公共卫生研究摘要 (2025-10-02)
共收录 55 篇研究文章
1. Acute Kidney Injury Following Mini Percutaneous Nephrolithotomy for Renal Stones: predictors and Follow-up Evaluation in Real-life Setting.
期刊: International braz j urol : official journal of the Brazilian Society of Urology 发表日期: 2026 链接: PubMed
摘要
To evaluate the prevalence, predictors, and progression of acute kidney injury (AKI) in patients undergoing mPCNL for nephrolithiasis. We retrospectively analyzed data from 569 patients who underwent mPCNL at a single tertiary academic center (01/2016-10/2024). AKI was defined per KDIGO criteria as sCr increase >0.3 mg/dL or ≥1.5× baseline. Stone-free status was no residual stones on CT at 3-month follow-up. Complications were classified using the modified Clavien system. Kidney function was reassessed 30-90 days post-op. Descriptive statistics, logistic regression, and Cox regression were applied. Median (IQR) age and stone volume were 57 (48-66) years and 2.1 (0.9-4.2) cm³. Median preoperative sCr and operative time were 0.9 (0.7-1.1) mg/dL and 90 (73-120) minutes. Post-mPCNL, 40 patients (7.0%) developed AKI. Complications occurred in 138 (24.2%) patients; 449 (78.9%) were stone-free. AKI patients had higher CCI (1.3 vs. 0.5, p=0.04), pre-op sCr (1.1 vs. 0.8 mg/dL, p<0.01), stone volume (5.7 vs. 2 cm³, p=0.02), and longer operative time (130 vs. 90 min, p=0.01). Complications were more frequent in AKI patients (42.5% vs. 22.8%, p=0.01). At multivariate analysis, operative time (OR 1.1, p=0.03), pre-op sCr (OR 3.8, p=0.001), and early complications (OR 2.5, p=0.02) were independently associated with AKI. AKI persisted in 9 (22.5%) patients, mainly those with complications (88.9% vs. 38.7%, p=0.01). On Cox analysis, lower BMI (HR 0.8, p=0.02) and absence of complications (HR 0.3, p=0.01) predicted faster AKI recovery. Acute kidney injury remains a clinically significant complication following mPCNL.
2. Ambient Trichloroethylene Exposure and Parkinson Disease Risk in Medicare Beneficiaries.
期刊: Neurology 发表日期: 2025-Oct-21 链接: PubMed
摘要
Trichloroethylene (TCE) is an important environmental contaminant in the United States due to widespread use industrially. Epidemiologic studies suggest that occupational exposure to TCE and TCE-contaminated drinking water may increase the risk of Parkinson disease (PD). The aim of this study was to investigate the nationwide relationship between ambient TCE and PD risk. We performed a nationwide, population-based, case-control study to investigate the association between incident PD in US Medicare beneficiaries aged 67 years and older in 2016-2018 and their residential exposure to ambient (outdoor) TCE in 2002. We assigned residence based on the latitude and longitude of Medicare beneficiaries’ zip + 4 center 2 years before diagnosis/reference. We assigned TCE exposure based on census tract-level data from the US Environmental Protection Agency’s (EPA’s) National Air Toxics Assessment program. We used logistic regression to estimate relative risk (RR) adjusted for age, sex, race, smoking, health care utilization, rural-urban commuting area (RUCA), and PM2.5. We also mapped the nationwide geospatial pattern of ambient TCE and then explored high-resolution local PD risk patterns using MapGAM for the 10-mile radius around the top 3 TCE-emitting facilities from the EPA’s Toxic Release Inventory in 2002. We identified 221,789 incident PD cases (median age 78.8 years; 45% female) and 1,132,765 matched controls (median age 75.7 years; 57% female). We found a dose-dependent positive association between ambient TCE concentrations and PD risk, wherein beneficiaries exposed to the top decile of ambient TCE levels (0.14-8.66 μg/m3) had an RR for PD of 1.10 (95% CI 1.08-1.13) compared with those exposed to the lowest decile of TCE (0.005-0.01 μg/m3). We observed high levels of ambient TCE in the rust belt region of the United States and several smaller areas throughout the nation. Our MapGAM results suggested greater PD risk in the area surrounding 2 of the 3 highest ambient TCE-emitting facilities, one of which demonstrated a marked decreasing gradient of risk with increasing distance from the facility. We identified a positive association between ambient TCE and PD risk, suggesting that TCE may contribute to PD. We identified relatively higher risk of PD near 2 TCE-emitting facilities. This study was limited to Medicare-aged individuals.
3. Future of home-based care with the integration of technology into policy and practice.
期刊: British journal of community nursing 发表日期: 2025-Oct-02 链接: PubMed
摘要
The current UK government has pledged to upgrade technology as we shift from analogue to digital, to support the challenges of providing care for an ageing nation with complex needs. Digital technology is firmly embedded across community nursing practice, yet staff often cite barriers to its implementation. The author explores the future of technology in home-based care, through the lens of telehealth, telemedicine, virtual wards and ambient documentation. Healthcare professionals must embrace the benefits of the digital world and understand the challenges of maintaining patient safety and measuring patient outcomes, while considering digital inclusivity and inequalities in accessibility.
4. Livebirth among 5940 Danish women diagnosed with breast cancer at age 18-40 years between 1968 and 2016: a register-based cohort study.
期刊: Human reproduction (Oxford, England) 发表日期: 2025-Oct-01 链接: PubMed
摘要
Does livebirth probability differ between women diagnosed with breast cancer and unaffected women and is it impacted by age at diagnosis, time trends, parity, partnership status, and the presence of lymph node metastases and distant metastases? Livebirth probability was significantly reduced in 5940 women diagnosed with breast cancer aged 18-40 years during 1968-2016 compared to 1 126 478 age-matched unaffected women, particularly among women with higher diagnosis age, parity ≥ 1, marriage, and the presence of nodal involvement and distant metastases. The survival rate for women diagnosed with breast cancer has increased over the recent decades, and in Denmark, the 5-year survival rate for women diagnosed <50 years of age was 92.2% in 2022. Chemotherapy can damage the ovarian reserve, resulting in premature ovarian insufficiency and infertility. The age of first-time mothers is increasing, and many women have not yet completed family building at the time of diagnosis. Consequently, greater focus is now placed on quality-of-life following breast cancer, including the possibility of survivors to have children. Studies have shown a decreased fertility rate in women diagnosed with cancer during their reproductive lifespan, however, studies specifically focusing on the probability of livebirth in women previously diagnosed with breast cancer are scarce. This is a national, register-based cohort study including women diagnosed with breast cancer from the Danish Cancer Register between 1968 and 2016, aged 18-40 years at time of diagnosis (n = 5940). Each woman was randomly matched with ∼190 unaffected women from the background population according to the age at diagnosis (n = 1 126 478). The women were followed in medical and sociodemographic national population registers until childbirth, death, immigration, or end of study (31 December 2018). In all analyses, we compared the probability of livebirth between women diagnosed with breast cancer and the age-matched comparison group. Analyses were stratified by parity- and partnership status at diagnosis, age-group at diagnosis, and year of diagnosis. Stratified analyses on the probability of livebirth were conducted for women with lymph-node metastases and distant metastases at the time of diagnosis. Analyses were adjusted for age, year of diagnosis, parity, educational level, and migration status. The study population consisted of 5940 women aged 18-40 years at diagnosis of breast cancer between 1968 and 2016 and 1 126 478 women in the age-matched comparison group. Breast cancer survivors had a significantly lower probability of livebirth than the age-matched comparison group (aHR 0.38 [95% CI 0.35-0.41]); negatively impacted by increasing age at diagnosis (35-40 years: aHR 0.34 [95% CI 0.28-0.40], 18-24 years: 0.66 [95% CI 0.46-0.95]), parity ≥1 (parous: aHR 0.31 [95% CI 0.27-0.35], nulliparous: 0.51 [95% CI 0.45-0.59]), and marriage (married: aHR 0.31 [95% CI 0.27-0.36], single 0.53 [95% CI 0.45-0.63]). Being diagnosed in recent decades increased the probability of livebirth in nulliparous women; however, the same association was not found for parous women. Among women with nodal involvement (48%) and distant metastases (3%), the probability of livebirth compared to unaffected women was aHR 0.30 [95% CI 0.26-0.35] and 0.18 [95% CI 0.08-0.42], respectively. We did not have information on whether the women desired children or whether they underwent fertility preservation (FP) prior to receiving gonadotoxic treatment. For women diagnosed in the most recent decades, the follow-up time was limited. Information on tamoxifen treatment for estrogen receptor-positive tumors could have been relevant, as it likely delays pregnancy and consequently reduces conception probability. Our results highlight the continued importance of onco-fertility counseling and FP in young women diagnosed with breast cancer, particularly among women diagnosed toward the end of their reproductive lifespan and those with the presence of lymph node metastases and distant metastases. The study is funded by the Independent Research Fund Denmark (Grant ID 10.46540/4308-00130B). Anja Pinborg has received grants (payment to institution) and consultancy fees from Gedeon Richter, Ferring Pharmaceuticals, Merck A/S, and Cryos; honoraria from Gedeon Richter, Ferring Pharmaceuticals, Merck A/S, and Organon; and support for attending meetings and/or travel (payment to institution) from Gideon Richter. These companies had no role in the study. The remaining authors have no conflicts or interests to declare. N/A.
