公共卫生研究摘要 (2025-09-24)
共收录 53 篇研究文章
1. Cold exposure among outdoor workers in the Arctic setting.
期刊: International journal of circumpolar health 发表日期: 2025-Dec 链接: PubMed
摘要
The main aim of this study was to describe the degree of cold exposure and occupational physical activity within three different outdoor occupational groups in northern Sweden using both technical measurements and self-reported survey items. The cold exposure and physical activity of workers in preschool, park and maintenance and power grid sectors (N = 133) were examined using a digital survey, temperature loggers and thigh-worn accelerometers. In the survey, 33% of workers indicated that they often or always felt cold at work, and 39% reported that they had inadequate knowledge about cold weather protection. The median (interquartile range, IQR) duration of working at ambient temperatures below 10°C was 131 (157) minutes. The physical activity while working outdoors was composed of sitting (20%), standing (54%) and walking (26%). About one-third of the participants reported that they often or always felt cold at their workplace, with an average of more than two hours spent outside at temperatures below 10°C. Possible remedies include increasing physical activity and improving thermal insulation of the clothing.
2. Redefining Interruptions: Events, Causes, and Impacts in Trauma Rooms.
期刊: Journal of patient safety 发表日期: 2025-Oct-01 链接: PubMed
摘要
Trauma rooms, as fast-paced and demanding health care environments, are highly susceptible to interruptions that can negatively impact workflow efficiency and patient safety. These interruptions often arise from human or environmental factors. This study investigates the role of the physical environment in influencing workflow interruptions by identifying key interruptive events in a trauma room, their primary sources, and outcomes using a pilot method of observational coding. This pilot study utilized video observations of 6 trauma cases in an urban level 1 trauma center. Using Noldus Observer XT 16 software, medical staff roles, interruptive events, their causes, and associated impacts were systematically coded and analyzed. A total of 114 events were observed. The most common events included “movement restrictions” (39%), “throwing objects” (17%), and “cleaning/clearing the floor” (13%). Key causes were “clutter/untidiness” (32%) and “mobile fixture/furniture location” (21%). Frequently observed impacts included “unnecessary task additions” (21%) and “hindered task completion” (20%). The results also revealed frequent associations between causes, events, and impacts. Movement restrictions caused by clutter/untidiness often led to disentangling cables and tubing (13.2%). Similarly, movement restrictions due to mobile fixture placement required equipment repositioning in 13.2% of cases. Throwing objects, often linked to behavioral habits, contributed to clutter (16%), whereas floor clearing/cleaning due to clutter added unnecessary tasks (13%). The findings underscored the significant role of physical-environmental factors in workflow interruptions in trauma rooms. These insights can inform evidence-based design improvements and operational strategies for future enhancements, ultimately improving staff and patient outcomes in high-pressure health care settings.
3. Predicting Lymph Node Metastasis in Rectal Cancer: Development and Validation of a Machine Learning Model Using Clinical Data.
期刊: JMIR medical informatics 发表日期: 2025-Sep-23 链接: PubMed
摘要
Rectal cancer (RC) is a common malignant tumor, with lymph node metastasis (LNM) being a critical determinant of patient prognosis. Traditional diagnostic methods have limitations, necessitating the development of predictive models using clinical data. This study aimed to construct and validate machine learning (ML) models to predict LNM risk in patients with RC based on clinical data. Retrospective data from 2454 patients with RC (SEER [Surveillance, Epidemiology, and End Results] database) were split into training (n=1954) and internal validation (n=500) sets. An external cohort (n=500) was obtained from the First Affiliated Hospital of Anhui Medical University. Lymph node features identified via computed tomographic scans were integrated with clinicopathological data. Variables were selected using LASSO (Least Absolute Shrinkage and Selection Operator), followed by univariate and multivariate logistic regression. Eleven ML models (Logistic Regression, K-Nearest Neighbors, Extremely Randomized Trees, Naive Bayes, XGBoost [XBG], Light Gradient Boosting Machine, Multilayer Perceptron, Gradient Boosting, Support Vector Machine, Random Forest, and Ada-Boost) were evaluated via area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis. LNM prevalence was 26.9% (training), 27% (internal validation), and 81% (external validation). Independent LNM predictors included tumor grade, clinical T stage, N stage, tumor length, neural invasion, and total lymph nodes. Internal validation AUC ranged from 0.859 to 0.964; external validation AUC was 0.735-0.838. In the internal validation set, Random Forest and Extremely Randomized Trees achieved the highest AUC (0.964, 95% CI 0.950-0.978), while XGB demonstrated superior cross-cohort stability (AUC 0.942, 95% CI 0.925-0.959). For external validation, Gradient Boosting had the highest AUC (0.838, 95% CI 0.801-0.875), followed by XGB (0.832, 95%CI 0.794-0.869). XGB showed minimal calibration error with curves closest to the ideal diagonal and yielded the highest net benefit in decision curve analysis across critical thresholds. This study successfully developed and validated 11 ML models to predict LNM risk in RC. The XGB model was optimal, achieving an AUC >0.9 in 10 internal models and an AUC >0.8 in 7 external models. The identified predictors of LNM can facilitate early diagnosis and personalized treatment, highlighting the potential of integrating computed tomographic scan data with clinicopathological findings to build effective predictive models.
4. Cultural Adaptation of Together+, a Status-Neutral mHealth Intervention to Improve HIV Prevention and Care for Adolescent and Young Men Who Have Sex With Men in Vietnam: Protocol for a Co-Design Study.
期刊: JMIR research protocols 发表日期: 2025-Sep-23 链接: PubMed
摘要
Adolescent and young men who have sex with men (AYMSM) are experiencing an ongoing epidemic in Vietnam. HIV testing and preexposure prophylaxis uptake among AYMSM remain low in Vietnam, especially compared to older men. AYMSM living with HIV are also less likely to initiate HIV care. M-Cubed is a status-neutral mobile intervention developed in the United States focusing on HIV prevention and care among men who have sex with men. The app has the potential to significantly contribute to improving the HIV prevention and care continuum for AYMSM. We propose to adapt the M-Cubed app for AYMSM in Vietnam to create Together+, a status-neutral app that promotes HIV testing, preexposure prophylaxis use, and HIV care. Adaptation will focus on ensuring that the content, features, and design of the app are culturally relevant to AYMSM in Vietnam. The adaptation process will comprise five phases: (1) adaptation and creation of videos and messages in Vietnamese, (2) in-depth interviews to further inform app adaptation, (3) app prototype development, (4) app theater testing, and (5) beta testing of the adapted app. AYMSM aged between 15 and 19 years and health care staff in Hanoi, Vietnam, will be recruited for in-depth interviews in phase 1 and focus group discussions in phase 4. Qualitative data will be analyzed thematically, and results will be generated after reviewing memos, code reports, and the matrix. To evaluate the feasibility and usability of the Together+ app, we will provide access to 30 AYMSM and encourage them to use the app for 30 days. We will assess observed use and collect quantitative and qualitative data from test users. After 30 days, we will evaluate the usability and feasibility of the Together+ app through in-app analytics as well as online quantitative surveys and individual exit interviews with participants. As of September 2025, we are in the process of adapting the set of 15 videos for Vietnamese AYMSM (phase 1) and analyzing qualitative data from in-depth interviews (phase 2). Data collection for the pilot phase will be completed by August 2026. Adaptations of proven effective interventions are a promising and efficient way to develop interventions for new service populations but require formal adaptation and evaluation in the new service population. Once culturally adapted for AYMSM in Vietnam, the Together+ app has the potential to significantly contribute to improving the HIV prevention and care continuum for this population. The findings of the adaptation process will document the level of usability and feasibility of the Together+ app and shed light on the perceptions of AYMSM and other stakeholders in Vietnam regarding status-neutral mobile health interventions. PRR1-10.2196/73895.
5. Perceived Quality of Service in Primary Health Care Based on Google Maps Reviews Before, During, and After the COVID-19 Pandemic: Sentiment Analysis.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-23 链接: PubMed
摘要
The COVID-19 pandemic caused many changes in primary health care systems in Europe. The fast adoption of telemedicine, the shift of health care resources to COVID-19-related tasks, and the tendency of patients to cancel their nonurgent appointments are some examples of these changes. Patient satisfaction is an important outcome of health care services, and the changes caused by COVID-19 in the system may have affected it. Google Maps reviews provide an important channel for patients to communicate about their experiences regarding the primary health care system. Drawing from research on social media data analytics and text mining, this study set out to investigate the changes in public sentiment regarding primary health care in Finland and Andalusia (Spain) before, during, and after the COVID-19 pandemic. We collected 55,043 Google Maps reviews from primary health care locations in Finland and Andalusia from January 1, 2013, to May 15, 2024. There are 604 primary health care locations in Finland and 1016 in Andalusia. The total number of Google Maps reviews collected was 12,247 for Finland and 42,796 for Andalusia. First, lexicon-based sentiment analysis using the open-source software AFINN was conducted for the Finnish- and Spanish-language datasets. Thereafter, transformer-based deep learning models for sentiment analysis were applied for both languages. The numeric user ratings and the results of the sentiment analysis were then analyzed. In addition, we conducted a word frequency analysis of the reviews. There were important changes in the ratings and sentiment in the data for Andalusia. The ratings shifted from median 4 (IQR 3) before the COVID-19 pandemic to median 1 (IQR 2) during and median 1 (IQR 3) after the COVID-19 pandemic, on a scale from 1 to 5. The median of the sentiment values of the review texts shifted from neutral before the COVID-19 pandemic to -2 (IQR 0.055) or -1 (IQR 1) during and after the COVID-19 pandemic, depending on which sentiment analysis method was used. Interestingly, changes in numeric ratings and sentiment of the review texts in Finland were only minor, and the median values were the same during all 3 periods. Lexical analysis revealed changes in word frequencies across the periods, reflecting shifts in primary health care experiences during the pandemic, especially among the Spanish-language reviews. The change toward a more negative public discussion on primary health care in Andalusia during the COVID-19 pandemic was considerable. This can be observed both in the numeric user ratings and in the sentiment analysis of the review texts. However, the data for Finland show that the public discourse stayed mostly neutral or slightly positive. The findings have implications on the quality management procedures in primary health care and on the use of user-generated content as an additional information source.
6. Optimizing Self-Monitoring in a Digital Weight Loss Intervention (Spark): Protocol for a Factorial Randomized Trial.
期刊: JMIR research protocols 发表日期: 2025-Sep-23 链接: PubMed
摘要
Self-monitoring is a vital component of behavioral obesity treatment. It often involves tracking dietary intake, physical activity, and body weight. However, the optimal combination of self-monitoring strategies that maximizes weight loss is unknown. To address this gap, we leverage a framework called the multiphase optimization strategy, which facilitates the identification of an intervention’s “active ingredients” that promote weight loss and its “inactive ingredients” that have little impact, thus adding unnecessary patient effort and time demands. This study aims to examine the unique and combined weight loss effects of 3 popular self-monitoring strategies (tracking dietary intake, steps, and body weight). Spark was an optimization-randomized clinical trial that used a 2 × 2 × 2 full factorial design with 8 experimental conditions. Participants, US adults with overweight or obesity (N=176), were randomized to receive 0-3 self-monitoring strategies in a 6-month fully digital weight loss intervention. For each assigned strategy, participants were instructed to self-monitor daily via commercially available digital tools (a mobile app, wearable activity tracker, and smart scale) and received a corresponding goal (eg, a daily calorie goal) and weekly automated feedback. All participants received core intervention components, including weekly lessons and action plans informed by Social Cognitive Theory, to promote healthy eating and physical activity. Assessments occurred at baseline and at 1, 3, and 6 months. Weight was assessed objectively via a smart scale. The primary aim is to test the main effects of the 3 self-monitoring components and their interactions on weight change from baseline to 6 months. Secondary outcomes include change in BMI, caloric intake, diet quality, physical activity, and health-related quality of life, as well as 1- and 3-month weight change and the relation between self-monitoring engagement and weight change. Patterns of engagement will be operationalized as the percentage of days of self-monitoring during the 6-month intervention. Moderators of weight loss success will be explored to understand whether certain subgroups of individuals benefit more from specific self-monitoring strategies. We also conducted a separate embedded experiment to test the impact of a self-directed web-based orientation session on 6-month trial retention. After the intervention, semistructured qualitative interviews were conducted with a subset of participants to elucidate factors that impact engagement and its link to weight loss. Recruitment occurred from September 2023 to November 2024. Data collection was completed in June 2025. Data analysis is ongoing. This trial will provide evidence as to which self-monitoring strategies are the “active ingredients” in a fully digital weight loss intervention and begin to explore which subgroups may do best with which strategies. These results have potential for public health impact by maximizing weight loss while minimizing patient burden. ClinicalTrials.gov NCT05249465, https://clinicaltrials.gov/study/NCT05249465. DERR1-10.2196/75629.
