公共卫生研究摘要 (2025-09-20)
共收录 58 篇研究文章
1. Trends in the Utilization of Different Carotid Revascularization Modalities in the United States Over a 17-Year Period.
期刊: Neurology 发表日期: 2025-Oct-21 链接: PubMed
摘要
In October 2023, the Centers for Medicare & Medicaid Services (CMS) in the United States expanded coverage for carotid artery stenting (CAS) to include non-high-risk patients with carotid disease. The aim of this study was to provide a 17-year snapshot of trends in carotid revascularization practices in the United States before this CMS policy change went into effect. We conducted a serial cross-sectional study using the 2006-2022 National Inpatient Sample and a retrospective cohort study using the State Emergency and Inpatient Databases of Florida (2005-2021), Georgia (2010-2020), Maryland (2012-2021), and New York (2005-2020). Cases of carotid revascularizations in these databases were identified using International Classification of Diseases codes. We calculated age-specific and sex-specific proportions of revascularizations for CAS and combined annual CAS/carotid endarterectomy (CEA) counts with census data to determine utilization rates per 100,000 population. Joinpoint regression estimated annualized percentage change (APC) over time. Hospitalizations in the 6 months preceding revascularization defined symptomatic vs asymptomatic cases and characterized the subset with symptomatic stenosis. Of 1,779,948 weighted revascularizations, the mean patient age was 71.0 years and 40.9% were performed in women. 17.2% of procedures were CAS, and this proportion more than doubled from 14.3% to 29.0%. Transcarotid artery revascularization accounted for 9.1% in 2022. The CAS proportion increased across age groups, including in those aged older than 70 years and in women, even after excluding mechanical thrombectomy admission. Carotid revascularization usage per 100,000 population declined (APC -3.9%, 95% CI -4.1% to -3.3%) but plateaued after 2015. Although CEA utilization declined from 2006 to 2022 (APC -5.5%, 95% CI -5.9% to -5.1%), CAS use declined from 2006 to 2016 (APC -3.2%, 95% CI -4.6% to -2.1%) but increased from 2016 to 2022 (APC 12.0%, 95% CI 10.1%-14.1%). Only 25.7% of revascularizations in the 4 states were performed for symptomatic disease, with 75.3% of hospitalizations in women for asymptomatic disease. Despite uncertain benefit in selected age and sex groups, including those older than 70 years and with asymptomatic carotid disease, CAS use increased across groups over the past decade and now accounts for >25% of carotid revascularizations in the United States.
2. What Influences College Students' Endorsement or Rejection of Affirmative Consent?
期刊: Violence against women 发表日期: 2025-Sep-19 链接: PubMed
摘要
Affirmative consent policies and practices, which require consent to have certain characteristics (e.g., reversible, specific, voluntary), contrast with traditional views of consent. Understanding why college students endorse or reject this model can help foster safer, more respectful campus sexual relationships. Among 316 southern U.S. undergraduates (81% cisgender women, 83.2% White, 71.5% liberal, 65.2% heterosexual), affirmative consent beliefs correlated significantly with gender, sexual identity, and political orientation. Lower apathy toward the issue of sexual misconduct on their college campus, as well as more egalitarian gender role beliefs, predicted higher endorsement of affirmative consent among college students. Interventions should target attitudinal shifts to challenge harmful myths and promote positive beliefs about consent and sexuality.
3. Assessing the User Experience of the EU Mobile App for Cancer Prevention: Mixed Methods Study.
期刊: JMIR formative research 发表日期: 2025-Sep-19 链接: PubMed
摘要
In 2022, nearly 20 million new cancer cases and 9.7 million deaths occurred globally. Europe, comprising under 10% of the world’s population, accounted for over 22% of cases and 20% of deaths, reflecting an aging population, lifestyle risk factors, and extensive screening. With 40% of cancers preventable through modifiable risk factor interventions, effective prevention is essential. The European Code Against Cancer provides evidence-based guidelines that drive health initiatives across Europe. Supported by Europe’s Beating Cancer Plan and the EU4Health program, the EU Mobile App for Cancer Prevention was developed to disseminate these recommendations. However, its effectiveness depends on usability across populations with varying digital and health literacy; this study evaluates the app’s usability among diverse European populations. This study aimed to identify enablers, barriers, and user requirements for the use and maintenance of the English version of the EU Mobile App for Cancer Prevention, focusing on how usability varied across individuals with different levels of digital health literacy and diverse sociodemographic backgrounds. In addition, user feedback on mock wireframes-visual representations of the app’s interface and functionality-was gathered to evaluate usability and ease of use, providing insights for tailoring the app design to a broader population. We conducted a mixed methods study in 7 European countries with 76 adults aged 19-84 years recruited via purposive quota sampling. Participants completed quantitative usability testing using mock wireframes to perform 10 predefined tasks simulating core app functionalities (eg, profile setup and health goal tracking). We recorded task completion time, success rates, self-reported confidence, and perceived difficulty. Digital health literacy was assessed using the eHealth Literacy Scale (eHEALS) scale. Qualitative data were collected through focus group discussions guided by a semistructured interview guide, and transcripts were analyzed via thematic content analysis. Statistical analyses included descriptive statistics and 1-way ANOVA to explore group differences. Overall task completion rates ranged from 75% to 98%, with a median of 86%, indicating general usability. However, usability varied by age, education, and digital health literacy: younger participants and those with higher education and literacy levels reported greater confidence and lower difficulty, whereas older adults and lower-literacy users experienced more challenges. Qualitative analysis identified key themes affecting usability: the need for accessibility (multilingual support and simple language), user-centric design (age-friendly interfaces and intuitive navigation), ethical concerns (data privacy and security), and motivational features (gamification and personalized health goals). The app is generally usable across diverse populations but requires streamlined interfaces and design adaptations to accommodate varying digital health literacy. Ensuring robust data privacy practices is essential for fostering user trust, and integrating motivational elements may enhance sustained engagement. Future work will involve piloting the finalized app to evaluate its real-world uptake and impact on cancer prevention behaviors.
4. Prescriber-Level Responses to the 2018-2019 Valsartan, Irbesartan, and Losartan Recalls and Drug Shortages: A National Study.
期刊: Medical care 发表日期: 2025-Sep-19 链接: PubMed
摘要
Global shortages for 3 angiotensin receptor-II blockers (ARBs)-valsartan, losartan, and irbesartan-occurred in 2018-2019 after recalls due to ingredient impurities. Provider-level responses to the ARB shortages in the United States and spillovers to other antihypertensive classes are unknown. To estimate changes in provider-level prescribing for ARBs and non-ARB antihypertensives up to 18 months after the 2018-2019 recalls and shortages. National cohort study of prescribers using all-payer pharmacy claims. Mixed interrupted time series models quantified changes in prescribing postshortages and heterogeneous changes by specialty, region, medical school graduation cohort, sex, and level of prerecall prescribing. Active providers exposed to the 2018-2019 valsartan, irbesartan, and losartan shortages (defined as top-25th percentile for these drugs in 2017). Within-class changes in prescribing for ARBs (recalled and nonrecalled). Between-class substitutions to non-ARB antihypertensives (ACE-Is, alpha- and beta-adrenergic blockers, calcium channel blockers, diuretics, and other agents). Among 138,032 prescribers who met the inclusion criteria, per-prescriber fills for valsartan decreased by 57%-59% after it was recalled in July 2018. We observed concurrent increases for losartan and irbesartan fills and no change in overall ARB prescribing. There were no significant changes in fills for ACE-Is or for other antihypertensives. Absolute decreases in valsartan fills were greatest among providers with higher levels of prescribing at baseline. However, relative changes did not differ by prescriber characteristics. In this prescriber level, national study, substitutions to other ARBs mitigated decreases in valsartan fills after it was recalled. There were no spillovers to non-ARB anti-hypertensives. The availability of close substitutes during drug shortages may mitigate gaps in access for prescribers and their patients.
5. Temporal dynamics of age differences in perceptual load effects on attention to negative emotional distractors.
期刊: Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition 发表日期: 2025-Sep-19 链接: PubMed
摘要
Age-related differences in how perceptual load affects attentional resource allocation toward negative emotional stimuli remain unclear. This study aims to address this issue using the random dot kinematograms (RDKs) paradigm. By adjusting the levels of perceptual load, we examined how different age groups were influenced by distractors with neutral and negative emotional valences. To further explore the temporal dynamics of the influence, we controlled the time interval between the primary task and the distracting stimuli. This enabled us to observe variations in participants’ performance at different time points following the presentation of the distractors. The results demonstrated that attentional resource allocation in both younger and older adults was influenced by the interplay of emotional distractors and perceptual load. In terms of the temporal dynamics of the results, during the early stage of processing, older adults were less affected by emotional distractors and perceptual load compared to younger adults. In the later stages, perceptual load modulated the allocation of attentional resources to negative emotional distractors differently across age groups. Older adults were more influenced by negative emotional distractors under high load conditions, whereas younger adults were more affected under low load conditions. These findings highlight distinct temporal processing patterns in older adults, contributing to our understanding of cognitive aging and its implications for attentional resource management.
6. Pneumococcal vaccination willingness and influencing factors among older adults in Chongqing, China: a cross-sectional study based on the WHO's behavioral and social drivers of vaccination framework.
期刊: Expert review of vaccines 发表日期: 2025-Sep-19 链接: PubMed
摘要
In the context of China’s rapidly aging population and persistently low pneumococcal vaccine coverage, this study applied the Behavioral and Social Drivers (BeSD) framework to investigate the willingness and determinants of pneumococcal vaccination among adults aged 60 years and older in Chongqing. We designed a cross-sectional survey targeting the community population and collected data on willingness toward pneumonia vaccination and associated demographic factors through questionnaires. A total of 1,617 valid questionnaires were collected, 37.7% expressed willingness to receive pneumococcal vaccines. Higher vaccination willingness was associated with living in urban areas, having urban employee basic medical insurance, having an average monthly household income per capita below 2,000 CNY, being aware of pneumococcal vaccines, and showing interest in receiving vaccination information. Concerning the BeSD framework, concern over worsening health condition emerged as the primary driver, whereas perceived high vaccine costs and lack of awareness about vaccine were identified as major reasons for hesitancy. This study provides that future strategies should focus on addressing psychological determinants within old adults, alongside extensive promotion of knowledge regarding pneumonia vaccination, as well as exploring the impact of financial incentives on vaccination programs and payment strategies to enhance vaccination coverage.
