjusting for relevant clinical variables. Specific analysis restricted to breast and thyroid SMNs were also performed. Stratified analyses on the basis of the radiation doses received by the bone marrow and specific organs were also conducted. We have identified several genetic associations: the RNASEL and APOBEC3F genes (odds ratio [OR], 5.43 [95% CI, 1.76 to 20.44]; P = .0055 and OR, 4.8 [95% CI, 1.28 to 22.95]; P = .027, respectively) are associated with the risk of SMN, while the FANCM gene (OR, 4.65 [95% CI, 1.06 to 21.56]; P = .041) is associated with the risk of developing breast SMN. This study provides new evidence regarding the involvement of genetics in the development of SMN. Additional research is needed to confirm these results and uncover the underlying mechanisms behind these associations. If replicated, these findings will help identify survivors at higher risk of developing SMN, enabling tailored treatment and follow-up strategies.
45. Colorectal Cancer Screening and Prevention.
期刊: American family physician 发表日期: 2025-Sep 链接: PubMed
摘要
In the United States, colorectal cancer is the third most commonly diagnosed cancer and the second most common cause of cancer death. The annual incidence has decreased since the 1980s. However, in the past 25 years, the incidence in adults 40 to 49 years of age, although low, has increased by 15%. The US Preventive Services Task Force recommends that adults with average risk and no signs or symptoms of colorectal cancer undergo periodic screening from 45 to 75 years of age. Starting screening or surveillance at an earlier age should be considered in patients with a prior diagnosis of adenomatous polyps or inflammatory bowel disease, a history of radiation to the abdomen or pelvis to treat a prior cancer, any genetic disorder that predisposes the patient to a high lifetime risk of cancer, or a first-degree relative with colorectal cancer or adenomatous polyps. Recommended screening modalities include stool-based fecal immunochemical tests, which can also include DNA analysis, and direct visualization via computed tomography colonography, flexible sigmoidoscopy, or colonoscopy. Blood-based testing has low sensitivity and high cost and is therefore a second-line screening option performed only when the patient declines all first-line tests. Physicians should emphasize to patients that regular screening is a powerful tool for preventing colorectal cancer and highlight modifiable risk factors, which include staying at a healthy weight; performing moderate to vigorous physical activity; eating a diet high in fruits, vegetables, and whole grains and low in red and processed meats; not drinking alcohol; and not smoking.
46. Trends in Births and Deaths: United States, 2010-2023.
期刊: National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 发表日期: 2025-Aug-27 链接: PubMed
摘要
This report presents and compares trends in U.S. births and deaths from 2010 through 2023. Births and deaths are shown by race and Hispanic origin and urbanicity of county of residence. Descriptive tabulations of trends in the numbers, rates, and ratios of births and deaths for the United States from 2010 through 2023 are presented and interpreted. From 2010 through 2023, the number of births for the United States declined by a total of 10%. Births were essentially stable from 2010 through 2016, declined from 2016 through 2019, and then fluctuated from 2019 through 2023. In contrast, the number of deaths generally increased from 2010 through 2023, by a total of 25%. Deaths increased from 2010 through 2019 and fluctuated from 2019 through 2023. The crude birth rate decreased 18% from 2010 through 2023, declining 0.8% per year from 2010 through 2015 and 2.0% per year from 2015 through 2019; the rate then fluctuated from 2019 through 2023. In contrast, the crude death rate increased 15% from 2010 through 2023, rising 1.0% on average from 2010 through 2019, and then fluctuating from 2019 through 2023. The birth-to-death ratio declined from 2010 through 2023, by a total of 28%, with the ratio decreasing 1.6% per year from 2010 through 2014 and 2.8% per year from 2014 through 2019; the ratio then fluctuated from 2019 through 2023. The ratio generally declined for the three largest race and Hispanic-origin groups from 2010 through 2023, fluctuating but increasing from 2019 through 2023. The differences in the ratios among the groups narrowed from 2010 through 2023. The birth-to-death ratio declined for both urban and rural counties from 2010 through 2023, with differences between ratios narrowing.
