公共卫生研究摘要 (2025-09-19)
共收录 52 篇研究文章
1. Healthcare professionals' awareness of and barriers to shared-clinical-decision-making for HPV vaccination among adults 27-45 years.
期刊: Human vaccines & immunotherapeutics 发表日期: 2025-Dec 链接: PubMed
摘要
The Advisory Committee on Immunization Practices recommends human papillomavirus (HPV) vaccination for inadequately vaccinated adults aged 27-45 based on shared clinical decision-making (SCDM). However, little is known about awareness and barriers to SCDM among US healthcare providers (HCPs), especially in Texas, where HPV vaccination rates are below the national average. Between January and April 2021, we conducted a population-based cross-sectional survey (12% response rate) of HCPs licensed in Texas to assess the prevalence and factors associated with awareness of the SCDM recommendation. HCPs were asked if they were aware and if they foresaw any barriers in implementing SCDM for HPV vaccine recommendation. Among the 1,279 respondents, 54.26% were aware of this recommendation. HCPs practicing as gynecologists/obstetricians (adjusted odds ratio [aOR]: 6.12; 95%CI: 2.60-14.40, p < .001), those working in Federally Qualified Health Centers (aOR: 2.13, 95%CI: 1.24-3.65, p = .006) or group practices (aOR: 1.68, 95%CI: 1.22-2.30, p = .001), those seeing ≤ 100 patients/week (aOR: 1.70, 95%CI: 1.15-2.51, p = .008), those who had received formal training on HPV vaccination promotion and counseling within the past two years (aOR: 3.42, 95%CI: 2.29-5.10, p = < 0.001), between two and five years ago (aOR: 2.35, 95%CI: 1.67-3.30, p = < 0.001), and more than five years ago (aOR: 1.70, 95%CI: 1.16-2.50, p = .006) had significantly higher odds of awareness of SCDM recommendation. HCPs practicing as nurse practitioners/advanced nurse practitioners (aOR: 0.56; 95%CI: 0.38-0.82, p = .003), physician assistants (aOR: 0.62; 95%CI: 0.41-0.94, p = .023), aged 55 years or older (aOR: 0.57; 95%CI: 0.32-0.99, p = .046), Asian (aOR: 0.59, 95%CI: 0.43-0.81, p = .001) and non-Hispanic Black (aOR: 0.62, 95%CI: 0.40-0.97, p = .037) had significantly lower odds of awareness of SCDM recommendation. Overall, 44.96% of HCPs anticipated no barriers and planned to engage in SCDM, while 18.32% cited time commitment as an anticipated barrier. Internists cited time commitment (39.13%) as an anticipated barrier more frequently than other specialties, while physician assistants were more frequently unclear about how to implement SCDM (12.36%). We found limited awareness of the SCDM recommendation guideline for HPV vaccination among Texas HCPs. Therefore, training HCPs to use decision aids to actively engage patients in the SCDM process could improve HPV vaccination rates among unvaccinated adults aged 27-45.
2. Parent Perspectives: Menstruation and Menstrual Hygiene Management for Autistic Daughters.
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2025-Dec-01 链接: PubMed
摘要
Parents of autistic daughters may be able to provide insight into how to address menstruation and menstrual hygiene management from their lived experiences. Menstrual hygiene management is considered an activity of daily living that is within the scope of occupational therapy practice. To investigate the perspectives of parents of autistic daughters and their firsthand experiences of menstruation and menstrual hygiene management. This was a qualitative, phenomenological study that used convenience and snowball sampling and an inductive thematic analysis of transcripts of virtual semistructured interviews. Trustworthiness was established through audit trails, member checking, and the use of an interview guide. Interviews were conducted through Zoom at the participants’ preferred time and location. Parents of autistic daughters (N = 8): seven biological mothers and one adoptive father. Seven themes emerged from the interviews: (1) inadequate expertise in women’s health for autistic individuals among medical professionals, (2) parental dependency, (3) intensified sensory experiences before and during menstruation, (4) limited menstrual awareness and understanding in individuals with ASD, (5) menstrual product preferences, (6) parental feelings about managing menstruation, and (7) strategies that worked for managing menstruation. The findings suggest that parents face significant challenges when caring for autistic daughters during their menstrual cycles. Occupational therapy practitioners may support autistic individuals as well as their parents and caregivers in this process by having a deeper understanding of their experiences. Plain-Language Summary: This study sheds light on the perspectives of parents of autistic daughters on the topic of menstruation and menstrual hygiene management, which are considered activities of daily living. Occupational therapy practitioners may gain knowledge from these firsthand perspectives to inform future occupational therapy practice. Menstruation and menstrual hygiene management are important activities of daily living that are not addressed well for individuals living with autism. Occupational therapy practitioners can support autistic individuals and their caregivers in improving the participation and performance in menstruation and menstrual hygiene management.
3. Co-Creation Study Protocol for Developing a Nurse-Led Intervention to Deprescribe Benzodiazepines and Z-Hypnotics in Primary Care Aimed at Empowering Women.
期刊: Health expectations : an international journal of public participation in health care and health policy 发表日期: 2025-Oct 链接: PubMed
摘要
Gender inequality in mental health is a persistent challenge that requires innovative solutions for its resolution. Interventions in primary care can be useful in narrowing the gap in the consumption of psychotropic drugs. This study proposes female empowerment as a non-medical alternative for facing women’s daily lives, which are often pathologised, and aims to develop a group intervention in primary care that promotes female empowerment and reduces the use of benzodiazepines and Z-hypnotics (BDZ/ZH). Co-creation is presented as a novel methodology for developing health interventions. Participatory workshops will be organised involving women who use BDZ/ZH and health professionals, including family doctors, primary care pharmacists, and nurses. These workshops will collectively identify the needs of participants and contribute to the design of the intervention, which will be developed as a nurse-led initiative. This methodology is essential for designing interventions that respond effectively to the particularities of women who use BDZ/ZH and is valuable in adapting to the actual clinical context of the health professionals involved in their care. Nurses’ ongoing patient relationships, deep knowledge of individual life contexts, and expertise in health promotion and education make them especially suited to lead empowerment-based interventions. This study protocol outlines a co-creation process involving patients and healthcare professionals from diverse fields of primary care-pharmacists, family physicians and nurses-to collaboratively design an intervention aimed at empowering women as a strategy for discontinuing benzodiazepines (BDZ) and hypnotics. The goal is to leverage both the lived experiences of patients and the clinical expertise of healthcare providers to develop a tailored, effective intervention. In the future implementation of the intervention, nurses are expected to take a leading role. This manuscript outlines a protocol for a participatory process and, as such, it has not been registered as a clinical trial.
4. Changes in Weight, Waist Circumference or Both With Incident Heart Failure in Chinese Middle-Aged and Older Adults.
期刊: Journal of cachexia, sarcopenia and muscle 发表日期: 2025-Oct 链接: PubMed
摘要
Previous studies have acknowledged that higher body weight and waist circumference were associated with an increased risk of heart failure. Notably, both body weight and waist circumference can change over time. However, no previous study has investigated the association between combined changes in weight and waist circumference in middle-aged and older adults and incident heart failure. This prospective study included 45 620 middle-aged and older Chinese adults (aged 45-104 years). These participants were free of critical diseases at baseline, including coronary heart disease, stroke, heart failure, atrial fibrillation and cancer. Weight change from 2006-2007 to 2012-2013 was categorized into five groups: excessive weight loss (change < -10%, N = 3943), lesser weight loss (-10% ≤ change < -5%, N = 5890), stable weight (±5%, N = 23 208), lesser weight gain (5% < change ≤ 10%, N = 7153) and excessive weight gain (> 10%, N = 5426). Waist circumference change was categorized into five groups: excessive waist circumference loss (change < -10%, N = 8236), lesser waist circumference loss (-10% ≤ change < -5%, N = 6215), stable waist circumference (±5%, N = 16 953), lesser waist circumference gain (5% < change ≤ 10%, N = 6642) and excessive waist circumference gain (> 10%, N = 7574). Combined changes in weight and waist circumference were divided into 25 groups, i.e., cross-classified combinations derived from the five categories of weight change and five categories of waist circumference change. Incident heart failure cases that occurred from 2012-2013 to December 31, 2022 were recorded. Cox proportional hazards regression models were used to estimate the associations of weight change, waist circumference change or both with heart failure. Multivariate models were stratified by age at risk (in 5-year intervals) and sex, and were adjusted for variables including height, smoking, drinking, educational attainment, occupation, dietary pattern, physical activity, hypertension, fasting blood glucose and total serum cholesterol. In the analysis of weight change, we additionally adjusted for weight at baseline and waist circumference change. Conversely, for the analysis of waist circumference change, adjustments were made for baseline waist circumference and weight change. When examining combined weight and waist circumference changes, adjustments were made for both baseline weight and waist circumference. Additionally, we employed restricted cubic spline analyses to examine the nonlinear associations between changes in weight or waist circumference and heart failure. We identified 1036 heart failure cases during follow-up. The median (interquartile range, IQR) of follow-up time was 9.66 (9.40, 9.96) years. The incidence rate of heart failure was 2.47 cases per 1000 person-years. The median (IQR) age of our participants was 52.1 (46.8, 57.7) years. The proportion of men was 77.9%. The mean (standard deviation) of weight and waist circumference at baseline (baseline, 2006-2007) was 70.1 (10.4) kg and 87.2 (9.0) cm, respectively. Compared with those who kept stable weight, participants in the excessive weight gain group had a higher risk (HR [hazard ratio], 1.27; 95% CI [confidence interval]: 1.03-1.57). Compared with those who kept stable waist circumference, participants in the excessive waist circumference gain group had a higher risk (HR, 1.28; 95% CI: 1.05-1.56), while those in the excessive waist circumference loss group had a lower risk of heart failure (HR, 0.76; 95% CI: 0.64-0.92). Compared with participants with stable weight and waist circumference, those who lost excessive weight and kept stable waist circumference (HR, 1.53; 95% CI: 1.10-2.14), those who lost lesser weight and gained excessive waist circumference (HR, 2.19; 95% CI: 1.38-3.46), and those who gained excessive weight and excessive waist circumference (HR, 1.48; 95% CI: 1.03-2.14) had a higher risk of heart failure. The restricted cubic spline illustrated a U-shaped relation between weight change and incident heart failure (P overall = 0.027, P for non-linear relation = 0.007), whereas a positive linear relation was observed for waist circumference change with incident heart failure (p overall < 0.001, p for non-linear relation = 0.675). Excessive weight gain and waist circumference gain were associated with 27% and 28% higher risk of heart failure, while excessive waist circumference loss was associated with a 24% lower risk of heart failure.