7. Zebrafish optic nerve injury results in systemic retinal ganglion cell dedifferentiation.
期刊: PLoS genetics 发表日期: 2025-Sep-19 链接: PubMed
摘要
Retinal ganglion cells (RGCs) are the sole projection neurons connecting the retina to the brain and therefore play a critical role in vision. Death of RGCs during glaucoma, optic neuropathies and after ocular trauma results in irreversible loss of vision as RGCs do not regenerate in the human eye. Moreover, there are no FDA approved therapies that prevent RGC death and/or promote RGC survival in the diseased or injured eye. There is a critical need to better understand the molecular underpinnings of neuroprotection to develop effective therapeutic approaches to preserve damaged RGCs. Unlike in mammals, RGCs in zebrafish are resilient to optic nerve injury, even after complete transection of the optic nerve. Here, we leveraged this unique model and utilized single-cell RNA sequencing to characterize RGC responses to injury and identify putative neuroprotective and regenerative pathways. RGCs are heterogeneous and studies in mice have shown that there is differential resiliency across RGC subtypes. Our results demonstrated that all RGC subtypes are resilient to injury in zebrafish. Quantifying changes in gene expression revealed the upregulation of progenitor and regenerative markers in all RGC subtypes after injury as well as distinct early and late phases to the injury response. This shift in gene expression causes injury-responsive RGCs to resemble RGC subtype 3, a low frequency population of endogenous immature RGCs that are normally maintained in the wild-type, uninjured adult retina. A similar but restricted transcriptomic injury response in RGCs of the uninjured contralateral eye was also detected, highlighting a systemic RGC response to unilateral optic nerve injury. Taken together, these results demonstrate that zebrafish RGCs dedifferentiate in response to injury, and this may be a novel mechanism mediating their unique cell survival and regenerative capabilities.
8. Genomic profiling and experimental validation of type VI secretion system-associated proteins in Klebsiella.
期刊: PLoS genetics 发表日期: 2025-Sep-19 链接: PubMed
摘要
Klebsiella is widely distributed in nature and recognized for its dual role as a human commensal and an opportunistic pathogen capable of causing severe infections. Among its key virulence mechanisms, the Type VI Secretion System (T6SS) plays a critical role in microbial competition, interspecies interactions, and environmental adaptation. In this study, we investigated a representative set of high-quality Klebsiella genomes and identified two major T6SS loci (T6SSkleb1 and T6SSkleb2), which exhibit distinct structural features and are predominantly found within the Klebsiella pneumoniae species complex (KpSC). Comparative genomics further revealed the diverse distribution of effector and immunity proteins and their correlation with T6SS loci. Based on this distributional bias, we developed a novel computational approach to identify protein families significantly associated with T6SS. These T6SS-associated gene clusters were implicated in mediating adhesion to host cell surfaces during urinary tract infections, as well as in metabolism and immune defense. Moreover, we identified three putative orphan effectors harboring DUF3258, DUF3751, and Sel1 domains. Overexpression of these proteins in Escherichia coli resulted in cytotoxic effects, supporting their potential as T6SS effectors. These findings establish a comprehensive framework for T6SS analysis, aiming to expand and enrich our understanding of the diversity, evolutionary trajectory, and functional implications of T6SS in Klebsiella.
9. Selection, Optimization, and Compensation Strategies Used by Older Adults to Live Well With Technology: Qualitative Study.
期刊: JMIR aging 发表日期: 2025-Sep-19 链接: PubMed
摘要
With rapid digitalization, technologies are increasingly integrated as part of our everyday lives and are becoming increasingly essential for individuals to participate in society. Technology presents opportunities to support healthy aging. Examples include digital health monitoring and opportunities to maintain social connectedness through online platforms. However, the processes in which older adults select and integrate technologies into their daily lives have not been well examined. This study uses the Selection, Optimization, and Compensation (SOC) model to understand how older adults integrate technology into their everyday lives to live well. The two key research questions are as follows: (1) How do older adults describe their technology use and their choices, analyzed with respect to SOC processes? (2) How do older adults perceive that technology is a part of living well? A descriptive qualitative study was conducted. Purposive sampling was used to recruit older adults who were aged 55 years and older, were living in the community, spoke and understood English, and resided in Australia. Five in-person focus groups comprising 20 older adults were conducted. Data were analyzed using hybrid inductive and deductive reflexive thematic analyses, based on the SOC model. All participants resided in Brisbane, Queensland. Older adults selected technology intentionally to enhance different aspects of their daily lives. Perceived “involuntary” selection of technology could lead to feelings of resentment or frustration. Optimization strategies included self-monitoring, integrating technology into daily routines, digital literacy and proficiency, and problem-solving skills. Compensatory strategies included choosing alternative technology that suited participants’ abilities or skills and seeking support through informal or formal avenues. These findings provide important considerations for technology developers to design technology in collaboration with older adults to ensure that they align with needs and preferences. Digital literacy is not sufficient to empower older adults to use technology; when empowering older adults to use technology, service providers should also consider facilitating other intrinsic and extrinsic resources and skills.
10. Parental attitudes and practices in families with siblings with and without intellectual disability: Influences of sociodemographic and child-related factors.
期刊: Research in developmental disabilities 发表日期: 2025-Sep-18 链接: PubMed
摘要
Parenting styles and attitudes are a relevant factor of a child’s developmental environment. When parents raise both a child with an intellectual disability and a typically developing (TD) sibling, their approaches may differ due to factors related to the child, family, and social context. This study explored whether parenting styles and attitudes are consistent across children and examined whether sociodemographic and child-related factors explain variations in parenting behaviors. Ninety-five parents with one child diagnosed with intellectual disability (according to DSM-5 criteria) and a TD sibling, participated. Data analyses included t-tests, ANOVAs, and mixed-design ANOVAs to compare parenting styles and attitudes across siblings while controlling for sociodemographic factors. Parents reported more authoritative and less permissive parenting, and greater satisfaction and autonomy promotion with their TD child compared to their child with intellectual disability. More positive parenting attitudes and less permissiveness were observed when the etiology of intellectual disability was Down syndrome, which extended to their sibling. Attending regular schools (vs. special education) was associated with less permissive parenting. Higher SES was related to greater promotion of autonomy and, for the TD child, to more parenting satisfaction and less permissiveness. The study provides evidence of both consistency and variation in parenting practices within families. Differences in parental attitudes and behaviors appear to be shaped not only by individual child characteristics but also by environmental factors such as school context and SES. These results suggest that parents adapt their parenting styles and attitudes between siblings, which is influenced by sociodemographic and child-related factors.
11. Genetic predisposition for morningness-eveningness and economic disadvantage: Evidence from Finland over 25 years.
期刊: Sleep medicine 发表日期: 2025-Sep-17 链接: PubMed
摘要
Individual chronotype may shape economic outcomes through alignment or misalignment with work and societal schedules. Genome-wide association studies suggest that morningness-eveningness has a partially genetic basis. This study examines how genetic predisposition to chronotype relates to economic disadvantage, using polygenic indices for morningness-eveningness both as predictors and as instruments for phenotypic chronotype. Employing various regression and extended regression models, we studied data from 20,121 working-aged adults representative of Finnish regions, combining genetic, registry, and survey data from 1992 to 2017. Genetic markers for morningness were monotonically negatively associated with educational attainment (p = 0.002)-a key determinant of economic success-particularly in males. Conversely, the same genetic markers were also monotonically negatively associated with the likelihood of belonging to the lowest income quintile in males (p = 0.012), suggesting differential valuation of chronotype traits in education versus the labour market. This pattern emerged in post-2000. Furthermore, among males with higher education, genetic predisposition to eveningness was linked to a higher likelihood of falling into the lowest income quintile (p < 0.001), indicating reduced economic returns to their education. No significant associations between chronotype-related genetic markers and income were observed in females across education levels. This study reveals emerging, gender-specific inequalities in how genetically influenced chronotype traits relate to economic outcomes. Genetic predisposition to eveningness favoured education but hindered income-especially in highly educated males-via phenotypic chronotype pathways. Though modest, these effects highlight the need for workplace inclusion through recognition of chronotype diversity, public sleep health initiatives, and flexible work structures.
12. Pre-diagnostic circulating bile acid concentrations and liver cancer risk: a nested case-control analysis of 12 cohorts.
期刊: JNCI cancer spectrum 发表日期: 2025-Sep-16 链接: PubMed
摘要
Bile acids are produced in the liver and are important for lipid digestion. Higher circulating bile acid levels, however, have been linked to metabolic disorders, inflammation, and gut microbiota dysbiosis, which have been implicated in liver carcinogenesis. To date, few epidemiological studies have explored the association between circulating bile acids and liver cancer risk. We conducted a nested case-control study among 12 prospective cohort studies located in the United States. Fifteen pre-diagnostic circulating bile acids were measured from blood samples among 872 individuals who developed liver cancer and 872 matched control participants. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable-adjusted conditional logistic regression analysis of circulating bile acid levels and liver cancer risk. Primary conjugated bile acid concentrations were positively associated with higher risk of liver cancer (OR per doubling in concentrations [log2] of glycocholic acid, 95% CI: 1.32, 1.24-1.40; glycochenodeoxycholic acid: 1.33, 1.24-1.43; taurocholic acid: 1.28, 1.22-1.35; and taurchenodeoxycholic acid: 1.32, 1.24-1.39). Secondary conjugated bile acids were also positively associated with liver cancer risk (doubling of concentrations OR ranged from 1.11 to 1.22). Unconjugated bile acid concentrations were generally not associated with liver cancer risk, except lithocholic acid (OR per doubling: 1.27, 1.16-1.39). When analyses were separated into the two main subtypes of liver cancer, hepatocellular carcinoma (HCC; 438 cases/438 controls) and intrahepatic cholangiocarcinoma (ICC; 111 cases/111 controls), significant heterogeneity was observed for primary conjugated bile acid concentrations (all p-values < 0.001) that showed positive significant associations with HCC but not ICC. These results suggest that bile acids may be important markers of HCC risk and contribute to hepatocarcinogenesis; however, further research using serial measurements is needed.
13. Anthropometric measures and incidence of obesity-related cancers in the HCHS/SOL Onco-SOL ancillary study.
期刊: JNCI cancer spectrum 发表日期: 2025-Sep-16 链接: PubMed
摘要
Obesity is highly prevalent among Hispanic/Latino adults and is an established risk factor for 13 cancers; however, studies focused on Hispanic/Latino adults are limited. We examined six anthropometric measures in association with incidence of obesity-related cancers (ORCs) among Hispanic/Latino adults, overall and by sex, age, and heritage. We included 16,415 Hispanic/Latino adults from the Hispanic Community Health Study/Study of Latinos. Baseline (2008-2011) anthropometric measures included body mass index (BMI), waist circumference, waist-to-height ratio, waist-to-hip ratio (WHp), fat mass index, and percent body fat. The incidence of 13 ORCs was ascertained through linkages with four state cancer registries (n = 330 incident ORC diagnosed over a mean follow-up of 10.7 years). Survey-weighted Cox models estimated covariate-adjusted hazard ratios (aHRs) and 95% confidence intervals (95%CIs) for the associations between each anthropometric measure and latent class analysis-derived groups and ORC risk. HRs were elevated among adults with the highest levels of anthropometric measures, and more so among women than among men. For example, a BMI ≥30 (vs < 25) kg/m2 was associated with aHR of 1.42 (95%CI = 0.88-2.30) overall, and aHRs of 2.22 (95%CI = 1.18-4.16) in women and 0.46 (95%CI = 0.20-1.02) in men. aHRs also varied by Hispanic/Latino heritage. For example, a one-standard deviation increase in BMI was associated with a 63% (HR = 1.63; 95%CI = 1.10-2.41) increase in ORC risk among South American adults, but not among Central American adults (HR = 1.03; 95%CI = 0.53-2.00). Multiple anthropometric measures were positively associated with ORC risk, particularly among women. Efforts to reduce obesity may be important for cancer prevention in Hispanic/Latino adults.