7. Understanding Cancer Survivorship Care Needs Using Amazon Reviews: Content Analysis, Algorithm Development, and Validation Study.
期刊: JMIR cancer 发表日期: 2025-Sep-23 链接: PubMed
摘要
Complementary therapies are being increasingly used by cancer survivors. As a channel for customers to share their feelings, outcomes, and perceived knowledge about the products purchased from e-commerce platforms, Amazon consumer reviews are a valuable real-world data source for understanding cancer survivorship care needs. In this study, we aimed to highlight the potential of using Amazon consumer reviews as a novel source for identifying cancer survivorship care needs, particularly related to symptom self-management. Specifically, we present a publicly available, manually annotated corpus derived from Amazon reviews of health-related products and develop baseline natural language processing models using deep learning and large language model (LLM) to demonstrate the usability of this dataset. We preprocessed the Amazon review dataset to identify sentences with cancer mentions through a rule-based method and conducted content analysis including text feature analysis, sentiment analysis, topic modeling, cancer type, and symptom association analysis. We then designed an annotation guideline, targeting survivorship-relevant constructs. A total of 159 reviews were annotated, and baseline models were developed based on deep learning and large language model (LLM) for named entity recognition and text classification tasks. A total of 4703 sentences containing positive cancer mentions were identified, drawn from 3349 reviews associated with 2589 distinct products. The identified topics through topic modeling revealed meaningful insights into cancer symptom management and survivorship experiences. Examples included discussions of green tea use during chemotherapy, cancer prevention strategies, and product recommendations for breast cancer. Top 15 symptoms in reviews were also identified, with pain being the most frequent symptom, followed by inflammation, fatigue, etc. The annotation labels were designed to capture cancer types, indicated symptoms, and symptom management outcomes. The resulting annotation corpus contains 2067 labels from 159 Amazon reviews. It is publicly accessible, together with the annotation guideline through the Open Health Natural Language Processing (OHNLP) GitHub. Our baseline model, Bert-base-cased, achieved the highest weighted average F1-score, that is, 66.92%, for named entity recognition, and LLM gpt4-1106-preview-chat achieved the highest F1-score for text classification tasks, that is, 66.67% for “Harmful outcome,” 88.46% for “Favorable outcome” and 73.33% for “Ambiguous outcome.” Our results demonstrate the potential of Amazon consumer reviews as a novel data source for identifying persistent symptoms, concerns, and self-management strategies among cancer survivors. This corpus, along with the baseline natural language processing models developed for named entity recognition and text classification, lays the groundwork for future methodological advancements in cancer survivorship research. Importantly, insights from this study could be evaluated against established clinical guidelines for symptom management in cancer survivorship care. By revealing the feasibility of using consumer-generated data for mining survivorship-related experiences, this study offers a promising foundation for future research and argumentation analysis aimed at improving long-term outcomes and support for cancer survivors.
8. Impact of Telemedicine on Health Expenditures During the COVID-19 Pandemic in Japan: Quasi-Experimental Study.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-23 链接: PubMed
摘要
The effects of telemedicine on health expenditures and health outcomes are an important policy question. Many countries loosened regulations on the use of telemedicine during the COVID-19 pandemic, thereby offering an opportunity to evaluate these effects via a natural experiment. This study aimed to assess the effect of greater telemedicine use on area-level health expenditures and health outcomes related to common chronic conditions in Japan during the COVID-19 pandemic. We compared prefectures (area levels of government) with higher prepandemic telemedicine rates (fiscal year [FY] 2019) versus those with lower rates and conducted a difference-in-differences analysis of the change in prefecture-level health expenditures from FY2017 to FY2022 and health outcomes from FY2017 to FY2021. The participants were the total population in Japan from FY2017 to FY2022 (n=126 million), and the exposure was the increase in telemedicine use following the government’s relaxation of restrictions on telemedicine use as an exceptional measure during the COVID-19 pandemic. Our main outcomes were the share of outpatient claims that were for telehealth services; total, inpatient, and outpatient annual prefecture-level health expenditures; all-cause mortality, glycated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol. Treatment prefectures (n=15, population of 62 million) were defined as those with greater-than-median telemedicine use before the pandemic, while control prefectures (n=32, population of 64 million) were defined as those with less-than-median telemedicine use. Treatment and control prefectures shared similar demographic characteristics before the pandemic. The growth in telemedicine after 2020 as a share of outpatient claims increased among the treatment prefectures by 0.35 percentage points more than among control prefectures, which represented more than a threefold increase in telemedicine use compared to the prepandemic median. In difference-in-differences analyses, this difference was associated with a 1.0% relative decrease (95% CI 0.3%-1.8%) in total health expenditure (P=.006) and a 1.1% relative decrease (95% CI 0.2%-2.0%) in inpatient expenditure (P=.02). Outpatient expenditures showed no significant difference as a result of increased telemedicine adoption. Most health outcomes-all-cause mortality, glycated hemoglobin, systolic blood pressure, diastolic blood pressure, and low-density lipoprotein cholesterol-did not show any significant changes. Areas in Japan with greater expansion of telemedicine use during the pandemic experienced a significant decrease in both inpatient and total health care spending compared with areas with less telemedicine use, without harming health outcomes.
9. Surveillance of Twitter Data on COVID-19 Symptoms During the Omicron Variant Period: A Sentiment Analysis.
期刊: JMIR formative research 发表日期: 2025-Sep-23 链接: PubMed
摘要
The global outbreak of COVID-19 has significantly impacted health care systems and has necessitated timely access to information for effective decision-making by health care authorities. Conventional methods for collecting patient data and analyzing virus mutations are resource-intensive. In the current era of rapid internet development, information on COVID-19 infections could be collected by a novel approach that leverages social media, particularly Twitter (subsequently rebranded X). The aim of this study was to analyze the trending patterns of tweets containing information about various COVID-19 symptoms, explore their synchronization and correlation with conventional monitoring data, and provide insights into the evolution of the virus. We categorized tweet sentiments to understand the predictive power of negative emotions of different symptoms in anticipating the emergence of new Omicron subvariants and offering real-time assistance to affected individuals. Relevant user tweets from 2022 containing information about COVID-19 symptoms were extracted from Twitter. Our fine-tuned RoBERTa model for sentiment analysis, achieving 99.7% accuracy for sentiment analysis, was used to categorize tweets as negative, positive, or neutral. Joinpoint regression analysis was used to examine the trends in weekly negative tweets related to COVID-19 symptoms, aligning these trends with the transition periods of SARS-CoV-2 Omicron subvariants from 2022. Real-time Twitter users with negative sentiments were geographically plotted. A total of 105,934 tweets related to fever, 120,257 to cough, 55,790 to headache, 101,220 to sore throat, 3410 to vomiting, and 5913 to diarrhea were collected. The most prominent topics of discussion were fever, sore throat, and headache. The weekly average daily tweets exhibited different fluctuation patterns in different stages of subvariants. Specifically, fever-related negative tweets were more sensitive to Omicron subvariant evolution, while discussions of other symptoms declined and stabilized following the emergence of the BA.2 variant. Negative discussions about fever rose to nearly 40% at the beginning of 2022 and showed 2 distinct peaks during the absolute dominance of BA.2 and BA.5, respectively. Headache and throat-related negative sentiment exhibited the highest levels among the analyzed symptoms. Tweets containing geographic information accounted for 1.5% (1351/391,508) of all collected data, with negative sentiment users making up 0.35% (5873/391,508) of all related tweets. This study underscores the potential of using social media, particularly tweet trends, for real-time analysis of COVID-19 infections and has demonstrated correlations with major symptoms. The degree of negative emotions expressed in tweets is valuable in predicting the emergence of new Omicron subvariants of COVID-19 and facilitating the provision of timely assistance to affected individuals.
10. Associations Between Social Determinants of Health and Adherence in Mobile-Based Ecological Momentary Assessment: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-23 链接: PubMed
摘要
Ecological momentary assessment (EMA) involves repeated prompts to capture real-time self-reported health outcomes and behaviors via mobile devices. With the rise of mobile health (mHealth) technologies, EMA has been applied across diverse populations and health domains. However, the extent to which EMA engagement and data quality vary across social determinants of health (SDoH) remains underexplored. Emerging evidence suggests that EMA adherence and data completeness may be sometimes associated with participant characteristics such as socioeconomic status, race/ethnicity, and education level. These associations may sometimes influence who engages with EMA protocols and the types of contextual data captured. Despite growing interest in these patterns, no review to date has synthesized evidence on how SDoH relate to EMA compliance and engagement. We conducted a scoping review to study two research questions: (R1) how EMA compliance rates in health studies can differ across SDoH and (R2) what types of SDoH have been identified through EMA health studies. Following PRISMA-ScR guidelines, we searched PubMed, Web of Science, and EBSCOhost using two sets of queries targeting EMA and its relationship to SDoH. Eligible studies were peer reviewed, were published in English between 2013 and 2024, and used mobile-based EMA methods. Studies were included if they (1) reported on differences in EMA compliance by SDoH or (2) reported at least one SDoH observed or uncovered during an EMA study. We used the social ecological model (SEM) as a guiding framework to categorize and interpret SDoH across individual, interpersonal, community, and societal levels. A qualitative thematic synthesis was conducted to iteratively and collaboratively extract, categorize, and review determinants. We analyzed 48 eligible studies, of which 35 addressed R1 by examining compliance patterns across various SDoH. Using the SEM, we identified 13 determinants categorized across 4 levels: individual (eg, daily routine, biological sex, age, socioeconomic status, language, education, and race or ethnicity), interpersonal (eg, social support), community and organizational (eg, social context, social acceptance, stigmatization, and youth culture), and policy or societal (eg, systemic and structural barriers). These studies described differences in EMA response rates, compliance, and dropout associated with these determinants, often among vulnerable populations. The remaining 13 studies addressed R2, demonstrating examples of the types of SDoH that EMA research can uncover, including family culture, social support, social contexts, stigmatization, gender norms, heroic narratives, LGBTQ+ culture, racial discrimination, and systematic and structural barriers. This scoping review illustrates how EMA compliance rates can differ across SDoH and highlights the potential of EMA to uncover social and cultural factors linked to health behaviors and outcomes. Our findings underscore the importance of integrating SDoH considerations into EMA study designs to capture context-specific sociocultural dynamics.
11. A Group-Based Telehealth Intervention for Birth Trauma: Protocol for a Pilot Feasibility and Waitlist Control Trial.
期刊: JMIR research protocols 发表日期: 2025-Sep-23 链接: PubMed
摘要
Traumatic childbirth experiences affect almost half of Australian women giving birth and can lead to significant mental health impacts, including postpartum depression, anxiety. and posttraumatic stress disorder (PTSD). Despite evidence supporting psychological interventions for birth trauma, there are prominent gaps in the accessibility of these treatments, particularly for postpartum women in regional or rural areas, who face long waitlists, geographical isolation, and high financial costs. Although narrative approaches hold promise for addressing birth-related trauma, no research study to date has specifically trialed a narrative-informed, group-based telehealth intervention in this space. This study aims to assess the acceptability and feasibility of a narrative-informed, group-based telehealth intervention for postpartum women in reducing the mental health impacts of having experienced a traumatic childbirth. This pilot feasibility trial with a waitlist control design evaluated a six-session narrative-informed, group-based intervention delivered weekly via telehealth to postpartum women who experienced a traumatic childbirth within the past 6 months. The intervention incorporated narrative therapy techniques, such as externalization, double-listening, and outsider witnessing. Participants from a specific catchment area of predominantly rural towns in New South Wales in Australia were randomly assigned to either an intervention group (IG) or a waitlist control group (WCG). Quantitative measures assessing mental health symptoms of postpartum depression (Edinburgh Postnatal Depression Scale [EPDS]), anxiety (Perinatal Anxiety Screening Scale [PASS]) and posttraumatic stress (City Birth Trauma Scale [City BiTS]) were administered prior to, in between, and at the end of treatment, and measures of client satisfaction (Client Satisfaction Questionnaire [CSQ-8]) and group cohesion (Group Cohesiveness Scale [GCS]) were administered on completion of the intervention. The project was funded in March 2024. Recruitment was completed between July and August 2024. Eleven pretreatment sessions were held in August 2024. Of the 33 expressions of interest (EOIs) received by August 2024, 9 participants were recruited and randomized to the IG (n=4, 44.4%) and the WCG (n=5, 55.6%). The IG completed the six-session program between September and October 2024, with data collection finalized for pre-, mid-, and postintervention timepoints. The WCG began receiving the intervention mid-October 2024, with the final data collection in December 2024. Key feasibility and acceptability metrics include attendance rates, participant retention, and group cohesion scores. Data analysis is ongoing, with manuscript preparation planned for mid-late 2025. This study addresses a critical gap in evaluating scalable, accessible mental health interventions for birth trauma recovery. By using narrative approaches in a telehealth group format, this intervention directly responds to the barriers around accessibility and affordability highlighted in recent policy recommendations. Thus, findings from this pilot study could provide important directions in reducing the burden on perinatal mental health services in regional and rural Australia. Australian New Zealand Clinical Trials Registry ANZCTR12624000460505p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12624000460505p. DERR1-10.2196/69051.