5. Stakeholder Perspectives on Early Feasibility Studies for Digital Health Technologies in the European Union: Qualitative Interview Study.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-01 链接: PubMed
摘要
Early feasibility studies (EFSs) are small-scale clinical investigations conducted during the early development of medical devices to assess initial safety and performance, especially when bench or in-silico testing is insufficient. While EFSs are well established for hardware devices, their application to digital health technologies (DHTs) including artificial intelligence (AI)-enabled medical devices remains limited. The rapidly evolving regulatory landscape, including the European Union Medical Device Regulation (EU MDR 2017/745) and the phased introduction of the European Union Artificial Intelligence (EU AI) Act, creates additional complexity for DHT developers. Despite the recognized potential of EFSs to support iterative, user-centered innovation, little is known about how European DHT companies and contract research organizations (CROs) perceive and implement EFSs, or what barriers and opportunities exist for broader adoption. This study aimed to explore stakeholder perspectives on the use, barriers, and opportunities of EFSs for DHTs in the European Union, and to generate stakeholder-driven recommendations for a harmonized EU-wide EFS framework. A qualitative descriptive study was conducted using semistructured interviews with representatives from 12 DHT companies and 3 CROs across a range of company sizes, MDR device risk classes, and clinical domains. Participants were recruited through purposive maximum-variation sampling until saturation was reached to capture diverse experiences in regulatory and clinical evidence generation. Interviews, conducted in November 2024 and January 2025, were transcribed and analyzed using thematic analysis, combining deductive and inductive coding. Interviews revealed that while EFSs are valued for providing early human-factor feedback and facilitating iterative design improvements, their current use in DHT development is limited. Key barriers include unclear and hardware-centric regulatory requirements under MDR, fragmented and inconsistent interpretations across EU member states, resource and expertise constraints, and limited dialog with regulatory authorities. The anticipated introduction of the EU AI Act is expected to further increase regulatory complexity, with stakeholders expressing uncertainty about overlapping obligations and the risk of slowed innovation. Some companies, particularly larger or AI-focused ones, have proactively prepared for these changes, while others, especially small and medium-sized enterprises, face significant resource challenges. Several companies reported prioritizing the US Food and Drug Administration pathway due to clearer guidance for DHTs and structured timelines. Stakeholders advocated for a harmonized EU EFS program with DHT-specific guidelines, standardized documentation, predictable timelines, and improved communication channels. Several international models were highlighted as best practices. EFSs remain underused in the EU DHT sector, primarily due to regulatory complexity, fragmentation, and a lack of tailored guidance. A harmonized, DHT-specific EFS framework featuring clearer definitions, standardized processes, and structured dialog between innovators and regulators could accelerate safe, effective, and user-centric digital health innovation. As the MDR and AI Act converge, coordinated regulatory approaches will be critical to balancing innovation, safety, and patient benefit in Europe.
6. Evaluating Diversity in Open Photoplethysmography Datasets: Protocol for a Systematic Review.
期刊: JMIR research protocols 发表日期: 2025-Oct-01 链接: PubMed
摘要
Photoplethysmography (PPG) is an optical method for measuring blood volume changes in microcirculation through noninvasive photodetection. It has become a widespread and essential clinical tool, used in pulse oximeters and wearable devices. However, technical aspects of PPG make it susceptible to intrinsic bias, with the potential to adversely affect particular patient and consumer populations. Developments in PPG technology, increasingly driven by openly accessible datasets as opposed to de novo experimentation, have the potential to help monitor an array of physiological variables. However, some populations may be underrepresented in PPG datasets. We describe a protocol for a systematic review to assess the biases within open access PPG datasets. This review aims to evaluate the underlying reporting patterns and structure of openly accessible PPG datasets. We will provide insight into the measured biosignals and demographic variables included in the datasets in the hope of shedding light on what PPG data parameters are being used to develop medical devices. Therefore, we can elucidate current gaps and areas for improvement to reduce bias in medical device development. This review will be reported in accordance with the standard PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We will include primary studies that mention PPG and specifically reference openly accessible datasets since 2000. The datasets must contain physiological parameters such as heart rate, blood pressure, or respiratory rate, as well as the PPG waveform data, collected from humans. Searches will be conducted in literature databases and data repositories, including MedLine OVID, IEEE Xplore, Scopus, and PhysioNet. Studies will be evaluated in accordance with the Standing Together Initiative recommendations, which are urging for health care technologies supported by representative data. Biosignal and demographic variables will be extracted from the PPG datasets, with steps taken to harmonize and store this information. Statistical analysis will be performed, including descriptive statistics and the chi-square test for comparisons. Additional statistical analyses will be performed after data extraction is completed and the level of heterogeneity is characterized. We will analyze the dataset diversity and the structural basis of PPG datasets. This includes statistically analyzing the demographic and biosignal variables in the datasets. By using statistical test fit for nominal variable comparisons, we will evaluate the frequencies of characteristics like the devices used, biosignals collected, clinical parameters, demographic characteristics, and geographic information. This systematic review is expected to be completed by September 2025. The screening and review of the articles is currently being conducted. This review will provide insight into the potential gaps of existing open access PPG datasets. It will inform future data collection and design of openly available PPG datasets for training medical devices, including wearables, to avoid perpetuating biases, allowing for application in diverse clinical settings.
7. Multiuser Application for the Diagnosis and Treatment of Depression in Women's Self-Help Groups: Pilot Randomized Controlled Trial.