14. Sociodemographic factors influencing childhood vaccination in Albania: a cross-sectional study.
期刊: European journal of public health 发表日期: 2025-Sep-16 链接: PubMed
摘要
Vaccine hesitancy (VH) is a growing threat to global health. In Albania, VH has increased over the past decade, with childhood immunization rates declining from 94% in 2008-2009 to 75% in 2017-2018. Current literature exploring sociodemographic influences on VH in Albania is limited. This study aims to identify key sociodemographic factors associated with VH among caregivers of children aged 0-18 years. A total of 4082 Albanian parents or legal caregivers participated in this cross-sectional study. A validated, anonymous questionnaire was used to collect sociodemographic data, behaviours and attitudes towards vaccines, and beliefs regarding vaccines safety and efficacy. Caregivers were randomly selected from health centres across Albania. VH and vaccine refusal were self-reported by 27.3% and 17.6% of respondents, respectively. Regression analysis identified significant factors influencingVH: marital status (single, widowed, separated, or divorced) (OR 1.91, 95% CI 1.4-2.7), urban residency (OR 1.7, 95% CI 1.4-2.0), having more than four children (OR 10.02, 95% CI 5.2-19.3), doctorate level education (OR 1.99, 95% CI 1.2-3.4), very poor income (OR 13.82, 95% CI 7.0-27.5), Roma ethnicity (OR 18.03, 95% CI 8.2-39.6), Evangelical Christian affiliation (OR 3.33, 95% CI 2.3-4.8), and Muslim faith (OR 1.33, 95% CI 1.1-1.7). Consulting a paediatrician or healthcare professional increased the odds of VH/refusal by 1.88 and 2.09 times, respectively. Sociodemographic factors are significant factors influencing parental VH in Albania. These insights can lead public health decision-makers in targeting hesitant parent groups and developing educational interventions that address specific barriers and concerns.
15. Characteristics and cardio-renal outcomes in CKD patients receiving guideline-directed therapy: insights from DISCOVER CKD.
期刊: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association 发表日期: 2025-Sep-16 链接: PubMed
摘要
In clinical trials, renin-angiotensin system inhibitors (RASi) and sodium-glucose co-transporter-2 inhibitors (SGLT2i), herein referred to as guideline-directed medical therapy (GDMT), alone or in combination, provide cardio-renal protection in patients with chronic kidney disease (CKD). However, data from real-world clinical practice on the impact of GDMT on clinical outcomes are limited. DISCOVER CKD (NCT04034992) is a multinational, observational cohort study in adults with CKD. We used the prospective cohort (enrollment: September 2019 to June 2022) to assess patient characteristics and outcomes up to 15 months by baseline GDMT use, including: a composite renal outcome (initiation of dialysis, kidney transplantation, estimated glomerular filtration rate < 15 ml/min/1.73 m2, or death attributable to renal causes); all-cause mortality and new cardiovascular (CV) events; and all-cause hospitalization. Inverse probability of treatment weighting method was employed in controlling confounding variables and estimating the effect of GDMT use. Of 1052 prospectively enrolled patients (62.5 ± 13.6 years, 36.9% female), most had CKD stage 3a (31.6%) or 3b (29.3%); 8.4% were receiving dialysis. At baseline, 643 (61.1%) were receiving GDMT (RASi only, n = 496; SGLT2i only, n = 25; both, n = 122; range 42.7% [USA] to 82.2% [Spain, Sweden]). Patients receiving GDMT had a higher comorbidity burden than those without GDMT. In patients with CKD stage 3-4, GDMT use was associated with significantly lower incidence of the composite renal outcome [propensity score (PS)-weighted hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.27-0.84, P = 0.01]. There was no significant difference between those receiving GDMT versus not in composite all-cause mortality and new CV events (PS-weighted HR 0.50, 95% CI 0.23-1.09; P = 0.08) or all-cause hospitalization rate (PS-weighted rate ratio 0.78, 95% CI 0.52-1.16; P = 0.216). GDMT use was associated with reduced adverse renal outcomes in real-world patients with CKD, underscoring the need to address large gaps in GDMT implementation.
16. The Boston Children's Hospital Sleep Corpus: A Collection of 15,695 Annotated Pediatric Polysomnograms.
期刊: Sleep 发表日期: 2025-Sep-16 链接: PubMed
摘要
Sleep is a fundamental biological process essential to health, particularly during early life when sleep patterns are developing and sleep disorders are common. Yet pediatric sleep research is hindered by a lack of large-scale, high-quality polysomnography (PSG) datasets. To address this need, we introduce the Boston Children’s Hospital (BCH) Sleep Corpus-the largest pediatric PSG dataset available-comprising 15 695 overnight recordings from 12 640 unique patients (median age ~ 6 years). The dataset includes 16.7 million annotated sleep stages, 2.25 million respiratory, arousal, and limb movement events, and over 11 000 patient diagnoses linked through de-identified electronic health records. Each PSG has a median duration of 8.9 hours, totaling 139 208 hours of EEG data. Sleep staging follows American Academy of Sleep Medicine guidelines and reveals age-related trends: REM sleep decreases from 33.5% in neonates to 16.3% in teenagers, while N2 sleep increases from 21.7% to 35.4%. Central apneas decline with age, while obstructive hypopneas and respiratory effort related arousals events rise. Limb movements are not scored in <1 yr but remain at around 30 per PSG across older age groups. We also present age- and region-specific EEG spectral norms and respiratory event trends across the pediatric age range. The dataset is organized in Brain Imaging Data Structure (BIDS) format and publicly available via the Brain Data Science Platform. The dataset provides a valuable resource for improving our scientific understanding of pediatric sleep and developing automated PSG analysis with artificial intelligence tools.
17. Immune Correlates and Vaccine Immunobridging: Statistical Innovations, Challenges, and Opportunities.
期刊: The Journal of infectious diseases 发表日期: 2025-Sep-16 链接: PubMed
摘要
In immunobridging, an investigational vaccine is approved based on a randomized trial of this vaccine versus an approved vaccine with an immunogenicity primary endpoint. Justification for immunobridging requires demonstration that meeting trial success criteria implies the investigational vaccine provides worthwhile protection against a relevant endpoint for a context of use. We consider recent statistical approaches whose integration supports immunobridging: (1) variable importance prediction analysis characterizing immune markers as correlates of risk; (2) controlled risk causal analysis evaluating markers as correlates of protection; and (3) transportability analysis combining data from efficacy and immunobridging trials for estimating investigational versus approved relative-vaccine efficacy.
18. Age and sex specific incidence rates and future projections for hip fractures in the Gambia, West Africa, and comparison across four countries in Africa.
期刊: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 发表日期: 2025-Sep-16 链接: PubMed
摘要
Longevity in African populations is increasing, where deprivation and malnutrition are common; hence fragility fracture incidence is expected to increase. Healthcare systems must adapt to provide for this aging population; however, currently fragility fracture incidence has yet to be determined in any West African setting. This study aimed to determine age- and sex-specific hip fracture incidence rates in adults in The Gambia, compare these with rates from other Southern African countries, and estimate future national hip fracture projections. All hip fracture cases in adults aged ≥40 yr, presenting to a hospital or traditional bone setter (TBS) in the study area over 2-yr, were identified. Age- and sex-specific hip fracture incidence per 100 000 person-years were estimated using the 2024 Gambian Population census. Incidence rate estimates were compared between The Gambia, Zimbabwe, South Africa, and Botswana. In The Gambia, future hip fracture numbers were estimated through to 2054 using United Nations population projections. Over 2-yr, 226 hip fracture patients, mean (standard deviation [SD]) age 71.2(12.5) years, 64.6% female, presented to hospital (184[81.4%]) or TBS (42[18.6%]). Most presented with a fragility fracture (205[90.7%]). High-impact trauma (eg, traffic accidents) was more common in younger men. Delays in presentation were common (68[30.1%]). Incidence rates for adults ≥40 yr in The Gambia were 28.1 and 51.7 per 100 000 person years for men and women, respectively, increasing with age. In those age ≥ 80 yr, incidence rates plateaued in men. The number of hip fractures is estimated to increase from 166 in 2024 to 621 by 2054. Age-specific hip fracture incidence rates were broadly comparable between The Gambia, Zimbabwe, Botswana, and Black South Africans. In summary, fragility fractures in Gambian adults were common, indicative of age-associated osteoporosis. Hip fracture cases will almost quadruple over coming decades; therefore, health service capacity must expand to manage this rising demand. Little is known about how many fragility fractures occur in Africa. In West Africa, many are first managed by traditional bone setters, a role passed down through generations. We studied patients ≥40 yr with hip fracture presenting to hospitals or traditional bone setters over two years in The Gambia. Hip fractures were more common in men than women 40-50 yr, due to high-energy trauma, and more common in women than men ≥60 yr, likely due to osteoporosis. Rates in The Gambia were similar to Black African adults elsewhere in Africa. Hip fracture cases are predicted to nearly quadruple in The Gambia by 2054.
19. Spatio-temporal analysis of human visceral leishmaniasis in the Central-West region of Brazil from 2010 to 2019.
期刊: Transactions of the Royal Society of Tropical Medicine and Hygiene 发表日期: 2025-Sep-16 链接: PubMed
摘要
Visceral leishmaniasis (VL) is considered a neglected tropical disease with high lethality. This study aimed to analyze the spatio-temporal dynamics of VL in the Central-West region of Brazil, from 2010 to 2019. Using data obtained from the Sistema de Informação de Agravos de Notificações (SINAN) from Brazil and spatio-temporal analysis tools, an ecological study of VL cases was carried out considering each federated unit in the Central-West region from 2010 to 2019. It was observed that state of Mato Grosso do Sul had the majority of municipalities with high incidence in all temporal series analyzed. A heterogeneous distribution of VL with spatial clustering in the state of Mato Grosso do Sul was observed. Furthermore, Goiás and Mato Grosso also presented high-risk municipalities, with clusters of higher relative risk (RR) observed from 2013 to 2017 in Goiás and from 2010 to 2013 in Mato Grosso. Therefore, it is observed that the states of Goiás, Mato Grosso and Mato Grosso do Sul need greater attention to support the adoption of effective measures to control VL in the Brazilian Central-West region.
20. Therapy-Related-Myeloid-Neoplasm-Risk score (TMNRS): a convenient score for tMN risk assessment in adult cancer patients.
期刊: JNCI cancer spectrum 发表日期: 2025-Sep-16 链接: PubMed
摘要
A prediction model for estimating risk of therapy-related myeloid neoplasms (tMN), a late effect with a high mortality after chemotherapy and/or radiation, is currently unavailable. Ability to predict risk at initial cancer presentation can be key for early detection and risk mitigation. Using SEER-Medicare linked database, 970,390 adults diagnosed with first primary cancer from 2000-2011 (with follow-up through 2015) were selected. The sample was divided into training (n = 582,234) and validation cohorts (n = 388,156). Various tMN risk factors were utilized for the development of tMN prediction model: The Therapy-Related Myeloid Neoplasm Risk Score (TMNRS). TMNRS was created as a simple arithmetic sum of independent predictors of tMN weighted according to the adjusted hazard ratio from the Cox proportional hazards analysis. In addition to the known risk factors of chemotherapy and radiation exposure, history of autoimmune disease and G-CSF exposure emerged as consistent predictors of tMN after each of the five cancers in the study. Cancer survivors were categorized into distinct risk groups with variable risk of tMN. TMNRS provides a simple and convenient office-based mechanism to identify solid cancer patients at variable risks of tMN development. This risk assessment tool provides preliminary insights that may contribute to future research on the management of patients, particularly those receiving adjuvant therapies. Further investigation is required to fully evaluate its clinical utility and potential effects on patient care.