12. Disease Activity Assessment Frequency in Rheumatoid Arthritis: A Retrospective Observational Study of the Medical Support System for Rheumatoid Arthritis System Implementation.
期刊: JMIR formative research 发表日期: 2025-Sep-23 链接: PubMed
摘要
Rheumatoid arthritis (RA) is a global health concern with increasing prevalence. Despite recommendations for regular disease activity assessments, their implementation in routine clinical practice remains challenging. The Medical Support System for Rheumatoid Arthritis (MiRAi) is an offline, semi-automated system that calculates disease activity indices by integrating patient and clinician inputs from electronic health records (EHRs). This study evaluated the association between MiRAi implementation and the frequency of disease activity assessments in patients with RA. We conducted a retrospective cohort study of patients with RA treated at a tertiary hospital in Japan between April 2022 and March 2023. We included all adult outpatients (aged ≥18 years) with RA diagnosed according to the 2010 ACR/EULAR [American College of Rheumatology/European Alliance of Associations for Rheumatology] classification criteria. The hospital introduced MiRAi in June 2022 and achieved full deployment by October 2022. MiRAi calculated the clinical disease activity index (CDAI) and the modified health assessment questionnaire (mHAQ) through automated extraction of joint counts, patient global assessment, and functional status from structured EHR fields. Primary outcomes included the frequency of CDAI and mHAQ assessments. We administered a structured post-implementation survey to assess rheumatologists’ perceptions of MiRAi. Physicians used MiRAi for 236/884 (26.7%) patients with RA. Patients with documented CDAI and mHAQ scores increased from 29 (5.9%) in June 2022 to 81 (19.0%) in November 2022, representing a 3.2-fold increase. Among surveyed rheumatologists (n=10), 5 (50%) reported the regular use of MiRAi. Physicians who regularly used MiRAi (n=5) cited improved accuracy in disease assessment and enhanced treatment decision-making. Non-users and occasional users (n=5) identified three primary barriers: limited familiarity with MiRAi, time constraints, and discrepancies between clinical judgment and MiRAi-generated outputs. Despite MiRAi’s availability, only 168 (19%) patients underwent quantitative disease activity assessment by the study end. Among 15 patients with high disease activity (CDAI >22), physicians recorded 3 treatment modifications and 2 intra-articular steroid injections. MiRAi implementation increased disease activity assessment frequency by 3.2-fold over 6 months; however, physician adoption remained at 26.7%, below the 80% target for routine care. Future implementation strategies should address identified barriers through system integration, structured user training, and workflow optimization to achieve guideline-concordant care for patients with RA.
13. Development and validation of Age-Specific algorithms for diabetes prediction.
期刊: Endocrine 发表日期: 2025-Sep-23 链接: PubMed
摘要
14. The IMPACT Survey: The Economic Impact of Caring for an Individual with Osteogenesis Imperfecta.
期刊: Advances in therapy 发表日期: 2025-Sep-23 链接: PubMed
摘要
The IMPACT Survey (“IMPACT”) investigated the economic, clinical, and humanistic challenges of osteogenesis imperfecta (OI) on affected individuals, caregivers, and the broader community. Prior publications detail the methodology, initial findings, healthcare expenditures, and quality of life (QoL) impact on adults with OI. Here, data is presented on the productivity and finances of caregivers and any predictors of impact. We hypothesise that caring for an individual with OI will impact the productivity and finances of caregivers. IMPACT, fielded July through September 2021 in eight languages, targeted adults and adolescents with OI, caregivers (with or without OI), and close relatives. Survey items covered demographics, socioeconomic factors, clinical characteristics, treatment patterns, QoL, and health economics. We performed descriptive analyses of caregivers’ productivity and finances and exploratory regression analyses to identify independent associations between care recipient and caregiver characteristics (“predictors”), and their economic impact on caregivers. Of 528 caregivers (without OI) with one care recipient, 64% were in paid employment. Of these, 50% reported missing workdays in the preceding 4 weeks (mean 1.9 days). Caregivers reported impacted finances, spending a mean total of €209 out of pocket (OOP) with the most spent on travel to medical appointments (mean €83) and medicine (mean €46) in the preceding 4 weeks. Caregiver spending varied across regions. Caregivers in the USA spent more in 4 weeks (mean €334) than caregivers in EU4 (France, Germany, Italy, and Spain) and UK (mean €163) or Nordic countries (mean €33). Predictors of productivity and OOP spending included caregiver age, sex and employment status, care recipient age, and various signs, symptoms, and events. Our results suggest that caring for an individual with OI may impact caregivers’ productivity and finances. The degree of impact may be predicted by caregiver and care recipient age, fracture frequency, and dental problems. The IMPACT Survey looked at how caring for someone with osteogenesis imperfecta affects caregivers’ work and finances. It aimed to understand the challenges caregivers face and what factors might make the experience of the caregivers worse. The survey was done in 2021 and was open to caregivers (both with and without osteogenesis imperfecta), as well as people with osteogenesis imperfecta. It asked about health, daily life, treatments, and the costs of care. The survey also looked at how often caregivers missed work and how much they spent on healthcare costs like travel and medication. Of 528 caregivers, 64% were employed. Half of them missed work in the last month, averaging 1.9 days off in 4 weeks. Caregivers reported spending an average of €209 on healthcare in the previous 4 weeks, with the most spent on travel to medical appointments (€83) and medicine (€46). Caregiver spending varied by country, with those in the USA spending more (€334) compared with Europe and Nordic countries (€33–163). The survey found that factors like the caregiver’s age, employment status, and the person they care for (e.g. their age and how often they fracture) impacted how much their work and finances were affected. The results show that caregiving for someone with osteogenesis imperfecta can impact both a caregiver’s job and finances.
15. Participatory Design Approach in the Use of Scenario Analysis for Futureproofing Medical Education: Case Study.
期刊: Journal of medical Internet research 发表日期: 2025-Sep-23 链接: PubMed
摘要
Medical education must evolve to prepare health care professionals for a rapidly changing world. Beyond digital literacy, clinicians must develop new competencies to navigate global megatrends, including shifting disease burden, technological advancements, climate change, and demographic shifts. The future job market will introduce novel roles, and educational institutions must remain adaptable to meet the evolving motivations and expectations of students. Megatrends, broad, transformative forces shaping societies, present both challenges and opportunities for health care education. The present work seeks to understand the implications of megatrends for medical education and explore the use of scenario analysis for curriculum design. A participatory design approach was employed to conduct a scenario analysis workshop at Trinity College Dublin’s School of Medicine in October 2024. Digital connectivity and climate change were selected as key drivers. Participants included medical educators, policymakers, clinicians, and students. Interactive methods such as group discussions, structured boards, and physical cards were utilized to facilitate data collection. Insights were analyzed thematically to identify critical competencies, mindsets, and structural requirements for future medical education. The scenario analysis revealed key competencies and mindsets necessary for future health care professionals. Essential competencies included complex adaptive systems thinking, patient-centeredness, continuous learning, and participatory health, while essential mindsets encompassed sustainability, prevention-focused care, and technological adaptability. Cross-scenario reflections highlighted the increasing need for interdisciplinary collaboration, ethical leadership, and curriculum flexibility. Actionable steps were identified, including integrating sustainability and digital health into curricula, fostering emotional intelligence in student selection, and incorporating adaptive learning models. This study demonstrates the value of participatory design in shaping medical education to align with global megatrends. The findings align with existing foresight research by organizations such as the World Health Organization and the European Commission, emphasizing the need for health care professionals to balance technological proficiency with human-centered care. While the study was limited to a single institutional setting, its insights provide a framework for other medical schools to anticipate future challenges and proactively reform curricula. Future research should explore multi-institutional applications and longitudinal studies to validate these findings.
16. Home-Based Exercise to Improve Functional Outcomes in Veterans With a Recently Healed Diabetic Foot Ulcer: Protocol for a Pilot Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Sep-23 链接: PubMed
摘要
Foot ulcers are a common complication of diabetes, often resulting from peripheral neuropathy and inadvertent trauma. Poor healing is exacerbated by peripheral arterial disease and poor glycemic control. Off-loading, a key treatment, leads to prolonged immobility. Patients rarely regain baseline mobility. Mobility is crucial to improve glycemia, promote vascular health, and improve immobility as it leads to nursing home admissions. There is limited research on exercise during ulcer remission. This pilot study will assess the feasibility and acceptability of a home-based exercise regimen aimed at safely increasing mobility and function, focusing on improving lower extremity strength, tissue perfusion, and glycemic control. Veterans aged ≥50 years with a recently healed diabetic plantar foot ulcer receiving care in the US Department of Veterans Affairs (VA) Maryland Health Care System and enrolled in a remote temperature-sensing mat program will be eligible. Potential participants will be identified via administrative codes used for the Prevention of Amputation in Veterans Everywhere directive, as well as using the VA’s Podimetrics SmartMat dashboard. In this pilot study, 25 veterans will be randomized (in a 3:1 ratio) to a 12-week home-based exercise regimen or standard of care. Participants will undergo tests for gait speed, knee extension strength, cutaneous perfusion, and community mobility. The intervention group will participate in internet-based videoconference exercise classes twice a week led by the study team and home cycling 3 times a week. The control group will receive standard-of-care guidance. Outcome measures will include feasibility; acceptability; and changes in gait speed, physical activity levels, and strength. This study was funded on July 1, 2024, with data collection planned from October 1, 2024, to March 31, 2026. The protocol was approved by the University of Maryland Institutional Review Board on May 13, 2024, and by the Baltimore VA Research and Development Committee on June 13, 2024. As of June 12, 2025, 12 participants have been enrolled in the study, and 6 (50%) participants have been randomized. Recruitment is expected to continue through December 2025. This project has potential for clinical rehabilitation translation. If it is found to be feasible and acceptable, the exercise intervention will be tested in a future multisite randomized clinical trial to assess its impact on mobility, cardiovascular events, and ulcer recurrence. ClinicalTrials.gov NCT06312579; https://clinicaltrials.gov/ct2/show/NCT06312579. DERR1-10.2196/71237.
17. Impact of Age on Aortic Valve Calcium Progression and Risk for Aortic Stenosis: Multi-Ethnic Study of Atherosclerosis.
期刊: European heart journal. Cardiovascular Imaging 发表日期: 2025-Sep-23 链接: PubMed
摘要
Aortic valve calcium (AVC) is strongly associated with the risk for severe aortic stenosis (AS). The prevalence of AVC increases with age, but the impact of age on the progression of AVC and its association with moderate-severe AS is unknown. Our study included 6,810 participants (52.9% women) without overt cardiovascular disease between ages 45 and 84 from the Multi-Ethnic Study of Atherosclerosis. AVC was measured using non-contrast cardiac CT at Visit 1. Progression was calculated as the change in AVC divided by years between CT scans (2-10 years). Incident moderate-severe AS was adjudicated using medical chart review and echocardiogram data from Visit 6 (median follow-up of 16 years). The association between AVC and moderate-severe AS was assessed using multivariable adjusted Cox proportional hazards ratios. There were 5,899 participants with AVC =0 and 911 with AVC >0. There were 3,834 participants age <65 years and 2,979 age ≥65 years. The median AVC was 34.1 AU (IQR 13-1,113) for participants <65 versus 69.0 AU (IQR 23-2,453) for participants ≥65. Participants <65 and ≥65 years had no significant difference in median annualized AVC progression within the baseline AVC categories of 1-99 (10 versus 12 AU/year, p=0.303) and AVC ≥100 (50 versus 47 AU/year, p=0.846). AVC >0 was associated with a similar significantly higher risk of incident moderate-severe AS for both younger (HR 13.37; 95% CI 5.67-31.52) and older participants (HR 10.59, 95% CI 6.77-16.56). AVC progression was significantly associated with baseline AVC burden and was similar for younger versus older persons after accounting for baseline AVC. The presence of AVC was significantly associated with a higher long-term risk for moderate-severe AS among both younger and older participants.