期刊: JMIR formative research 发表日期: 2025-Oct-01 链接: PubMed
摘要
Depression in women results in elevated morbidity rates, functional impairment, diminished quality of life, and an increased risk of suicide. Numerous obstacles impede access to mental health treatment for women in India. Digital mental health solutions can bridge the treatment gap, but it is important to tailor these solutions to the context and to end-users. We conducted a pilot randomized controlled trial to test the feasibility, acceptability, and preliminary effectiveness of a mental health app deployed in community-based organizations in improving depression outcomes. The Multiuser Interactive Health Response Application (MITHRA) is a multiple-user mobile app used in community-based organizations for screening, tracking, and supporting stepped-care treatment for depression. MITHRA is based on the healthy activity program, a brief psychological intervention based on behavioral activation. It includes audio, video, and enhanced touchscreen capabilities to overcome the barrier of illiteracy and lack of access. It was developed in collaboration with a participatory design group consisting of primary and secondary end-users and is available on tablets installed in self-help groups (SHGs), which are community-based organizations in India. The SHGs were randomized to MITHRA (n=3) or enhanced usual care (EUC; n=3). During SHG meetings, women completed the Patient Health Questionnaire-9 (PHQ-9). Based on their PHQ-9 scores, they were assigned different modules. In the EUC SHGs, women viewed one module of education on symptoms of depression. Primary outcomes include feasibility and acceptability, and secondary outcomes include depressive symptoms and functioning. Repeated-measures ANOVA was performed to compare the change in the outcome scores over time between study groups. A P value of<.05 was considered statistically significant. MITHRA was found to be feasible and acceptable. A total of 96% of intervention arm participants completed at least half of their assigned modules. Although not powered for effectiveness outcomes, in this trial, we found that the change at 6 months from baseline in depressive symptoms (PHQ-9) were significantly different between MITHRA and EUC (P=.037), with greater improvement in the intervention group. Similarly, significant improvement in the World Health Organization Disability Assessment Scale score was noted in the MITHRA group (P=.005). MITHRA is feasible and acceptable for use in women’s SHGs. Larger studies should examine the effectiveness of this approach in identifying and treating depression.
8. The Intention of Primary Health Nurses to Participate in Internet Plus Nursing Service: Cross-Sectional Survey.
期刊: JMIR nursing 发表日期: 2025-Oct-01 链接: PubMed
摘要
“Internet Plus Nursing Service” (IPNS) offers innovative solutions for China’s growing home health care demands. Understanding primary care nurses’ participation intentions is crucial for service optimization. This study evaluates primary health nurses’ intention to participate in IPNS-a technology-mediated home care model combining mobile health platforms with in-person visits-and examines how digital readiness, safety perceptions, and organizational factors influence participation decisions, to guide policy optimization for scalable digital home health care delivery. A cross-sectional survey was conducted in Jiangsu Province, China (December 2023-December 2024) using the validated Participation Intention of Nurses on IPNS Scale. Convenience sampling enrolled 3952 nurses from 13 prefecture-level cities in Jiangsu-the second-tier administrative divisions in China that typically encompass both urban and rural areas, each with independent health care systems governed by municipal health authorities. Statistical analyses included t tests and ANOVA with SPSS 22. A total of 3952 surveys were completed. The participation intention scale yielded a mean (SD) total score of 66.13 (7.89) across respondents. Subscale analysis revealed mean (SD) scores of 18.57 (2.68) for participation attitude, 18.87 (2.49) for subjective norms, and 25.67 (3.48) for perceived behavioral control. Significant demographic predictors of participation intention were identified through statistical analysis. Male nurses demonstrated stronger intention (t72.974=-23.139, P<.0001), as did those over 30 years old (F39,51=27.215, P<.0001) and bachelor’s degree holders (t2185.018=-4.994, P<.0001). Workplace characteristics also showed significant associations, with nursing management department staff (F39,51=45.877, P<.0001) and those with less organizational workloads (F39,51=9.829, P<.0001) displaying greater intention. Professional factors including higher positional rank (F39,51=37.32, P<.0001), more advanced titles (F39,51=30.176, P<.0001), and over 11 years of experience (F39,51=5.242, P=.001) predicted stronger participation intent. Finally, nurses earning 5000-10,000 RMB (a currency exchange rate of RMB 1=US $0.71 is applicable) monthly showed significantly higher intention scores (F39,51=16.141, P<.0001). Policymakers should prioritize 3 interventions: (1) develop IPNS-specific safety protocols and legal safeguards, (2) optimize workload allocation through intelligent scheduling systems, and (3) establish tiered incentive mechanisms targeting middle-income nurses and experienced practitioners.
9. An mHealth App (NeoMayor) to Promote Healthy Lifestyles and Brain Health in Older Adults: Design and Validation Study.
期刊: JMIR aging 发表日期: 2025-Oct-01 链接: PubMed
摘要
In Latin American countries, the prevalence of noncommunicable diseases has increased rapidly in recent decades. Mobile health (mHealth) apps are now widely available at low cost and are easy to implement, offering an opportunity to encourage healthy lifestyles in older adults. However, at present, there are no mHealth apps that integrate multidomain healthy lifestyle interventions specifically adapted for older adults in Chile. This study aims to describe the development and validation of NeoMayor, an mHealth app designed to promote healthy lifestyles as well as cardiovascular and brain health in older adults in Chile. NeoMayor was developed iteratively with feedback from users and input from a multidisciplinary team of clinicians, researchers, and software developers. Using lean user experience methodology, we ensured user involvement throughout the design and validation process. The research was conducted in 2 phases. In the design and development phase, we created and adapted evidence-based recommendations. In the validation phase, we conducted a pilot study to assess usability, adherence, and cardiovascular health (CVH). A total of 60 functionally independent and cognitively healthy participants used the NeoMayor app for 2 months. Clinical and cognitive assessments were conducted before and after app use. We held 26 cocreation sessions with users, consulted experts, performed a literature review, and collaborated with a team of app developers to create a functional prototype. The mean age of the participants was 71 (SD 15) years, and 85% (51/60) were female. Participants had an average of 9.8 (SD 3.6) years of education. At the end of the 2-month intervention, usability testing indicated high engagement and adherence, with participants using the app for an average of 6.6 (SD 11.85) minutes per day twice a week. Improvements were observed in global CVH, with the mean Life’s Essential 8 CVH index score increasing from 64 (SD 10) to 68 (SD 11; P<.001). Reductions were noted in systolic blood pressure (10 mm Hg) and waist circumference (7 cm), along with increased high-density lipoprotein cholesterol levels. Participants also showed improvements in self-reported physical activity and diet, higher scores on the Short Physical Performance Battery, and faster performance times on the sit-to-stand and gait speed tests. The app was optimized for broad compatibility with Android devices, safe data collection and storage, and compliance with data privacy regulations following good clinical practices. The final product is ready for testing in a randomized controlled trial. This study represents the first initiative in Chile to develop and validate an mHealth app to promote healthy lifestyles as well as cardiovascular and brain health in older adults, offering an effective, accessible, and affordable solution for promoting healthy aging in Latin American countries.
10. Optimizing the Color Shapes Task for Ambulatory Assessment and Drift Diffusion Modeling: A Factorial Experiment.
期刊: JMIR formative research 发表日期: 2025-Oct-01 链接: PubMed
摘要
Recent advances in cognitive digital assessment methodology, including high-frequency, ambulatory assessments, promise to improve the detection of subtle cognitive changes. Computational modeling approaches may further improve the sensitivity of digital cognitive assessments to detect subtle cognitive changes by capturing features that map onto core cognitive processes. We explored the validity of a brief smartphone-based adaptation of a visual working memory task that has shown sensitivity for detecting preclinical Alzheimer disease risk. We aimed to optimize properties of the task for computational cognitive feature extraction with drift diffusion modeling. We analyzed data from 68 participants (n=47, 69% women; n=55, 81% White; mean age 49, SD 14; range 24-80 years) who completed 60 trials for each of 16 variations of a visual working memory binding task (the Color Shapes task) on smartphones, over an 8-day period. A drift diffusion model was fit to the response time and accuracy data from the task. We experimentally manipulated 3 properties of the Color Shapes task (study time, probability of change, and choice urgency) to test how they yielded differences in key drift diffusion model parameters (drift rate, initial bias toward a response option, and caution in decision-making). We also evaluated how an additional task property, the test array size, impacted responses across all conditions. For array size, we tested a whole display of 3 shapes against a single probe of 1 shape only. The 3 task property manipulations yielded the following results: (1) increasing the ratio of different responses was credibly associated with higher initial bias toward the different response (mean 0.06, SD 0.02 for the whole display; mean 0.15, SD 0.02, for the single probe condition); (2) increasing the choice urgency during the test phase was credibly associated with decreased caution in decision-making in the single probe condition (mean -0.04, SD 0.02) but not in the whole display (mean -0.01, SD 0.02); and (3) contrary to expectation, longer study times did not yield a credibly faster drift rate but produced credibly slower ones for the whole display condition (mean -0.28, SD 0.05) and a null effect for the single probe condition (mean 0.01, SD 0.05). In addition, as expected, we found that individual differences in drift rate were associated with age in both array sizes (r=-0.45 with Bayes factor=191), with older participants having a slower drift rate. Older participants also showed higher caution (r=0.42 with Bayes factor=80.76) in the single probe condition. We identified a version of the Color Shapes task optimized for smartphone-based cognitive assessments in real-world settings, with data designed for analysis through computational cognitive modeling. Our proposed approach can advance the development of tools for efficient and effective early detection and monitoring of risk for Alzheimer disease.