21. Exploring the Therapeutic Role of Probiotics and Prebiotics in Mitigating Diseases Associated with Advanced Glycation End Products.
期刊: Journal of applied microbiology 发表日期: 2025-Sep-16 链接: PubMed
摘要
Advanced glycation end products (AGEs) are a class of compounds generated when reducing sugars interact with proteins, lipids, and other molecular structures. Excessive accumulation of AGEs in the body accelerates aging and contributes to various chronic conditions, including diabetes, neurodegenerative diseases, cardiovascular diseases, and inflammatory bowel diseases. Despite growing interest in strategies to prevent glycation damage, effective interventions to combat AGE-related diseases remain limited. This review examines the role of AGEs in disease pathology and evaluates strategies to mitigate their harmful effects. It further summarizes natural products and pharmaceutical agents currently used for anti-glycation purposes, along with their underlying mechanisms. Additionally, we explore the promising therapeutic potential of probiotics and prebiotics in protecting against AGE-related diseases, highlighting research evidence demonstrating their ability to reduce AGE accumulation and inhibit their formation. This review aims to inform the development of more effective glycation inhibitors and addresses the pressing gap in current research regarding targeted AGEs interventions.
22. Plasma branched-chain amino acid and cardiovascular disease risk factors: a longitudinal analysis of a lifestyle trial.
期刊: The Journal of clinical endocrinology and metabolism 发表日期: 2025-Sep-16 链接: PubMed
摘要
Branched-chain amino acid (BCAAs) levels have been associated with a higher risk of cardiovascular diseases (CVD), but studies of the impact of BCAAs on CVD risk factors have mainly been cross-sectional. We examined the longitudinal association between changes in BCAA levels and CVD risk factors in a lifestyle trial. We used data from 708 male and female participants, aged 25-78, of the U.S. PREMIER study. Data and biospecimens were from the NHLBI BioLINCC Repository. Participants received lifestyle advice or comprehensive counseling on diet, physical activity, and weight loss. Biomarkers were measured with NMR spectroscopy at baseline and the 6-month follow-up. Linear regression models assessed changes in BCAA levels in relation to changes in cardiometabolic risk factors. We adjusted for multiple testing by using false discovery rate-adjusted Q values. Increases in BCAA levels over 6 months (per 1 SD) were associated with increases in insulin resistance (HOMA-IR: Beta = 0.22, SE = 0.07), inflammation (GlycA: Beta = 0.03 mmol/l, SE = 0.004), ApoB (Beta = 0.02 g/l, SE = 0.006), and VLDL-cholesterol (Beta = 0.03 mmol/l, SE = 0.007) over the same period (all Q-values <0.01). Associations with HDL-cholesterol and triglycerides differed for valine versus leucine and isoleucine. No significant associations were observed with fasting glucose or blood pressure. Increasing levels of BCAAs were associated with insulin resistance, inflammation, and unfavorable lipid profiles, indicating their potential as targets for CVD prevention. Further research is warranted to elucidate how individual BCAAs influence lipid metabolism.
23. Methyl-prednisolone plus methotrexate-based regime vs prednisone-based standard of care for giant cell arteritis: a propensity score study.
期刊: Rheumatology (Oxford, England) 发表日期: 2025-Sep-16 链接: PubMed
摘要
Treatment of giant cell arteritis (GCA) still requires substantial exposure to glucocorticoids (GC), which are associated with significant toxicity. This study compares the efficacy and safety of the GC-only standard of care (SOC) with a regimen combining intravenous methyl-prednisolone (IVMP) pulses, methotrexate (MTX) and lower-doses of prednisone, in newly diagnosed patients with GCA. A usual clinical practice study was conducted in three Spanish academic hospitals. 151 patients diagnosed with GCA were treated with SOC-prednisone (40-60 mg/d) or with IVMP (125-500 mg/d x3) followed by lower-dose prednisone (≤30 mg/d) and MTX (IVMP/MTX), with a follow-up of 2 years. A propensity score was used to adjust for baseline differences in the multivariate analyses. 79 (52.3%) patients received SOC-prednisone and 72 (47.7%) IVMP/MTX. The clinical characteristics at baseline were similar in both groups. 100% patients achieved remission after a median time of 4 weeks, without differences between groups. Relapse rates were also similar. Patients receiving IVMP/MTX had significantly lower cumulative GC doses and reached prednisone ≤5 mg/d faster than SOC patients (mean 13.8 vs 56.5 weeks; p< 0.001). Patients in the IVMP/MTX group were less likely to suffer any GC-related adverse effect (adjusted OR 0.35, 95%CI 0.14-0.85; p= 0.021). The combination IVMP/MTX with lower-dose prednisone is as effective as the SOC in inducing remission and preventing relapses in GCA. The IVMP/MTX scheme significantly reduces GC exposure and GC-associated adverse effects. IVMP/MTX could be a potential GC-sparing strategy, especially in patients with GCA at higher risk of GC toxicity.
24. Azithromycin resistance in non-typhoidal Salmonella: a review.
期刊: The Journal of antimicrobial chemotherapy 发表日期: 2025-Sep-16 链接: PubMed
摘要
Antibiotics are crucial for controlling severe or invasive non-typhoidal Salmonella (NTS) infections. However, the high resistance or toxicity of traditionally first-line antibiotics calls for alternatives. The excellent membrane permeability, long half-life and safe to use in children render azithromycin a promising candidate. However, azithromycin resistance has been observed in NTS isolates recovered from humans, food, animals and the environment, with particularly high rates in Asia. Although azithromycin resistance remains low in Europe, the USA and Australia, an increasing tendency has been noted in the USA in recent years. Macrolide inactivation by phosphotransferases, methylation of 23S rRNA by methyltransferases, ribosomal protein alteration and efflux pumps are involved in azithromycin resistance in NTS isolates, among which phosphotransferase encoded by the mph (A) gene is the predominate mechanism. Current studies face limitations, such as the lack of a standardized azithromycin breakpoint for NTS isolates, insufficient integrated national surveillance and limited robust clinical evidence for treating NTS infections. Therefore, future studies addressing these issues are highly recommended.
25. State-of-the-Art Review: Hepatitis C.
期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 发表日期: 2025-Sep-16 链接: PubMed
摘要
Hepatitis C virus (HCV) infection remains a major cause of chronic liver disease and premature mortality worldwide. The World Health Organization and US Department of Health and Human Services have committed to eliminating HCV infection as a major public health threat by 2030, as defined by a 90% reduction in incidence of new HCV infections and 65% reduction in mortality from a 2015 baseline. To help to achieve HCV elimination, it will be necessary to increase HCV screening and increase uptake of HCV treatment, particularly within primary care, correctional, and substance use treatment settings. In this review, we provide strategies for healthcare providers to implement in their practice to enhance patients’ completion of the steps of the HCV care cascade. Improving successful completion of each step of the cascade will help alleviate the burden of HCV infection and make the 2030 HCV elimination goals a reality.
26. Safety and Efficacy of Low-Temperature Gel of Recombinant Humanized Type III Collagen in the Treatment of Midface Volume Deficit.
期刊: Aesthetic surgery journal 发表日期: 2025-Sep-16 链接: PubMed
摘要
Midface volume loss contributes significantly to facial contour changes. Congenital traits, genetic predisposition, and environmental factors can reduce collagen fiber quantity and quality, leading to decreased skin firmness, wrinkles, and midface depression. Type III collagen, abundant in the human body, has low immunogenicity, good tissue compatibility, and promising biomedical applications. However, employing animal-derived collagen, typically in liquid form, is limited by potential adverse reactions and disease transmission. To assess the safety and efficacy of localized injections of low-temperature gel recombinant humanized Type III collagen (rhCol III) in treating midface volume deficit. In vivo animal experiments and retrospective clinical data analysis were conducted. Low-temperature gel rhCol III significantly improved facial volume and midfacial contour with a favorable safety profile in subchronic systemic toxicity tests in Sprague-Dawley rats, skin degradation studies in New Zealand white rabbits, and human clinical trials. In humans, the treatment group showed significant improvement in Merz Aesthetic Scale, Global Aesthetic Improvement Scale, and satisfaction scores vs controls at 1 month (P < .0001), with effects lasting at least 6 months. Low-temperature gel rhCol III offers a safe, effective, and durable option for correcting midface volume deficit, with minimal risk of complications. These results suggest potential value in enhancing clinical strategies for facial volume restoration.
27. Respiratory symptoms among epoxy-exposed workers in the wind turbine industry: a cross-sectional study.
期刊: Annals of work exposures and health 发表日期: 2025-Sep-16 链接: PubMed
摘要
The aim was to estimate the prevalence and risk of respiratory symptoms among workers exposed to epoxy resin systems in the wind turbine industry. We conducted a cross-sectional study including 180 epoxy-exposed production workers from two Danish wind turbine blade factories and 41 non-exposed office workers. Respiratory symptoms were defined as having two or more symptoms (i.e. wheezing in chest, waking up with chest tightness, shortness of breath, attack of coughing, or asthma attack) within the last 12 mo. Epoxy exposure was defined as exposure status (epoxy-exposed production worker or non-exposed office worker) and years of epoxy-exposure (years of employment as production worker). Epoxy skin sensitization status was obtained through a patch-test. The association between epoxy-exposure and respiratory symptoms was estimated using modified Poisson regression (prevalence ratio (PR)) adjusting for smoking and age. A total of 13.3% of the epoxy-exposed production workers and 4.9% of non-exposed office workers reported two or more respiratory symptoms (PRadj=1.8, 95% CI 0.4-9.5). For years of exposure, PRadj values were 1.2 (<1 yr), 1.0 (≥1-<5 yr), and 2.6 (≥5 yr). Higher PRadj were found among men. Epoxy-sensitized production workers had a PRadj of 0.4, while non-sensitized workers had a PRadj of 1.9, compared to non-exposed office workers. Epoxy-exposed production workers showed a tendency to report respiratory symptoms more often than non-exposed office workers. However, we found no clear association between exposure duration and symptoms. Further studies are highly warranted to evaluate the potential association between epoxy exposure and respiratory symptoms.
28. Evaluation of occupational exposure to airborne quartz in the cutting and grinding of ceramic tiles.
期刊: Annals of work exposures and health 发表日期: 2025-Sep-16 链接: PubMed
摘要
Crystalline silica was categorized by the International Agency for Research on Cancer as a known human carcinogen. Activities related to the processing of ceramic tiles, releasing crystalline silica, may vary considerably in terms of hours worked per day and days worked per week. This variability could be particularly high for craftsmen who process ceramic materials directly on-site during installation. The aim of this study is to measure the likely exposure to respirable crystalline silica (RCS) during ceramic tiles installation, evaluating the exposure to RCS of workers processing these tiles. Exposure assessments to RCS were conducted via both fixed-site and personal sampling for 2 working hours. The measured concentrations were calculated as 8-h time-weighted average (TWA) exposures, assuming no further RCS exposure in the time period. The permitted exposure time, not to exceed the occupational exposure limit (OEL) value, was then calculated also considering the assigned protection factor of selected respiratory protective equipment. The results of this study, considered as a worst-case simulation, show that, during the processing of ceramic tiles releasing RCS, the worker exposure can be very high (up to 240.9 µg/m3), exceedance of several OELs, including the European OEL of 100 µg/m³. Even working for a few hours a day, the RCS 8-h TWA OEL is likely to be exceeded. Inhaled exposure concentrations can be reduced by using appropriate respiratory protection, by a factor equal to 10 or 20. The assumption of this work was that (i) the cutting/grinding times are not always necessarily equal to 2 h and that (ii) these processes are not characterized by pre-established and continuous processing times. For these reasons, it is important to carefully evaluate the duration of exposure to RCS during the various tasks/activities performed, as these may vary depending on different factors.