5. Enhanced visualization of influenza A virus entry into living cells using virus-view atomic force microscopy.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Sep-23 链接: PubMed
摘要
Influenza A virus (IAV) entry into host cells begins with interactions between the viral envelope proteins hemagglutinin (HA)/neuraminidase (NA) and sialic acid moieties on the cell plasma membrane. These interactions drive IAV’s lateral diffusion along the cell membrane and trigger membrane morphological changes required for endocytosis. However, directly visualizing these dynamic processes, which are crucial for IAV entry, has been challenging using conventional microscopy techniques. In this study, we enabled live-cell observation of nanoscale morphological dynamics of IAV and the cell membrane by reducing the mechanical invasiveness of atomic force microscopy (AFM). A customised cantilever with less than half the spring constant of conventional cantilevers enabled virus-view AFM imaging that preserved IAV-membrane interactions. By combining virus-view AFM with confocal microscopy, we performed correlative morphological and fluorescence observations of IAV lateral diffusion and endocytosis in living cells. Variations in diffusion coefficients of single virions suggested heterogeneity in sialic acid density on the cell membrane. NA inhibition decreased diffusion coefficients, while reduced sialic acid density increased them. The timing of clathrin accumulation at virion binding sites coincided with a decrease in diffusion coefficients, a relationship that was maintained independent of NA activity or sialic acid density. As clathrin assembly progressed, ~100-nm-high membrane bulges emerged adjacent to the virus, culminating in the complete membrane envelopment of the virus at peak clathrin accumulation. Our virus-view AFM will deepen our understanding of various virus-cell interactions, facilitate the evaluation of drug effects and promote future translational research.
6. Neighborhood-Level Socioeconomic Vulnerability and Perioperative Complications in Hysterectomy for Benign Indications.
期刊: Obstetrics and gynecology 发表日期: 2025-Sep-19 链接: PubMed
摘要
To evaluate the association between neighborhood-level socioeconomic vulnerability, measured by the VVI (Vizient Vulnerability Index) and perioperative complications after hysterectomy for benign conditions. This retrospective cohort study analyzed patients who underwent hysterectomy for benign indications (2015-2024) using the Vizient Clinical Database. Patients were categorized into VVI quartiles (quartile 1, least vulnerable; quartile 4, most vulnerable) based on census tract data across nine socioeconomic domains: public safety, transportation, social cohesion, environmental quality, housing, neighborhood resources, health care access, education, and income. The primary outcome was the occurrence of perioperative complications, classified as major, minor, or any complication, with the Clavien-Dindo scale. Logistic regression was used to estimate the association between neighborhood vulnerability and surgical complications. Additional analyses evaluated the association of specific individual- and neighborhood-level social determinants, with race included as a marker of structural racism exposure, and perioperative outcomes. Among 1,055,338 patients, 18.4% (n=194,002) experienced complications, including 4.4% (n=46,356) major and 16.0% (n=169,361) minor complications. Complication rates increased proportionally across VVI quartiles (P<.001). Major complications rose from 3.6% in quartile 1 to 5.7% in quartile 4; minor complications increased from 13.8% to 19.8%; and any complications increased from 15.9% to 22.5%. Higher VVI quartiles were associated with increased odds of major, minor, and any complications compared with quartile 1, with the strongest effects in quartile 4. After adjustment, the association remained significant for quartiles 3 and 4. Comorbidities were the strongest individual-level predictor. Black race, as a marker of structural racism exposure, was independently associated with complication risk across all VVI quartiles. We demonstrate that VVI, a measure of neighborhood-level social vulnerability, is associated with perioperative complications at the time of hysterectomy for benign indications independently of individual-level factors. Patients in the two most vulnerable quartiles experienced poorer outcomes compared with those in the least vulnerable quartile. Racial disparities, particularly affecting Black patients, persisted across VVI categories, reflecting the compounded influence of structural racism and neighborhood inequities.
7. Introducing the Hauora Māori Equity Toolkit for Specialist Healthcare Services (HMET-SHS).
期刊: The New Zealand medical journal 发表日期: 2025-Sep-19 链接: PubMed
摘要
The Hauora Māori Equity Toolkit for Specialist Healthcare Services (HMET-SHS) is an innovative tool designed to support equitable service delivery within specialist healthcare services. A multidisciplinary team reviewed the health system structure and developed the HMET-SHS in the form of a Periodic Service Review (PSR) for measuring and monitoring Hauora Māori outcomes in specialist health services. The HMET-SHS promises to reshape specialist healthcare services and champion equitable healthcare improvements for all New Zealanders.
8. Drug harm prevention needs among adolescents in Aotearoa New Zealand: findings from the Youth19 Survey.
期刊: The New Zealand medical journal 发表日期: 2025-Sep-19 链接: PubMed
摘要
Drug use (including tobacco, alcohol and illicit drugs) is a leading cause of premature death, health loss and health inequities in Aotearoa New Zealand. Effective prevention and early intervention have potential to reduce drug-related human suffering across the lifecourse, thus decreasing pressure on health and social services. To inform policy and practice, we investigated drug harm indicators among secondary students in Aotearoa and identified sub-populations at greatest need. We used Youth19 survey data (N=7,721) to investigate five indicators related to e-cigarette, tobacco, alcohol or cannabis use: prevalence of 1) past month use, 2) heavy use, 3) worry about use, 4) desire to cut down or stop, and 5) reported difficulty accessing cessation help. We found many adolescents, particularly those who used tobacco, were worried about their own drug use and wanted to cut down, yet getting appropriate help was not always easy. Need was not evenly spread; Māori, Pacific and LGBTQ+ youth, those aged under 16 years and those living in small towns, rural areas and the most socio-economically deprived communities had higher needs on many indicators. Greater investment in drug harm prevention and early intervention may be warranted, with a focus on under-served populations.
9. An mHealth App-Based Social Capital Intervention (PrEP US NoW) to Improve Sexual Health and Uptake of Pre-Exposure Prophylaxis Among Young, Black, Sexual Minority Men: Protocol for Intervention Development and a Pilot Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Sep-18 链接: PubMed
摘要
Black Americans are disproportionately impacted by HIV. This disparity is more profound in the Southern United States, with the highest rates being among young, Black, sexual minority men, who are also less likely to receive state-of-the-art interventions such as pre-exposure prophylaxis (PrEP). Individual-level interventions to increase PrEP uptake do not often capitalize on the opportunity to leverage the significant effects of this group’s social networks, including Black women, on attitudes, beliefs, and behaviors around HIV prevention. To increase PrEP use, an intervention, PrEP US NoW, was designed to engage young, Black, sexual minority men’s social networks in discussions with supportive Black female facilitators and ultimately enhance their social capital. First, qualitative information on core health-promoting elements of social capital bonds was captured among young, Black, sexual minority men and Black women in extant social support networks. This information was then applied to adapt an existing, evidence-based mobile health app to create the PrEP US NoW pilot through an unblinded randomized controlled trial. Six social network groups (5 young, Black, sexual minority men + 1 Black woman) will participate in the intervention arm. These will be recruited through a network-based approach and will undergo tailored training (mobile-based and face-to-face) for app usage. At baseline, men will undergo HIV testing and both men and women will complete a sociodemographic survey. The groups in the intervention arm will engage in four 60-minute discussions led by Black women through the modified mobile health app. After the intervention, young, Black, sexual minority men will complete surveys electronically at 1 and 3 months (accompanied by HIV testing) on additional factors such as experiences of discrimination and PrEP stigma. The Black women will complete an electronic survey at 1 month, measuring feasibility and acceptability, and will participate in web-based qualitative interviews at 3 months to gain more knowledge on the PrEP US NoW facilitation process. Participants in the control arm will not engage in Black women-facilitated group discussions and will use a control version of the app. The baseline and follow-up surveys and HIV testing will be documented similarly to the intervention arm. Phase 1 (development) of PrEP US NoW research activities lasted from November 2019 to June 2024. Data collection for the phase 2 randomized controlled trial began in August 2024 and is expected to be completed in December 2025. The findings will capture the intervention’s feasibility and acceptability and changes in PrEP uptake among young, Black, sexual minority men. The development and pilot implementation trial of the PrEP US NoW intervention is thought to leverage essential social capital among young, Black, sexual minority men, which may promote engagement in PrEP care, thus decreasing the overall number of HIV diagnoses. ClinicalTrials.gov NCT07024745; https://clinicaltrials.gov/study/NCT07024745. DERR1-10.2196/66326.
10. Dialectical Processes of Health Framework as an Alternative to Social Determinants of Health Framework.
期刊: American journal of public health 发表日期: 2025-Sep-18 链接: PubMed
摘要
The social determinants of health (SDOH) framework has proven useful for research and practice in addressing the social causes of many health outcomes. However, its limitations may restrict its value as the world undergoes rapid ecological and social change. We argue that SDOH does not adequately incorporate rapidly changing or “far upstream” social processes (particularly social movements), the dialectics of social conflict and creative social innovation, or bidirectional causation. Ecosocial theory addresses some of these issues, yet dialectical frameworks offer additional insights during periods of rapid social change and disruption. The implications for research methods and practice are discussed. (Am J Public Health. Published online ahead of print September 18, 2025:e1-e9. https://doi.org/10.2105/AJPH.2025.308239).
11. Effectiveness of Antivirals Nirmatrelvir-Ritonavir and Molnupiravir in Viral Sepsis: Retrospective Cohort Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Sep-18 链接: PubMed
摘要
Viral infections, including those leading to sepsis, are common but often overlooked in clinical practice, yet the treatment strategies for viral sepsis remain inadequately defined. This study aims to investigate the effectiveness of antivirals nirmatrelvir-ritonavir and molnupiravir in the treatment of culture-negative sepsis. This retrospective cohort study was conducted across public hospitals in Hong Kong. We included patients diagnosed with COVID-19 between February 22, 2022, and June 30, 2023, who had no secondary bacterial or fungal infections. Propensity score matching was used to assess the efficacy of the antivirals nirmatrelvir-ritonavir and molnupiravir in patient subgroups with or without organ dysfunction at hospital admission, including circulatory shock, respiratory failure, acute kidney injury, coagulopathy, acute liver impairment, a composite of all organ dysfunctions, or no organ dysfunction. Key outcomes were in-hospital mortality and length of stay, reported as hazard ratios (HR) and mean differences, respectively. The study included 15,599 COVID-19 patients with a mean age of 75.1 (SD 15.9) years. Molnupiravir treatment was associated with a significantly lower risk of mortality in patients in both the presence of any organ dysfunction (HR 0.75, 95% CI 0.58 to 0.96) and without organ dysfunction (HR 0.29, 95% CI 0.15-0.56). Nirmatrelvir-ritonavir was associated with decreased mortality with respiratory failure (absolute risk difference: 9.5%, 95% CI 6.26-12.72) and without organ dysfunction (HR 0.17, 95% CI 0.05-0.56). Antivirals also reduced the length of hospital stay; nirmatrelvir-ritonavir reduced length of stay in respiratory failure by an average of 3.37 (95% CI 2.32-4.42) days, acute kidney injury by 7.25 (95% CI 2.97-11.52) days, and coagulopathy by 7.04 (95% CI 2.99-4.05) days. Molnupiravir reduced the length of stay in acute kidney injury by an average of 6.7 (95% CI 2.39-11.08) days and coagulopathy by 5.68 (95% CI 1.20-10.16) days. Antivirals reduced mortality among hospitalized COVID patients, with the greatest reduction observed in patients without organ dysfunction. Antivirals were also effective in reducing the length of hospital stay.
12. Exposure to Radiation and Thyroid Cancer Risk Among Young Female Nurses: Longitudinal Analysis From the Korea Nurses' Health Study.