18. Causal Links Between Psychiatric Disorders, Sleep Apnea, and Oral and Maxillofacial Diseases Modules: A Mendelian Randomization Study.
期刊: The Journal of craniofacial surgery 发表日期: 2025-Sep-23 链接: PubMed
摘要
The impact of psychiatric disorders on oral/maxillofacial diseases through sleep apnea syndrome (SAS) remains incompletely understood. Using bidirectional and multivariable Mendelian randomization (MR), this study aimed to investigate potential causal links between psychiatric disorders, SAS, and oral/maxillofacial diseases, while assessing the mediating role of SAS. The authors analyzed genome-wide association study (GWAS) summary statistics using univariable MR to evaluate whether genetically predicted psychiatric disorders influence oral/maxillofacial manifestations; bidirectional MR and mediation MR were used to determine causal directionality and mediation effects. Univariable MR revealed that major depressive disorder increased risks of dentofacial anomalies (OR=1.25, 95% CI: 1.06-1.48, P=0.007), temporomandibular disorders (TMD) (OR=1.54, P=8×10-5), and temporomandibular muscle pain (OR=1.52, P=0.0008); post-traumatic stress disorder elevated risks of dentofacial anomalies (OR=1.07, P=0.02) and TMD (OR=1.09, P=0.04); autism spectrum disorder was associated with temporomandibular muscle pain (OR=8.10, P=0.008). Bidirectional MR confirmed mutual causation between SAS and dentofacial anomalies. Mediation analysis estimated SAS mediated 21.5% (95% CI: 13.1%-31.2%) of the effect of major depressive disorder on dentofacial anomalies. Psychiatric disorders exert causal effects on oral/maxillofacial diseases, partially mediated by SAS; these results highlight SAS as a mediator between psychiatric disorders and oral/maxillofacial diseases and underscore its bidirectional causality with dentofacial anomalies, suggesting novel targets for preventive interventions.
19. "Lipidogram for a first-grade student" - screening for premature cardiovascular risk factors in children of Zabrze, Poland.
期刊: European journal of preventive cardiology 发表日期: 2025-Sep-23 链接: PubMed
摘要
20. Fortilin Binds IRE1β to Facilitate Mucin 5AC Expression via the IRE1β/XBP1 Signaling Pathway.
期刊: American journal of respiratory cell and molecular biology 发表日期: 2025-Sep-23 链接: PubMed
摘要
Airway mucus is a complex process influenced by various factors and signaling pathways. A key player is mammalian inositol-requiring enzyme 1 beta (IRE1β), a paralog of IRE1 alpha (IRE1α), found only in epithelial cells lining the mucosal surfaces of the gastrointestinal and respiratory tracts. IRE1β processes X-box binding protein 1 (XBP1) mRNA via its endoribonuclease (RNase) domain, generating the active XBP1 spliced form (XBP1s). XBP1s is crucial for mucin production, the main components of mucus. IRE1β is upregulated in human bronchial epithelial (HBE) cells from individuals with cystic fibrosis and asthma. Fortilin binds to IRE1α, blocking its kinase/RNase functions and preventing cell death. However, the interaction between fortilin and IRE1β, and its effects on airway mucus under basal conditions, remain unknown. We investigate whether fortilin binds IRE1β, regulates its RNase activity, and is associated with IRE1β-mediated mucin production. We find that fortilin binds to the cytosolic domain of IRE1β, significantly increasing its RNase and kinase activities. Furthermore, fortilin depletion significantly attenuates mucin 5 AC (MUC5AC) expression by reducing XBP1 splicing and AKT phosphorylation in differentiated HBE cells under air-liquid interface culture (ALI-HBE cells). IRE1 inhibitor KIRA8 blunts IRE1β kinase/RNase activities in ALI-HBE cells, inhibiting both XBP1 splicing and AKT phosphorylation regardless of fortilin presence. These data suggest that fortilin promotes IRE1β-mediated MUC5AC expression primarily via the IRE1β/XBP1 signaling pathway. The IRE1β-fortilin complex holds promise for developing innovative therapies to regulate mucin production in conditions characterized by airway mucus hypersecretion, including chronic obstructive pulmonary disease, asthma, bronchiectasis, and cystic fibrosis.
21. The Effectiveness of Isoniazid Preventive Treatment among Contacts of Multidrug-Resistant Tuberculosis: A Systematic Review and Individual-Participant Meta-Analysis.
期刊: American journal of respiratory and critical care medicine 发表日期: 2025-Sep-23 链接: PubMed
摘要
Recent empirical research suggests isoniazid may lead to a risk reduction of incident tuberculosis among close tuberculosis contacts of multi-drug resistant (MDR) tuberculosis. To evaluate the association between isoniazid tuberculosis preventive treatment (TPT), compared to no treatment, upon incident tuberculosis in household contacts of MDR tuberculosis cases using a large global consortium of tuberculosis contact tracing studies. We conducted a systematic review and individual-participant meta-analysis among observational studies of household contact tracing studies. Participants were included if they were exposed to someone with MDR-tuberculosis and were given either 6 months of isoniazid TPT or no TPT. Our primary outcome was incident tuberculosis in contacts exposed to tuberculosis. We derived adjusted hazard ratios (aHRs) using mixed-effects, multivariable survival regression models with study-level random effects. The effectiveness of isoniazid TPT against incident tuberculosis was estimated through propensity score matching. We stratified our results by contact age, background tuberculosis burden, and Mycobacterium tuberculosis infection status. We included participant-level data from 6,668 contacts exposed to multidrug-resistant tuberculosis from 17 countries. The effectiveness of isoniazid TPT against incident tuberculosis in contacts of multidrug-resistant tuberculosis was 57% (aHR, 0.43; 95% CI, 0.26-0.71) and did not appreciably change with adjustment for additional potential confounders. The reduction in incident tuberculosis was marginally greater among child (<20 years old) contacts (0.51; 95% CI, 0.28-0.92) compared to adult contacts (0.69; 95% CI, 0.22-2.20). The reduction in incidence was 73% (0.27; 95% CI, 0.11-0.70) in the first year of follow-up; effectiveness dropped to 60% (0.40; 95% CI, 0.15-1.06) from 12-23 months of follow-up and was non-significant after two years (28% effectiveness; 0.72; 95% CI, 0.33-1.54). Among over 6,500 contacts of MDR-tuberculosis, isoniazid TPT was highly effective in preventing incident tuberculosis. The reduction was greatest in high-burden countries and waned after 2 years of follow-up.
22. Clinical Utility of Early Intervention Including the 5-Step Precision Medicine Method in First-Episode Psychosis: Protocol for a Cohort Study With Nested Economic and Process Evaluations.
期刊: JMIR research protocols 发表日期: 2025-Sep-23 链接: PubMed
摘要
Psychotic disorders such as schizophrenia present a significant challenge to health care systems due to their high disability rates and treatment costs. With discontinuation rates for antipsychotics reaching over 40% in the first year and 80% after 3 years, it is crucial to tailor antipsychotic selection and dosing early in treatment. Personalized precision psychiatry, underpinned by pharmacogenetics, holds considerable potential in individualizing antipsychotic treatment for patients with first-episode psychosis. An internationally pioneering method called 5-step precision medicine (5SPM) focuses on the application of pharmacogenetics to clinical practice. The recently launched Prevention and Early Intervention in Mental Health (PRINT) program in Salamanca, Spain, integrates this method to enhance early intervention for adolescents and young people with first-episode psychosis. The Clinical Utility of Early Intervention Including the 5SPM Method in First-Episode Psychosis (CLUMP) project aims to explore whether an early intervention model of personalized precision psychiatry including pharmacogenetics improves adherence to antipsychotic medicines and, therefore, clinical and functional outcomes in young people experiencing the first episode of a psychotic illness. To achieve our objectives, we shall compare adherence to the first prescribed antipsychotic medication and clinical and functional outcomes between patients with first-episode psychosis. We shall compare 2 cohorts: cohort 1 will receive the recently introduced PRINT program including the 5SPM method, and cohort 2 will have received standard care provided by mental health services before the PRINT program implementation. The primary outcome to measure treatment adherence will be all-cause discontinuation proportions during the 1-year follow-up. Secondary outcome measures will include pragmatic efficacy, tolerability, and functional outcome measures. For additional comparative purposes, we shall analyze the environmental, clinical, and pharmacogenetic information of patients with psychotic disorders of more than 5 years of evolution and with other mental disorders whose data are currently stored and have been ethically approved for research use. A total of 300 patients will be included in the study. Analyses will include descriptive statistics, comparison tests, Kaplan-Meier survival curves, multivariate log rank tests, qualitative analysis, and cost-benefit evaluation. Ethics approval was obtained in June 2023. Recruitment for the CLUMP project began in January 2025, and enrollment for cohort 1 will continue until May 2026. All data collection is expected to be completed by June 2027. Data analyses are estimated to take approximately 6 months. The project is scheduled to conclude in December 2027. The CLUMP project is set to provide the first clear blueprint for implementing and evaluating the impact of personalized precision psychiatry based on pharmacogenetics in the context of early intervention programs for the benefit of young people experiencing the first episode of a severe mental illness such as schizophrenia. DERR1-10.2196/74408.
23. Factors governing individual response to ionizing radiation and risk of diseases of the circulatory system: human epidemiological studies.
期刊: International journal of radiation biology 发表日期: 2025-Sep-23 链接: PubMed
摘要
Purpose: Growing evidence from the Japanese atomic bomb survivors, and occupationally and medically exposed groups indicates that ionizing radiation could increase the risk of various diseases of the circulatory system (DCS), even at low levels of exposure. As radiation protection systems increasingly consider the possibility of individualized radiation protection, better understanding is needed of the factors that may impact radiation-related risk, whether intrinsic (such as age, sex or genetics), or extrinsic (such as smoking). Here, we comprehensively review potential effect modification of radiation exposure and the risk of DCS in medical, occupational and environmental settings.Conclusion: Several studies indicate potential effect modification, usually detrimental, with use of anthracycline in medical settings. There was some indication that younger age at exposure increased risk for various DCS outcomes, but this was less consistent across studies and settings. Interpretation of the data is complicated by considerations of statistical power, differences in specific disease outcomes, and narrow ranges of exposure and/or potential modifiers within studies. Future studies with well-defined exposure over a wide range of ages, along with biological samples, are required to better inform the nature of these interactions.
24. Bioleaching of different types of metals by Exiguobacterium himgiriensis isolated from printed circuit board.
期刊: Environmental technology 发表日期: 2025-Sep-23 链接: PubMed
摘要
The ubiquity of electronic devices has made them indispensable in daily life. Nevertheless, this high priority leads to a surge in electronic waste, or e-waste, which is extremely dangerous for the environment and human health. E-waste contributes to environmental pollution and threatens ecosystems and human health. Management of recycling methods and efficient e-waste is crucial to lower these dangers. Traditional recycling techniques are effective, but often release harmful pollutants. The present study has attempted to use the metal-resistant Exiguobacterium himgiriensis isolated from e-waste, such as the Printed Circuit Board (PCB), to investigate its efficiency in removing heavy metals from these substrates. By using ICP-OES, it has been found that this species of bacterium recovered different types of metals (Co 84.67%, Ni 83.25%, Pb 80.17%, Cu 80.06%, Zn 76.71%, Al 76.13%, Fe 71.74%, and Ag 64.97% respectively) within 5 days under laboratory conditions. Detecting structural and functional group changes in the control PCB and bioleached residue by the FT-IR, FE-SEM, EDS, and XRD techniques confirms the evidence of bioleaching. Bacteria can increase their dissolving capacity and decrease surface tension by chemically changing metals. E. himgiriensis bioleaches PCB samples for 5 days, resulting in rougher, uneven surfaces with fractures and fissures. FT-IR spectroscopy reveals the bacterium’s impact on metals, particularly Si, O, and Fe. This study could help reduce environmental pollution and health risks associated with e-waste by developing an economical and environmentally friendly method for bioleaching different metals in PCB.