29. Chamber validation study of simultaneous collection and analysis of aromatic diisocyanates and the corresponding diamines using the ASSET-ICA sampler.
期刊: Annals of work exposures and health 发表日期: 2025-Sep-16 链接: PubMed
摘要
Simultaneous sampling of diisocyanates and diamines is of great importance since occupational exposure to both diamines and diisocyanates may occur during production of the diisocyanates and polyurethane (PU) products or during thermal degradation of PU material. A methodology for the simultaneous collection and determination of diisocyanates and diamines using ASSET EZ4-ICA dry sampler (Supelco, PA, United States) was presented. The sampler was previously validated and is sold commercially for isocyanate detection. This work investigated to also include diamine determinations (specifically MDA and TDA) to enable a user-friendly approach, without the use of fragile glassware and solvents during sampling. In addition, a sampler based on the same design as the ASSET-sampler but with a modified impregnation with dibutyl amine (DBA) and sulfuric acid was also demonstrated. During sampling, isocyanates were collected and derivatized with DBA and the diamines were derivatized in a subsequent work-up procedure with ethyl chloroformate to form carbamate esters. For the ASSET-ICA sampler, no breakthrough was observed for 2,4’-MDA or 4,4’-MDA for sampling at 200 mL/min for up to 4 h (240 min). For 2,4-TDA and 2,6-TDA, no breakthrough was observed for up to 60 min of sampling. For the sampler with modified impregnation, no breakthrough of TDA was observed for up to 240 min of sampling. No losses were observed for the MDA isomers when storing the samplers in a refrigerator (8 °C) for up to 21 d after sampling. However, for the TDA isomers, minor losses could be observed after storage for 8 d. Storing the samplers in a freezer (-18 °C) or performing the addition of 500 µL of 3M sulphuric acid to the sampler filter media after sampling improved the stability of the TDA isomers during storage and no losses were observed for 21 d of storage. Also, for the sampler with modified impregnation, storage for up to 21 d could be made without any significant losses of TDA. Comparable concentrations were measured in ASSET-ICA samplers and in impinger-filter samples when sampling of a controlled test atmosphere was performed at different relative humidity (30% to 70% RH) and also during sampling of thermal degradation products from PU foam.
30. The Medical Impacts of Thermobaric Weapons: A Scoping Review.
期刊: Military medicine 发表日期: 2025-Sep-15 链接: PubMed
摘要
Thermobaric weapons (TW) are a class of explosive weapons designed to use oxygen from the surrounding environment to deliver blasts generating intense pressure and heat, penetrating structures more efficiently than conventional weapons. Despite the increasing use of TW in conflicts globally, no comprehensive evaluation of the literature on TW has been published to date. This review aims to assess current evidence on the medical Impacts of TW. A scoping review of the literature was conducted in accordance with PRISMA Scoping Review (PRISMA-ScR) methodology. Structured searches of databases including Web of Science, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Global Index Medicus, Military and Government Collection, Global Health, SciELO, and Google Scholar as well as grey literature sources were performed to identify records that described injuries related to TW use. The search identified 7,365 records. After title-abstract, full text screening and exclusion of duplicative data, 16 eligible reports, including 3 grey literature reports, were included in analysis. Represented regions included Eastern Europe, the Middle East, East Africa, and Southeast Asia. Of the reports, 8 were narrative reviews, 3 were case series, one was a case control, one was a modelling study, and 3 were grey literature reports. Four reports were conducted in high-resource settings in North America and Europe, although 6 were in low-resource conflict settings in the Middle East and Eastern Europe. Ten reports described disability, with only 6 reports presenting primary data, and no reports including analysis on patient physiology, hemodynamics, or psychological trauma. Six reports collected data from combatants only, one incorporated both combatant and civilian data, and the remaining did not specify population status. Non-uniform reporting across eligible reports prevented pooled analysis thus limited conclusions that could be drawn. All reports included in analysis highlighted the complex multidimensional injury patterns associated with TW, exceeding the severity of normal blast injury including pulmonary barotrauma, full-thickness burns, chemical inhalation injuries, and tertiary injuries resulting from confined-space detonations. Despite the significance of TW use and impact on casualties in modern conflict, this review identified a significant gap in the evidence base on the medical effects of TW. This lack of primary clinical data significantly constrains efforts to guide data-driven approaches to treatment algorithms, performance improvement, and rehabilitation needs for survivors of TW-related injuries. The establishment of a global registry on TW could address this evidence gap through documentation of the injuries caused by TW.
31. Discrepancy between active trachoma and tests of chlamydial infection in Alto Amazonas, Peru.
期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 发表日期: 2025-Sep-15 链接: PubMed
摘要
Trachoma mapping in Latin America is incomplete, especially in indigenous communities of the Amazon thought to be at highest risk. The aim of this study was to determine the prevalence of clinical, microbiological, and serologic evidence of trachoma in a remote area of the Peruvian Amazon. A population-based sample of households from rural communities in Alto Amazonas province was selected using two-stage cluster sampling. In children aged 1-9 years, conjunctival photographs, conjunctival swabs, and dried blood spots were collected. Photographs were graded for trachomatous inflammation-follicular (TF). Swabs were processed for Chlamydia trachomatis with a nucleic acid amplification test. Dried blood spots were assessed for antibody responses to C. trachomatis with a multiplex bead assay. A total of 778 children aged 1-9 years from 21 communities participated. The age-adjusted prevalence of TF among 1-9-year-old children was 25.4% (95%CI 21.3-29.5%), compared with 0.8% (95%CI 0.5-1.0%) for ocular C. trachomatis and 6.6% (95%CI 4.5-9.0%) for Pgp3-specific antibodies to C. trachomatis. This region of the Peruvian Amazon had a high burden of clinical trachoma but low levels of C. trachomatis ocular infection and seropositivity.
32. Uptake rates of influenza vaccination in over 65s in Denmark: a comparison between Danish-born and migrant populations, 2015-21.
期刊: European journal of public health 发表日期: 2025-Sep-15 链接: PubMed
摘要
WHO’s Immunization Agenda 2030 has placed renewed focus on life-course vaccination, including among migrants. Despite the availability of a seasonal vaccine, influenza remains a key contributor to winter excess mortality in Northern Europe, yet limited data on influenza vaccination uptake in migrants has been published. We analyzed Danish national registry data to determine influenza vaccine uptake across six flu seasons (2015/16-2020/21) among migrants (asylum-pathway and quota refugees, family reunified migrants) ≥65 years matched 1:6 on age and gender to Danish-born individuals. We used multivariate logistic regression models controlling for migrant status (immigration status, time in Denmark) and other sociodemographic variables (age, gender, nationality, urban/rural residence) to identify factors associated with influenza vaccination uptake. All analyses were done in R v4.2.1. Across all six seasons, overall flu vaccination uptake was 49.3% (Danish-born: 50.9%; migrant cohort: 39.4%). Migrants were less likely [odds ratio (OR): 0.66; 95% confidence interval (CI): 0.64-0.67] to receive an influenza vaccine across all seasons, with this gap widening from 2015/16 (OR: 0.78; 95% CI: 0.74-0.84) to the 2020/21 season (OR: 0.44; 95% CI: 0.42-0.46). Family-reunified migrants were less likely to receive an influenza vaccine across the study period than asylum-pathway and quota refugees and those from the Sub-Saharan Africa region had the lowest uptake in terms of area of origin. This large and unique dataset shows that migrant groups have lower uptake rates for influenza vaccination compared with Danish-born individuals, with the gap widening over time. Going forward, developing tailored interventions, co-developed in collaboration with communities themselves, will be key.
33. Key lessons in caring for caregivers: Acknowledging identity to strengthen second victim support.
期刊: International journal for quality in health care : journal of the International Society for Quality in Health Care 发表日期: 2025-Sep-15 链接: PubMed
摘要
34. The US Advisory Committee on Immunization Practices (ACIP): Trustworthy Travel Vaccine Guidance and Politics.
期刊: Journal of travel medicine 发表日期: 2025-Sep-15 链接: PubMed
摘要
35. Non-pharmaceutical interventions to prevent community transmission of infectious diseases with pandemic potential-an umbrella review and evidence map.
期刊: European journal of public health 发表日期: 2025-Sep-15 链接: PubMed
摘要
During the COVID-19 pandemic, most countries implemented non-pharmaceutical interventions (NPIs) to mitigate virus transmission and decrease morbidity and mortality. The aim of this umbrella review was to identify and map systematic reviews on the effectiveness of NPIs to reduce widespread community transmission of infectious diseases with pandemic potential. We searched electronic databases (Medline, Embase, Scopus, INAHTA [International Network of Agencies for Health Technology Asseesment], and World Health Organization COVID-19) and websites (January 2024). Systematic reviews on NPIs during outbreaks, epidemics, or pandemics of COVID-19, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, or Ebola were included and organized in an interactive evidence map grouped by type of intervention (individual/population/environmental), disease, risk of bias, and search date. Five of the 132 included reviews were assessed as having low, 43 moderate, and 84 high risk of bias. COVID-19 was targeted in 100 reviews, influenza 66, SARS 39, MERS 34, and Ebola in five reviews. The most frequently investigated NPIs were use of face masks, hand washing, physical distancing, travel restrictions, restrictions on public gatherings, and school closures. The five reviews at low risk of bias concluded at low level of evidence about the effectiveness of most NPIs, with exceptions of hand hygiene and some measures in school settings where low- to moderate-certainty evidence was found. There is substantial lack of evidence regarding the effectiveness of several commonly used NPIs, including restrictions on public gatherings, travel restrictions, and visiting restrictions in long-term care facilities. There is a paucity not only of systematic reviews but also of primary studies at low risk of bias.
36. The OASIS Consortium: Integrating Multi-Omics Technologies to Transform Chemical Safety Assessment.
期刊: Toxicological sciences : an official journal of the Society of Toxicology 发表日期: 2025-Sep-15 链接: PubMed
摘要
Next Generation Risk Assessment (NGRA) aims to improve safety testing of pharmaceuticals, agrochemicals, and industrial chemicals. NGRA employs New Approach Methodologies (NAMs), such as novel in vitro assays coupled with exposure modeling, to minimize the use of animal models which can fail to predict specific biological effects in humans. The strategy of the ‘Omics for Assessing Signatures for Integrated Safety (OASIS) Consortium combines multi-omics technologies (including transcriptomics, proteomics, and Cell Painting (high-content imaging)) and multiple cell model systems (ranging from simple cell cultures to complex organotypic models). By integrating these approaches with internal exposure estimates, the consortium aims to improve the translation between in vitro and in vivo test systems, ultimately enhancing the relevance of safety assessment to human biology. OASIS’s integrated approach aims to better translate the biological effects across different chemical and biological spaces, starting with the liver as a use case. By using compounds with well-characterized in vivo and in vitro nonclinical safety and toxicology data related to adverse organ specific effects in rats and humans, OASIS aims to create novel integrated methods that improve safety assessment while reducing animal use. Ideally, these efforts will contribute to regulatory science across sectors and support the adoption of more predictive, efficient, and cost-effective toxicological models.