期刊: JMIR cancer 发表日期: 2025-Sep-18 链接: PubMed
摘要
Thyroid cancer is one of the most commonly diagnosed malignancies in South Korea, with incidence rates among the highest globally. Young women, in particular, represent a high-risk group, likely due to a combination of biological, occupational, and environmental factors. However, the specific risk factors contributing to thyroid cancer development in this population remain poorly understood. This study aims to identify the risk factors associated with thyroid cancer among young female nurses using longitudinal survival analysis. This longitudinal study used data from the Korea Nurses’ Health Study (KNHS), a prospective national cohort of female nurses. Data from the first, fifth, seventh, and ninth surveys were used to construct a person-period data set. Female nurses aged in their 20s at baseline were included. Time-varying explanatory variables included age, marital status, BMI, smoking, alcohol consumption, perceived stress, sleep problems, nursing position, night shift work, working unit, and duration of radiation exposure. The dependent variable was self-reported physician-diagnosed thyroid cancer. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to examine the association between risk factors and thyroid cancer occurrence. A total of 22,759 person-period cases were analyzed, and 105 thyroid cancer events were identified. Kaplan-Meier analysis showed significant associations between thyroid cancer occurrence and age (χ²1=51.6, P<.001), marital status (χ²1=25.1, P<.001), sleep problems (χ²1=20.3, P<.001), night shift work (χ²1=20.1, P<.001), working unit (χ²1=13.0, P<.001), and duration of radiation exposure (χ²1=91.0, P<.001). In the Cox regression model, nurses aged in their 20s had a significantly higher risk of thyroid cancer than those aged in their 30s (hazard ratio [HR] 4.602, 95% CI 1.893-11.188). Those who worked night shifts were also at an increased risk (HR 1.923, 95% CI 1.127-3.280). Compared with no exposure, radiation exposure showed a dose-response relationship: <1 year: HR 3.449, 95% CI 1.474-8.074; ≥1 year: HR 4.178, 95% CI 2.702-6.461. Younger age, night shift work, and duration of radiation exposure were significantly associated with an increased risk of thyroid cancer in young female nurses. These findings highlight the importance of early screening and occupational risk management, including regular radiation monitoring and support for circadian health, in health care settings. RR2-10.4178/epih.e2024048.
13. Clustering of Lifestyle Behaviors and Their Association With Risk of Metabolic Syndrome Among Adults in Taiwan: Nationwide Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Sep-18 链接: PubMed
摘要
Metabolic syndrome (MetS) is a multifaceted health condition influenced by physiological and lifestyle factors, leading to increased risks of cardiovascular disease and other chronic health issues. Lifestyle behaviors often manifest in various clustering patterns, and evidence of their impact on MetS remains limited. This study explores the relationship of latent classes of lifestyle behaviors with the risk of MetS and its components. This cross-sectional study used data from Taiwan’s 2020-2022 Adult Preventive Health Services Database, which was linked to 2020-2022 National Health Insurance claim data. The study included 241,156 adults aged 40 years and older who participated in adult preventive health services between 2020 and 2022. Lifestyle behaviors were assessed through smoking, alcohol consumption, betel quid chewing, and physical activities. Latent class analysis was used to identify lifestyle behavior patterns, while binary logistic regression examined the association of these patterns with MetS risk and its components. The latent class analysis identified 5 distinct lifestyle behavior patterns, with an overall MetS prevalence of 35.72% (86,143/241,156). Compared to the “healthy lifestyle” group (27,465/241,156, 11.39% prevalence), the “insufficiently physically active (IPA)” group (182,101/241,156, 75.51%, adjusted odds ratio [aOR] 1.41, 95% CI 1.37-1.45; P<.001), the “occasional drinking but physically active” group (18,244/241,156, 7.57%, aOR 1.27, 95% CI 1.21-1.32; P<.001), the “occasional drinking and regular smoking with IPA” group (9539/241,156, 3.96%, aOR 2.38, 95% CI 2.26-2.50; P<.001), and the “unhealthy in all behaviors” group (3807/241,156, 1.58%, aOR 2.38, 95% CI 2.22-2.55; P<.001) showed significantly higher odds of developing MetS. Compared to the “healthy lifestyle” group, all other lifestyle patterns were also associated with significantly higher odds of central obesity (P<.001), elevated blood pressure (P<.001), elevated fasting blood glucose (P<.001), elevated fasting triglycerides (P<.001), and reduced high-density lipoprotein cholesterol (P<.001), with the most potent effects observed in the “occasional drinking and regular smoking with IPA” group and the “unhealthy in all behaviors” group. An exception was noted for the “occasional drinking but physically active” group, which showed a significantly lower likelihood of reduced high-density lipoprotein cholesterol (aOR 0.90, 95% CI 0.85-0.94; P<.001). Engaging in sufficient physical activity and adopting multibehavior interventions tailored to specific lifestyle patterns are crucial for effectively preventing MetS in adults.
14. Effectiveness of Gamification Interventions to Improve Physical Activity and Sedentary Behavior in Children and Adolescents: Systematic Review and Meta-Analysis.
期刊: JMIR serious games 发表日期: 2025-Sep-18 链接: PubMed
摘要
Physical activity (PA) is critically linked to the health outcomes of children and adolescents. Gamification interventions represent a promising approach to promote PA engagement. However, the effects of these interventions on both PA and sedentary behavior (SB) in this population remain controversial. This review seeks to clarify this controversy. This systematic review aimed to evaluate the effectiveness of gamification interventions in enhancing PA and reducing SB in children and adolescents, while identifying potential moderators for PA promotion. We systematically searched PubMed, Web of Science, Embase, EBSCO, and Cochrane Library databases for randomized controlled trials (RCTs) published between January 1, 2010, and August 1, 2024. Included RCTs examined gamification interventions targeting PA, SB, daily step counts, and BMI in children and adolescents. Random-effects meta-analyses were performed using RevMan 5.4 (Cochrane) and Stata 18.0 (StataCorp), with subgroup analyses assessing moderating effects of theoretical paradigms, game elements, and intervention duration. Methodological robustness was evaluated via the Egger regression test, sensitivity analyses (leave-one-out method), and funnel plot inspection for publication bias. A total of 16 RCTs involving 7472 children and adolescents (age range 6-18 y) were included. Our findings showed that the gamification interventions significantly increased moderate-to-vigorous physical activity (MVPA; standardized mean difference [SMD] 0.15, 95% CI 0.01 to 0.29; P=.04) and reduced BMI (SMD 0.11, 95% CI 0.05 to 0.18; P<.001). However, there was no significant improvement in SB (SMD 0.07, 95% CI -0.07 to 0.22; P=.33), vigorous physical activity (SMD 0.12, 95% CI -0.3 to 0.55; P=.56), moderate physical activity (SMD 0.16, 95% CI -0.2 to 0.53; P=.38), light physical activity (SMD -0.00, 95% CI -0.49 to 0.48; P>.99), and daily step count (SMD 0.22, 95% CI -0.51 to 0.94; P=.55). Subgroup analyses revealed significant moderation effects for MVPA improvement by theoretical paradigm, game elements, intervention duration, and study setting. This meta-analysis confirms that gamification interventions effectively increased MVPA in children and adolescents, with sustained effects persisting beyond follow-up. The efficacy of these interventions is significantly moderated by theoretical paradigms, game elements, and intervention duration. However, blinding infeasibility contributed to prevalent performance bias, potentially introducing detection bias for subjective SB and PA metrics. Future research should strengthen blinding protocols for outcome assessors, enhance allocation concealment reporting, and validate conclusions through high-quality RCTs.
15. Affordable, convenient and discreet: why emergency contraception is the family planning method of choice among female university students in Zambia.
期刊: Culture, health & sexuality 发表日期: 2025-Sep-18 链接: PubMed
摘要
A significant unmet need for family planning exists among Zambian adolescent women aged 15-24. This study investigated knowledge, attitudes and behaviours regarding contraception use and associated barriers with obtaining contraception, among a group of female university students in Lusaka, Zambia. A descriptive qualitative study was conducted using focus-group discussions (FGDs). Through a preliminary online survey, enrolled university students indicated interest in attending FGDs to discuss sexual and reproductive health perceptions, attitudes and behaviours, including contraception use. FGDs were audio-recorded, transcribed and thematically analysed. Thirty-four female students participated in five FGDs. A key theme of frequent emergency contraception (EC) use emerged as a preferred pregnancy prevention method owing to its convenience, affordability and discretion. Barriers to accessing long-term, more reliable contraception methods included premarital sex stigma, healthcare workers’ refusal to provide contraceptives, fears of contraceptive use judgement and misconceptions about side effects of other methods. Findings highlight favourable EC use among female university students over more reliable contraception options owing to significant health system and societal barriers. Differentiated service delivery methods, youth-friendly spaces and improved education to destigmatise contraception are needed in Zambia to mitigate high rates of unintended pregnancies for this vulnerable population.
16. Measuring health-related quality of life among school adolescents across Chinese Human Geography Regions: psychometric validation and norm development of the Mandarin Chinese self-reported KID-SCREEN-10 index.
期刊: Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 发表日期: 2025-Sep-18 链接: PubMed
摘要
The self-reported KIDSCREEN-10 index (KS-10) is widely used to assess health-related quality of life (HRQoL) in children and adolescents, but psychometric evidence for its Mandarin Chinese version remains limited. This study evaluates its psychometric properties, develops a population-based norm, and establishes a norm-referenced scoring algorithm. Data were collected from a two-wave cross-sectional survey across the Chinese Human Geography Regions (June 20-July 11, 2022). The sample included 3290 adolescents (ages 10-18; 51.5% female; 75.8% Han ethnic group) in their junior secondary education stage, obtained through convenience sampling (first wave) and multistage, stratified, cluster sampling (second wave). Psychometric properties were evaluated using the Rasch measurement method, and both a population-based norm and a norm-referenced scoring algorithm were developed and established. Confirmatory factor analysis confirmed unidimensionality after two modifications. Rasch analysis demonstrated satisfactory psychometric performance, including an appropriate 5-category rating scale and strong goodness-of-fit. Minor local dependence was observed in a few item pairs, indicating slight unidimensionality violations. Both Rasch-generated reliability measures performed well. The person-item map showed acceptable matches and provided insights for further improvements. No substantial uniform differential item functioning was detected across 14 groups. The Mandarin Chinese self-reported KS-10 demonstrates satisfactory psychometric properties and provides a concise measure of adolescent HRQoL. It is a user-friendly instrument suitable for routine school monitoring, large-scale population surveys, and clinical applications. The population-based norm and norm-referenced scoring algorithm support its broader application and promotion, and offer new insights for interpreting HRQoL sum scores.
17. Correction: The Role of Environmental Factors in Technology-Assisted Physical Activity Intervention Studies Among Older Adults: Scoping Review.
期刊: JMIR mHealth and uHealth 发表日期: 2025-Sep-18 链接: PubMed
摘要
[This corrects the article DOI: 10.2196/59570.].
18. Validating the standardised outcomes in nephrology-life participation (SONG-LP) measure in people receiving peritoneal dialysis: Rationale and process.
期刊: Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis 发表日期: 2025-Sep-18 链接: PubMed
摘要
Life participation has been identified as a critically important core outcome to be reported in all trials in people receiving peritoneal dialysis (PD). Life participation is defined as the ability to participate in meaningful activities such as work (e.g. employment, housework, study), family, social (e.g. time with friends) and leisure (travel, hobbies, exercise) activities. However, life participation is rarely and inconsistently reported in trials in PD. The standardised outcomes in nephrology-life participation (SONG-LP) instrument was validated in adult kidney transplant recipients and demonstrated internal consistency and test-retest reliability. In this article, we outline the rationale and process for validating the SONG-LP instrument in people receiving PD.
19. Evaluation of blue and white collar employees in terms of physical activity and physical fitness (university example).