11. Quality of First Prenatal Consultations in Malemba Nkulu, Democratic Republic of Congo: Challenges and Opportunities in a Cross-Sectional Study.
期刊: JMIR pediatrics and parenting 发表日期: 2025-Oct-01 链接: PubMed
摘要
Maternal mortality remains alarmingly high in the Democratic Republic of Congo (DRC), particularly in rural areas where access to quality prenatal care is limited. Despite global efforts to improve maternal health, systemic gaps persist in the delivery of antenatal services. The objective of this study is to assess the quality of first antenatal consultations in the Malemba Nkulu health zone and identify structural and procedural factors contributing to substandard care. A cross-sectional descriptive study was conducted in November 2023 across 8 health facilities selected through simple random sampling. Data were collected from 248 pregnant women attending their first prenatal visit and from 14 health care providers. Quality indicators were assessed using a structured checklist based on World Health Organization (WHO) standards. Variables included provider qualifications, availability of diagnostic tools, and completeness of clinical assessments. Only 2% (5/248) of first antenatal consultations met the minimum quality standards. Major deficiencies included lack of physical examinations 78% (193/248), absence of essential laboratory tests 92% (228/248), and inadequate counseling 85% (212/248). Facilities lacked basic equipment such as blood pressure monitors and hemoglobin tests. Provider training was inconsistent, and community awareness of prenatal care remained low. The quality of first antenatal consultations in Malemba Nkulu is critically poor, reflecting broader systemic challenges in rural maternal health care. Strengthening provider training, improving infrastructure, and enhancing community engagement are essential to reduce maternal mortality and improve outcomes in resource-limited settings.
12. Chronic subdural hematoma: clinical and surgical experience with surgical management in a large cohort of patients in the late and frailest phase of life.
期刊: Neurosurgical focus 发表日期: 2025-Oct-01 链接: PubMed
摘要
To date, there is no consensus on treatment indications for chronic subdural hematoma (CSDH) in patients in their 10th decade of life. The present investigation aims to focus on and carefully evaluate the clinical course of this particularly fragile subgroup of patients. The authors retrospectively analyzed the clinical, radiological, and surgical records from a multicentric prospectively maintained database of patients with CSDH surgically treated between June 2005 and August 2021. Patients included in the study were divided into two subgroups: group A, those whose age was < 90 years; and group B, those whose age was ≥ 90 years. The following variables were recorded for each patient: age, sex, clinical disease onset, history of traumatic brain injury, antiplatelet or anticoagulant use, and pre- and/or postoperative corticosteroid medication intake. The surgical approach and whether a surgical drain had been left in the subdural space were recorded, as was the anesthesia protocol. Clinical results were measured using the Markwalder Grading Scale. Recurrence and mortality were analyzed separately. The final cohort comprised 1312 patients who had undergone surgery for CSDH, 1240 patients whose age was < 90 years and 72 patients whose age was ≥ 90. Patients in their 10th decade of life experienced similar or even better clinical outcomes than their younger counterparts. In particular, the pre-postoperative variation in Markwalder grades was favorable in elderly patients (p = 0.006). Multivariate analyses confirmed that local anesthesia (p = 0.013), single-sided CSDH (p = 0.010), and no antiplatelet or anticoagulant intake (p = 0.004 and p = 0.037, respectively) are independent predictors of favorable outcomes. Patients in their 10th decade can experience clinical and radiological outcomes similar to those in their younger counterparts. Such patients could be eligible for standard minimally invasive treatments.
13. Population Structure of Phytophthora ×alni on a Local Scale and Its Temporal Development.
期刊: Phytopathology 发表日期: 2025-Oct-01 链接: PubMed
摘要
Within Phytophthora alni, an invasive pathogen of alders (Alnus spp.), three species have been identified. The most frequent and pathogenic species is P. ×alni. It has a variable intraspecific structure, with the dominance of the Pxa-1 genotype and the presence of dozens of rare genotypes (in most cases derived from Pxa-1). Its local populations are highly variable, and their population structure and development remain unknown. We compared two sets of strains isolated from identical sites during the epidemic (2005-2010) and post-epidemic (2020-2024) phases of the disease in the Vltava River basin (Czech Republic) and studied them using microsatellite marker analysis and fitness tests (sporangia production, growth, and virulence). We acquired 151 P. ×alni isolates of 23 multilocus genotypes. We found that during the post-epidemic phase, genetic diversity decreased, and the dominance and incidence of the Pxa-1 genotype increased. Only the dominant genotype (Pxa-1) was repeatedly isolated from the same sites, whereas the rare genotypes were replaced. During the post-epidemic phase, both the incidence of rare genotypes and the degree of their derivation from Pxa-1 decreased. The rare genotypes had lower fitness than Pxa-1 (the more changes there were, the worse the fitness was). These results allow us to hypothesize the evolution of local populations of P. ×alni in Europe, as the most pathogenic genotype, Pxa-1, will also prevail during the late phases of the disease and the risk of further damage to the surviving host populations will persist.
14. Performance and Stability of Winter Wheat Cultivars to Stagonospora Nodorum Blotch Epidemics in Multi-Environment Trials.
期刊: Phytopathology 发表日期: 2025-Oct-01 链接: PubMed
摘要
Field performance of winter wheat genotypes with quantitative resistance to Stagonospora nodorum blotch is influenced by genotype-by-environment interactions (GEI). This phenomenon explains why cultivars may perform inconsistently across environments, affecting decisions on locally adapted varieties. Further, GEI can also impact risk assessment when cultivar reaction is used as a model predictor under the assumption of stability of responses across environments. Thus, this study investigated GEI effects on four disease metrics; final disease severity (SEV), relative area under disease progress stairs (rAUDPS), time to 50% disease incidence (T50) and the apparent rate of disease increase (ω), describing SNB epidemics of 18 commercial soft red winter wheat cultivars planted in 18 environments in North Carolina from 2021 to 2024. Linear mixed models with various variance-covariance structures for random effects were used to analyze the disease data and a 3rd order factor analytic model provided the best fit to the data across the metrics examined. Type B genetic correlation (rg), broad-sense heritability (Hb^2), overall cultivar performance (OP), and global stability (RMSD), were estimated using model outputs and the factor analytic selection tool method. For SEV, rAUDPS and T50, values of rg ranged from -0.15 to 0.99 with most environment pairs exhibiting high rg values indicating an agreement in cultivar rankings. Cultivar ‘USG 3230’ was the top-performing and most stable, while ‘TURBO’ and ‘SH7200’ were more unstable cultivars. Cultivar reaction classes derived from OP exhibited consistent class-level means of marginal predictions supporting their utility as stable indicators of SNB susceptibility in risk assessment models.
15. Effects of Remote Patient Monitoring on Health Care Utilization in Patients With Noncommunicable Diseases: Systematic Review and Meta-Analysis.