37. Management of non-response to Hepatitis B re-vaccination.
期刊: Occupational medicine (Oxford, England) 发表日期: 2025-Sep-15 链接: PubMed
摘要
Bloodborne viruses, including Hepatitis B (HBV), are a known occupational hazard for healthcare workers (HCWs), particularly those involved in exposure-prone procedures. Whilst standard vaccines can provide immunity, 5-10% of people remain non-responders (anti-HBs titre <10IU/L) despite repeated vaccinations. Fendrix® (HBV recombinant DNA vaccine) has been shown to be highly effective in renal patients and those with human immunodeficiency virus, implying it may also have benefits for healthy non-responders. Our analysis set out to identify and compare response rates to re-vaccination (with Fendrix® or HBvaxPro40®) in HCWs with non-response to standard vaccination procedures. Between 1 March 2010 and 30 April 2024, either Fendrix® or HBvaxPro40® was offered to HCWs with inadequate response to two courses of Engerix B® standard vaccination. Antibody tests were performed 6 weeks post-final vaccine dose. Serological results from this period were retrospectively statistically analysed to compare differential vaccine responses. Eighty-five HCWs were identified as non-responders and offered further vaccination (42 received Fendrix® and 43 received HBvaxPro40®). Fendrix® resulted in a seroconversion rate of 95% (40/42) compared to 72% (31/43) with HBvaxPro40®; a significantly higher number responded more strongly to Fendrix® (74% versus 23%). Our results demonstrate the rationale for offering additional vaccination with Fendrix® to HCWs when standard vaccination and repeated administration has not elicited an adequate immune response. Multi-centre evaluation of this vaccination strategy for non-responder HCWs should be considered to generate evidence for the most acceptable and efficacious approach.
38. The Work Productivity and Activity Impairment (WPAI) questionnaire.
期刊: Occupational medicine (Oxford, England) 发表日期: 2025-Sep-14 链接: PubMed
摘要
39. Work-related airways disease and risk factors in Mozambiquan wood processing workers.
期刊: Occupational medicine (Oxford, England) 发表日期: 2025-Sep-14 链接: PubMed
摘要
Inhalation of wood dust particulates, bioaerosols and chemical components cause airway disease of a sensitising or irritative nature. This study investigated the disease burden and factors associated with work-related airways disease among wood processors. A cross-sectional study enrolled 450 workers from 21 Mozambican wood mill and furniture industries. Work-related asthma (WAS) and work-related ocular-nasal (WONS) symptoms were evaluated, using European Community Respiratory Health Survey (ECRHS) questionnaire. Objective assessments included spirometry, fractional exhaled nitric oxide (FeNO) and Phadiatop tests. The average age was 38 years, three-quarters did not smoke and almost half were atopic. The proportion of workers with WAS was 14% and WONS was 40%. There were 3% that demonstrated bronchial reversibility, 16% fixed airway obstruction and 5% with FeNO > 50 ppb. WONS was positively correlated with female sex [odds ratio (OR) = 2.60, 95% confidence interval (CI) 1.15-5.90] and atopy (OR = 2.04, 95% CI 1.20-3.47). Bronchial reversibility was associated with increasing age (OR = 1.06, 95% CI 1.02-1.10), atopy correlated with high FeNO (OR = 2.85, 95% CI 1.09-7.44). Processing Mutondo wood was positively correlated with WAS (ORadj = 3.68, 95% CI 1.58-8.58), and WONS (ORadj = 9.34, 95% CI 4.54-19.20). Certain wood types, Missanda (ORadj = 6.84, 95% CI 4.17-11.20), Panga-panga (ORadj = 2.31 95% CI 1.49-3.60) and Mahogany bean (ORadj = 2.52, 95% CI 1.41-4.51) were primarily correlated with WONS. Mozambiquan wood processors experience significant work-related airway disease attributable to dust particulate. Mutondo wood type, was positively correlated with both lower and upper airway symptoms, whereas other species were linked only to upper airway symptoms.
40. Patient and family-centered care among Middle Eastern and North African children living in the United States.
期刊: Patient education and counseling 发表日期: 2025-Sep-13 链接: PubMed
摘要
National estimates of the quality of care received by Middle Eastern and North African (MENA) individuals are unknown. Perceptions of patient-centered care (PCC) are important indicators of quality of care that differ by racial/ethnic minority groups. Our study aimed to estimate differences in parents’ perceptions of patient- and family-centered care (PFCC), an indicator of quality of care perceived by parents, between foreign-born MENA and other racial and ethnic groups. Data from 2000 to 2017 National Health Interview Survey and 2001-2018 Medical Expenditure Panel Survey was combined and analyzed at a federal statistical research data center, using the Head and Bute’s extension of Street’s ecological model as theoretical lens. The sample included 33,677 parents of foreign-born MENA children who reported visiting a health care provider within the past 12 months. Dependent variables included parent reports of communication variables related to how often providers: listened; showed respect; spent enough time; and explained things well. Multivariable logistic regression was used to evaluate the odds of receiving PFCC using a composite measure of PFCC quality and separate domains. Parents of foreign-born MENA children had higher odds of reporting all PFCC qualities compared to foreign-born White (OR=2.49; 95 %CI=1.04-5.97) and Asian (OR=2.54; 95 %CI=1.13-5.68) groups. When separated by PFCC quality, parents of foreign-born MENA children had 3.23 times higher odds (95 %CI= 1.18-8.81) of reporting that their provider spent enough time with them compared to foreign-born Hispanics. This study provides the first estimates of PFCC among MENA adults. Future studies can be designed to test unique health interventions and make recommendations for providers to deliver more culturally responsive care. Findings add to the timely dialog advocating for a separate racial/ethnic category for MENA populations recently proposed by the US government and acknowledged by scientists for more rigorous and accurate assessments of health equity for all US populations.
41. How does oncologists' communication affect patients' well-being and online health information seeking? - A randomized experiment.
期刊: Patient education and counseling 发表日期: 2025-Sep-13 链接: PubMed
摘要
Patients with cancer increasingly rely on online information about their disease. However, the impact of clinicians’ responses to patients presenting this information remains unclear. This randomized experiment tested the effects of oncologists’ communication approaches on patients’ trust, satisfaction, and intentions to seek and discuss online information. Additionally, we explored moderating effects of patients’ psychological characteristics. In an online vignette experiment, we manipulated clinicians’ communication approaches (patient-centered vs. clinician-centered) in hypothetical oncology consultations. (Former) cancer patients (N = 270, 62 ± 13 years, 55 % female) were randomly assigned to one out of eight conditions. We performed 1-way ANOVA’s, independent samples t-tests and multiple regressions. Participants exposed to a patient-centered approach reported higher satisfaction with the consultation (d =0.62, p < .001), stronger trust in the clinician (d =0.49, p < .001), and stronger intentions to seek (d =0.40, p < .001) and discuss online information (d =0.69, p < .001) compared to participants exposed to a clinician-centered approach. Moderation analyses indicated that the effect of communication approach on intention to discuss online information depended on participants’ trait anxiety (b =-0.43, p = .017) and uncertainty intolerance (b =-0.35, p = .041). Uncertainty intolerance further moderated patient satisfaction with the consultation (b =-0.33, p = .049). Participants’ monitoring coping style moderated the effect of communication approach on online information seeking (b =0.23, p = .036). Clinicians’ patient-centered responses to online information seeking may positively affect patient satisfaction with the consultation, trust in the consultation, and online information seeking behavior. We provide initial evidence that these effects do not apply equally to every patient: levels of trait anxiety, uncertainty intolerance and monitoring coping style influence the relationship between the applied communication approach and patient outcomes. Clinicians are advised to emphasize collaborative information exchange and guide patients to trustworthy online sources.
42. Evaluating co-design processes used in the development of healthcare interventions in residential aged care: a scoping review.
期刊: Journal of public health (Oxford, England) 发表日期: 2025-Sep-13 链接: PubMed
摘要
Co-design is increasingly used in residential aged care research. However, there is limited literature on how these co-design processes are evaluated, particularly in the absence of co-design evaluation frameworks developed specifically for this setting. We examined how co-design processes used with residents and informal carers to develop healthcare interventions in residential aged care are evaluated. Six electronic databases were searched, and 4594 studies reporting co-design of healthcare interventions with older adults and/or informal carers in residential aged care were screened. Data extraction included study characteristics and co-design evaluation practices. Of 22 included studies, six evaluated their co-design process. Narrative reflection was the most common approach (n = 4). Evaluation was predominantly retrospective and based on researchers’ reflections, drawing on data collected during the process. No studies used pre-defined evaluation criteria to measure the impact or effectiveness of the co-design process, or if the process meaningfully involved residents or their informal carers. Co-design is increasingly used in residential aged care research, although evaluation of these processes is uncommon. As a result, little is known about how effectively co-design is being applied in this setting, or whether it is achieving its core aim of meaningfully involving end-users in research.
43. Treatment discontinuation in older patients with multiple sclerosis.
期刊: Multiple sclerosis and related disorders 发表日期: 2025-Sep-09 链接: PubMed
摘要
To examine disease activity in older people with multiple sclerosis (pwMS) following discontinuation of disease-modifying treatments (DMTs). PwMS aged 60 years or older who discontinued DMTs were included. Data on clinical and demographic factors, as well as new or gadolinium-enhancing lesions on magnetic resonance imaging (MRI) during the final year on DMT and after discontinuation, were analysed. McNemar’s test was used to assess intra-patient MRI activity differences before and after discontinuation. Cox regression evaluated factors influencing MRI activity post-discontinuation. We included 114 pwMS (78.1 % female) from 3 Italian MS centres who discontinued a DMT. The mean age at disease onset was 42.4 years (SD: 11.74), and at DMT discontinuation, 65.7 years (SD: 3.84). Median EDSS was 5.5 (IQR: 2.5-6.0). First-line DMTs were discontinued in 105 participants. No significant changes in MRI activity before and after discontinuation were observed (p = 0.5). Pre-discontinuation MRI activity was the only factor associated with post-discontinuation activity (p = 0.021). In pwMS aged over 60 years, discontinuing DMTs does not increase the risk of MRI-detected disease activity. Discontinuation may be a viable option for this population.