期刊: Work (Reading, Mass.) 发表日期: 2025-Sep-18 链接: PubMed
摘要
BackgroundDue to the long hours spent in business life, the nature of the job can affect the physical activity and physical fitness level. Although some studies have been conducted showing that university employees have low levels of physical activity due to their jobs, there is no study comparing blue- and white-collar university employees whose job descriptions are more similar than in other fields.ObjectiveThe aim of this study was to evaluate the weekly physical activity levels and general physical fitness levels of blue-collar and white-collar employees working in a similar field in the university environment.MethodsThe study was a quantitative study with two groups. The study was carried out with the participation of academic, administrative and technical service personnel working throughout the university. White-collar employees consisted of academic and administrative staff (n:50) and blue-collar employees consisted of technical service personnel (n:50). In the study, physical activity and physical fitness levels were assessed.ResultsAs a result of the comparison of groups, statistically significant differences were found in favour of the blue-collar group for all physical activity and physical fitness parameters. Linear regression analysis showed that physical activity level was effective on dynamic balance and physical endurance,ConclusionBlue-collar university employees were better in terms of physical activity and physical fitness. White-collar university employees do not expend too much physical energy due to their job descriptions, while blue-collar employees are more physically active. Therefore, it seems that some regulations are needed to make white-collar university employees more active.
20. Genomic diversity and environmental factors associated with Listeria monocytogenes presence in surface water.
期刊: The Science of the total environment 发表日期: 2025-Sep-17 链接: PubMed
摘要
This study aimed to detect and characterize Listeria monocytogenes (L. monocytogenes) in irrigation water to help reduce the risk of foodborne illnesses. Over nearly a year, water samples (n = 1050) were collected monthly from 120 locations across four Chilean watersheds to assess the prevalence and genetic diversity of the pathogen. The average detection of L. monocytogenes across all watersheds ranged from 15 % to 25 %, underscoring the variability in L. monocytogenes contamination at various sites. Water type, collection month, watershed, pH and season were the primary determinants of the likelihood of L. monocytogenes in surface waters. The genetic analysis of the isolates revealed that clonal L. monocytogenes isolates were identified across regions and were collected throughout the study period. Genomic characterization revealed that most of the 221 isolates sequenced were of serogroup IVb. Virulence-related genes in LIPI1 were present in almost all isolates, while LIPI3 and LIPI4 were less common. Moreover, although infrequent, we found three isolates carrying antimicrobial resistance genes mefA and msrD. These results highlight the genetic diversity of L. monocytogenes in Chilean freshwater environments. At the same time, the environmental persistence ability of L. monocytogenes strains or the presence of reservoirs across different areas could explain the dissemination and persistence of some strains. Ultimately, we did not identify an association between the presence of Salmonella and L. monocytogenes in these watersheds. Insights from this study are vital for improving monitoring efforts and developing targeted control strategies to mitigate public health risks.
21. Epidemiology and Clinical Impact of Mycoplasma pneumoniae in an Italian Pediatric Center: An Observational Study from 2017 to 2024.
期刊: The Pediatric infectious disease journal 发表日期: 2025-Sep-17 链接: PubMed
摘要
Mycoplasma pneumoniae (MP) is a common cause of lower respiratory tract infections in children. During the COVID-19 pandemic, a marked decline in MP infections was observed, with a delayed resurgence reported in some European countries. This study aimed to assess the epidemiological trends and clinical features of MP infections in a pediatric tertiary care academic hospital in Italy from 2017 to 2024. We conducted a retrospective, single-center study including immunocompetent patients 30 days to 17 years of age, hospitalized with confirmed MP infection. Clinical, laboratory, and radiologic data were analyzed across 3 periods: prepandemic (2017-2019), pandemic (2020-2022) and postpandemic (2023-2024). Statistical analyses were performed to compare incidence and clinical characteristics over time. Of 303 included patients, 130 were hospitalized prepandemic and 148 postpandemics. The proportion of MP among acute respiratory infection hospitalizations nearly doubled, from 3.2% in 2019 to 6.1% in 2024. Despite the higher incidence, the need for respiratory support remained stable (25.7% overall; P = 0.3), the pediatric intensive care admissions were rare and unchanged (2.0% vs. 2.0%, P = 1.0) and median hospital stay was consistent across both periods (5 days, interquartile range 4-8; P = 0.803). MP incidence increased significantly postpandemic, and clinical severity remained comparable to prepandemic levels. Ongoing epidemiologic surveillance is essential to better understand infection dynamics and to guide effective clinical management strategies.
22. Neonatal Enterovirus and Parechovirus Infections: National Enterovirus Surveillance System, United States, 2004-2023.
期刊: The Pediatric infectious disease journal 发表日期: 2025-Sep-17 链接: PubMed
摘要
Enteroviruses (EVs)-including echoviruses (Es) and coxsackieviruses-and parechoviruses (PeVs) can cause severe illness among neonates. Recent data on which EV and PeV infections are most reported among US neonates are limited. The National Enterovirus Surveillance System (NESS) is a US laboratory-based national surveillance system that collects reports of EV and PeV typing results from patients of all ages. We analyzed NESS data on EV and PeV infections from specimens collected during 2004-2023, including mortality data from 2014 to 2023. During 2004-2023, 11,065 EV and PeV infections were reported to NESS: 823/9393 (9%) of infections with reported age occurred among neonates. Among 690 neonatal infections with identified virus type, Coxsackievirus type B5 (CV-B5, n = 90; 13%), CV-B4 (70; 10%), CV-B3 (68; 10%), PeV-A3 (63; 9%) and E-11 (56; 8%) were reported most frequently overall, with the top virus types varying from year to year. During 2014-2023, 85/503 neonates with EV or PeV infections had reported outcome (17%), of whom 18/85 (21%) died. This analysis utilized 2 decades of surveillance data to identify top EV and PeV virus types reported among US neonates. Mortality data emphasize that EV and PeV infections can be severe among neonates and result in death. The variety of enteroviruses observed highlights the need for strengthened surveillance and further research to improve the current understanding of neonatal enteroviral disease and inform future development of prevention and treatment strategies.
23. Immunogenicity of Three-session Intradermal Rabies Post-exposure Prophylaxis in Indian Children and Adolescents.
期刊: The Pediatric infectious disease journal 发表日期: 2025-Sep-17 链接: PubMed
摘要
Rabies is a uniformly fatal but vaccine-preventable disease. In India, the standard 4-session intradermal rabies post-exposure prophylaxis is currently administered. The World Health Organization has recommended a shortened 3-session regimen. Pediatric and adolescent-specific data for this abbreviated protocol remain sparse. To evaluate the immunogenicity of the 3-session intradermal rabies post-exposure prophylaxis regimen among children and adolescents under 18 years of age in India and to assess its adequacy for potential policy adoption. A descriptive cross-sectional study was conducted at the Animal Bite Clinic of a tertiary teaching hospital in New Delhi, India. Eighty-two children and adolescents presenting for the 4th rabies vaccine dose were enrolled. Blood samples were collected before administration of the fourth dose, and IgG anti-rabies virus glycoprotein antibody values were estimated using indirect enzyme-linked immunosorbent assay. Values ≥0.5 EU/mL were considered seroprotective. Participants were followed up for 1 year for any development of rabies. Of the 82 participants, 79 (96.3%) had seroprotective values. The geometric mean value was 2.67 EU/mL. Three participants (3.7%) had values <0.5 EU/mL. Follow-up assessment post-4th dose confirmed seroconversion in 2 of them. The use and type of rabies immunoglobulin had no significant effect on seroconversion. No participants developed rabies over a 1-year follow-up. Although seroconversion was achieved in 96.3% of participants after 3 sessions, the 3.7% with nonprotective values raise concerns. Given the fatal nature of rabies and infrastructural variability in Indian healthcare, continuation of the 4-session regimen is recommended until broader validation is conducted in a representative pediatric population via multicentric studies.
24. Fluoride contamination of groundwater in different geological settings of Punjab Province, Pakistan: Levels, possible mechanisms and health risks.
期刊: The Science of the total environment 发表日期: 2025-Sep-17 链接: PubMed
摘要
Groundwater fluoride contamination is a global concern, particularly in South Asia. Like other Asian countries, this problem has also been reported on a large spatial scale in Pakistan. The present study was designed to investigate the geochemical mechanisms responsible for fluoride mobilization in different geological settings of Punjab, Pakistan, and the human health risk to the local populations due to elevated fluoride (F) intake via groundwater. Groundwater samples (N = 134) were collected in diverse aquifer systems (Thal Desert, Upper and Lower Indus floodplain areas) of Punjab, Pakistan, and analyzed for F and other anions by using ion-chromatography (IC). Fluoride concentrations (mg/L) ranged from 0.1 to 6.2 (2 % samples >1.5 mg/L) in Lower Indus Areas (LIA), 0.3-10.3 (25 % samples >1.5 mg/L) in Upper Indus Areas (UIA), and 0.6-4.7 (71 % samples>1.5 mg/L) in Thal desert areas (TDA). The mineral saturation indices suggest that fluoride-bearing minerals (e.g. fluorite) are mainly responsible for fluoride mobilization in the study area. The extensive fluoride contamination in the Thal desert areas is associated with the dissolution of evaporites due to a rapid increase of aquifer levels in recent years and may result in elevated pH, HCO3, and Na along with Ca-deficient water (controlled by calcisols) and Na-HCO3 type facies, which finally triggers the F mobilization into groundwater via ion exchange process. On the other hand, alkaline aquifers in the upper Indus areas (Kasur, Okara) experience excessive pumping and fluoride leaching due to the evaporative dissolution process. A human health risk assessment model (HHRA) shows that children and male populations are at a higher risk of fluorosis particularly in Thal desert areas of Punjab, Pakistan. Furthermore, large numbers of people (approximately 100-200 people/km2 at TDA and 200-500 people/km2 at UIA) in the studied areas are at risk of fluorosis and other health risks due to ingestion of fluoride-contaminated drinking water.
25. Shigella PCR-positive Gastroenteritis in Children: Insights From a Comparison Between Culture-positive and Culture-negative Cases.
期刊: The Pediatric infectious disease journal 发表日期: 2025-Sep-15 链接: PubMed
摘要
Detection of Shigella in stool by polymerase chain reaction (PCR) is rapid and highly sensitive but presents challenges in distinguishing between disease-associated and asymptomatic Shigella carriage. This study compared children with gastroenteritis who had Shigella identified in their stool by PCR-testing and a positive stool culture to those with Shigella identified by PCR-testing but a negative culture. All stool samples of outpatients and inpatients (<18 years) tested by multiplex-PCR at the Soroka University Medical Center laboratory between January 2020 and July 2024 were analyzed. Shigella PCR-positive samples underwent culture for species identification and antimicrobial susceptibility testing. The Vesikari scale was used to determine disease severity. Logistic regression assessed associations between culture-positivity and clinical findings, while receiver operating characteristic analysis evaluated the relationship between cycle threshold (Ct) values, culture-positivity and disease severity. Among 39,777 stools tested by multiplex PCR, 2041 (5.1%) were Shigella-positive, of which 897 (43.9%) were also culture-positive. Among culture-positive cases, 77% grew S. sonnei and 18% S. flexneri. Antibiotic susceptibility testing showed 36% sensitivity to ceftriaxone and 77% to azithromycin. Culture-positive cases had lower Ct values than culture-negative cases [23 (95% confidence interval [CI]: 20-26) vs. 30 (95% CI: 25-36), P < 0.001]. Among 395 hospitalized children with Shigella PCR-positive samples, 167 (42%) had positive stool cultures. Severe disease was more common in culture-positive cases (71% vs. 54%, P < 0.001). A Ct value of 28 predicted culture-positivity (adjusted odds ratios = 6.97, 95% CI: 5.62-8.68; P < 0.001) and 27 predicted severe disease (adjusted odds ratios = 1.93, 95% CI: 1.20-3.12; P = 0.007). Among children with Shigella-positive PCR results, those with culture-positive samples exhibited greater disease severity and lower Ct values.