47. Referrals from Health Care Professionals to Community-Based Exercise Programmes Targeting People with Balance and Mobility Limitations: An Interviewer-Administered Survey.
期刊: Physiotherapy Canada. Physiotherapie Canada 发表日期: 2025-Feb 链接: PubMed
摘要
Purpose: To describe programme representatives’ perceptions of the: (1) type and work setting of health care professionals who refer to community-based exercise programmes with health care-community partnerships (CBEP-HCPs) by community size; (2) nature, frequency, and utility of strategies used to promote referral from health care professionals to CBEP-HCPs; and (3) facilitators and barriers to CBEP-HCP promotion. Method: We invited individuals involved with the Together in Movement and Exercise (TIME™) programme in 48 centres to participate in a cross-sectional survey. TIME™ is a group, task-oriented CBEP-HCP taught by fitness instructors; health care partners promote referrals. Data were summarized using frequencies and percentages. Content analysis was used for open-ended questions. Results: Twenty-three representatives of 27 TIME™ programmes (56% response rate) participated. Out of 26 health care partners identified, 69% were physical therapists. We report the most common findings: programmes received referrals from physical therapists (16, 70%); programmes gave health care partners promotional materials (e.g., flyers) to facilitate referrals (n = 17, 63%); strong relationships with health care partners facilitated promotion (n = 18, 78%); and representatives perceived their lack of credibility challenged promotion (n = 3, 23%). Conclusions: Physical therapists were the most common referral source. Health Care partners were instrumental in programme promotion. Future research is needed to leverage referrals from physical therapists in settings other than hospitals and to better understand the role of health care partners in CBEP-HCPs. Objectif : décrire les perceptions des représentants des programmes à l’égard 1) du type et du milieu de travail des professionnels de la santé qui aiguillent les patients vers des programmes d’exercice communautaire faisant l’objet de partenariats entre le milieu communautaire et le secteur de la santé (PEC-PCSS), selon la dimension de chaque communauté; 2) de la nature, de la fréquence et de l’utilité des stratégies utilisées pour promouvoir l’aiguillage des professionnels de la santé vers les PEC-PCSS et 3) des incitatifs et des obstacles à la promotion des PEC-PCSS. Méthodologie : les chercheurs ont invité les personnes de 48 centres qui ont participé au programme Together in Movement and Exercise (TIMEMC, ensemble dans le mouvement et l’exercice) à remplir un sondage transversal. Le programme TIMEMC est un PEC-PCSS collectif orienté vers les tâches donné par des entraîneurs physiques; les partenaires du secteur de la santé favorisent les aiguillages. Les chercheurs ont résumé les données en regroupant les fréquences et les pourcentages. Ils ont analysé le contenu des questions ouvertes. Résultats : au total, 23 représentants de 27 programmes TIMEMC (taux de réponse de 56 %) ont participé. Sur les 26 partenaires du secteur de la santé, 69 % étaient des physiothérapeutes. Les chercheurs rendent compte des observations les plus fréquentes : des programmes ont reçu des aiguillages de physiothérapeutes (n = 16, 70 %); des programmes ont remis du matériel promotionnel aux partenaires du secteur de la santé (p. ex., des dépliants) pour faciliter des aiguillages (n = 17, 63 %); des relations solides avec les partenaires du secteur de la santé ont facilité la promotion (n = 18, 78 %) et des représentants ont eu l’impression que leur manque de crédibilité a compliqué la promotion (n = 3, 23 %). Conclusions : les physiothérapeutes étaient les principales sources d’aiguillage. Des partenaires du secteur de la santé ont participé à la promotion du programme. D’autres recherches s’imposent pour stimuler les aiguillages des physiothérapeutes provenant d’autres milieux que les hôpitaux et pour mieux comprendre le rôle des partenaires du secteur de la santé dans les PEC-PCSS.
48. Entry-to-Practice Business and Practice Management Competencies: A Qualitative Systematic Review to Inform Canadian Physiotherapy Curricula.