44. Characterization of CR-39 detectors for monitoring indoor radon 222.
期刊: Applied radiation and isotopes : including data, instrumentation and methods for use in agriculture, industry and medicine 发表日期: 2025-Sep-05 链接: PubMed
摘要
Radon gas (Rn-222) is a carcinogenic agent classified by the WHO as Group 1 and is the leading cause of lung cancer in non-smokers. Due to its natural origin in the Earth’s crust, this gas is primarily transported by exhalation through cracks, with concentrations that vary depending on soil morphology and climatic seasons. This article studies the radiological impact of radon gas on health in homes in the city of Tunja, Boyacá. For this purpose, solid-state nuclear track detectors CR-39 (SSNTD) were used, exposed for an approximate period of 60 days. The results showed average concentrations of 218.11 Bq·m-3, a value that falls within the reference limits recommended by the ICRP. This study highlights the importance of establishing public policies in developing countries like Colombia, where specific regulations for radon measurement and control do not yet exist. The results obtained can be used to identify risk areas and serve as a basis for implementing prevention measures and protecting public health.
45. Best practice indicators in workplace mental health promotion: development and expert validation.
期刊: Health promotion international 发表日期: 2025-Sep-03 链接: PubMed
摘要
Most of our waking hours are spent in the workplace, where mental health significantly impacts workers’ quality of life and overall well-being. Mental health can have both positive and negative consequences not only on the working population but also on organizations and society as a whole. In this context, best practices in Workplace Mental Health Promotion (WMHP) are essential for guiding initiatives aimed at fostering mental health in occupational settings. The main objective of this study was to develop and validate best-practice indicators for WMHP. For this purpose, a qualitative empirical design was employed. Drawing on a review of the WMHP literature, a list of potential indicators was generated and subsequently submitted to an expert panel for evaluation. The reliability of the expert judgments was assessed using the intraclass correlation coefficient (ICC). Content validity was evaluated through the content validity ratio (CVR) and the modified kappa statistic (K*). As a result, 27 validated, evidence-based indicators were obtained, which showed consistency with findings from previous research. These results have important theoretical and practical implications and can inform future research as well as guide practitioners and organizations in the implementation of WMHP practices.
46. Actual concordance between veterans' with Gulf War Illness and their providers' illness perceptions is not related to patient satisfaction nor treatment adherence.
期刊: Patient education and counseling 发表日期: 2025-Sep-02 链接: PubMed
摘要
Patients with persistent physical symptom (PPS) conditions, such as Gulf War Illness (GWI), report disagreement or “non-concordance” with their providers about PPS conditions and dissatisfaction with healthcare. When patients perceive concordance with their providers about their PPS condition, they have increased satisfaction and adherence. While literature supports perceived concordance, there is a lack of research on actual concordance (i.e., the congruence of patients’ and providers’ perceptions of the patients’ illness). Among dyads of Veterans with GWI and their provider, we tested the hypotheses that greater actual concordance would be associated with greater Veterans’ satisfaction and adherence. We also explored the relationship of actual concordance with Veterans’ and providers’ perceived concordance. Correlations suggest there is little agreement between Veterans and providers regarding GWI illness perceptions or perceptions of concordance. Polynomial regression analyses showed that actual concordance was not significantly related to Veterans’ satisfaction, adherence, or perceptions of concordance, nor to providers’ perceptions of concordance. Although literature finds Veterans’ perceived concordance with their provider about PPS influences patients’ experiences of care, our results suggest that actual concordance may have limited influence on experiences of care and either Veterans’ or providers’ perceived concordance. That is, the results suggest there does not need to be objective agreement between patients and providers about PPS, rather patients’ perception of agreement influences their satisfaction and adherence. Our results suggest that patients with PPS and their providers may have difficulties in estimating if there is shared agreement in the relationship and demonstrate the importance of explicitly assessing patients’ perceptions of concordance.
47. MoLEP-Co-creating a Mycobacterium leprae transmission interruption program for the Morogoro region, Tanzania.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Sep 链接: PubMed
摘要
The global goal for leprosy elimination is the interruption of Mycobacterium leprae transmission, resulting in zero new leprosy patients. In alignment with this objective, Tanzania’s updated national leprosy strategy emphasizes early detection, systematic contact tracing, post-exposure prophylaxis (PEP) with single-dose rifampicin (SDR), and integration of services into primary health care. However, the feasibility of accelerating M. leprae transmission interruption in high-burden areas with this strategy has yet to be demonstrated. In 2024, the Morogoro Leprosy Elimination Program (MoLEP) was launched in the country’s most endemic region. Developed through a collaborative process, MoLEP aligns global practices with local conditions and needs. Key interventions include training frontline health workers and expanding contact tracing with SDR-PEP. Furthermore, targeted activities will respond to high transmission areas and the detection of child cases, which serve as indicators of recent transmission. Strengthening the drug supply chain is also a priority. MoLEP will generate critical data on the feasibility and effectiveness of these interventions in accelerating progress toward elimination. The implementation is guided by a comprehensive monitoring and evaluation framework, alongside clearly defined governance structures, to facilitate evidence-informed decision-making. Findings are expected to guide strategic scaling and replication in other high-burden regions across Tanzania and beyond.
48. Clinical Benefit From Molecularly Guided Cancer Care: A Matching-Adjusted Indirect Comparison of Larotrectinib Versus Standard of Care.
期刊: JCO precision oncology 发表日期: 2025-Sep 链接: PubMed
摘要
Widespread adoption of the tropomyosin receptor kinase (TRK) inhibitor larotrectinib has been hampered by limited comparisons against non-TRK inhibitor standard of care (SoC) regimens because of the rarity of TRK fusions. Cross-trial comparisons may be facilitated using matching-adjusted indirect comparison (MAIC), a validated methodology that balances baseline population characteristics. MAIC was conducted using individual patient-level data from three larotrectinib trials, compared with aggregate real-world data (RWD) from adult patients with locally advanced/metastatic TRK fusion-positive cancer in the Hartwig Medical Foundation database. Patient populations were matched on available clinical characteristics. Estimates of overall survival (OS; defined as the time from start of first postbiopsy treatment [or larotrectinib] to death) were compared between larotrectinib and non-TRK inhibitor SoC. The analysis included 24 patients receiving nontargeted TRK inhibitor SoC and 120 receiving larotrectinib. After matching, median OS was 50.3 months (IQR, 23.3-not estimable) for larotrectinib versus 13 months (IQR, 6.4-18.3) for SoC; larotrectinib was associated with an 84% risk reduction of death (adjusted hazard ratio, 0.16 [95% CI, 0.07 to 0.36]). To account for the longer follow-up time in the larotrectinib group than in the SoC group (median: 56.7 v 23.2 months), a restricted mean survival analysis was conducted up to 26.2 months (largest observed event time in SoC arm), which showed median survival of 22.6 months for larotrectinib and 12.8 months for SoC (mean difference: 9.8 months [95% CI, 5.6 to 14.0]). In patients with TRK fusion-positive cancer, larotrectinib was associated with a mean survival advantage of 9.8 months compared with non-TRK inhibitor SoC, corroborating favorable findings for larotrectinib from a previous analysis that used a different set of RWD.
49. Landscape heterogeneity, forest structure, and mammalian host diversity shape tick density and prevalence of the causative agent of Lyme borreliosis.
期刊: FEMS microbiology ecology 发表日期: 2025-Aug-23 链接: PubMed
摘要
Ticks, particularly Ixodes ricinus, and the associated Lyme borreliosis risk, represent key concerns within the One Health framework, prompting extensive research in this field. However, comprehensive studies that jointly consider landscape characteristics, local forest structure and management, climate, and host community composition-alongside direct measures of tick density and infection status with Borrelia spp., the bacterial agents causing Lyme borreliosis, are scarce. In this study, we test the hypothesis that habitat diversity exerts a dilution effect, primarily by supporting greater diversity of mammal hosts. Therefore, we examined I. ricinus tick density and Borrelia spp. prevalence in relation to a comprehensive set of habitat and host-related variables. Ticks were collected using the flagging method and mammal hosts were monitored using an innovative camera-trapping approach across 25 forest plots along a land-use gradient within the Schwäbische Alb exploratory in Germany. Both tick density and Borrelia spp. prevalence are influenced by a complex combination of habitat factors across different spatial scales, as well as the mammal host community composition. Overall, our results provide novel support to the dilution effect hypothesis, suggesting that greater habitat and host diversity contribute to a reduced Lyme borreliosis risk in this region.
50. PDK1, associated with glycolytic metabolism, is a potential prognostic biomarker in osteosarcoma.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The study explores the prognostic significance and therapeutic potential of 3-phosphoinositide dependent protein kinase-1 (PDK1) in osteosarcoma. Using bioinformatics analysis and experimental validation, we analyzed PDK1 expression and its correlation with patient prognosis from GEPIA and UCSCXena databases. High PDK1 expression was found to be significantly associated with reduced survival in osteosarcoma patients, suggesting its value as a prognostic biomarker. Functional assays were performed to investigate the biological processes influenced by PDK1. Gene Ontology (GO) analysis indicated that PDK1 is involved in metabolism and cell proliferation. KEGG enrichment analysis revealed that genes related to PDK1 are enriched in pathways associated with metabolism, cell proliferation, and immune escape. In vitro experiments demonstrate that silencing PDK1 impairs glycolysis, reduces proliferation, and induces apoptosis in 143B osteosarcoma cells. Pan-cancer analysis confirms PDK1’s overexpression and poor prognosis association in multiple malignancies. Pan-cancer analysis extended the findings to other cancer types, confirming that PDK1 is overexpressed in multiple malignancies and generally associated with poor prognosis. This reinforces the potential of PDK1 as a universal biomarker and therapeutic target in oncology. The findings suggest PDK1 as a critical regulator of glycolytic metabolism and a potential therapeutic target in osteosarcoma. Targeting PDK1 could provide a novel therapeutic strategy for treating osteosarcoma and possibly other cancers.
51. Mortality prediction for ICU patients with mental disorders using large language models ensemble and unstructured medical notes.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Assessing mortality risk in the intensive care unit (ICU) is crucial for improving clinical outcomes and management strategies. Conventional artificial intelligence studies often neglect vital clinical information contained in unstructured medical notes. Recently, large language models (LLMs) have achieved leading-edge performance in natural language processing tasks, though each model has limitations stemming from its architecture and pre-training. The ensemble of heterogeneous language models, including both conventional LMs and LLMs, effectively addresses these constraints. The study introduces a predictive ensemble classifier using a decision fusion approach of diverse medical LLMs and LMs, including Asclepius, Meditron, GatorTron, and PubMedBERT. These models, fine-tuned with multimodal data from the medical records of 11,914 individuals diagnosed with various mental disorders from the MIMIC-IV dataset, enhance the diversity of the resulting ensemble model. The performance of our multimodal ensemble model was rigorously evaluated, delivering superior results compared to individual LLM and LM models based on single modalities. Our study underscores the substantial influence of language models on mental health management in the ICU, advocating for advanced clinical decision-making techniques that integrate unstructured medical texts with language models to enhance patient outcomes.