26. Highly sensitive and wide-range quantification of bovine αS1-casein in foods for predicting potential milk allergenicity using an IgE multi-epitope-specific antibody.
期刊: Food chemistry 发表日期: 2025-Sep-13 链接: PubMed
摘要
Cow’s milk allergy (CMA) is a common immunoglobulin E (IgE)-mediated food allergy, with αS1-casein being the major allergen. Therefore, IgE epitopes could serve as reliable biomarkers for αS1-casein detection and milk allergenicity prediction. Here, a conventional sandwich enzyme-linked immunosorbent assay (pAb-tαS1-casein-based sELISA) and an Fe-N-C single-atom nanozymes (Fe-N-C SANs) probe-based sELISA were developed using a polyclonal antibody targeting nine IgE epitopes of αS1-casein (pAb-tαS1-casein) to detect αS1-casein and predict potential milk allergenicity. The developed assays showed high sensitivity, specificity, accuracy, precision, recoveries, and ultra-wide linear detection ranges (spanning four to five orders of magnitude) for αS1-casein detection. The capacity of these assays to predict milk allergenicity in real samples was confirmed using serum IgE from CMA patients. These results highlight the reliability of the developed methods for the highly sensitive quantification of αS1-casein and the prediction of potential milk allergenicity in foods.
27. Post-vaccination sero-monitoring of bovine calves in Indian subcontinent: A review on progress towards brucellosis control.
期刊: Veterinary immunology and immunopathology 发表日期: 2025-Sep-12 链接: PubMed
摘要
Brucellosis caused by Brucella abortus remains a major zoonotic challenge in India, causing substantial economic losses in livestock and public health risks. Although India has implemented nationwide S19 vaccination in cattle and buffaloes, comprehensive evaluation of its effectiveness across different regions and between species has been lacking. This study sought to assess post-vaccination sero-conversion rates in calves of aged 4-8 months across five Indian states/union territories (UTs), examine species-specific differences in vaccine response between cattle and buffaloes, and generate practical recommendations to optimize the national brucellosis control program. A multi-phase sero-monitoring study analyzed 19,893 serum samples, comprising 16,085 cattle calves and 3609 buffalo calves during 2021-2024. The samples were collected from Andhra Pradesh, Chandigarh, Haryana, Odisha, and Tamil Nadu and tested using laboratory standardized indirect enzyme-linked immunosorbent assay (iELISA).Significant disparities were observed between species with overall sero-conversion rates of 75.87 % in cattle versus 67.22 % in buffaloes (p < 0.001). Tamil Nadu demonstrated exceptional performance (84.61 %; 95 % CI: 84.20-84.95), with districts like Namakkal achieving 100 % sero-conversion. Other regions showed varied efficacy: Chandigarh (80.77 %), Andhra Pradesh (69.52 %), and Haryana (69.43 %) consistently exhibited 10-15 % lower rates in buffaloes (p < 0.001). Odisha displayed notable phase-wise improvement (71.84 %; CI: 70.02-71.12), with Jagatsinghpur district reaching 97.85 % and buffalo calves improving from 17.64 % (Phase I) to 57.5 %. While, the S19 program achieves moderate efficacy but highlights species-specific disparities and replicable success models such as Tamil Nadu. Targeted buffalo vaccination strategies and adoption of best practices are recommended to achieve > 80 % vaccination coverage thereby herd immunity. Overall, this study provides an evidence-based framework for strengthening India’s brucellosis control program and contributing to global eradication efforts.
28. Retrospective assessment of vaccination policy optimizations during an Omicron BA.2 epidemic in Hong Kong: A modelling study.
期刊: Journal of infection and public health 发表日期: 2025-Sep-12 链接: PubMed
摘要
Suboptimal COVID-19 vaccine distribution hampers their potential disease protection impact. The 2022 BA.2 epidemic in Hong Kong, occurring over a year into vaccination efforts, resulted in one of the highest daily mortality rates of the pandemic. We developed an age- and dose-structured SEIR model to describe the transmission dynamics in this epidemic. Then we fitted the model to severe disease data to estimate the transmission dynamics of the epidemics by Bayesian inference. After that, we conducted extensive counterfactual simulations based on the fitted transmission dynamics and considered varying age-specific vaccination coverages and timing to estimate the impact on severe disease across scenarios. If individuals over 80 had primary series coverage similar to the adult population, 27.6 % (95 % posterior predictive interval [PPI]: 24.7 %, 31.1 %) of deaths could have been averted. High primary series coverage in 40-49-year-olds averted 32.6 % (95 % PPI: 30.0 %, 35.5 %) more hospitalisations. Advancing the adult or senior vaccination campaign by two weeks significantly reduced deaths by 498 (95 % PPI: 309, 688) and 601 (95 % PPI: 412, 792), respectively. Earlier vaccination of children had no significant impact on population-wide deaths. Low elderly primary series coverage led to the most preventable deaths, while high coverage in middle-aged groups significantly averted excess hospitalisations. Our study underscores the importance of targeting COVID-19 vaccinations in high-risk and transmission-driving groups, as well as vaccination time-sensitivity, where each week difference, averts or abets morbidity and mortality.
29. Long-term Impact of Invasive Meningococcal Disease in Australian Adolescents and Young Adults.
期刊: The Pediatric infectious disease journal 发表日期: 2025-Sep-12 链接: PubMed
摘要
Limited data exist on the long-term impact of invasive meningococcal disease (IMD) contracted during adolescence and early adulthood. This study aimed to determine the long-term outcomes on neurocognitive, psychological and quality of life (QoL) outcomes in adolescents and young adults. IMD survivors aged 15-25 years (2-10 years post-IMD hospitalization) and non-IMD age-matched control participants were recruited across mainland Australian states (2016-2023) and completed neurocognitive, psychological, QoL and physical assessments. A total of 41 IMD cases (93% serogroup B and 73% females) and 51 control participants (57% females) were enrolled in the study. There was no clinically significant difference in Full-Scale IQ between IMD cases (106, SD 11) and control participants [109, SD 14, adjusted difference -4, (95% confidence interval, -10 to 3), P = 0.2]. Mean QoL scores for IMD cases (0.80, SD 0.21) and control participants (0.90, SD 0.09) were similar [adjusted difference -0.06, (95% confidence interval, -0.13 to 0.02), P = 0.2]. Mathematical reasoning was poorer in cases than in controls (P = 0.02). IMD cases had significantly higher rates of psychological symptoms than controls (58% vs. 31%, P = 0.01), including posttraumatic stress disorder symptoms (10% vs. 0%, P = 0.03) and alcohol dependence (18% vs. 2%, P = 0.04). Physician-assessed physical sequelae were present in 15% of IMD survivors (50% severe). While long-term outcomes for adolescents and young adult IMD survivors show no significant impact on intellectual functioning or overall QoL, they experienced substantial psychological and physical sequelae. The impact on mental health underscores the need for comprehensive postdischarge psychological follow-up and care for IMD survivors, in addition to care for physical sequelae.
30. Cortical tau deposition promotes atrophy in connected white matter regions in Alzheimer's disease.
期刊: Brain : a journal of neurology 发表日期: 2025-Sep-12 链接: PubMed
摘要
In Alzheimer’s disease (AD), fibrillar tau pathology is a key driver of neurodegeneration and cortical atrophy. Yet, emerging evidence suggests that tau aggregates also contribute to white matter (WM) damage. Specifically, physiological tau stabilizes intra-axonal microtubules, while hyperphosphorylated tau disrupts microtubule integrity, ensuing intraneuronal tau aggregation, neuronal disconnection, and axonal degeneration. Therefore, we investigated whether cortical tau promotes atrophy in connected WM regions in AD. To this end, we included 186 amyloid-positive (Aβ+) patients across the AD spectrum and 102 cognitively normal (CN) amyloid-negative (Aβ-) participants from ADNI, with baseline amyloid-PET, tau-PET, and T1-weighted MRI. Longitudinal tau-PET and MRI (∼2-years) were available for a subset of 138 participants, to further assess the relationship between tau accumulation and WM atrophy over time. For replication, we included 378/60 CN Aβ+/Aβ- participants from the A4/LEARN cohort with baseline amyloid-PET, tau-PET, and T1-weighted MRI, where a subset of 141/4 CN Aβ+/Aβ- subjects had ∼5-year longitudinal tau-PET and MRI. Cortical tau-PET Standardized Uptake Value Ratios were extracted from 210 cortical regions of the Brainnetome Atlas. In addition, we used a diffusion MRI-based tractography template to determine WM volumes of fiber tracts connected to cortical regions using segmented T1-weighted MRI. Using linear regression, we tested whether higher cortical tau-PET at baseline was associated with (i) lower baseline WM volume and (ii) faster WM volume loss over time, and (iii) whether faster longitudinal tau-PET increases paralleled faster WM loss. Testing the reverse model examined whether baseline WM atrophy predicted faster subsequent tau-PET increase in connected regions. Models were adjusted for age, sex, intracranial volume, WM hyperintensity volume, ApoE4 status and global amyloid-PET. In ADNI, elevated baseline cortical tau-PET in temporal regions was associated with lower baseline WM volume in adjacent regions, with more pronounced effects in patients across the AD spectrum and with weaker associations in the preclinical A4/LEARN sample. In both samples, higher baseline temporo-parietal tau-PET as well as faster tau-PET increase over time were significantly linked to accelerated volume loss in connected WM regions, which was especially pronounced in individuals on the AD spectrum. Importantly, baseline WM volume did not predict subsequent tau-PET change rates in adjacent cortical regions, suggesting a unidirectional relationship between fibrillar tau and subsequent WM degeneration. Together, our findings suggest that cortical tau accumulation promotes atrophy in adjacent WM regions in AD, highlighting that tau-induced axonal degeneration and potentially neuronal disconnection may play a pivotal role in disease progression.
31. Epidemiology and Risk Factors of Pediatric Clostridioides difficile Infection: A Nationwide Claims-based Comparison With Adults in Japan.
期刊: The Pediatric infectious disease journal 发表日期: 2025-Sep-12 链接: PubMed
摘要
Pediatric Clostridioides difficile infection (CDI) is a growing concern, yet nationwide data from Japan are scarce. Current guidelines often discourage CDI testing in infants due to a presumed low incidence of clinical disease. We aimed to characterize the epidemiology and risk factors of pediatric CDI in Japan, focusing on age-specific patterns and community-onset cases. We performed a retrospective analysis using the Japan Medical Data Center claims database from 2013 to 2022. CDI cases were defined by the presence of both diagnostic testing and anti-CDI treatment within 7 days. Episodes that relapsed within 8 weeks were excluded. CDI onset setting was classified according to CDC/NHSN criteria. Risk factors were evaluated by age and onset setting. Of the 4090 CDI cases, 284 were pediatric. The incidence in children aged 0-2 years was comparable to that in older children, challenging current assumptions. Risk factor profiles varied by age group and setting, with inflammatory bowel disease being a prominent risk factor in children (28.9% vs. 14.8% in adults/older adults), particularly in adolescents (43.5%). Critically, nearly half of community-onset pediatric CDI cases had no prior antibiotic exposure. This first large-scale study of pediatric CDI in Japan revealed that CDI can occur in children without prior antibiotic exposure, particularly in community settings. These findings support consideration of revisions to management strategies for pediatric CDI.