期刊: Physiotherapy Canada. Physiotherapie Canada 发表日期: 2025-Feb 链接: PubMed
摘要
Purpose: There is increasing demand for business skills among health care professionals. The aim of this qualitative systematic review was to identify and summarize existing business and practice management (BPM) competencies for rehabilitation university graduates with the intention to inform curricula. Method: The key electronic databases searched include ABI/INFORM Global, CINAHL, Education Source, Embase, and Medline. The initial search was performed in December 2018 and updated June 2021 with the following inclusion criteria: articles addressing BMP competencies in university-level rehabilitation programmes in developed countries. To ensure professional position statements and standards documents were captured, this grey literature was also included. Resources were extracted using EndNote and two reviewers independently screened and appraised the resources using the AACODS Checklist. Results: Nine resources met the inclusion criteria and were incorporated in the qualitative synthesis. Quality-assessment scores ranged from 4 to 6 out of 6 on the AACODS Checklist. Several practice management competencies were consistent across multiple rehabilitation professions. However, business competencies were inconsistent with “marketing” and the “ability to develop a business plan” arising sporadically across Occupational Therapy and Physiotherapy competency profiles, as well as individual audiology courses. Conclusions: There is insufficient evidence to suggest that a consensus exists for BPM competencies for rehabilitation university graduates in Canada. The aggregate list of 64 competencies compiled can be used to inform further research. Objectif : la demande de compétences en affaires est croissante chez les professionnels de la santé. La présente analyse systématique qualitative visait à déterminer et à résumer les compétences en affaires et en gestion de la pratique (AGP) existantes chez les diplômés universitaires en réadaptation afin d’éclairer le cursus. Méthodologie : les chercheurs ont fouillé les principales bases de données électroniques, soit ABI/INFORM Global, CINAHL, Education Source, Embase et Medline. Ils ont effectué la recherche initiale en décembre 2018 et l’ont mise à jour en juin 202, selon les critères d’inclusion suivants : les articles sur les compétences en AGP dans les programmes de réadaptation universitaires des pays industrialisés. Pour s’assurer que les déclarations professionnelles et les normes en fassent partie, ils ont également inclus ces publications parallèles. Ils ont extrait les ressources au moyen de EndNote, et deux analystes les ont évaluées séparément à l’aide de la liste de vérification AACODS. Résultats : neuf ressources, qui respectaient les critères d’inclusion, ont été intégrées à la synthèse qualitative. Les scores d’évaluation de la qualité se situaient entre 4 et 6 sur 6 sur la liste de vérification AACODS. Plusieurs compétences en gestion de la pratique concordaient dans de multiples professions de la réadaptation. Toutefois, les compétences en affaires ne concordaient pas avec la « commercialisation » et la « capacité de préparer un plan d’affaires » qui surgissent sporadiquement dans les profils de compétences en ergothérapie et en physiothérapie, de même que dans les cours d’audiologie individuels. Conclusions : les données sont insuffisantes pour affirmer qu’il y a un consensus sur les compétences en AGP pour les diplômés universitaires en réadaptation au Canada. La liste regroupée des 64 compétences compilées pourrait servir à éclairer de futures recherches.