52. Elevated cardiovascular risk factors and chronic disease mortality in the Caribbean: A Cross-Sectional Study.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Cardiovascular disease (CVD) remains a leading cause of premature mortality in the Caribbean, with particularly high rates from stroke and hypertensive heart disease. While global outcomes have improved, CVD-related mortality in the Caribbean remains elevated. This study examined sex-specific CVD mortality, risk factors, and health policy indicators across non-Latin Caribbean nations, using data from the 2019 PAHO Enlace Portal and comparing results to North America (United States and Canada). Despite North Americans exhibiting more overall risky CVD behaviors, CVD mortality was higher in the Non-Latin Caribbean compared to North America (196.7 vs. 122.6 deaths per 100,000). Total-to-HDL cholesterol ratios were significantly higher in the Caribbean, both in men (4.01 vs. 3.63; p < 0.0001) and women (3.82 vs. 3.01; p < 0.0001), indicating reduced cardioprotective effects of HDL. Hypertensive heart disease mortality was significantly higher in Caribbean women compared to North American women (p < .01), with a similar but non-significant trend in men. Caribbean men also had significantly higher rates of undiagnosed hypertension compared to North American men (47.6% vs. 20.8%; p < .001). NCD policy implementation across the Caribbean was inconsistent, with major gaps in CVD drug therapy access, alcohol advertising restrictions, NCD planning, and surveillance systems. These findings underscore the urgent need for regional investment in prevention, policy enforcement, and culturally relevant strategies to reduce CVD disparities and improve health outcomes in the Caribbean.
53. Perspectives of multidisciplinary healthcare providers in elderly daycare centres: Challenges, opportunities and impacts on geriatric care in Chiangrai Municipality, Thailand.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The global surge in the ageing population has intensified pressure on healthcare delivery systems, leading to a heightened demand for elderly daycare services. This demographic shift necessitates innovative approaches to meet the complex needs of older adults, including expanding community-based care options. Elderly daycare centers play a crucial role in comprehensive geriatric care by offering services. Understanding how healthcare providers experience their work in Elderly Daycare Centres is essential for improving both service quality and staff preservation. This study seeks the experiences of these providers to understanding of meanings healthcare professionals assign to challenges they face, the successful practices they employ, and highlight opportunities for enhancement within geriatric care. Interpretative phenomenology influenced by Heidegger’s philosophy in qualitative research was conducted. Thirteen semi-structured interviews and narrative accounts with multidisciplinary healthcare providers from four Elderly Daycare Centres were collected and analysed, and interpretative phenomenological analysis (IPA). Multidisciplinary healthcare providers discovered four key aspects of their experience while delivering services in the first two programs (the Muscle Strengthening Program and the Nutrition Program for individuals with nutritional deficiencies): Opportunities in policy implementation, Challenging experience, Enhancing organisational effectiveness and engaging support, and Reflections on Program Outcomes and Impacts. All findings mirrored the value and impact of providing healthcare services in Elderly Daycare Centres on the experiences of healthcare providers from various disciplines. Elderly Daycare Centres not only provide healthcare services that offer emotional support but also positively influence seniors’ mental and physical well-being. Multidisciplinary healthcare providers caring for older adults encounter various experiences shaped by the complexities of aging populations. Support of this nature will heighten awareness of the difficulties elderly individuals encounter and advance potential solutions. Therefore, healthcare professionals stressed the need for a more holistic and coordinated care framework to improve both the delivery of services and health outcomes for elderly individuals.
54. Harambee! 2.0: Community resources and resilience factors to leverage for improving HIV testing behaviors among African immigrant communities in Seattle, Washington.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Significant challenges promoting positive HIV testing behaviors among African immigrant communities in the U.S. persist, though existing community resources may be leveraged to improving these behaviors and increasing testing uptake. We conducted 30 key informant interviews and five focus group discussions (n = total 72 participants) among members of the Ethiopian, Somali, and Eritrean communities in Seattle, WA to identify these resources. Our findings highlight the following three main themes for responsive interventions: (1) capitalize on religious leaders and institutions as key facilitators; (2) leverage existing community resources, such as ethnic community centers, health boards, and healthcare professionals; and (3) utilize existing culturally-rich media for health promotion, centering on multi-linguality, -culturality, and -generationality. Our findings suggest that a wealth of community resources and resilience factors exist to leverage to improve HIV testing behaviors among African immigrant communities in the U.S.
55. Measurement properties of instruments used to measure health-related quality of life in pediatric and adults patients with inherited epidermolysis bullosa: A systematic review and meta-analysis protocol.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Inherited Epidermolysis Bullosa (EB) is a group of rare, genetic skin diseases characterized by extreme fragility of the skin and mucous membranes, leading to blistering and wounds in response to minimal trauma or friction. These clinical manifestations significantly reduce health-related quality of life (HRQoL). The objective of this protocol article is to provide information about the methods planned to be used to assess the measurement properties of HRQoL instruments specifically developed for EB patients of all age groups through a systematic review and meta-analysis. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols (PRISMA-P) guideline. The literature search will be conducted in PubMed, Web of Science (WOS) and EMBASE, including terminology that aligns with the four key elements of the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) research question (construct, target population, measurement properties and type of PROM), as well as the terminology proposed by COSMIN for measurement properties. Studies that include information on measurement properties (specifically, validity and/or reliability) with a sample of patients with inherited EB will be selected. Both title and abstract screening and full text review, will be conducted by two independent reviewers using the Rayyan tool. In addition, the risk of bias will be assessed using the COSMIN-Risk of Bias checklist. The data from each study and each measurement property will be summarized in accordance with the COSMIN guidelines. The evidence gathered will strive to adjudicate data on measurements properties of HRQoL instruments used in EB patients, and the limitations of the future systematic review will be discussed. Ultimately, results of the future systematic review will help develop more personalized guidelines for the assessment of HRQoL in EB patients of all age groups. The protocol is registered in OSF with registration number vrm87: https://osf.io/vrm87/.
56. Analysis of global, regional and national trends in the burden of soft tissue and other extraosseous sarcomas from 1990 to 2021: A systematic analysis of the global burden of disease study 2021.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Soft tissue and other extraosseous sarcomas (STSES) are rare malignant tumors originating from mesenchymal tissues with complex etiologies. A systematic analysis of global burden trends is urgently needed. Utilizing the Global Burden of Disease (GBD) 2021 database, we assessed STSES incidence, mortality, disability-adjusted life years (DALYs), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) across regions and countries from 1990 to 2021, stratified by sociodemographic index (SDI). Spatiotemporal models, Joinpoint regression (to calculate average annual percentage changes, AAPC), and decomposition analysis were employed to evaluate the impacts of population growth, aging, and epidemiological factors on disease burden. In 2021, there were 96,201 new STSES cases globally, resulting in 50,203 deaths and 1.678 million DALYs. While age-standardized rates (per 100,000 person-years) showed declining trends (AAPC for ASIR = -0.13, ASMR = -0.60, ASDR = - 0.94), absolute burden increased by 77.97% due to population growth. Males exhibited consistently higher burden than females, with incidence peaking at 55-74 years. Notably, young females (10-29 years) transiently surpassed males in DALYs. Significant regional disparities emerged: High-SDI regions (e.g., Western Europe) demonstrated lower ASMR attributable to advanced diagnostics and treatment, whereas low-SDI regions (e.g., Uganda, ASMR = 1.96/100,000) faced poorer prognoses due to healthcare deficiencies. SDI exhibited a nonlinear association with disease burden-middle-SDI regions (0.4-0.8) showed rising ASIR, potentially linked to industrial pollution and improved diagnostic capabilities. These findings underscore the critical need for context-specific prevention and resource allocation strategies to address the evolving global STSES burden. The global STSES burden is predominantly driven by population growth, necessitating targeted prevention strategies addressing occupational exposures in males and subtype-specific risks among young females. While high-SDI regions demonstrate mortality reduction through precision oncology, low-SDI regions require urgent improvements in healthcare accessibility to mitigate survival disparities. Persistent regional heterogeneity underscores the imperative for international collaboration to standardize diagnostic protocols and ensure equitable resource allocation. These insights emphasize the need for stratified surveillance systems and translational research to optimize context-specific intervention frameworks.
57. Perinatal colonization with extended-spectrum beta-lactamase-producing and carbapenem-resistant gram-negative bacteria among home births in Bangladesh.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Neonatal infections are increasingly caused by antibiotic-resistant bacteria. It is unknown to what extent home-based births, which account for nearly a third of deliveries in Bangladesh, may also result in exposure to antibiotic-resistant bacteria. We enrolled mothers who delivered at home and their newborns from a rural community in Bangladesh during April-June, 2022. Within 2-7 days after delivery, we collected vaginal and rectal swabs from mothers and rectal swabs from the newborns. Swabs were cultured on chromogenic culture media selective for extended-spectrum β-lactamase-producing bacteria (ESBL-PB) and carbapenem-resistant bacteria (CRB). Demographic and risk factor data were collected via surveys. Birth attendants who facilitated the deliveries were interviewed regarding infection prevention practices. We performed descriptive analyses and Firth’s penalized logistic regression to identify potential risk factors associated with colonization. Of the 50 mothers enrolled, the median age was 23 years (range 18-26). Thirty-eight (76%) mothers had at least one antenatal care visit. Only one mother reported hospitalization during pregnancy, and 4 reported antibiotic use during pregnancy. Following delivery, 47 (94%) mothers were colonized with ESBL-PB, and 37 (74%) were colonized with CRB. Of the newborns, 36 (72%) were colonized with ESBL-PB, and 27 (54%) were colonized with CRB. No associations were found with any perinatal exposures, though all households reported incomes below the international poverty level. Of the 9 birth attendants who were able to be interviewed, 7 (78%) reported performing hand hygiene before delivery, and 8 (89%) reported glove use during delivery. Attendants reported cleaning equipment shared across deliveries with soap and water and using boiled water for delivery (89%, n = 8). Women and newborns in this rural population were frequently colonized with both ESBL-PB and CRB following home deliveries. This demonstrates the importance of community-based antibiotic-resistant bacterial transmission and need for further understanding community exposures driving antibiotic resistance.
58. Differences in access to water, sanitation, and hygiene facilities among residents of Korail Slum, Bangladesh, during normal vs. water-logging situations.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Slum areas in Dhaka, Bangladesh, experience frequent water-logging after heavy rain. However, the extent to which access to water, sanitation, and hygiene (WASH) varies between normal vs. water-logging periods has not been described. The objectives of this study are: 1) to describe WASH access and behaviors among Korail Slum residents during normal vs. water-logging periods, and; 2) to describe the extent to which the differences in WASH access and behaviors between normal vs. water-logging periods varied by socioeconomic status (SES). We conducted a cross-sectional study in Korail Slum, Dhaka, Bangladesh, during November 2024 using face-to-face interviews and rapid observation of WASH infrastructures. We selected adult residents to Korail Slum via systematic random sampling and invited them to participate. We interviewed participants regarding WASH access and behaviors, as well as their education, income, and asset ownership (i.e., socioeconomic status (SES) indicators). We categorized participants into SES tertiles using principal component analysis (PCA). We analyzed data using descriptive statistics and McNemar’s tests. Nearly all of our participants (n = 404) reported a Basic level of water access during normal and water-logging periods, and no participant reported using unimproved latrines or open defecation. Approximately 85% of the participants reported access to Basic hygiene facilities during normal periods, most (95%) of whom also reported the access during water-logging periods (p-value = 0.134). The majority of participants did not always wash their hands at key moments during the normal period. Among those who reported always washing hands during the normal period, between 15% to 30% regressed and did not always wash their hands during the water-logging period. There were no statistically significant variations in the difference between WASH access and behaviors at normal vs. water-logging periods by socioeconomic tertile. We found near-universal access to water and improved sanitation, but low level of hand hygiene behaviors. Limitations regarding generalizability and potential social desirability bias should be considered as caveats in the interpretation of the study findings.