25. Repeated gonadotropin stimulation modulates the expression of specific proteins in mouse oviduct.
期刊: JBRA assisted reproduction 发表日期: 2025-Sep-23 链接: PubMed
摘要
Superovulation protocol modifies the oviductal site-specific expression of some proteins regulating cell cycle and oxidative stress response. Swiss CD1 female mice (n=24) were sorted into 2 groups: one was used as control (Ctr, n=10), the other consisted of mice undergoing 8 Rounds (8R) of repeated gonadotropin stimulation (n=14). After their removal, oviducts were cut into two portions: one including Infundibulum and Ampulla (If-Am), and the rest including Isthmus (Is). Both portions were separately used to assess the expression levels of oviductal proteins regulating cell cycle and oxidative stress response. Statistical analysis employed t-test with significance at p<0.05. In Ctr mice, superoxide dismutases 1 and 2 were significantly more expressed in the If-Am, while phospho-p53, glutathione peroxidase 1 and estrogen receptor beta mainly in the Is. Conversely, catalase, cleaved-caspase 3, estrogen alpha and progesterone receptors were similarly distributed across the oviduct. After 8R, glutathione peroxidase 1 and superoxide dismutase 1 increased in both segments, superoxide dismutase 2 and cleaved-caspase 3 increased mainly in If-Am, while catalase and phosphorylated p53 mainly in Is. Estrogen alpha/beta and progesterone receptors levels remained unchanged. Altogether, these results demonstrated that in the mouse oviduct many proteins were expressed in a site-specific manner and that repeated gonadotropin stimulation could modulate their expression levels. These data suggest that different localization of proteins between Infundibulum-Ampulla and Isthmus regions is fundamental for creating a suitable microenvironment for embryo development.
26. Exercise, Novelty and Ageing.
期刊: European journal of preventive cardiology 发表日期: 2025-Sep-23 链接: PubMed
摘要
27. Anti-inflammatory cytokine profile and Jarisch-Herxheimer reaction in Leptospirosis patients: A prospective case-series study in New Caledonia.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Sep-23 链接: PubMed
摘要
Leptospirosis is a neglected zoonosis. This spirochetal disease is common in tropical countries where rainfall and poor sanitation facilitate skin contact with environmental Leptospira shed in animal urine. Antibiotics are effective against spirochetes, although a harmful Jarisch-Herxheimer (JHR) reaction can occur within hours of treatment, with the onset of chills, fever and/or hypotension. However, the awareness and incidence of JHR in leptospirosis are poorly understood. This prospective observational study enrolled 81 patients diagnosed with leptospirosis from four hospitals in New Caledonia between 2021 and 2024. To evaluate the patients’ inflammatory status and identify risk factors for JHR, we collected data on clinical, socioeconomic, and biological factors (including blood cytokine levels) at admission and during the hours following treatment with different regimens of β-lactam antibiotics. The majority of the cohort were middle-aged men, most of them Melanesian farmers. They exhibited high levels of C-reactive protein (CRP), neutrophilia, thrombocytopenia, and elevated biochemical markers indicative of liver and kidney dysfunction, which are typical of leptospirosis. Unexpectedly, pro-inflammatory cytokine levels were low or undetectable upon admission, while high levels of the anti-inflammatory cytokine IL-10 were measured. After antibiotherapy, increased levels of the pro-inflammatory cytokines TNF and IL-6, as well as IL-10 were observed. Strikingly, there was no increase in IL-1ß, the main player in the “cytokine storm”. JHR, identified with a new clinical score, occurred in 48% (possibly 61%) of patients and was associated with higher cytokine levels, as expected. This study confirms the stealth nature of leptospires, which induce a potent anti-inflammatory response rather than inflammation. It calls into question both the cytokine storm hypothesis, which is often cited in leptospirosis and the use of immunosuppressive drugs. The high incidence of JHR in New Caledonia suggests that the systematic use of ß-lactams as a first-line treatment should be reevaluated.
28. Airway Epithelial Heterogeneity and Mucus Plugging in Asthmatic Bronchioles.
期刊: American journal of respiratory and critical care medicine 发表日期: 2025-Sep-23 链接: PubMed
摘要
Bronchiolar dysfunction is associated with asthma exacerbations and poor symptom control. However, the molecular pathophysiology of asthmatic bronchiolar disease is poorly defined. Test the hypothesis that asthmatic bronchioles exhibit disturbances in epithelial biology that produce MUC5AC-dominated mucus plugs. Peripheral lung tissues from severe asthmatics, fatal asthmatics (FA), and controls were evaluated with histology, RNA in situ hybridization, and immunohistochemistry. Isolated bronchiolar and bronchial basal cell responses to IL13 were compared in culture. Spatial transcriptomics and multiplex immunophenotyping were performed on excised tissue sections. In excised tissues, severe and FA bronchiolar epithelia, depleted of distal airway secretory cells (DASCs) and enriched in MUC5AC goblet cells, circumscribed MUC5AC-dominated mucus plugs. In cultured bronchiolar basal cells, IL13 suppressed FOXA2 and DASC gene signatures and upregulated MUC5AC expression. Additional studies in severe and FA excised tissues demonstrated that bronchiolar epithelia were populated by MUC5AC-expressing goblet cell niches heterogeneously distributed within single segments and, indeed, individual bronchioles. Spatial transcriptomics and immuno-proteomics of these MUC5AC-expressing bronchiolar niches identified increased goblet, suprabasal (SERPINB3), and basal cell, juxtaposed to a loss of DASC, gene signatures. MUC5AC-high niche bronchiolar basal cells expressed reduced FOXA2 and elevated type-2 inflammatory (T2) gene signatures. Immune cell distributions surrounding asthmatic bronchioles differed from controls but did not correlate with MUC5AC-high niches. Asthmatic bronchioles exhibit a T2-driven proximalization associated with mucus plugging. MUC5AC-high niches were identified heterogeneously in bronchiolar epithelia independent of immune cell localizations, suggesting asthmatic bronchioles contain cellular niches which perpetuate T2-initiated epithelial remodeling.
29. Evaluating the protective effect of public open space on social connectedness: evidence from a natural experiment cohort study in three Canadian cities.
期刊: Health & place 发表日期: 2025-Sep-22 链接: PubMed
摘要
Community design has the potential to address urban isolation and loneliness at a population level, but limited research on the causal effects of the built environment constrains evidence-based action in cities. This study examined the effect of public open space on changes in social connectedness among adults (n = 665) during the COVID-19 pandemic, using geospatial data from OpenStreetMap and health survey data from three cities (Montréal, Saskatoon, and Vancouver). Treating the pandemic as a natural experiment, we used multilevel models to analyze whether public open space exposure (defined as the ratio of land area within 500m of home) modified changes in community belonging, loneliness, and neighbouring from 2018 to 2020/2021. First, we found little evidence of changes in social connectedness in our cohort overall and within subgroups. On average, loneliness increased slightly, and belonging and neighbouring remained stable. Second, we found that higher public open space exposure (≥10 % neighbourhood land area) had a modest protective effect on community belonging only (0.14, 95 % CI = 0.01 to 0.27). These findings add to a limited but growing evidence base on the role of the built environment in shaping social connectedness, while highlighting challenges involved in examining causal impacts. As cities invest in public open space to support policy goals around sustainability and livability, evaluating co-benefits for social connectedness are critical opportunities for strengthening the evidence on built environment solutions to social isolation and loneliness.
30. A comparison of HIV pre-exposure prophylaxis accessibility by public transit- and drive-time in Dallas-Fort Worth, Texas, 2024.
期刊: Health & place 发表日期: 2025-Sep-22 链接: PubMed
摘要
31. Climate change-induced heatwaves in Nigeria: Causes, challenges, and adaptive strategies.
期刊: Journal of environmental management 发表日期: 2025-Sep-22 链接: PubMed
摘要
Heatwave issues is a major environmental concern in Nigeria. This study examines the increasing issues associated with climate change-related heatwaves, focusing on Nigeria. Considering the geographical vulnerability, socioeconomic, rapid urbanisation, infrastructure, and policy implementation deficit factors linked to Nigeria, this study aims to provide insight into the effects of prolonged high temperatures on the environment, human health, agriculture, infrastructure, economic stability, and the ecosystem. Relevant weather data and climate trends from 1980 to 2099 were collected from Scopus, web of science, google scholar, Research gate, PubMed, Nigerian Meteorological Agency (NiMet), and the World Bank databases for review. This study used the standard, systematic and bibliographic review of literature to which followed the Preferred Reporting Items Systematic Review and Meta-Analysis (PRISMA) method to analyse the retrieved literatures. The research reveals that the challenges associated with high-intensity heat events include severe health risks, increased mortality from heat-related illnesses, reduced productivity (agriculture and labour outputs), water scarcity, strain on energy resources, and socio-economic inequalities. The health risks include heat exhaustion, dehydration and cardiovascular complications. The most significant risk bearers are the vulnerable populations (children, the elderly, and low-income earners). Both short and long-term remedial actions are required to lessen the negative effects of heatwaves, including early warning systems, provision of healthcare services for vulnerable populations and providing heat-resilient infrastructure, afforestation, reforestation programs and promoting sustainable energy solutions to reduce reliance on fossil fuels.
32. Preimplementation expectations and perceptions of a preoperative frailty screening and optimization intervention: A qualitative analysis.
期刊: Surgery 发表日期: 2025-Sep-22 链接: PubMed
摘要
Patients with frailty face greater postoperative mortality and adverse outcomes. However, evidence regarding interventions for mitigating the risks associated with frailty is lacking. The PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery trial is an ongoing stepped-wedge cluster randomized Hybrid Type-1 clinical effectiveness-implementation trial on frailty screening and multidisciplinary optimization in Veterans Affairs medical centers. We sought to identify systemic and individual-level factors influencing the implementation of the intervention in order to tailor it to local contexts and improve implementation. This qualitative analysis summarizes the findings of our preimplementation formative evaluation of the PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery trial. The trial implementation and analysis were determined by the Consolidated Framework of Implementation Research. We conducted individual interviews and focus groups with Veterans Affairs surgical chiefs and other stakeholder providers at 3 participating sites. Our analytic approach relied on team-based thematic analysis with a dual coding review (Krippendorf α = .92). Among 28 interviews and 6 focus groups, innovation, setting, and implementation were the 3 most relevant Consolidated Framework of Implementation Research domains. Participants valued the multidisciplinary format and envisioned many positive impacts of the frailty screening and optimization intervention. However, concerns arose around the intervention’s relative advantage over the current process and compatibility with current workflow, staffing, and resources. Participants made recommendations to address barriers, which varied by local context and specialty. Although providers supported the PAtient-centered mUltidiSciplinary care for vEterans undergoing surgery intervention and its purpose, local logistical barriers and site/specialty-specific contextual factors were identified through formative evaluation that would influence uptake of the intervention. Our study supports the use of a preimplementation formative evaluation to inform adaptations for complex trial designs.
33. Global and regional burden of inguinal, femoral, and abdominal hernia among older population: Findings from Global Burden of Disease database.
期刊: Surgery 发表日期: 2025-Sep-22 链接: PubMed
摘要
This study aimed to assess the global and regional burden of inguinal, femoral, and abdominal hernia among individuals aged 60 years and above from 1990 to 2021, using data from the Global Burden of Disease 2021 database. The analysis focused on incidence, prevalence, death, and disability-adjusted life years, with a detailed examination of age, sex, and regional disparities. We conducted a cross-sectional analysis of the Global Burden of Disease 2021 database, extracting data on incidence, prevalence, death, and disability-adjusted life years for inguinal, femoral, and abdominal hernia among individuals aged 60 years and above. Age-standardized rates were calculated, and temporal trends from 1990 to 2021 were quantified using estimated annual percentage change. Regional variations were explored across 204 countries and territories, and sociodemographic index regions. Age-period-cohort analysis was used to identify temporal trends, whereas Bayesian age-period-cohort modeling provided projections through 2050. In 2021, an estimated 36,877 deaths (95% uncertainty interval: 31,269-43,197) occurred because of inguinal, femoral, and abdominal hernia globally among individuals aged 60 years and above, with an age-standardized death rate of 3.62 (95% uncertainty interval: 3.06-4.23) per 100,000 population, declining by -1.72% (95% confidence interval: -1.88 to -1.55) annually. Disability-adjusted life years reached 811,296 (95% uncertainty interval: 683,554-970,553), with an age-standardized disability-adjusted life year rate of 76.23 (95% uncertainty interval: 64.26-91.00) per 100,000, declining by -1.76% (95% confidence interval: -1.88 to -1.64) annually. Incidence rose from 943,797 (95% uncertainty interval: 597,192-1,401,851) in 1990 to 1,480,996 (95% uncertainty interval: 939,275-2,168,972) in 2021, with a slight annual decline in age-standardized incidence rate (-0.84% [95% confidence interval: -1.02 to -0.67]). Prevalence increased from 2,519,472 (95% uncertainty interval: 1,852,442-3,287,447) in 1990 to 3,616,357 (95% uncertainty interval: 2,610,365-4,812,502) in 2021. Regional disparities were evident, with the highest burden observed in South Asia and Central Europe. Bayesian age-period-cohort model projections indicated a continued rise in absolute burden by 2050, despite declining age-standardized rates for most metrics except incidence. The global burden of inguinal, femoral, and abdominal hernia among individuals aged 60 years and above remains substantial, with significant regional disparities. While absolute numbers are projected to rise, age-standardized rates are expected to decline, except for incidence. These findings underscore the need for targeted prevention and optimized health care strategies for older populations globally.