期刊: JMIR mHealth and uHealth 发表日期: 2025-Oct-01 链接: PubMed
摘要
Management of noncommunicable diseases (NCDs) is an increasing challenge for health care systems. Although remote patient monitoring presents a promising solution by utilizing technology to monitor patients outside clinical settings, there is a lack of knowledge about the effect on resource utilization. This systematic review aimed to review the effects of remote patient monitoring on health care resource utilization by patients with NCDs. Eligible randomized controlled trials (RCTs) involved digital transmission of health data from patients to health care personnel. Outcomes included hospitalizations, length of stay, outpatient visits, and emergency visits. A systematic literature search was performed in Medline, Embase, and Cochrane Central Register of Controlled Trials in June 2024. Titles, abstracts, and full texts were screened individually by 2 authors. Risk of bias was assessed, and data were extracted, analyzed, and pooled in meta-analysis when possible. Confidence in the estimates was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We included 40 RCTs published between 2017 and 2024. The largest group of NCDs was cardiovascular disease (16 studies). Remote patient monitoring may slightly decrease the proportion of hospitalizations compared with usual care (risk ratio [RR] 0.86, 95% CI 0.77 to 0.95; low certainty). Compared with usual care, remote patient monitoring had fewer or an equal number of hospitalizations (mean difference -0.13, 95% CI -0.29 to 0.03; low certainty). Hospital length of stay may be slightly reduced with remote patient monitoring compared with usual care (mean difference -0.84, 95% CI -1.61 to -0.06 days; low certainty). The proportion of outpatient visits showed probably little to no difference between remote patient monitoring and usual care (RR 0.94, 95% CI 0.87 to 1.02; moderate certainty). Compared with usual care, remote patient monitoring had slightly more outpatient visits, but the CI was wide (mean difference 0.41, 95% CI -0.22 to 1.03; low certainty). The results indicate a small or no difference between remote patient monitoring and usual care regarding proportion of emergency visits (RR 0.91, 95% CI 0.79 to 1.05; low certainty). We are uncertain whether remote patient monitoring increases or decreases the number of emergency visits, as the evidence was of very low certainty. This systematic review showed that remote patient monitoring possibly led to lower proportions of patients being hospitalized, fewer hospitalizations, and shorter hospital length of stay compared with usual care. Patients undergoing remote monitoring had possibly more outpatient visits compared with usual care. The proportions of patients with outpatient visits or emergency visits were probably similar. Finally, we had very low certainty in the number of emergency visits. The results should be considered with caution as the certainty of evidence was moderate to very low. We did not find results regarding institutional stay.
16. Unsupervised Large Language Models to Identify Topics in Cancer Center Patient Portal Messages.
期刊: JCO clinical cancer informatics 发表日期: 2025-Oct 链接: PubMed
摘要
The increasing use of patient portal messages has enhanced patient-provider communication. However, the high volume of these messages has also contributed to physician burnout. Patient-generated portal messages sent to a single cancer center from 2011 to 2023 were extracted. BERTopic, a natural language processing topic modeling technique based on large language models, was optimized. For further categorization, the topic words were labeled using GPT-4, followed by review by two oncologists. Uniform Manifold Approximation and Projection was used for dimensionality reduction and visualizing topics. Message volume changes over time were assessed using a Student’s t test. A total of 2,280,851 messages were analyzed. The monthly average number of messages increased from 2,071 in 2012 to 43,430 in 2022 (P < .001). There was a significant rise in message volume after the COVID-19 pandemic, with a posterior probability of a causal effect of 96.4% (P = .04). Scheduling-related messages were the most frequent across departments, whereas symptoms and health concerns were second or third most common topics. In medical oncology and surgical oncology, topics on prescriptions and medications were more common compared with radiation oncology and gynecologic oncology. Despite concurrent institutional changes in self-scheduling systems, scheduling-related messages did not decrease over time. The substantial increase in patient portal messages, particularly scheduling-related inquiries, underscores the need for streamlined communication to reduce the burden on health care providers. These findings highlight the need for strategies to manage message volume and mitigate physician burnout, laying groundwork for artificial intelligence-driven future triage systems to improve message management and patient care.
17. Analysis of the surgical waiting list for conditions not covered by the Explicit Health Guarantees in orthopedics and traumatology in Chile.
期刊: Medwave 发表日期: 2025-Oct-01 链接: PubMed
摘要
Surgical waiting lists for conditions not covered by the Explicit Health Guarantees represent unmet needs and structural gaps within the Chilean public health system. The field of orthopedics and traumatology accounts for a high volume of pending procedures, with total knee arthroplasty being the most frequently delayed. The coexistence of deferrable pathologies not formally recorded, combined with the low efficiency in the use of operating rooms, aggravates this problem. This study aims to characterize the surgical waiting list for conditions not covered by the Explicit Health Guarantees in Chile between 2022 and 2024, with a focus on orthopedics and traumatology. Additionally, we identify the most delayed procedures, the most affected health services, and the current capacity for resolution. A descriptive observational study based on official data requested from the Ministry of Health through transparency and public records, including the Department of Health Statistics and Information and the National Health Fund. Surgical procedures awaiting treatment were analyzed by specialty, region, establishment, sex, and age for the period from 2022 to 2024. Orthopedics and traumatology were the specialties with the highest number of pending procedures (22 to 24% of the total). Knee arthroplasty consistently ranked first, with over 20 000 cases annually. The O’Higgins Health Service had the highest burden. In 2022, the rate of arthroplasties performed on patients covered by the National Health Fund was four times lower than on patients covered by Social Security Health Institutions. No region achieved a surgical volume sufficient to reduce the waiting list significantly. The problem of waiting lists in orthopedics is mainly due to organizational shortcomings. Creating the role of trauma emergency ward, optimizing the use of wards, and creating outpatient surgical units are short- and medium-term measures to reverse this trend. Las listas de espera quirúrgica fuera de las patologías cubiertas por el sistema de Garantías Explícitas en Salud, representan necesidades insatisfechas y brechas estructurales en el sistema público de salud chileno. Ortopedia y traumatología concentran un alto volumen de procedimientos en espera, siendo la artroplastia de rodilla el más recurrente. La coexistencia de patologías diferibles que no se contabilizan formalmente y la baja eficiencia en el uso de pabellones, agravan esta situación. El objetivo de este estudio es caracterizar la lista de espera quirúrgica no cubierta por las Garantías Explicitas en Salud en Chile, entre 2022 y 2024, con énfasis en ortopedia y traumatología. Además, se identifican los procedimientos más postergados, los servicios de salud más afectados y la capacidad de resolución actual. Estudio observacional descriptivo basado en datos oficiales solicitados al Ministerio de Salud vía transparencia y registros públicos como el Departamento de Estadística e Información en Salud y el Fondo Nacional de Salud. Se analizaron prestaciones quirúrgicas en espera, por especialidad, región, establecimiento, sexo y edad para el período de 2022 a 2024. Ortopedia y traumatología fue la especialidad con mayor número de procedimientos en espera (22 a 24% del total). La artroplastia de rodilla lideró consistentemente el listado, con más de 20 000 casos anuales. El Servicio de Salud O’Higgins concentró la mayor carga. En 2022, la tasa de artroplastias realizadas en pacientes del Fondo Nacional de Salud fue cuatro veces menor que en pacientes asociados a las Instituciones de Salud Previsional. En ninguna región se alcanzó un volumen quirúrgico que permitiera reducir significativamente la lista. El problema de las listas de espera en ortopedia obedece principalmente a deficiencias organizacionales. Crear el rol de pabellón de urgencias traumatológicas, optimizar el uso de pabellones, crear unidades quirúrgicas ambulatorias, son medidas a corto y mediano plazo para revertir esta tendencia.
18. A perspective on engaging the disability community in exoskeleton design, implementation, and policymaking.
期刊: Ergonomics 发表日期: 2025-Oct-01 链接: PubMed
摘要
Cutting-edge exoskeleton technologies are being developed to rehabilitate older adult patients in medical settings and prevent injury of able-bodied individuals in industrial settings. However, both medical and occupational exoskeletons offer yet underrecognized opportunities to support individuals across the full range of disabled experiences. This perspective piece offers guidance towards design, implementation, and policy for exoskeletons to be used by a diverse set of disabled individuals. To improve the usefulness, usability, and safety of exoskeletons for disabled users, ergonomists can employ inclusive design, universal design, user-centered design, and participatory design principles. In applying these principles, ergonomists must partner with disabled users as they are experts of their own different and overlapping physical, cognitive, sensory, and mental-health-related disabilities. This partnership should be long-standing and extend throughout all stages of the design process via participatory design sessions and community engagement studios. This perspective piece contributes key considerations and underrecognized opportunities for ergonomists to create exoskeletons supporting a wider range of individuals, namely disabled users. By establishing a partnership with the disability community in design, implementation, and policymaking, we can improve the accessibility of the modern world for disabled and non-disabled users.