49. Differential Pattern of Obesity in Total Hip and Knee Arthroplasty Candidates.
期刊: Physiotherapy Canada. Physiotherapie Canada 发表日期: 2025-Feb 链接: PubMed
摘要
Purpose: This study examined the differential pattern of obesity between men and women with severe OA of the knee or hip joint. The relationship between creatinine, a pro-inflammatory parameter and obesity, sex, and site of joint involvement was examined. Method: This study involved a secondary analysis of prospectively collected data of patients who underwent hip or knee arthroplasty. Results: Data of 5,130 patients (1,989 males, 39%, 3,141 females, 62%), mean age: 66 (11) were used for data analysis. Of these patients, 2,038 patients underwent hip and 3,092 patients underwent knee arthroplasty. Prevalence of obesity (grade I and II) was higher in the TKA group as compared with THA group (55% vs. 38%) with the prevalence of morbid obesity (Grade II) being twice as many in the TKA group (27% vs. 14%), p < 0.001. There was a statistically significant association between obesity and site of joint involvement (p < 0.001) and for the interaction between sex of the patient and site of arthritis (p < 0.001). In the TKA group, the sex factor was the only factor that was related to the pre-op creatinine level (p < 0.001). In THA group, both sex (p < 0.001) and obesity (p = 0.002) showed an association with pre-op creatinine. Conclusions: This study provides further evidence that obesity has a multifaceted interaction with osteoarthritis with a differential pattern in hip and knee joints. Creatinine considered as a pro-inflammatory factor appears to have a differential role in hip and knee OA. Objectif : examen du profil différentiel d’obésité entre les hommes et les femmes présentant une arthrose importante de l’articulation du genou ou de la hanche. Les chercheurs ont examiné le lien entre la créatinine, un paramètre pro-inflammatoire et l’obésité, le sexe et le foyer de l’atteinte articulaire. Méthodologie : analyse secondaire de données prospectives recueillies auprès de patients qui avaient subi une arthroplastie de la hanche ou du genou. Résultats : les chercheurs ont utilisé les données de 5 130 patients (1 989 de sexe masculin [39 %] et 3 141 de sexe féminin [62 %]) d’un âge moyen de 66 ans (11) pour procéder à l’analyse des données. De ce nombre, 2 038 ont subi une arthroplastie de la hanche (APH) et 3 092, une arthroplastie du genou (APG). La prévalence d’obésité (de grade I et II) était plus élevée dans le groupe d’APG que dans celui d’APH (55 % par rapport à 38 %), et la prévalence d’obésité morbide (grade II), deux fois plus élevée dans le groupe d’APG (27 % par rapport à 14 %, p < 0,001). Les chercheurs ont constaté une association statistiquement significative entre l’obésité et le foyer d’atteinte articulaire (p < 0,001) et entre le sexe du patient et le foyer de l’arthrite (p < 0,001). Dans le groupe d’APG, le facteur du sexe était le seul à être relié au taux de créatinine avant l’opération (p < 0,001). Dans le groupe d’APH, les deux sexes (p < 0,001) et l’obésité (p = 0,002) étaient associés à la créatinine avant l’opération. Conclusion : la présente étude fournit de nouvelles données probantes démontrant que l’obésité a une interaction multidimensionnelle avec l’arthrose dans un profil différentiel d’articulations de la hanche et du genou. La créatinine considérée comme facteur pro-inflammatoire semble jouer un rôle différentiel en cas d’arthrose de la hanche et du genou.
50. Exploring the Education and Practice Experiences of Pelvic Health Physiotherapists in Canada: A Qualitative Descriptive Study.
期刊: Physiotherapy Canada. Physiotherapie Canada 发表日期: 2025-Feb 链接: PubMed
摘要
Purpose: Pelvic health physiotherapy involves sensitive practices including internal assessment and treatment of the pelvic floor. Pelvic health physiotherapy education is not standardized in Canada, which may lead to diverse experiences. The purpose of this study was to explore the education and practice experiences of pelvic health physiotherapists in Canada. Method: This descriptive qualitative study used semi-structured interviews with physiotherapists providing pelvic health services in Canada and a reflexive thematic analysis approach. Results: Based on interviews with 20 pelvic health physiotherapists (19 women and one man) from six provinces, we identified four themes: the right fit, managing vulnerability, the holistic nature of pelvic health physiotherapy, and entering pelvic health physiotherapy requires thoughtful consideration. Participants described pelvic health physiotherapy as the right fit for themselves personally and professionally. The clinical practice involved managing their patients’ and their own vulnerability and taking a holistic and biopsychosocial approach to treating patients with pelvic health conditions. Participants described the importance of mentorship and a supportive clinical environment when entering the field. Conclusions: This study provides an understanding of pelvic health physiotherapists’ experiences, which can help to guide the advancement of pelvic health physiotherapy education and practice supports in Canada. Objectif : la physiothérapie pelvienne comprend des pratiques délicates, y compris une évaluation interne et le traitement du plancher pelvien. L’enseignement de la physiothérapie pelvienne n’est pas standardisé au Canada, ce qui peut donner lieu à des expériences