34. Healthcare access and utilization of deep brain stimulation and supplementary care in black and white patients with Parkinson's disease.
期刊: Parkinsonism & related disorders 发表日期: 2025-Sep-21 链接: PubMed
摘要
Information comparing healthcare access and utilization between Black and White patients with Parkinson’s disease (PD), particularly for deep brain stimulation (DBS) and supplementary care, remains sparse due to the lack of large Black population in a majority of healthcare facilities and limited scope of information in electronic datasets. We hypothesized that Black PD patients are less likely to have implantation for DBS due to many reasons, including ones not explored yet such as a lower likelihood of being assessed for DBS and/or acceptance for DBS when indicated, but more likely to have supplementary care. We searched electronic medical records in our tertiary center between January 1, 2006 and October 1, 2021, followed by chart reviewing and extracting demographics, socioeconomic status, comorbidities, and healthcare access and utilization, including medications, DBS and supplementary care. Of 2827 patients in records, 1211 were assessed by movement neurologists here, who verified the diagnosis in 882 of them (72.8 %). We included 846 patients (95.9 %) (Black/White 255/591) with needed information for analysis. Compared to White patients, Black patients lacked male predominance, had lower socioeconomic status, more comorbidities, and frequent care in emergency/inpatient settings. There was no difference in overall medication use, but Black patients were less likely to have implantation and evaluation for DBS, and to accept DBS when indicated, and more likely to have supplementary care. Black patients are less likely to have DBS implantation, evaluation, and acceptance but more likely to have supplementary care compared to White patients. These new findings could help improve healthcare.
35. A microfluidic paper-based analytical device for the determination of zinc(II) in children's urine samples and food zinc supplement solutions.
期刊: Talanta 发表日期: 2025-Sep-17 链接: PubMed
摘要
In this work, an innovative microfluidic paper-based analytical device (μPAD) was developed for the quantification of zinc(II) in biological samples of non-invasive collection, namely children’s urine. Zinc(II) in urine can be considered a biomarker of children’s psychological development and mental conditions, as well as indicative of urinary tract diseases. The developed device is based on the colourimetric reaction between zinc and dithizone in an alkaline medium and is described as a simple, low-cost method with potential on-site applications. The colour reaction takes about 5 min, and the resulting signal remains stable for 30 min. It enables the quantification of zinc(II) within the dynamic range of 50.0-750 μg/L, with a limit of detection (LOD) of 10 μg/L and a limit of quantification (LOQ) of 34 μg/L. After the device’s assembly, it remains stable for use for up to one week when stored at room temperature, either in air or vacuum conditions. The method validation was performed by comparing the results obtained using the μPAD with those from atomic absorption spectrometry (AAS), where urine samples were analysed directly, or diluted (1:2) when necessary. The developed μPAD offers a user-friendly, portable, and cost-effective approach for the monitoring of zinc(II) levels in children’s urine, providing point-of-care analysis in clinical diagnostics and public health monitoring.
36. More Than Moderation: A New Era in Oncology Health Promotion.
期刊: Clinical journal of oncology nursing 发表日期: 2025-Sep-17 链接: PubMed
摘要
As professionals grounded in evidence, we have a spurring opportunity to align our personal and professional lives with what we now know: There is no safe level of alcohol when it comes to cancer risk. We can lead by reassess.
37. "It's soul destroying to be honest": A qualitative study of morally uninhabitable working environments and the responsibilization of healthcare professionals working in concurrent disorders.
期刊: Social science & medicine (1982) 发表日期: 2025-Sep-13 链接: PubMed
摘要
Healthcare professionals’ wellbeing is crucial for healthcare system functioning and population health. Prolonged moral distress may result in burnout, undermining healthcare professionals’ wellbeing, negatively impacting quality of patient care, and resulting in considerable healthcare system costs. We conducted 36 interviews with healthcare professionals working with patients with concurrent mental and substance use disorders in British Columbia, Canada, exploring their perceptions of the institutional constraints which shaped their experiences and caring practices. We conducted a reflexive thematic analysis of the interviews guided by the theoretical concept of responsibilization. While most participants found their work rewarding, many encountered institutional constraints which limited their ability to provide the standard of care to which they felt morally and ethically obligated. Prolonged exposure to such morally uninhabitable working environments resulted in participants’ moral distress and burnout. Central to participants’ narratives was the role of responsibilization in both contributing to and exacerbating moral distress and burnout. On top of their caring duties, participants perceived a need to over-function to offset institutional constraints within healthcare, and address their and their colleagues’ moral distress and burnout without adequate institutional support. Findings demonstrate how individual-centered interventions are inadequate without proper institutional support, and have the potential to re-enact rather than rectify moral distress and burnout. Structural interventions are paramount to redress these occupational harms and protect healthcare professionals’ wellbeing.
38. Attuning to uncertainty: Enacting health in platformised taxicab driving.
期刊: Social science & medicine (1982) 发表日期: 2025-Sep-09 链接: PubMed
摘要
Increasing use of digital platforms for coordinating and organising work processes has drawn research interest in and policy concern about conditions of labour and employment in global and local contexts. Studies of platform work consistently associate it with work insecurity, unpredictability, low wages, and income insecurity. Such conditions have also been directly linked to experiencing poor health, including stress, depression, and anxiety. Drawing on ethnographic fieldwork with taxi and private hire drivers in the North East of England, we outline a practice-based thematic map of how these workers experience, understand and relate between different stressor conditions in their daily working lives. Comparing across different types of taxicab driving in our data, we identify how, in a traditionally ‘unhealthy’ occupation, the configuration of stressors inhabited by these drivers has shifted in the wake of intensified forms of uncertainty brought about by platformisation, and how they attempt to pragmatically respond to these shifts. By adding an insiders’ perspective on the issue of autonomy and control, this paper provides key insights into how workers affected by platformisation navigate constraints to living healthily in uncertain conditions.
39. Premenstrual Disorders and Quality of Life in Sweden.
期刊: JAMA network open 发表日期: 2025-Sep-02 链接: PubMed
摘要
Premenstrual disorders (PMDs), including premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), are associated with significant physical and psychological burdens. However, their associations with quality of life (QOL) remain insufficiently studied, particularly with limited consideration of comorbidities and potential confounders. To assess the QOL among women with PMDs compared with women without PMDs in Sweden. This cross-sectional study included participants from the LifeGene cohort, a population-based longitudinal study with linkage to national health care registers. Participants were women aged 15 to 60 years. Data were collected from October 2009 to May 2018 and analyzed from June 2024 to January 2025. PMDs were ascertained using a modified Premenstrual Symptoms Screening Tool, supplemented by diagnoses recorded in Swedish health care registers. QOL was assessed using the EuroQol 5-Dimensions 3-Levels scale including 5 dimensions: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. The primary outcome was the total QOL score, with additional analyses excluding the anxiety or depression and pain or discomfort dimensions. Associations between PMDs and total QOL score were evaluated using linear regression models, adjusting for age, socioeconomic status, and potential confounders. Analyses were further stratified by the history of comorbidities. PMS, PMDD, and each QOL dimension were also examined separately. In this study of 17 284 women, at a mean (SD) age of 32.4 (8.1) years, 1813 women (10.5%) met the criteria for PMDs. Women with PMDs had significantly lower QOL compared with those without PMDs (mean z score difference: 0.21; 95% CI, 0.17-0.26). This association persisted in the prospective analysis (mean z score difference: 0.34; 95% CI, 0.24-0.45) or after excluding the anxiety or depression and pain or discomfort dimension. PMDD appeared to have a stronger association with reduced QOL than PMS. In the analysis of individual QOL dimensions, PMDs were strongly associated with endorsing anxiety or depression (PR, 1.31; 95% CI, 1.25-1.37) and pain or discomfort (PR, 1.14; 95% CI, 1.08-1.21). In this cross-sectional study of women in Sweden, PMDs, particularly PMDD, were significantly associated with reduced QOL, independent of potential confounders and comorbidities. These findings highlighted the need for both health care and social support to better manage the disease and improve the overall QOL of affected women.
40. Full Endoscopic Decompression Surgery for Far-Out Syndrome Via Pseudoarthrosis Formed by L5 Transverse Process and Sacral Ala: A Preliminary Outcome.
期刊: Pain physician 发表日期: 2025-Sep 链接: PubMed
摘要
Far-out syndrome (FOS) refers to the compression of the L5 nerve root in the extraforaminal region by a pseudoarthrosis formed between the L5 transverse process and the sacral ala. If conservative treatment for this condition fails, surgical intervention should be considered. This study aims to introduce a minimally invasive endoscopic technique for treating FOS via the pseudoarthrosis approach. A technical note and preliminary outcome. We retrospectively analyzed the medical history, physical examination, auxiliary examinations, and imaging data as well as the visual analog scale (VAS), Oswestry Disability Index (ODI), and Macnab scores of 5 FOS patients treated with minimally invasive endoscopic surgery at our hospital from April 2024 to July 2024. The implementation process of this surgical technique is illustrated through typical cases. We performed decompression surgery via the L5 transverse process-sacral ala pseudoarthrosis approach using full endoscopy, which successfully relieved the clinical symptoms in the 5 patients. The patients’ postoperative VAS scores were significantly lower than the preoperative scores (P = 0.041). Similarly, the postoperative ODI scores were markedly decreased (P = 0.043), and the last follow-up showed a 100% excellent rate (Macnab score). Imaging examination indicated a sufficiently expanded extraforaminal outlet, and the nerve roots were adequately decompressed. The study involved a relatively small number of samples and a short follow-up period. The full endoscopic decompression surgery via the L5 transverse process-sacral ala pseudoarthrosis approach can address the extraforaminal compression in FOS. This procedure is a feasible endoscopic surgical option that serves as a valuable supplement to the minimally invasive treatment for FOS.
41. Physician Payment Reform in Interventional Pain Management: Balancing Cost, Quality, Access, and Survival of Independent Practices.
期刊: Pain physician 发表日期: 2025-Sep 链接: PubMed
摘要
On July 14, 2025, the Centers for Medicare and Medicaid Services (CMS) released the 2026 Physician Proposed Payment Rule aimed at reducing wasteful spending, enhancing quality measures, improving chronic disease management, and protecting independent practices from systemic financial pressures that have favored large healthcare systems and plagued independent practices. The goals are admirable, but the proposed measures with uniform reductions of 2.5% in physician payments based on efficiency adjustments apply across the board to all physicians. Further, practice expense (PE) reductions of 4% to 6%, meant to apply for hospital-based physicians will inadvertently apply to independent physicians constituting 43% of the physician workforce providing services in ambulatory surgery centers (ASCs), as well as hospitals. Thus, reductions of work relative value unit (wRVU) based on efficiency adjustment of 2.5% and PE reductions of 4% to 6%, with total reductions of 7% to 9%, compromise and limit patient care by putting additional pressure on independent physicians. Further, CMS’ proposal to start Ambulatory Specialty Model (ASM) for low back pain with specialties of interventional pain management (IPM) and pain management involved. These specialties have no control over costs incurred as an overwhelming majority of patients are chronic pain patients and managed by family physicians, chiropractors, physical therapists, neurosurgeons, and others, resulting in 9% reductions, or increase in reimbursement over a period of 3 years with recurring changes of 3% each year.The proposal includes a 3.8% conversion factor (CF) payment update and increased reimbursement for office-based services, including evaluation, management, and procedures. The changes will increase reimbursement by 8% to 10% for office-based services, but they also decrease reimbursement for all procedures performed outside offices by 7% to 9%. These proposals arrive at a time when non-physician health care providers are striking for wage increase tied to inflation, and ironically, physicians have experienced repeated cuts in reimbursement with occasional stagnation, leading to 33% reduction from 2001 to 2025 in general, and 41% reductions in reimbursement for interventional pain physicians. In addition, there is an additional 2% sequester cut each year from 2011 to last until 2031, and there is a potential for 4% PAYGO cuts starting next year. Further, supply costs have increased 56% to 80% during these years. Further, despite technological advancements such as EMRs and AI, administrative burdens have intensified rather than improved. Independent physicians contend with complex prior authorizations, evolving Medicare coverage policies, growing audit risk with increased documentation and compliance demands from all payers’ sources, 30% of interventional pain physicians under audit at any time. Our data on interventional pain physicians and published data on other physicians shows that efficiency has decreased and PEs have been skyrocketing.Ironically, CMS has proposed on January 10, 2025, a 4.3% payment increase to Medicare Advantage Plans, amounting to $21 billion in 2026. To add fuel to the fire, CMS on April 7, 2025, issued a final rule of increasing on average by 5.06% from 2025 to 2026. These proposals come amid growing concerns about Medicare Advantage over payments, including $44 billion due to favorable selection, $40 billion from risk adjustment discrepancies, and $15 billion for duplicative coverage of veterans who already receive benefits through the Veterans Administration (VA). In addition, according to the Medicare Payment Advisory Commission (MedPAC), traditional Medicare beneficiaries also face higher costs, contributing an additional $198 annually, totaling roughly $13 billion per year. All of these added together, CMS is spending on Medicare Advantage over $110 billion a year.Thus, as independent practice continues to come under assault, the American Society of Interventional Pain Physicians (ASIPP) and other societies urge CMS to create a separate identifier for independent pain physicians to distinguish them from hospital-based physicians and prevent these cuts from harming independent practices. This separate but equal treatment of independent physician practices ultimately interferes with patient care.