19. Regulating AI in Nursing and Healthcare: Ensuring Safety, Equity, and Accessibility in the Era of Federal Innovation Policy.
期刊: Policy, politics & nursing practice 发表日期: 2025-Oct-01 链接: PubMed
摘要
The rapid integration of artificial intelligence in healthcare, accelerated by the Trump administration’s 2025 AI Action Plan and private sector innovations from companies like Nvidia and Hippocratic AI, poses urgent challenges for nursing and health policy. This policy analysis examines the intersection of federal AI initiatives, emerging healthcare technologies, and nursing workforce implications through document analysis of regulatory frameworks, the federal AI Action Plan’s 90+ initiatives, and insights from the American Academy of Nursing’s November 2024 policy dialogue on AI transformation. The analysis reveals that while AI demonstrates measurable improvements in discrete clinical tasks-including 16% better medication assessment accuracy and 43% greater precision in identifying drug interactions at $9 per hour compared to nurses’ median $41.38 hourly wage-current federal policy lacks critical healthcare-specific safeguards. The AI Action Plan’s emphasis on rapid deployment and deregulation fails to address safety-net infrastructure needs, implementation pathways for vulnerable populations, or mechanisms ensuring health equity. Evidence from the Academy dialogue indicates that AI’s “technosocial reality” fundamentally alters care delivery while potentially exacerbating disparities in underserved communities, as demonstrated by algorithmic bias in systems like Optum’s care allocation algorithm. The findings suggest that achieving equitable AI integration requires comprehensive regulatory frameworks coordinating FDA, CMS, OCR, and HRSA oversight; community-centered governance approaches redistributing decision-making power to affected populations; and nursing leadership in AI development to preserve patient-centered care values. Without proactive nursing engagement in AI governance, healthcare risks adopting technologies that prioritize efficiency over the holistic, compassionate care fundamental to nursing practice.
20. The Association Between Surgeon-Anesthesiologist Dyad Familiarity and Operative Mortality: A Retrospective Study at a Large Academic Cardiac Surgery Program.
期刊: Anesthesia and analgesia 发表日期: 2025-Oct-01 链接: PubMed
摘要
Effective teamwork is essential in high-stakes environments such as cardiac surgery, where complex procedures require coordinated efforts, particularly between surgeons and anesthesiologists. While team dynamics have been shown to affect surgical outcomes, the impact of surgeon-anesthesiologist familiarity on operative mortality in cardiac surgery remains underexplored. We aimed to assess whether increased familiarity within this dyad was associated with reduced operative mortality and improved patient outcomes. We conducted a retrospective, single-center cohort study using data from a large academic medical center, covering cases from July 2011 to January 2024. Surgeon-anesthesiologist dyads were defined by unique pairings who worked together in each case. Familiarity was measured by the frequency of collaboration over the previous 365 days and divided into quintiles. The primary outcome was operative mortality, defined as death before discharge or within 30 days post-procedure. Secondary outcomes included operative length, hospital and intensive care length of stay, reoperation, readmission, and reported organ system complications. A logistic mixed-effects model adjusted for patient demographics, comorbidities, and procedure type, was used to examine associations. We identified 481 unique surgeon-anesthesiologist pairs from 16,811 cases. Higher dyad familiarity was associated with significantly lower operative mortality when analyzing the entire cohort (P < .001). Patients cared for by higher-familiarity dyads also had reduced rates of several adverse outcomes, although deep sternal wound infection showed no association with dyad familiarity. After adjusting for confounders, the odds of operative mortality were significantly higher for the lowest-familiarity dyads compared to the highest-familiarity dyads (odds ratio [OR], 1.90, 95% confidence interval [CI], 1.29-2.81, P = .001). Increased surgeon-anesthesiologist familiarity was associated with lower operative mortality and improved outcomes in cardiac surgery, highlighting the importance of consistent team collaboration. Multi-center studies are warranted to validate these findings and explore familiarity’s effects across diverse clinical settings.
21. Addressing global health challenges: a comprehensive framework for determinants of health.
期刊: International journal of injury control and safety promotion 发表日期: 2025-Oct-01 链接: PubMed
摘要
World Health Organization’s (WHO) Healthy Cities Programme (HCP), initiated in 1984, addresses the global health challenges arising from urbanization and globalization within its six regions. In 2021, the Government of India (GOI) recommended to develop 500 Health Cities by 2030, aligning with WHO’s HCP. The programme emphasizes addressing social, political, environmental and economic health determinants for policy interventions, guided by existing models of determinants of health (MoDH). However, these models exhibit gaps in capturing determinants in an evolving globalized world. This research conducts content analysis of the proceedings of ten WHO-led Global (GCHP) and international conferences on health promotion (ICHP) to identify the existing and emerging determinants. The integrative literature review of MoDH revealed limitations in addressing emerging legal, technological, and commercial determinants, and spatial scales, thereby informing the development of an updated framework for determinants of health for effective decision-making amidst dynamic global health landscapes.
22. The Impact of Dose in an mHealth Intervention to Support Parents and Carers Via Healthy Beginnings for Hunter New England Kids Program: Pragmatic Randomized Controlled Trial.
期刊: JMIR formative research 发表日期: 2025-Oct-01 链接: PubMed
摘要
The dose of mobile health (mHealth) interventions can influence participant engagement, acceptability, and overall impact. However, few mHealth interventions have explored this dose-response relationship. This study aims to explore how dose influences the acceptability, engagement, cost, and impact on infant feeding status of a parent-targeted mHealth text messaging program which aims to enhance child health, including breastfeeding exclusivity and duration. This pragmatic randomized controlled trial was conducted from October 2021 to May 2024. The Healthy Beginnings for Hunter New England Kids (HB4HNEKids) program provides- text messages aimed to support parents and carers and their children by providing evidence-based preventive health information across the first 2000 days. Participants were enrolled in HB4HNEKids from 5 Child and Family Health Services in the Hunter New England region of New South Wales, Australia, and randomized into either a high-dose or low-dose text message group for the first 2 years of the pilot program. Dose refers to the quantity and frequency of text messages sent to participants. Participants in the high-dose text message group received an average of 111-121 text messages, and the low-dose text message group received 80-82 text messages across the 2 years. Outcomes of interest included acceptability, engagement, cost, and infant feeding status in relation to dose. Engagement with the messages was determined using click rates and program opt-out rates. Participant acceptability was assessed via a brief survey. Impact on infant feeding status (ie, breastfeeding, formula feeding, or mixed feeding) was determined by participants reporting their feeding status at several time points across the program. Cost was determined by assessing the per participant and total cost of sending text messages for each dose group across the 2-year period. There were no statistically significant differences in click rates between high or low-dose text message groups. In the first 6 months, significantly more participants opted out of the high-dose text message group (191/2724; 7%) compared to the low-dose (108/2812; 3.8%; P<.001). In terms of program acceptability, 183 out of 214 (85.5%) participants of the high-dose and 228 out of 252 (90.5%) participants of the low-dose text message group were satisfied with the frequency of text messages. In addition, 188 out of 215 (87%) participants of high-dose and 220 out of 255 (86%) participants of low-dose text message group indicated they would recommend the program to other caregivers. The average per participant and total cost to the health service for sending messages was lower in the low-dose group (A$9.32 per participant and A$15,271.48 total; A$1 is approximately equal to US $0.68) compared to the high-dose text message group (A$12.96 per participant and A$21,241.44 total). The HB4HNEKids program demonstrated positive outcomes including high acceptability across both groups and no impact on infant feeding status, irrespective of dose. Given the higher opt-out rates and message costs in the high-dose text message group, a lower dose is likely more scalable for future use.