diversifiées. La présente étude visait à explorer les expériences d’éducation et de pratique des physiothérapeutes en santé pelvienne au Canada. Méthodologie : la présente étude qualitative descriptive a fait appel à des entrevues semi-structurées avec des physiothérapeutes qui offrent des services en santé pelvienne au Canada et a recouru à une approche d’analyse thématique réflexive. Résultats : après des entrevues avec 20 physiothérapeutes en santé pelvienne (19 femmes et un homme) de six provinces, les chercheurs ont dégagé quatre thèmes : le bon choix, la gestion de la vulnérabilité, la nature globale de la physiothérapie pelvienne et l’importance de bien examiner les enjeux avant d’opter pour la physiothérapie pelvienne. Les participants décrivent la physiothérapie pelvienne comme un bon choix personnel et professionnel. La pratique clinique incluait la gestion de leur propre vulnérabilité et de celle de leurs patientes et l’adoption d’une approche globale et biopsychosociale du traitement des patientes ayant des affections pelviennes. Les participants ont décrit l’importance du mentorat et d’un environnement clinique favorable pour entrer dans le domaine. Conclusions : la présente étude permet de comprendre les expériences des physiothérapeutes en santé pelvienne, ce qui peut contribuer à faire progresser l’enseignement de la physiothérapie pelvienne et le soutien de la pratique au Canada.
51. Navigating alcohol's impact: A mixed-methods analysis of community perceptions and consequences in Northern Tanzania.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Worldwide, alcohol is a leading risk factor for death and disability. Tanzania has particularly high rates of consumption and few resources dedicated to minimizing alcohol-related harm. Ongoing policy efforts are hampered by dynamic sociocultural, economic, and regulatory factors contributing to alcohol consumption. Through the voices of Kilimanjaro Christian Medical Centre (KCMC) patients, this study aimed to investigate community perceptions surrounding alcohol and the impact of its use in this region. This mixed-methods study was conducted at KCMC between October 2021 and May 2022. 676 adult (≥18 years old) Kiswahili-speaking patients who presented to KCMC’s Emergency Department (ED) or Reproductive Health Clinic (RHC) were enrolled through systematic random sampling to participate in quantitative surveys. Nineteen participants were selected for in-depth interviews (IDIs) through purposeful sampling. The impact and perceptions of alcohol use were measured through Drinkers’ Inventory of Consequences (DrInC) scores and analyzed in RStudio using means and standard deviations. IDI responses were explored through a grounded theory approach using both inductive and deductive coding methodologies in NVivo. Men attending the ED were found to have the highest average [SD] DrInC scores (16.4 [19.6]), followed by ED women (9.11 [13.1]), and RHC women patients (5.47 [9.33]), with higher scores indicating a broader array of consequences. Participants noted alcohol to have both perceived advantages and clear harms within their community. Increased conflict, long-term health outcomes, financial instability, stigma, and sexual assault were seen as negative consequences. Benefits were primarily identified for men and included upholding cultural practices, economic growth, and social unity. Physical and financial harm from alcohol impacted both genders; however, alcohol-related stigma and sexual assault were found to affect women disproportionately. Our findings suggest that perceptions around drinking are nuanced, and alcohol’s social and physical consequences differ significantly by gender. To effectively minimize local alcohol-related harm, future alcohol-focused research and policy efforts should consider the complex sociocultural role that alcohol holds in the Moshi community.
52. Factors associated with the effectiveness of oral health promotion in the Family Health Strategy.
期刊: Brazilian oral research 发表日期: 2025 链接: PubMed
摘要
This study investigated associations between sociodemographic and professional profiles, work-related factors, and the effectiveness of oral health promotion strategies implemented by dentists in the Family Health Strategy. A cross-sectional study was conducted with 211 dentists working in Oral Health Teams within the Family Health Strategy in the state of Paraíba, Brazil. Data were collected online using a validated instrument. A matrix encompassing the core values and pillars of health promotion was employed to evaluate the effectiveness of oral health promotion strategies. Data were analyzed using Poisson regression (p < 0.05), and all analyses were performed in Stata, version 14. Greater effectiveness of oral health promotion strategies was associated with mixed Oral Health Teams (urban and rural coverage) (PR = 1.54; 95%CI: 1.154-2.076; p = 0.003) and with dentists under temporary contracts (PR = 1.67; 95%CI: 1.240-2.250; p = 0.001). The effectiveness of oral health promotion strategies was associated with work-related factors. Evaluations of oral health promotion practices are essential to support improvements in oral health management. The findings highlight the need to strengthen these practices through professionals who, in addition to having a defined employment relationship and a structured work process, value oral health promotion as a key component of care.