42. Escalating Growth of Spending on Medicare Advantage Plans: Save Medicare from Insolvency and Balance the Budget.
期刊: Pain physician 发表日期: 2025-Sep 链接: PubMed
摘要
The U.S. health care system faces escalating costs and inefficiencies, with Medicare projected to reach insolvency by 2036. Despite this, Medicare Advantage (MA) plans continue to receive preferential funding, resulting in overpayments, rising patient out-of-pocket expenses and limited accountability, instead of being a tool to achieve lower spending and increase quality. Physicians endure payment cuts, sequestration, and denied services, threatening access to care. To analyze MA plans’ growth, costs, and policy implications and assess their impact on Medicare solvency, physician reimbursement, and patient care quality. A comprehensive policy and financial analysis using data from Medicare Payment Advisory Commission, Centers for Medicare and Medicaid Services, Congressional Budget Office, peer-reviewed literature, and federal reports from 1997-2025. We reviewed legislative history, financial trends, and quality metrics of Medicare and MA programs. Specific focus was placed on benchmarks, rebates, risk adjustments, favorable selection, coding intensity, and patient access barriers. Data on enrollment trends, geographic variation, and out-of-pocket costs were analyzed. MA enrollment grew from 6.9 million (16% of Medicare beneficiaries) in 2014 to 33.6 million (54%) in 2024. Payments to MA plans exceed fee-for-service (FFS) Medicare by 22%, translating to $84 billion annually, plus $15 billion in quality bonuses. Out-of-pocket maximums surged 859% since 1999, and inappropriate care denials affect 13%-18% of cases. Risk adjustment and coding practices inflate payments, undermining program sustainability. The present investigation relies on secondary data from government agencies and published literature; real-time administrative and clinical data from MA plans were unavailable due to reporting gaps. Originally intended to reduce costs, MA plans have driven higher expenditures, limited access, and increased patient burdens. Policy reforms-including alignment of MA payments with FFS Medicare, elimination of favorable selection and upcoding incentives, and enforcement of coverage requirements-are critical to preserving Medicare solvency and ensuring equitable patient care.
43. Optimizing the implementation of case-area targeted interventions during cholera outbreaks with context-specific delivery mechanisms.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Sep 链接: PubMed
摘要
Cholera, a severe fecal-oral disease, disproportionately affects the poorest communities who lack access to safe water and sanitation. Individuals living in the same household, or within a few hundred meters, of a patient are at increased risk of infection. Thus, during cholera outbreaks, targeted response strategies, such as case-area targeted interventions (CATIs), provide health (e.g., vaccination and antibiotic prophylaxis) and water, sanitation, and hygiene services for affected households and at-risk neighbors living in a defined ring. Previous research on CATIs has focused on impact and effectiveness, and less on implementation processes. As cholera outbreaks occur in diverse settings with differentiated challenges, we investigated how CATI and CATI-like mechanisms can be best used and adapted. Drawing on 43 peer-reviewed articles and gray literature sources retrieved through a narrative review, and 15 key informant interviews conducted using a snowball sampling approach, we identified 27 CATI or CATI-like experiences across 15 countries in Africa, Asia, the Caribbean, and Middle East between 2004 and 2024. Four delivery mechanisms were identified: CATI, pre-CATI, case-cluster, and health-facility-based interventions (HBI). Challenges to implementation included: delays in response; difficulty accessing populations; resource shortages to initiate, maintain, or scale up response; overwhelmed response capacity; limited skills and knowledge; low uptake and acceptance; weak coordination; poor reporting and monitoring; and sustainability concerns. Implementers adapted delivery to overcome challenges, particularly in outbreaks with high case-loads and in insecure and hard-to-reach contexts by ensuring readiness and early activation, strengthening local actors’ capacity, optimizing resources, adjusting ring sizes, and prioritizing cases. Based on these results, we developed a practitioner-centered framework to optimize programmatic implementation through context-specific delivery mechanism and ultimately decrease cholera incidence.
44. Patterns of prescription of antihypertensive medications in Poland: a one-year assessment of initiation and persistence of therapy in a nationwide population cohort.
期刊: Journal of hypertension 发表日期: 2025-Aug-20 链接: PubMed
摘要
This study assessed the prescribing patterns and treatment persistence of antihypertensive medications over a 12-month period in a nationwide cohort from Poland. We examined data on all 141 668 patients in Poland who received their first hypertension prescription in January 2021, sourced from the e-Health Centre database encompassing all filled prescriptions. Treatment persistence over the first 12 months was assessed as a measure of long-term adherence. We assessed the degree of persistence to therapy as the percentage of patients having a supply of the drug for each consecutive month until the end of follow-up. Antihypertensive therapy was started with a monotherapy in 57% of cases; 23% (21% of women and 25% of men; P < 0.001) started with a two-drug antihypertensive combination and 13% (11% of women, 17% of men; P < 0.001) with a single-pill combinations (SPCs). Only 33% of patients (29% of women, 36% of men; P < 0.001) received drug classes combinations endorsed by guidelines. Treatment persistence after 1 year exhibited significant age-related disparities - persisting in 17-53% among younger and middle-aged individuals, and 59-87% among older patients. Initiation with an SPC was associated with higher 1-year persistence. Among patients still on antihypertensive therapy at 12 months, 30% were on monotherapy, 27% on two drugs, and 43% on three or more agents. In Poland, monotherapy is the predominant first line treatment of hypertension. A substantial proportion of younger and middle-aged patients discontinue therapy within the first year. The use of SPCs at initiation is associated with an improved long-term persistence.
45. Health-Related Social Media Misinformation: Implications for the Burden of Noncommunicable Diseases in Sub-Saharan Africa.
期刊: West African journal of medicine 发表日期: 2025-Apr-30 链接: PubMed
摘要
The use of social media platforms for social and educational interactions has transformed the way information sharing takes place. However, this has also exposed the public to health-related misinformation, posing significant challenges for global health. This is particularly challenging in sub-Saharan Africa (SSA), where the burden of noncommunicable diseases (NCDs) now compounds existing challenges from communicable diseases. This review aimed to examine the growing challenge of health-related social media misinformation and the potential implications for NCD burden in SSA, and explore possible strategies for combating social media misinformation in the context of NCDs. Useful data for this review were obtained by consultation of online sources of information using search engines and online databases. Social media platforms serve various health-related purposes, including health interventions, health campaigns, medical education, disease outbreak surveillance, and behavior change. WhatsApp, Facebook, X (formerly Twitter), and YouTube are the leading platforms associated with health-related misinformation in SSA. Potential implications of health-related social media misinformation are misconceived clinical diagnosis, inappropriate self-medication and failure to adhere to evidence-based treatment modalities. Social media misinformation in the area of NCDs can potentially influence people’s health-related attitudes, behaviour and undermine appropriate implementation of evidence-based interventions. Collaboration among stake holders such as healthcare professionals, religious organizations and social media influencers, as well as public awareness campaigns and regulatory policies are plausible strategies for combating the issue. There is limited research on the implications of health-related social media misinformation on NCDs in SSA highlighting the need for further studies. L’utilisation des plateformes de médias sociaux pour les interactions sociales et éducatives a transformé la manière dont l’information est partagée. Cependant, cela a également exposé le public à des informations erronées liées à la santé, ce qui pose des défis majeurs pour la santé mondiale. Cette situation est particulièrement préoccupante en Afrique subsaharienne (ASS), où la charge des maladies non transmissibles (MNT) s’ajoute aux défis existants liés aux maladies transmissibles. Cette revue vise à examiner le défi croissant de la désinformation liée à la santé sur les médias sociaux et ses implications potentielles sur la charge des MNT en ASS, ainsi qu’à explorer des stratégies possibles pour lutter contre la désinformation dans ce contexte. Les données utiles pour cette revue ont été obtenues par consultation de sources en ligne via des moteurs de recherche et des bases de données. Les plateformes de médias sociaux remplissent divers rôles liés à la santé, notamment les interventions sanitaires, les campagnes de santé publique, l’éducation médicale, la surveillance des épidémies et le changement de comportement. WhatsApp, Facebook, X (anciennement Twitter) et YouTube sont les principales plateformes associées à la désinformation en matière de santé en ASS. Les implications potentielles incluent des diagnostics erronés, l’automédication inappropriée et le non-respect des traitements fondés sur des données probantes. La désinformation sur les MNT diffusée via les médias sociaux peut influencer les attitudes et comportements liés à la santé, et compromettre la mise en œuvre adéquate des interventions fondées sur des preuves. La collaboration entre les professionnels de santé, les organisations religieuses et les influenceurs des médias sociaux, ainsi que les campagnes de sensibilisation et les politiques réglementaires, sont des stratégies plausibles pour combattre ce phénomène. Les recherches sur les effets de la désinformation sanitaire sur les MNT en ASS restent limitées, soulignant le besoin d’études approfondies. Médias sociaux, Désinformation, Maladies non transmissibles, Afrique subsaharienne.
46. A Two-Year Prospective Study of the Mechanisms and Patterns of Limb Injury in Multiply Injured Patients at UNIOSUN Teaching Hospital, Osogbo, Nigeria.
期刊: West African journal of medicine 发表日期: 2025-Apr-30 链接: PubMed
摘要
Multiple injured patients are patients who sustained injury to more than one system in the body, while a polytraumatized patient is the one who sustained injury to two or more regions of a system in the body. Better patient outcomes and effective management depend on an understanding of the patterns and characteristics of limb injuries in the multiply injured individuals. This is especially important in places with little resources, like Southwestern Nigeria, where trauma is common and it’s important to make the best use of the few available medical resources. Therefore, the aim of this research is to determine the common aetiology that led to various limb injuries in the multiple injured patients at UNIOSUN Teaching Hospital, Osogbo, Osun state. A prospective observational design was employed, involving multiple injured patients admitted to UNIOSUN Teaching Hospital from May 1st, 2022 to April 30th, 2024. Data collection includes demographic information, aetiology of the injury and type of injury sustained. SPSS Version 20 was employed to determine the frequency and distribution of data. Descriptive analysis revealed demographic characteristics, patterns of limb injury, highlighting the common causes, prevalence of different types of limb injuries, distribution of affected limbs and sides in the multiply injured patients. The study found a higher representation of males in road traffic accidents, with a diverse age group. Most participants were passengers or pedestrians, with 71.4% of injuries being closed. Most participants did not use seat belts and were not seated. This study demonstrated that limb injuries from road traffic accidents predominantly affected young adult males, with motorcycle crashes being the leading cause. Fractures, especially of the lower limbs, were the most common injury types, and surgical intervention was frequently required. These findings show the significant burden of limb trauma managed at UNIOSUN Teaching Hospital and emphasize the demographic and clinical patterns associated with such injuries. Les patients polytraumatisés sont ceux qui ont subi des blessures touchant plusieurs systèmes corporels, tandis qu’un patient polytraumatisé au sens strict est celui qui a subi des lésions dans deux régions ou plus d’un même système. Une meilleure prise en charge et des résultats cliniques optimaux dépendent de la compréhension des modèles et des caractéristiques des blessures aux membres chez ces patients. Cela est particulièrement crucial dans les régions à faibles ressources comme le sud-ouest du Nigeria, où les traumatismes sont fréquents et où il est essentiel d’optimiser l’utilisation des ressources médicales limitées. Cette étude vise donc à identifier les causes les plus courantes des blessures aux membres chez les patients polytraumatisés admis à l’Hôpital Universitaire UNIOSUN, Osogbo, État d’Osun. Une étude prospective d’observation a été menée auprès des patients polytraumatisés admis entre le 1er mai 2022 et le 30 avril 2024. Les données recueillies incluent les informations démographiques, l’étiologie des blessures et le type de traumatisme subi. Le logiciel SPSS version 20 a été utilisé pour analyser la fréquence et la distribution des données. L’analyse descriptive a permis de mettre en évidence les caractéristiques démographiques, les modèles de blessures aux membres, les causes fréquentes, la prévalence des différents types de blessures, ainsi que la distribution des membres et des côtés affectés. L’étude a révélé une prédominance masculine dans les accidents de la route, avec une large diversité d’âges. La majorité des participants étaient des passagers ou des piétons, et 71,4 % des blessures étaient fermées. La plupart ne portaient pas de ceinture de sécurité et n’étaient pas assis correctement. Cette étude montre que les blessures aux membres causées par les accidents de la route touchent principalement les jeunes hommes adultes, les accidents de moto étant la cause principale. Les fractures, en particulier celles des membres inférieurs, étaient les types de blessures les plus fréquents, nécessitant souvent une intervention chirurgicale. Ces résultats soulignent la lourde charge des traumatismes gérés à l’Hôpital Universitaire UNIOSUN et mettent en lumière les profils démographiques et cliniques associés à ces blessures. Polytraumatisme, Blessure aux membres, Fracture ouverte, Fracture fermée, Accidents de la route.