32. Prospective study of metyrapone in endogenous Cushing's syndrome (PROMPT).
期刊: European journal of endocrinology 发表日期: 2025-Sep-12 链接: PubMed
摘要
We evaluated the safety and efficacy of metyrapone treatment for Cushing’s syndrome (CS). International, prospective, single-arm, open-label study. Fifty adults with endogenous CS (either unsuitable for or uncontrolled after surgery) and three urinary free cortisol (UFC) concentrations each >1.5-fold the upper limit of normal (ULN) were enrolled. After 12 weeks of metyrapone titration, participants with mean 24h UFC (mUFC) <2-fold ULN could enter a 24-week extension phase. Safety was assessed, and doses adjusted at weeks 1-5, 8, 12, and 24. Pre-defined endpoints included normalization of mUFC at weeks 12 (primary), 24, and 36, and proportion of “responders” (normalization or >50% decrease of baseline mUFC), time to eucortisolemia, salivary cortisol day-curve, and quality of life (QoL). Of the 49 evaluable participants, 47 completed the 12-week visit; 40 were evaluated at week 24 and 35 at week 36. The primary endpoint was met in 46.9% of participants (95% confidence interval [CI] 32.5-61.7%), with efficacy maintained at week 24 (52.5%; 95% CI 37.5-67.1%) and week 36 (48.6%; 95% CI 33.0-64.4%). The responder rates were 80.9%, 77.5%, and 71.4% at weeks 12, 24, and 36, respectively. Forty-seven participants (94%) developed mild-to-moderate adverse events (AEs), mostly during the first 12 weeks and most commonly nausea (38%), fatigue (26%), and headache (22%); eight experienced severe AEs. Six participants developed reversible adrenal insufficiency during titration. Clinical features and QoL improved. Metyrapone is a safe and effective treatment for endogenous CS.
33. Newborn Technology Use in Low-Resource Settings: The Role of Health Professionals' Communication in Implementation.
期刊: Health policy and planning 发表日期: 2025-Sep-12 链接: PubMed
摘要
Neonatal deaths remain a critical public health challenge in many low- and middle-income countries (LMICs), including Kenya. Affordable technologies such as Comprehensive Positive Airway Pressure (CPAP) and phototherapy machines can reduce neonatal mortality and are used in these settings. However, their introduction and implementation in resource-constrained health system contexts are poorly understood. This study investigates how communication among health professionals influences decisions to use CPAP and phototherapy devices in Kenyan newborn units. Using a focused ethnographic approach, we conducted unstructured non-participatory observations, semi-structured interviews, and document reviews in two newborn units in level five Kenyan referral hospitals. The study participants were all health professionals working in the newborn units. We gathered data in two phases, six months apart, and analysed the data thematically. Data collection and analysis were informed by The Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework. We found four interconnected contextual factors that influenced health professionals’ communication on the initiation, maintenance, discontinuation, and repair of neonatal technologies. These factors are as follows: First, physical environment, including space availability, newborn unit layout, and the arrangement of cots and incubators. Second, socio-organisational dynamics, such as the team composition, workload, management approach, and workplace culture. Third, technology-specific attributes, particularly the perceived complexity of CPAP and phototherapy’s features and functions. Finally, the wider system encompasses administrative burdens from research and donor-supported programmes, as well as political, financial, and regulatory factors. Stakeholders, including funders, policymakers, local governments, and health professionals, must recognise that interconnected physical, organisational, technological, and wider contexts shape communication, decision-making, and use of life-saving technologies. A tailored approach that considers these complex realities, rather than a one-size-fits-all approach, should contribute to better integration and sustainability of these technologies, leading to improved outcomes in newborn care.
34. Strengthening antimicrobial resistance surveillance across African military settings.
期刊: International health 发表日期: 2025-Sep-12 链接: PubMed
摘要
While antimicrobial resistance (AMR) surveillance within civilian health systems has progressed, military health systems remain under-represented in related research and policy frameworks. Military personnel, particularly during deployments, often operate in environments characterised by combat-related injuries, overcrowding and inadequate sanitation, which increase the risk of spread and emergence of drug-resistant infections. Despite these vulnerabilities, national AMR strategies in Africa largely prioritise civilian systems, with minimal integration of military health surveillance data or clinical insights from military medical facilities. As a result, AMR trends within military populations and conflict zones remain poorly documented. This paper examines the distinctive AMR challenges in African military settings and proposes strategies for incorporating military medical surveillance data into national AMR frameworks. Drawing on international models, such as the US Armed Forces Health Surveillance Division’s Antimicrobial Resistance Monitoring and Research programme, it highlights the potential for military facilities to serve as sentinel sites for resistance monitoring. Integrating military medical surveillance data into national systems would enhance understanding of resistance patterns and support more inclusive and effective containment strategies, while strengthening antimicrobial stewardship within military health facilities to reduce inappropriate antimicrobial use.
35. Carotid artery calcifications on panoramic radiographs are associated with vascular disease severity on carotid ultrasound.
期刊: Dento maxillo facial radiology 发表日期: 2025-Sep-12 链接: PubMed
摘要
The aim of this study was to investigate whether any feature of carotid artery calcification (CAC) detected on panoramic radiographs (PRs) is associated with more severe signs of cardiovascular disease (CVD), as assessed by carotid ultrasound (CUS) including multi-view assessment of carotid intima media thickness (cIMT). The present investigation was a retrospective sub-study of the randomised controlled trial Visualization of Asymptomatic Atherosclerotic Disease for Optimum Cardiovascular Prevention (VIPVIZA), which included 60-, 50-, and 40-year-old inhabitants of Västerbotten County, each of whom underwent CUS. The present sub-study included 135 participants who had undergone PR for odontological indications within 18 months before or after CUS examination. Findings of CAC on PR were compared with CUS findings of cIMT and carotid plaque. CAC features were categorised into four types: single, scattered, vessel width-defining, or vessel-outlining. Compared to participants without CAC on PR, those with any CAC type on PR exhibited significantly more carotid plaque (80.9% vs 43.2%, P < .001) and a higher average cIMT score (0.83 vs 0.77 mm, P = .013) on CUS. The vessel-outlining CAC group exhibited the most pronounced cIMT and carotid plaque occurrence (P = .011). All CAC types detected on PR were associated with CVD on CUS, and vessel-outlining CAC indicated more severe CVD. By detecting CAC on PR, especially vessel-outlining CACs, dentists could contribute to the early identification of patients with asymptomatic CVD, and recommend that these patients seek medical attention for preventive treatment.
36. Health Effects of Air Pollution from PM2.5 on Short-Term International Travelers to Thailand.
期刊: Journal of travel medicine 发表日期: 2025-Sep-12 链接: PubMed
摘要
Thailand has increased in popularity as a top travel destination but there are concerns regarding significant seasonal levels of particulate matter 2.5 (PM2.5) that are 2.5 μm or smaller in diameter which may affect the health of travelers during periods of high air pollution. The aim of this study is to examine the prevalence of short-term health effects and the association between exposure to PM2.5 and adverse health outcomes among international travelers. A cross-sectional study was conducted in Bangkok and Chiang Mai, Thailand, between February and May 2024 during a period of high pollution levels. Data were collected via online questionnaires distributed at the international airports in both cities. Travelers aged 20 or older visiting during this polluted season were included, excluding those staying longer than six months. PM2.5 levels were obtained from the Thai Pollution Control Department from February to May 2024. Among 617 participants, 63.5% were male, 75.2% (n=464) visited Bangkok, and 66.1% (n=408) were from North America/Canada. Tourism was the primary purpose of travel for 81.4% (n=502). Mean PM2.5 levels were 30.5 μg/m3 (SD=13.2) in Bangkok and 65.9 μg/m3 (SD 32.0) in Chiang Mai. Travelers who visited Chiang Mai reported significantly more short-term health symptoms than those who visited Bangkok (58.8% vs. 0.4%, p < 0.001). Among Chiang Mai visitors, respiratory symptoms were most common (46.4%), followed by eye (20.3%) and skin issues (11.1%). Reporting from participants who reduced outdoor activities during periods of high pollution were associated with a 69% lower level of symptoms (aOR = 0.31, 95% CI: 0.1-0.7). A majority of travelers reported health symptoms during their visit to Thailand during high-pollution seasons. Limiting outdoor activities appeared to mitigate these effects. Pre-travel advice should highlight the health risks associated with air pollution and emphasize preventive measures for minimizing exposure.
37. Multidrug-resistant yeasts in fresh fruits from organic and conventional farming: quantification, species identification, and antifungal susceptibility profiles.
期刊: Letters in applied microbiology 发表日期: 2025-Sep-12 链接: PubMed
摘要
The global increase in fungal infections and antifungal resistance has drawn attention to environmental sources of potentially pathogenic yeasts. This study investigated the fungal load and antifungal susceptibility of yeasts isolated from fresh fruits (strawberries, bananas, guavas, and apples) grown under organic and conventional farming systems. Samples were analyzed for total yeast counts (CFU g-1) and for quantification of yeasts capable of growing on medium supplemented with fluconazole (8 and 64 µg mL-1), followed by phenotypic identification and antifungal susceptibility testing via broth microdilution. The highest fungal loads were observed in strawberries across both cultivation systems. While no differences were found between organic and conventional fruits, variation in total and fluconazole-tolerant yeast counts was observed between fruit types. Among 29 presumptively fluconazole-resistant isolates, 23 were confirmed as resistant by MIC testing. All isolates were resistant to itraconazole, and most showed cross-resistance to voriconazole. Identified species included Meyerozyma guilliermondii, Pichia kudriavzevii, Trichomonascus ciferrii, Papiliotrema laurentii, and Rhodotorula mucilaginosa, many of which are associated with invasive fungal infections. These findings highlight the potential of fresh fruits to act as reservoirs for opportunistic and multidrug-resistant yeasts. Enhanced microbiological surveillance of plant-derived foods is recommended as part of integrated public health strategies, particularly within the One Health framework.
38. Understanding the Emergence, Use, and Appeal of Nicotine Pouches: From the Chemistry Lab to TikTok.
期刊: Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco 发表日期: 2025-Sep-12 链接: PubMed
摘要
39. DNA damage response signaling in oocytes from an oncofertility perspective.
期刊: Biology of reproduction 发表日期: 2025-Sep-12 链接: PubMed
摘要
The remarkable advances in cancer therapies significantly enhance the survival rates and longevity of cancer patients. Among childhood, adolescent, and young adult female cancer survivors, however, anti-cancer agents frequently cause primary ovarian insufficiency (POI), early menopause, and infertility, primarily due to the depletion of the ovarian reserve. Oocytes, the female germ cells, exhibit a notable susceptibility to DNA damage, given that they remain in meiotic arrest of prophase I for prolonged durations from months to years, which increases the risks of accumulating DNA damage overtime. To counteract this, a tightly controlled DNA damage response (DDR) signaling ensures that only oocytes with an intact genome progress to ovulation, fertilization, and next generations. Chemotherapeutic anti-cancer agents, including doxorubicin, cisplatin, cyclophosphamide, along with irradiation, elicit DNA damage via various mechanisms, including DNA crosslinking, single and double-strand DNA breaks, and oxidative stress. The genotoxic insults activate DDR in the oocytes, which detect and repair DNA damage or initiate apoptosis to eliminate impaired oocytes. Although several protein molecules such as DNA damage-sensing kinases, checkpoint kinases, p53 family transcription factors, and pro-apoptotic molecules, have been discovered, the precise mechanisms of DDR in determining the fate of oocytes, particularly how they differ from those in somatic cells and cancer cells, remain poorly understood. From an oncofertility perspective, the current review analyzes the molecular mechanisms of anti-cancer agent-induced DDR in oocytes and discuss knowledge gaps and urgent future research directions for preserving the ovarian reserve, fertility, and endocrine functions of young female cancer patients.