53. Competency-based education in intensive care multiprofessional training: a scoping review.
期刊: Critical care science 发表日期: 2025 链接: PubMed
摘要
To map the development and implementation of competency-based education in intensive care multiprofessional training on the basis of national and international literature. A scoping review was conducted with searches in six databases and gray literature. The initial search identified 1,636 potentially eligible records, and 31 studies were included in the final sample. The data were grouped into three themes: development of competency-based education, implementation of competency-based education in curricula, continuing education and training programs, and student assessment. The studies were published between 2000 and 2024 and focused primarily on medical education, with a predominance of publications from North America and Europe. Heterogeneity was identified in the conceptual strategies of competency-based education, with an initial focus on skill lists evolving into core competencies, milestones, and entrustable professional activities. Benefits such as transparency in the learning process, individualized tracking, and the promotion of reflective learning were identified. Challenges to implementing effective competency-based education include the need for faculty training, resistance to change, a lack of time and resources, and the development of more robust assessment tools. The lack of studies on competency-based education in Latin America and the reduced number of studies in other health fields, such as nursing and physiotherapy, were highlighted. Competency-based education appears promising for training in intensive care; however, further research is needed to assess its impact on quality of care and patient safety, as well as to broaden the discussion to include diverse contexts and health fields.
54. Assessment of the Quality of post-abortion care records in 20 Public Health Facilities in Uganda: What are the gaps and how can we improve quality?
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Effective strategies for reducing maternal mortality depend on the accuracy of data. In sub-Saharan Africa, however, weak health systems often result in significant gaps in data collection and analysis. These gaps can lead to misreporting, missing data, or double-counting at health facilities, ultimately skewing the aggregated data reported by Ministries of Health. This is a big problem given that the data shapes planning and policy of the country. In this study, we assessed the data quality of Post-abortion Care (PAC) records across 20 health facilities in Uganda. A two-stage design was employed. In stage 1, DHIS2 data from 80 public health facilities were reviewed for completeness, timeliness, and internal consistency (2018-2021). In stage 2, 20 facilities that met a predefined eligibility criterion (≥ 50% discrepancy or missing data during stage 1) were purposively selected for in-depth validation. Data were collected retrospectively from facility registers for the last 7 months of 2021 and prospectively for the first 6 months of 2022. Data quality was assessed using adapted WHO data quality review (DQR) metrics. Health facilities achieved a 100% timeliness rate for report submissions, with all documents provided by the 7th day of each month. Although a statistically significant positive correlation was observed between the number of women who received PAC and those who received post-abortion family planning (PAFP) (r = 0.083, p < 0.001), the association was very weak suggesting limited internal consistency between the two indicators and raising questions about the reliability of data linkages between care and follow-up services in routine reporting systems. Moreover, comparing facility records with DHIS2 data revealed that outpatient records were more accurate than inpatient records, with PAC data being more inaccurate than other maternal health indicators. Further analysis by facility type indicated a higher number of case-load outliers at Health Centre IIIs and IIs (1049) compared to hospitals and Health Centre IVs, highlighting disparities in data quality across different levels of healthcare facilities. Despite high submission rates, PAC data accuracy was notably low, highlighting the need for better data management and record-keeping, particularly in lower-level health facilities. Addressing these disparities is crucial for improving maternal health outcomes, emphasizing the necessity for targeted interventions to enhance data accuracy and reliability within Uganda’s health system.