23. Innovative Web-Based Future Planning and Well-Being for Caregivers of Individuals With Intellectual and Developmental Disabilities: Protocol of a Pragmatic Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Oct-01 链接: PubMed
摘要
Nearly three-quarters of the estimated 4.9 million people with intellectual and developmental disabilities (IDDs) in the United States live with family caregivers, 25% of whom are aged older than 60 years. People with IDDs experience disproportionately high rates of mortality, morbidity, and acute care use, often due to a lack of accessible, tailored resources to support them throughout the lifespan. Few caregivers engage in long-term care (LTC) planning, often due to a lack of information and support. This protocol describes the design and methods of the Future Planning and Well-Being for Individuals with Intellectual Disabilities and Family Caregivers study, a randomized controlled trial evaluating the effectiveness of the Map Our Life web-based LTC planning tool compared to an attention control website on caregiver-reported burden, caregiver-reported well-being, and progress in and communication of future plans for the individual with an IDD. The Future Planning and Well-Being for Individuals with Intellectual Disabilities and Family Caregivers study is a national, multisite, randomized controlled clinical trial with a target enrollment of 1050 family caregivers of individuals with IDDs at 6 sites across the United States. Participants are randomly assigned (1:1) to either the Map Our Life web-based LTC planning tool plus enhanced usual care or an attention control group consisting of a Centers for Disease Control and Prevention-sponsored health promotion website for people with disabilities plus enhanced usual care. Primary outcomes, including caregiver-reported burden, caregiver-reported well-being, and LTC planning behaviors, are assessed at baseline and at 1, 6, and 18 months. Data will be analyzed using mixed-effects models to accommodate the repeated measures design. This study was funded in July 2022, received initial Institutional Review Board approval in August 2023, and was registered on ClinicalTrials.gov in December 2023. Recruitment began in December 2023 and is scheduled to conclude in December 2025. Primary outcome analyses will commence immediately following the completion of final follow-up surveys. LTC planning is an important component of addressing health disparities among individuals with disabilities and their family caregivers. By focusing on using an innovative and accessible tool for LTC planning, the study addresses a critical gap in available resources with the potential to improve quality of life and reduce caregiver burden. ClinicalTrials.gov NCT06065527; https://clinicaltrials.gov/study/NCT06065527. DERR1-10.2196/77184.
24. Advancing Inclusive Brain Health and Dementia Care for People with Intellectual and Developmental Disabilities: A Public Health Framework.
期刊: The Gerontologist 发表日期: 2025-Oct-01 链接: PubMed
摘要
Adults with intellectual and developmental disabilities (IDD) face disproportionately high rates of chronic conditions, including an elevated risk for dementia. Yet access to appropriate brain health promotion and dementia care remains limited due to stigma, underdiagnosis, misdiagnosis, and systemic barriers. This article presents the Healthy Brain Initiative for People with Intellectual and Developmental Disabilities (HBI-PwIDD), which aims to: 1) raise awareness of brain health and support health-promoting approaches for people with IDD experiencing Alzheimer’s disease and related dementias; 2) build interprofessional partnerships to develop an inclusive, competent workforce; and, 3) strengthen engagement of people with IDD and their supporters in accessing quality healthcare and improving outcomes. Applying a disability intersectionality lens, we integrate brain health promotion with dementia-capable services, emphasizing the critical role of disability-inclusive public health planning. We highlight person-centered approaches grounded in legal and human rights principles that provide access to brain health care and community-based supports. Finally, we discuss how tailored public health messaging and evidence-based workforce strategies can advance national and state brain health and dementia plans and improve equity in care for individuals with IDD. This paper illustrates how integrating disability-inclusive practices within public health systems can promote inclusive aging, improve dementia-related outcomes, and guide gerontologists in building inclusive, life course-oriented models of care.
25. Effects of low protein diet supplemented with ketoanalogues on kidney function and nutritional outcomes in a nonagenarian population with advanced chronic kidney disease: a pilot study.
期刊: Minerva endocrinology 发表日期: 2025-Oct-01 链接: PubMed
摘要
Ageing leads to an increase in the incidence of chronic diseases, including chronic kidney disease (CKD). The increasing proportion of elderly people with reduced renal function draws attention to a sub-population of patients for whom an alternative approach to traditional pharmacological and dietary treatment may be needed. The low-protein diet (LPD) in subjects with CKD helps control complications and may contribute to slowing the progression of the disease. In the follow-up during the conservative phase, nutritional status and the LPD are key points. Of interest, ketoanalogues (KAs) in combination with a LPD significantly reduces the progression to end-stage kidney disease. The aim of this pilot study is to determine the impact at 12 months of LPD supplemented with essential amino acids (EAA) and KAs in a population of 21 over-90-year-olds with advanced CKD in the conservative phase. The protein intake of the LPD was 0.6 g/kg body weight/day. Anthropometric measurements and biochemical parameters were monitored at baseline and after 12 months of dietary intervention. The Kidney Failure Risk Equation (KFRE) was used to predict the risk of end stage renal disease. Significant change in GFR (from 18.04±1.31 to 24.30±2.09 mL/min, P<0.001), azotemia (from 122.38±19.16 to 70.19±15.00 mg/dL, P<0.001) and KFRE score at 2 years (from 33.67±3.88 to 15.09±3.03%, P<0.001) and at 5 years (from 71.94±5.13 to 39.76±6.60% at 5 years, P<0.001). Laboratory parameters (azotemia, albumin, total protein, total cholesterol, transferrin, Hb, PTH, HbA1c, TSAT, CRP) improved. Two patients were hospitalized during the observation period, no cardiovascular events or deaths were reported. LPD supplemented with EAA and KAs has proven to be a safe and effective tool in the conservative treatment of the over-aged with advanced CKD. Dietary treatment improves renal function and management of complications, reducing the risk of terminal uremia and initiation of replacement treatment by not exposing patients to the risk of malnutrition.
26. High prevalence of inappropriate antithrombotic use in patients with symptomatic chronic subdural hematomas: should our focus be on preventing the subdural tsunami?
期刊: Neurosurgical focus 发表日期: 2025-Oct-01 链接: PubMed
摘要
Antithrombotic (AT) therapy is frequently prescribed to patients for stroke prevention, atrial fibrillation, or other purposes, but it is a potential risk factor for chronic subdural hematoma (cSDH) development and growth. Premorbid AT use is common among patients who present with cSDH requiring treatment. The authors assessed the prevalence of AT use outside established clinical guidelines among patients who underwent cSDH treatment at three academic hospitals. This was a multicenter retrospective review of patients with cSDH who underwent surgical intervention and/or middle meningeal artery embolization (MMAE) between 2019 and 2024. Demographic data, presenting clinical and radiographic findings, and AT indications and types were extracted. Appropriateness of AT use was assessed according to clinical guidelines. The cohort comprised 148 patients (77% male; mean age 74.96 ± 10.37 years) who underwent evacuation surgery alone (66.9%), MMAE (18.9%), or surgery with MMAE (14.2%). At presentation, the mean maximum hematoma thickness was 18.83 ± 6.5 mm, and 87.8% of patients had a midline shift. The most common indications for AT use were atrial fibrillation (27.0%) and coronary artery disease (24.3%). Antiplatelet monotherapy had been prescribed premorbidly to 58.1% of patients, anticoagulation monotherapy to 28.4%, and both to 13.5%. AT agents included aspirin (47.3%), direct oral anticoagulants (20.9%), warfarin (18.9%), dual antiplatelet therapy (18.2%), clopidogrel (7.4%), and therapeutic low-molecular-weight heparin (3.4%). Per clinical guidelines, 31.1% of patients were found to be inappropriately on AT therapy. Specific AT agents were not found to be associated with inappropriate AT consumption. Multivariable analysis identified cardiac stents (OR 3.95, 95% CI 1.05-14.88; p = 0.042) and primary and secondary stroke prevention (OR 10.59, 95% CI 3.20-35.09; p = 0.001) as indications associated with inappropriate AT use. Conversely, atrial fibrillation was associated with a lower likelihood of inappropriate AT use (OR 0.17, 95% CI 0.03-0.85; p = 0.031). In this study, nearly one-third of patients requiring treatment for cSDH were found to be inappropriately using AT medications, with primary and secondary stroke prevention and cardiac stents identified as independent predictors of such use. Greater vigilance among care teams is essential to address the burden of inappropriate AT use and potentially prevent the development of cSDH.