40. Trends in Antibiotic Resistance in Community-acquired Urinary Tract Infections Among Children: Nationwide Survey.
期刊: The Pediatric infectious disease journal 发表日期: 2025-Sep-11 链接: PubMed
摘要
Urinary tract infection (UTI) is one of the most common bacterial infections in children. Early antibiotic treatment may prevent complications. Empirical treatment requires up-to-date knowledge of the local epidemiology. This study aims to describe trends in resistance rates in community-acquired UTI between 2017 and 2023, assess whether current recommendations for empirical treatment are valid and identify risk factors for resistance. Data were collected retrospectively from the computerized system of Maccabi Health Services for all children under 18 years old diagnosed with a UTI in 2017, 2022 and 2023. Data was evaluated using chi-square tests and regression models to identify resistance trends and associated risk factors. A total of 24,592 urinary samples were included in the study. Escherichia coli was the most frequently isolated pathogen (76%-78%), with higher prevalence among females than males (78.3% vs. 59.3%, P < 0.001). Sensitivity to first-generation cephalosporins improved significantly (73% in 2017 to 82% in 2022, P < 0.001), while second- and third-generation cephalosporins showed minor fluctuations. Resistance to fluoroquinolones increased markedly, from 7% to 20% (P < 0.001). Female gender, older age, prior antibiotic use and urinary tract abnormalities were significant risk factors for resistance. The increased resistance rate observed for most pathogens and antibiotics was statistically significant. Nevertheless, due to small absolute changes, the recommendations for empirical antibiotic treatment in Israel are still valid. Fluoroquinolones, which are not recommended as empirical treatment, should be avoided due to high levels of resistance.
41. Fusobacterium on the Rise: A Decade of Otogenic and Beyond.
期刊: The Pediatric infectious disease journal 发表日期: 2025-Sep-11 链接: PubMed
摘要
Fusobacterium has become increasingly recognized pediatric pathogen, responsible for a wide spectrum of infections, including otogenic, oropharyngeal, intra-abdominal and soft tissue infections. However, large-scale studies remain limited. This study aimed to assess the incidence, clinical features, complications and outcomes of pediatric Fusobacterium infections. Retrospective cohort study of children (0-18 years) diagnosed with Fusobacterium infections at a tertiary pediatric hospital between 2010 and 2023. A total of 195 cases were identified, with a 10-fold increase in incidence over 13 years. Linear regression demonstrated a significant annual rise in Fusobacterium isolations [β = 2.25, 95% confidence interval (CI): 1.99-2.60, P < 0.01], affecting both otologic (β = 0.65, 95% CI: 0.19-1.11, P < 0.01) and nonotologic sources (β = 1.58, 95% CI: 1.23-1.94, P < 0.001). Infections were primarily otogenic (50.2%), followed by skin and soft tissue, intra-abdominal and pharyngeal infections. Patients with otogenic infections were significantly younger (mean 2.6 vs. 10.3 years, P < 0.001). Hospitalization was required in 80.5%, and complications occurred in 37%. No mortality was observed. Pediatric Fusobacterium infections are rising, with significant clinical complexity and complications. While often otogenic, these infections affect multiple body systems. Awareness of their evolving epidemiology is crucial for optimizing diagnosis and management.
42. Yiqi Xugu HeJi restores cartilage metabolic homeostasis via AKT1-Thr473 activation in osteoarthritis.
期刊: Phytomedicine : international journal of phytotherapy and phytopharmacology 发表日期: 2025-Sep-05 链接: PubMed
摘要
Osteoarthritis (OA) is a degenerative joint disease marked by cartilage degradation, inflammation, and changes in subchondral bone structure. Despite its widespread use in treating OA, the mechanisms of traditional Chinese medicine (TCM) are not well understood. This study aimed to explore the bioactive components and therapeutic mechanism of Yiqi Xugu HeJi (YQXGHJ), a classic TCM prescription, in alleviating OA progression. A destabilization of the medial meniscus (DMM)-induced OA rat model was established to evaluate the protective effects of YQXGHJ. Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS) identified serum-absorbed compounds, while network pharmacology and molecular docking predicted potential targets. Cellular and molecular validation, including CCK-8, EdU, flow cytometry, qPCR, Western blotting, immunofluorescence, and Transwell assays, were performed in IL-1β-induced chondrocyte inflammation models. Key signaling pathways were verified using the AKT inhibitor MK2206. YQXGHJ significantly alleviated cartilage degeneration and subchondral bone sclerosis in DMM rats. In vitro, YQXGHJ-containing serum promoted chondrocyte proliferation, suppressed apoptosis, and restored the balance between anabolic (COL2A1, SOX9) and catabolic (MMP13, IL-6) markers. Network pharmacology and docking pinpointed AKT1 as a central target, with KEGG analysis emphasizing the PI3K-AKT pathway. Western blot and immunofluorescence confirmed that YQXGHJ activated PI3K/AKT signaling and enhanced phosphorylation at the AKT1-T473 site. Inhibition of AKT1 phosphorylation by MK2206 abolished these protective effects, confirming pathway specificity. YQXGHJ mitigates OA progression by reestablishing cartilage metabolic balance through the activation of the PI3K/AKT signaling pathway, specifically enhancing AKT1-T473 phosphorylation. This study provides a pharmacological and mechanistic foundation for the clinical use of YQXGHJ in treating OA.
43. Global Mpox outbreaks: A comprehensive epidemiological assessment (2022-2024).
期刊: Journal of infection and public health 发表日期: 2025-Sep-04 链接: PubMed
摘要
The global outbreak of monkeypox (Mpox) in humans has become a substantial public health concern, with over 115,000 confirmed cases across 126 territories worldwide between May 2022 and November 2024. In this context, we examined the basic reproduction number (R0), doubling time, case fatality rate, and inter-country connectivity of ongoing outbreaks documented in Our World in Data portal. Epidemiological parameters R0 and doubling time were examined using a 9-day mean infectious period. Networks were analyzed using correlation and co-occurrence of outbreaks. The disease hub regions were examined using connectivity graphs’ degree and betweenness centrality measures. Furthermore, spatial autocorrelation analysis was performed using Moran’s I to assess distribution trends. The R0 and doubling time varied across regions, with a global mean of 1.046 and 373.12 days, respectively. This finding suggests that sustained transmission is limited; however, the potential for exponential spread of disease outbreaks persists. Global spatial autocorrelation analysis revealed moderate clustering of Mpox cases (Moran’s I = 0.067, p-value = 0.075). Outbreak connectivity analysis revealed significant intercountry disease spread, indicating rapid cross-border transmission. Countries such as Germany, the United States, Australia, Italy, Belgium, and Spain were identified as disease-controlling hubs. The results also show the interconnectedness of global cases identified by network analysis. Understanding outbreak dynamics, global spatial distribution patterns, and connectivity is essential for advancing the One Health approach and mitigating future disease risks. The findings reveal the risk of global Mpox transmission, emphasizing the need for continued surveillance, contact tracing, quarantine measures, and global collaboration to help curtail the global spread of Mpox.
44. Effect of dapagliflozin on proteinuria and the slope of the estimated glomerular filtration rate in patients with immunoglobulin A nephropathy: A multicenter prospective study.
期刊: The Journal of international medical research 发表日期: 2025-Sep 链接: PubMed
摘要
ObjectiveThe sodium-glucose cotransporter-2 inhibitor dapagliflozin reduces proteinuria and slows the decline in estimated glomerular filtration rate in patients with chronic kidney disease. Dapagliflozin is reported to be effective in patients with immunoglobulin A nephropathy; however, there have been only a few real-world clinical trials involving patients with immunoglobulin A nephropathy. Therefore, we aimed to evaluate the effect of dapagliflozin in Japanese patients with immunoglobulin A nephropathy.MethodWe performed a multicenter, nonblinded, single-arm, prospective observational study involving 44 patients with immunoglobulin A nephropathy. Patients who had completed corticosteroid treatment and were currently undergoing renin-angiotensin system inhibitor therapy were primarily enrolled.ResultsAt baseline, the mean estimated glomerular filtration rate was 56.2 ± 29.4 mL/min/1.73 m2, and the median urinary protein-to-creatinine ratio was 0.63 g/g (interquartile range: 0.32-1.22 g/g). The estimated glomerular filtration rate decreased significantly after 1 month and plateaued thereafter. The urinary protein-to-creatinine ratio significantly decreased in patients with higher proteinuria (>0.5 g/g), but not in those with less proteinuria (<0.5 g/g). The post-treatment estimated glomerular filtration rate slope was significantly attenuated compared with the pretreatment slope, especially in patients with a relatively rapid decline in estimated glomerular filtration rate.ConclusionDapagliflozin reduces residual proteinuria, even after treatment with corticosteroids and renin-angiotensin system inhibitors, in patients with biopsy-confirmed immunoglobulin A nephropathy. These findings may guide future treatment strategies for immunoglobulin A nephropathy.
45. Impact of more primary care visits on commercial health care costs.
期刊: The American journal of managed care 发表日期: 2025-Sep 链接: PubMed
摘要
To evaluate the relationship between the frequency of routine primary care visits and total health care expenditures among commercially insured adults. Retrospective cross-sectional statistical analysis of a nationally representative data set of health care utilization and expenditures over a 2-year period. We used multivariate regression analysis to evaluate the association between the annualized number of visits with a primary care physician for routine care and total health care expenditures for commercially insured adults younger than 65 years, adjusting for underlying clinical complexity measured through risk scoring. Data were drawn from information collected by the Agency for Healthcare Research and Quality between 2021 and 2022. For a sample cohort of 3879 participants, more frequent primary care visits were associated with incremental reductions in expenditures only for participants with high underlying clinical complexity. A relative risk level of approximately 2 times the average commercially insured adult was identified as an inflection point, above which cost reductions vs counterfactual prediction were observed, up to a limited number of visits. Our results show a relationship between primary care visit frequency and health care expenditures with similar directionality and risk dependency as has been observed in other studies for Medicare-insured adults. This finding suggests that certain commercial populations may benefit from risk-stratified, high-touch primary care models like those being employed for some Medicare populations. The health care cost reduction benefits of these models appear premised more on clinical need than coverage type. Demonstrating this relationship is useful for health care providers, insurers, and policy makers who are developing advanced primary care models.
46. Plant derived polysaccharides as prebiotic-like components: natural sources of glycolipid regulators and substitutes.