55. Bacterial assemblages on eggs reflect nesting strategies in wetland-associated birds.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Birds host diverse bacterial assemblages, which play a critical role in individual health, but which can also lead to disease or mortality. It is therefore important for developing embryos to acquire appropriate bacterial communities from maternal (vertical transmission) and environmental (horizontal transmission) sources. Eggshell bacterial assemblages are acquired before and after oviposition, and are shaped by external factors, including habitat, nesting material and parental incubation. Understanding the source of eggshell bacteria is important, because eggshell penetration of horizontally-transmitted bacteria can affect embryonic health. Most research on eggshell-associated bacteria has occurred on ‘dry-nesting’ terrestrial birds. However, little is known on bacterial acquisition in waterbirds, particularly in nests where eggs are in direct contact with water. Moist environments favour bacterial growth and wet-nesting species are therefore expected to have higher bacterial loads. To date, no study has focussed on contrasting the abundance and diversity of eggshell bacterial assemblages in wet- and dry-nesting species. We used both bacterial culture and genetic techniques (automated ribosomal intergenic spacer analysis) to document the bacterial load and assemblage structure of eggshell-associated bacteria in both wet- and dry-nesting wetland-associated bird species. Bacterial loads were several orders of magnitude greater on eggs of wet-nesting species and bacterial assemblages tended to cluster by nesting strategy. These findings suggest a possible association of eggshell-associated bacteria with nesting strategies in these species. Further research is, however, required to confirm these patterns, incorporating more comprehensive sampling and utilising more advanced genetic approaches. Overall, our findings highlight a promising direction for future research into the association between nesting in moist environments and eggshell-associated bacteria, as well as the potential for antimicrobial adaptations that may characterise the eggshells of these species.
56. Understanding age at menarche: Environmental and demographic influences over a quarter century in India.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
This study investigates the factors influencing the age of menarche in various Indian states over a quarter century from 1992 to 2019, with the aim of understanding how climate change and demographic factors have shaped menarche timing. Data from the Indian Demographic and Health Survey (DHS) for 1992-93 and 2019-21, along with climate data from NASA’s POWER project, were analyzed using a cross-sectional study design, including 23,083 respondents from 1992 and 45,329 from 2019. Across most states, a slight decrease in age at menarche was observed, with the exception of Maharashtra, which showed an increase. Higher specific humidity was associated with earlier onset of menarche, whereas higher temperatures correlated with delayed onset. Improvements in educational attainment, particularly higher education levels, were strongly linked to earlier menarche, indicating that demographic changes had a significant influence. The findings highlight the need for public health interventions that improve nutrition, healthcare access, and educational programs to promote health awareness. Ongoing monitoring of climatic impacts on health is essential for understanding and mitigating the effects of environmental changes on menarche timing.
57. Appreciation should be EA-SI-demystifying the definition and operationalization of experienced appreciation at work by developing a new construct.
期刊: Frontiers in psychology 发表日期: 2025 链接: PubMed
摘要
In this article, we developed the new construct, Experienced Appreciation in Social Interactions (EA-SI), to reduce the inconsistency in defining and measuring experienced appreciation at work. The integrative theoretical model is based on the well-validated Stress as Offense to Self-theory. To operationalize the construct, we validated the EA-SI Work Scale in two independent German samples of employees. Colleagues and supervisors were investigated as potential sources of experienced appreciation. Study One included N = 231 participants. Study Two encompassed N = 391. In both studies, we applied a cross-sectional field-study design based on self-reported surveys. Using exploratory and confirmatory factor analyses, the construct EA-SI turned out to be unidimensional. The Pearson product-moment correlations showed that the more employees felt appreciated, the higher their self-esteem and the lower their stress perception. The premises of the theoretical foundation were replicable. Higher experienced appreciation was related to more work satisfaction, life satisfaction, and work engagement, as well as lower emotional exhaustion. These relations were true for both groups of appreciators. When tested in hierarchical regressions, EA-SI added incremental prediction beyond the influence of social support in most of the analyses. The instrument’s internal consistency and retest reliability were good to excellent. The results indicated the EA-SI Work Scale to be content, construct, and criterion valid. Based on these findings, the strengths and limitations of the article and possible implications for future research and practical use are discussed.