47. Effects of behavior change techniques in interventions promoting condom use among youth in the Global North.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Declines in condom use among the general young population highlight the need for effective interventions to prevent sexually transmitted infections and unwanted pregnancies. With this study, we aim to examine the relationship between Behavior Change Techniques (BCTs, the active components of interventions) and the effects of condom interventions among youth. We quantify the number of BCTs used in the interventions, assess their alignment with underlying behavioral theory, and evaluate coverage of specified Mechanisms of Action (MoA, underlying process through which behavior may be influenced) within the behavioral theory. Face-to-face theory-based interventions aiming to promote condom use among youth were identified in a previous systematic review. Interventions were analyzed using the BCT Taxonomy v.1.0., alignment with theory was determined using the Theories and Techniques tool. Wilcoxon rank-sum tests assessed BCT effectiveness. Spearman’s rank correlation coefficient determined associations between intervention effects and the total number of BCTs, the proportion of BCTs aligned with MoAs, and the proportion of MoA covered by BCTs. In 21 interventions we identified a median of 3 BCTs (IQR = 1-5) per intervention. BCTs were poorly reported. No grouping of BCTs was associated with more intervention effects on increasing condom use. Neither the proportion of BCTs aligned with the MoAs of the underlying theory in the intervention (median = 85.7%, IQR = 50.0-100%, Spearman’s ρ = -0.09) nor the proportion of MoAs of the underlying theory covered by at least one BCT in the intervention (median = 44.4%, IQR = 25.0-50.0%, Spearman’s ρ = 0.27) were correlated with intervention effects. This study provides initial insights into the use of BCTs and the application of behavioral theory in theory-based condom promotion interventions targeting the general young population. No associations between the use of BCTs and the intervention effects on condom use were found. Robust conclusions regarding the utilization of BCTs, their alignment with theory, and their effects can only be reached when future research consistently and comprehensively reports the use of BCTs.
48. Assessing the determinants of food choices among adolescents in India: A rainbow model using the socio-ecological framework.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
In India, the rising risk of overweight and obesity among adolescents is a significant public health concern, primarily associated with their frequent consumption of nutrient-poor snacks, sugar-sweetened beverages, and fast foods. Identifying the determinants of their food choices is crucial for developing effective nutrition promotion strategies. This study aimed to identify the determinants of food choices among adolescents in two metro cities in North and South India using a cross-sectional, mixed-methods approach. The study involved adolescents (n = 869) studying in 8th and 9th grades from randomly selected government and private schools, utilizing a pre-tested questionnaire and virtual food preference flip cards (quantitative phase), along with in-depth interviews with adolescents, teachers, and parents (n = 11) (qualitative phase). A four-level socio-ecological model was adopted to categorize the determinants associated with adolescent’s food choices. The findings revealed that taste (51%) was the primary determinant driving adolescents to choose outside foods, followed by peer influence (31%) and trendy foods (27%). In-depth interviews further highlighted the impact of social media, parental influence, celebrity endorsements, popular food trends, and marketing incentives such as toys and coupons on adolescents’ food choices. The study provides a springboard for future research into the development of a nutrition-friendly choice architecture to encourage adolescents to make healthy food choices. Public health policy should utilize these determinants to transform the existing food environment of adolescents.
49. Dynamics and diversity in adolescents' experienced barriers and facilitators for physical activity maintenance.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Despite the well-documented health benefits of physical activity (PA), over 80% of adolescents worldwide fail to meet recommended daily levels. This study identified experienced barriers and facilitators for PA maintenance among Dutch adolescents, examine how they form barrier and facilitator profiles, and explore how barriers and facilitators evolve over time. First, we conducted 21 interviews with adolescents (13-16 years) to uncover relevant barriers and facilitators. Then, we developed and applied a card sorting task based on Q methodology, and examined barrier and facilitator configurations with 30 adolescents (aged 13-18 years) who had maintained a physical activity for ≥2 years, followed by interviews. Factor analysis revealed five facilitator profiles: Mental and physical health benefits, A way to be myself around others, Pursuing health goals, Developing confidence and strength, and Developing along my own path. Four barrier profiles emerged: Low motivation and energy, Not a good fit for me, Balancing act, and Proximity, possibility and perception. Facilitator profiles ranged from immediate characteristics of the activity, such as enjoyment, social connection, and mental well being, to more future-oriented drivers such as autonomy and self-development. Barriers profiles varied from predominantly internal (e.g., low motivation) to external (e.g., distance, weather) or mixed influences linking life demands to reduced personal resources. Across participants, enjoyment was the most consistent facilitator, but perceived influences often shifted with time, from immediate, activity-based facilitators related to competence and relatedness, toward motivations tied to autonomy, identity and coping with growing responsibilities characteristic of this life stage. These results highlight the diversity and dynamic nature of barriers and facilitators in adolescent PA maintenance. Tailoring PA promotion programs to adolescents’ evolving motivations and constraints can increase their effectiveness, supporting sustained active lifestyles into adulthood.
50. Increasing Screening Colonoscopy Rates in Middle-Aged Adults Through the Implementation of a Recall System.
期刊: Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates 发表日期: 链接: PubMed
摘要
Colon cancer is a global disease that continues to increase in middle-aged adults. Although screening colonoscopies are recommended to prevent colon cancer colonoscopy rates continue to decline, notably in the middle-aged adult population. At a gastroenterology clinic in the United States, 32% of middle-aged adults were found to not be up-to-date on their screening colonoscopy exams. Reasons for this included a lack of communication secondary to patient awareness and provider failure. The purpose of this project is to improve surveillance colonoscopy rates among middle-aged adults by improving communication efforts. At a gastroenterology clinic in Southeast Alabama, an electronic chart review was used to identify middle-aged adult patients due for a screening colonoscopy. Each participant was issued two reminder phone calls and a letter. The phone call and letter alerted participants they were due for a screening colonoscopy and provided them with an opportunity to schedule the procedure. A pre-and post-chart audit was utilized to analyze completed colonoscopy rates before and after the intervention. Post-chart audit findings revealed a 60% increase in completed colonoscopy rates within three months of project completion. These results reveal that implementing a phone and mail recall is effective at increasing screening colonoscopy rates.
51. Assessment of environmental risk factors for blastomycosis during a large outbreak at a Michigan paper mill.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Blastomycosis is a rare, potentially fatal fungal infection caused by inhalation of Blastomyces spores, typically acquired outdoors in the midwestern and eastern United States. In 2023, the largest recorded U.S. blastomycosis outbreak occurred among workers at a paper mill in Michigan’s Upper Peninsula. Few data exist on occupational risk factors or indoor exposure to Blastomyces, limiting prevention efforts. We assessed workplace environments and conditions associated with blastomycosis risk through a cross-sectional medical survey and environmental sampling. During April 22-28, 2023, we conducted a voluntary medical survey, including a work and health questionnaire and urine antigen testing, for 603 workers out of approximately 1,000 at the mill. We compared worker characteristics, work locations, and environmental exposures by blastomycosis case status and modeled disease risk using Poisson regression. We tested 533 environmental samples of outdoor soil, indoor surface dust, and raw materials for Blastomyces using polymerase chain reaction and culture-based methods. Twenty percent of workers were classified as blastomycosis cases based on positive urine antigen testing during the survey, self-reported provider diagnoses, or confirmed or probable case status reported by state or local health departments. Prevalence was highest among workers in paper machine line #1 (27%) and maintenance areas (25%). Adjusted analyses indicated a 40% [Prevalence Ratio (PR): 1.40; 95% confidence interval (CI): 1.00, 1.95] and 53% (PR: 1.53; 95% CI: 1.04, 2.25) higher risk for workers in these locations, respectively, compared to workers working elsewhere. Working in both locations doubled blastomycosis risk. Daily exposure to indoor pooling water was associated with a nearly two-fold higher prevalence of blastomycosis (PR: 1.79; 95% CI: 1.25, 2.57). All indoor and outdoor environmental samples were negative for Blastomyces. Blastomycosis was associated with specific indoor work locations and environmental conditions, suggesting the potential for occupational exposure to Blastomyces in indoor industrial settings. These findings may guide future outbreak investigations and occupational prevention strategies.
52. Prevalence and predictors of Biker's hand syndrome among the professional bike riders in Bangladesh: A cross-sectional study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The use of motorbikes for the rapid growth of ride-sharing platforms in Bangladesh and the increasing economic reliance on this occupation are significant sources of non-traumatic injuries, particularly those affecting the wrist and hand. This study aimed to determine the prevalence and factors that contribute to the occurrence of biker’s hand syndrome among bike riders in Bangladesh. A cross-sectional study was conducted among professional bike riders using the Cornell hand discomfort questionnaire. This study includes 630 male bike riders from the cities of Dhaka and Sylhet in Bangladesh, selected through two-stage cluster sampling using a face-to-face interviewer-administered questionnaire. A binary logistic regression analysis was used to identify the factor that predicts biker’s hand syndrome. The prevalence of pain, ache, or discomfort was reported as 58.3% in the right hand (RH) and 51.3% in the left hand (LH). Participants who ride bikes with an engine capacity of less than 150cc (aOR 2.218, CI 1.192-4.128, p = 0.012 in RH and aOR 1.210, CI 0.672-2.157, p = 0.525 in LH), and uncomfortable handlebar (aOR 2.110, CI 1.171-3.801, p = 0.013 in RH and aOR 1.519, CI 0.888-2.598, p = 0.127 in LH) reported higher likelihood of hand syndrome. Individuals whose motorcycle does not fit their body physique have over five times higher odds of hand discomfort (aOR 5.136, CI 2.939-8.974, p < 0.001 in RH and aOR 3.676, CI 2.210-6.113, p < 0.001 in LH). This study highlights a considerably greater occurrence of hand syndrome among professional bikers in Bangladesh. Implementing regular stretching exercises, the use of a comfortable hand gripper, and improving motorcycle-to-body fit could reduce hand syndrome risk by over fivefold. Policymakers and organizations involved in occupational health and safety should priorities taking appropriate measures to address this issue.
53. Effectiveness of the capability approach in rehabilitation for persons with neuromuscular diseases: A controlled before-after study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Rehabilitation of persons with neuromuscular diseases (NMD) requires a personalised approach that focuses on achieving and maintaining a level of functioning that enables them to be in a state of well-being. The capability approach states that well-being should be understood in terms of capabilities, which are the opportunities that people have to be and do things they have reason to value. The aim of this study is to investigate whether providing care inspired by the capability approach (capability care) has an effect on the well-being of persons with NMD. In the Rehabilitation and Capability care for persons with NeuroMuscular Diseases (ReCap-NMD) study, 64 adults with facioscapulohumeral muscular dystrophy or myotonic dystrophy type 1 were included in two groups, using a before-after controlled design with 6 months between the measurement moments. The first group received rehabilitation as usual, the second received capability care. This article reports on the primary outcome measure, the Canadian Occupational Performance Measure (COPM) and secondary quantitative outcome measures (questionnaires on participation, capability well-being and health-related quality of life). There was no difference between capability care and usual care on the COPM and the secondary outcome measures. There was a similar improvement for both capability care and usual rehabilitation on the COPM at 6-month follow-up. This means that the effect of capability care is similar to usual rehabilitation. This is the first study that explicitly developed, implemented and evaluated a clinical healthcare intervention inspired by the capability approach. We found no difference on the COPM between persons with NMD receiving capability care compared to usual rehabilitation. There is a need for further research on the clinical relevance and added value of the capability approach for rehabilitation and other fields in healthcare. Trialregister.nl NL8946.