期刊: Food chemistry 发表日期: 2025-Sep-01 链接: PubMed
摘要
Dietary intervention has gradually become an effective measure to prevent and treat metabolic diseases. Plant-derived polysaccharides (PDPs) can be used as substrates for gut microbiota (GM), directly or indirectly producing beneficial metabolites to show powerful regulation of glucolipid metabolism. This review focuses on mining the key GM of PDPs in exerting the regulatory function of glucolipid metabolism, which provides direction for subsequent personalized diet design. It also exhaustively analyzes the complex crosstalk mechanism of PDPs-gut-host in glycolipid metabolism based on the gut-organ axis, and summarizes and discusses the structure of PDPs with such activities from a new perspective, providing information support for the subsequent discovery of related prebiotics. In addition, some PDPs play a powerful role in replacing sugars and fats without altering or having superior properties to previous foods. This review can provide reference for developing novel prebiotics and probiotics to prevent abnormal glycolipid metabolism.
47. Impact and care gaps of headache disorders in active-duty military personnel: A cross-sectional study from a European armed forces population.
期刊: Cephalalgia : an international journal of headache 发表日期: 2025-Sep 链接: PubMed
摘要
AimPrimary headache disorders such as migraine and tension-type headache are highly prevalent in military populations and may severely impact operational performance and readiness. Despite this, data from many European armed forces are lacking. This study investigates headache phenotypes, diagnosis, treatment and functional impairment in active-duty personnel of a major European military organization.MethodsThis cross-sectional cohort study utilized an anonymous 33-item online questionnaire distributed across military medical centers in Germany between May and July 2023. The survey assessed demographics, headache types according to the International Classification of Headache Disorders, 3rd edition (ICHD-3), diagnostic awareness, treatment history and headache-related disability using the Migraine Disability Assessment Score (MIDAS).ResultsOf the 1189 participants, 914 (77%) completed the survey. Among them, 839 (94.9%) reported experiencing headaches in the past 12 months. Based on ICHD-3 criteria, 227 individuals (27.1%) met the complete set of criteria for migraine, while 246 (29.2%) were classified as probable migraine. Tension-type headache was reported by 222 respondents (26.5%), and cluster headache was resported by 34 (4.1%). Notably, 61.4% of participants had never received a formal diagnosis and only 38.6% had ever sought medical care for their headaches. Functional impairment was substantial: 63.8% reported losing at least one workday in the past three months due to headache. Among those with migraine, an average of 3.9 workdays per month were lost. Despite this burden, only 27.3% of individuals with migraine had ever used preventive medication.ConclusionsPrimary headache disorders are common, underdiagnosed and inadequately treated in this military population, leading to significant functional and operational impairment. Our findings underscore the urgent need for improved screening, diagnosis and evidence-based treatment strategies in uniformed health systems. The results may inform similar efforts in other military and high-demand occupational settings.
48. Machine learning methods for gene regulatory network inference.
期刊: Briefings in bioinformatics 发表日期: 2025-Aug-31 链接: PubMed
摘要
Gene Regulatory Networks (GRNs) are intricate biological systems that control gene expression and regulation in response to environmental and developmental cues. Advances in computational biology, coupled with high-throughput sequencing technologies, have significantly improved the accuracy of GRN inference and modeling. Modern approaches increasingly leverage artificial intelligence (AI), particularly machine learning techniques-including supervised, unsupervised, semi-supervised, and contrastive learning-to analyze large-scale omics data and uncover regulatory gene interactions. To support both the application of GRN inference in studying gene regulation and the development of novel machine learning methods, we present a comprehensive review of machine learning-based GRN inference methodologies, along with the datasets and evaluation metrics commonly used. Special emphasis is placed on the emerging role of cutting-edge deep learning techniques in enhancing inference performance. The major challenges and potential future directions for improving GRN inference are also discussed.
49. Education strategies to facilitate lifestyle medicine practice within health systems: a multiple case study of US health systems.
期刊: Translational behavioral medicine 发表日期: 2025-Jan-16 链接: PubMed
摘要
Lifestyle medicine (LM) is an evidence-based field of medicine that is effective in treating and preventing leading causes of morbidity and mortality. Despite demonstrated impact, few physicians and other healthcare professionals regularly implement LM. Continuing education may be an effective avenue for improving practitioner knowledge, confidence, and practice of LM, but there is a gap in the understanding of how educational content and strategies can be utilized to effectively increase LM adoption. The purpose of this study is to identify educational strategies that facilitate the implementation of LM in health systems (HS). Eight US HSs participated in this multiple case study. We conducted in-depth, semi-structured interviews (n = 68 total; 6-8 within each HS) with HS employees leading and delivering LM programs. Interviews included questions about LM implementation and educational strategies. Transcripts were analyzed following the framework analysis approach. Strength of endorsement was assessed through quantitative and qualitative analysis. Four topic areas were identified as critical content for effective continuing education in LM. The need for further education in behavior change counseling received the strongest endorsement. Other topics included LM definition and evidence, referral opportunities, and business development skills. Ten types of continuing educational strategies were identified that facilitate LM. There was the strongest endorsement for pilot programs, employee wellness, and interpersonal educational activities, including peer-learning, communities-of-practice, and supervisor-learning/mentorship. Continuing education can facilitate LM implementation in HSs. Educational strategies should emphasize training that builds skills in behavior change counseling, leverages employee wellness pilot programs, and nurtures interpersonal learning. We know that doctors and nurses can help their patients be healthier by encouraging them to adopt healthy behaviors, like diet, exercise, sleep, social connectedness, managing stress, and avoiding risky substances. This is called lifestyle medicine (LM). Although doctors and nurses are taught about how these behaviors impact the body, they are not trained in how to talk to their patients about making healthy choices. Teaching our doctors, nurses, and other health professionals about how to talk to their patients can help them feel more comfortable having those conversations. The purpose of this study is to learn more about how we can teach doctors and nurses about how to talk to their patients about healthy behaviors. Researchers talked with over 60 experts in different roles employed by health systems to learn about how they teach doctors and nurses about talking to patients about LM. We learned that healthcare professionals learn a lot about LM if they participate as a patient in a LM program. We also learned that training sessions or classes are helpful but are best when they are coupled with other tools, such as coaching or regular reminders about healthy behaviors. Finally, we learned that healthcare professionals really learn best together, and that when possible, we should allow them to train and practice in groups and receive coaching from more experienced coworkers.
50. Translation of the connect through PLAY physical activity intervention for underserved youth from in-person to virtual delivery: a feasibility study.
期刊: Translational behavioral medicine 发表日期: 2025-Jan-16 链接: PubMed
摘要
Afterschool “aftercare” programs (ASPs) have been recognized as critical settings to promote youth adequate daily physical activity (PA). However, several social and contextual challenges, especially faced by ASPs serving under-resourced schools/communities, inhibit youth from meeting PA goals, with the COVID-19 pandemic only exacerbating these challenges. Connect through PLAY (CTPI) is a 16-week social-motivational PA intervention designed to increase PA in underserved youth (ages 9-16) by providing staff training and resources to overcome social-contextual challenges and integrate youth social-motivational needs into the PA programming of existing ASPs. This study aimed to evaluate the feasibility of translating the CTPI intervention into a virtual format during the onset of the COVID-19 pandemic. To date, we know little about whether establishing a positive social-motivational climate is possible through a virtual format. The intervention included three components: (i) a novel PA curriculum, (ii) small group sessions, and (iii) staff health initiative. Youth and staff surveys were collected at baseline and endpoint to assess integration, acceptability, and potential effectiveness (longitudinal subsample n = 27 youth; 37% female; 36.1% Black/African American; Mage = 9.96 years). Paired sample t-tests indicated significant improvements in youth PA interest, cognitive engagement, regulatory motives, and PA participation, with medium to large effect sizes. Staff reported high acceptability and enthusiasm for continuing the intervention’s virtual activities. Findings demonstrate that PA interventions focused on cultivating a positive social-motivational climate can be successfully adapted to virtual formats, providing valuable health promotion opportunities with greater reach to youth within under-resourced communities. An effective afterschool-based physical activity intervention focused on cultivating a positive social-motivational climate can be successfully adapted to a virtual format, providing valuable health promotion opportunities that can be implemented wide scale and with greater reach to youth within under-resourced communities.
51. Healthcare utilization and resource distribution before and after interdisciplinary pain rehabilitation in primary care.
期刊: Scandinavian journal of pain 发表日期: 2025-Jan-01 链接: PubMed
摘要
Most patients with chronic pain are identified and managed in primary care (PC). Chronic pain management is challenging, which is manifested by increased healthcare utilization (HCU) in this patient group. The interdisciplinary pain rehabilitation program (IPRP) is the gold standard treatment for patients with chronic pain but is scarcely used in PC. The aim of this study was to evaluate the HCU of patients with chronic pain in PC 1 year before and 1 year after an IPRP by examining the distribution of costs and resources. This retrospective cohort study combined data from a national pain registry and HCU data from regional administrative registries, including 146 patients who participated in an IPRP in PC. The outcome measure was the number of outpatient healthcare contacts. Costs and the distribution of resources were compared across the two measurement intervals using paired t-tests. HCU costs were described from a healthcare provider perspective. HCU decreased by 16% in the year following IPRP compared to the year before. Costs for outpatient visits dropped by 12% or €434 per participant. Visits to physiotherapists and general practitioners decreased the most, by 31% (p = 0.048) and 23% (p < 0.001) respectively. Visits to nurses, occupational therapists, and psychologists/social workers in turn increased marginally (6%, 5% vs 10%). IPRP in PC may lead to reduced HCU, freed resources, and streamlined chronic pain management. The study offers valuable insights into expected changes in HCU for chronic pain patients after an IPRP and how these changes may impact daily activities at the PC center.
52. Prevalence and associated factors of occupational injuries among garment and textile workers: Evidence from the Bangladesh Labour Force Survey 2016-17.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Annually, numerous workers face job loss, injuries, and fatalities due to various occupational injuries (OIs). However, less is known regarding the burden of OIs and their associated factors in the textile and garment industries in Bangladesh. This study aimed to determine the prevalence of OI and the individual and job-related factors associated with OI among textile and garment workers in Bangladesh. We analyzed cross-sectional data of 13,738 workers collected during 2016-2017 from the nationally representative Bangladesh Labor Force Survey. We employed multiple Firth logistic regression models to explore the different levels of associated factors of OI. The overall prevalence of OI was 1.8%, with a higher prevalence in the textile industry (3.8%) compared to the garment industry (1.2%). Within the textile industry, jute manufacturing exhibited the highest prevalence (12.3%), while in the garment sector, the embroidery and wearing industries had the highest prevalence (1.8%). Adjusted models revealed that, in the textile industry, migrant workers had higher odds of OI (Adjusted Odds Ratio, AOR = 1.65; p = 0.017) compared to non-migrant workers. In the garment industry, male workers (AOR = 1.95; p = 0.002) and those working over 48 hours per week (AOR = 1.70; p = 0.063) were at greater risk of OI. A hazardous work environment significantly increased the odds of OI in both industries (textile: AOR = 13.06; p < 0.001; and garment: AOR = 3.13; p < 0.001). Additionally, garment workers without adequate protective equipment or cloth while working had a higher likelihood of OI (AOR = 1.90; p = 0.006). Regionally, workers in the Barisal division had higher odds of OI in the textile industry. Although the overall prevalence of OI was low, the disproportionate burden among certain subgroups, especially in jute manufacturing and the manufacture of spooling and thread, highlights critical areas for intervention. Improving workplace safety through the provision of protective equipment and a safer working environment is essential to mitigating OI in the textile and garment industries of Bangladesh.