27. Effectiveness of a Participatory and Culturally Tailored Learning Program for Coronavirus Prevention in Muslim Older Adults With Hypertension and Diabetes: Quasi-Experimental Study.
期刊: Asian/Pacific Island nursing journal 发表日期: 2025-Oct-01 链接: PubMed
摘要
Respiratory infections have increased globally over time, with older adults being the most susceptible demographic. Programs based on cultures and experiences strongly correspond with useful, real-world applications. This study evaluated a participatory and culturally based learning program’s effect on awareness, knowledge, and preventive behaviors regarding coronavirus and health care among Muslim older adults with hypertension and diabetes in Thailand. The quasi-experimental study used a 2-group pretest-posttest design with participants aged 60-80 years with hypertension and diabetes. The sample included 35 in the experimental group and 32 in the control group. An interactive 6-week learning program focusing on coronavirus prevention and health care was developed by incorporating Muslim cultural perspectives and Kolb experiential learning model, alongside standard care. The control group received only standard care. Data were collected via a questionnaire covering general information, awareness, knowledge, and preventive behaviors related to coronavirus prevention and health care. The content validity indices of sections II, III, and IV were 0.98, 0.99, and 0.96, respectively. The Cronbach α coefficients of awareness and behaviors were 0.89 and 0.86, respectively, while the KR-20 for knowledge was 0.86. Data analysis was conducted using the t test, Mann-Whitney U test, and Wilcoxon signed-rank test. The results indicated that, after participating in the program, the awareness, knowledge, and preventive behaviors related to coronavirus and health care among older adults in the experimental group significantly improved compared to their preprogram levels and to those in the control group, with a P value <.01. The program effectively improved coronavirus prevention and health care among Muslim older adults. It could be broadly applied in similar contexts and to other severe respiratory diseases.
28. Targeting SUV4-20H Epigenetic Enzymes Enhances Topoisomerase II Poisoning in Prostate Cancer.
期刊: Cancer research 发表日期: 2025-Oct-01 链接: PubMed
摘要
Commonly used in cancer therapy, topoisomerase II (TOP2) poisons are designed to stabilize the normally transient DNA TOP2 cleavage complexes in chromatin, leading to deleterious DNA double-strand breaks. TOP2 poisons are often associated with significant side effects, highlighting the need to identify strategies aimed at improving the efficacy of TOP2 poisons in order to lower the required dosage. Here, we demonstrated that inhibiting histone H4-lysine 20 (H4K20) methyltransferases SUV4-20H1 and SUV4-20H2 induced synthetic lethality in combination with the TOP2 poison etoposide in prostate cancer. Remarkably, the loss of the SUV4-20H enzymes, which prevents the conversion of H4K20 mono-methylation to higher methylation states, increased replication fork velocity without impacting prostate cancer cell behavior. However, these apparently innocuous epigenetic changes significantly enhanced the trapping of TOP2 complexes in chromatin and increased DNA damage in response to etoposide. Furthermore, SUV4-20H depletion and the subsequent changes in H4K20 methylation impaired the repair of TOP2-induced DNA breaks by disrupting BRCA1-mediated homologous recombination processes, ultimately leading to extensive cancer cell death and significant inhibition of prostate tumor growth in vivo. Overall, these findings demonstrate that targeting the epigenetic activity of SUV4-20H is a powerful strategy to enhance the efficacy of TOP2 poisons and may represent a therapeutic alternative in prostate cancer, where SUV4-20H2 expression emerges as a potential marker of aggressive disease and high metastatic risk.
29. Rv2647-Mediated NLRP3 Ubiquitination Inhibits Macrophage Pyroptosis and Promotes Mycobacterium tuberculosis Survival.
期刊: ACS infectious diseases 发表日期: 2025-Oct-01 链接: PubMed
摘要
Inflammasome-mediated pyroptosis and cytokine release are crucial host defenses against intracellular pathogens. Mycobacterium tuberculosis (M. tb) is a successful intracellular pathogen, and it is largely unclear how it evades immune clearance and persists in macrophages. This study investigated whether the Rv2647 protein acts as a key virulence factor of M. tb and explored the potential mechanism of inhibiting macrophage pyroptosis and promoting M. tb survival. The results showed Rv2647 promoted NLRP3 degradation via enhancing its ubiquitination, which led to the inactivation of NLRP3/caspase-1/GSDMD and reduction of IL-1β secretion, thereby inhibiting macrophage pyroptosis and facilitating M. tb survival. Furthermore, Rv2647-mediated enhancement of NLRP3 ubiquitination and degradation depended on its binding to ISG15, competitively inhibiting ISGylation of NLRP3. The study identified Rv2647 as the key virulence factor that promoted M. tb survival by inhibiting macrophage pyroptosis, whose mechanism was to competitively inhibit the ISGylation of NLRP3 and enhance its ubiquitination, thus suppressing NLRP3/caspase-1/GSDMD-mediated pyroptosis. This finding highlighted Rv2647 as a promising drug target or vaccine antigen for tuberculosis prevention and control.
30. Prevention of cognitive impairment and dementia in people with Parkinson's disease: A call-to-action.
期刊: Journal of Parkinson’s disease 发表日期: 2025-Oct-01 链接: PubMed
摘要
Mild cognitive impairment and dementia are common symptoms in people with Parkinson’s disease (PwPD) that impair the quality of life of those affected. However, PD-specific concepts for the prevention of cognitive decline are rarely incorporated into routine care. Here, we provide key data on cognitive impairment in PwPD and a framework for primary, secondary, and tertiary prevention in this context. The importance of cognitive reserve as a protective buffer for cognitive decline in PwPD is highlighted. Relevant lifestyle and health-related factors, including cognitive aspects, physical and social activity, diet, hearing loss, and cardiovascular factors, are discussed. Evidence on the efficacy of possible cognition-enhancing interventions in PwPD-pharmacological, cognitive, physical, nutritional, and multidomain interventions-is summarized. On this basis, and the recommendations of the European Task Force for Brain Health Services, a proposal is developed outlining options for preventing cognitive impairment in PwPD that could be implemented in routine care, as well as further developments needed to achieve a best-case scenario. The main pillars of a strategic agenda for this purpose include: (i) regular assessment of cognitive state, overall risk, and risk factors for cognitive decline; (ii) risk communication and education concerning modifiable risk factors with standardized procedures; (iii) risk reduction with multi-domain interventions for secondary prevention; and (iv) cognitive enhancement with cognitive and physical training for tertiary prevention. As the proposal makes clear, the prevention of cognitive impairment in PwPD requires interdisciplinary collaboration organized throughout PD care networks. Many people with Parkinson’s disease (PwPD) experience cognitive problems, relating to memory and thinking. This can impair their quality of life. However, there are few strategies in regular medical care to help prevent these issues. This text explains the main facts about cognitive problems in PwPD and suggests ways to prevent them. It describes how “cognitive reserve” can help protect cognitive skills. Lifestyle factors that are important for cognitive health, like staying mentally, physically, and socially active, and a healthy diet, are discussed. Managing hearing loss, heart disease, and other health issues is also important. Different interventions to support brain health in PwPD are reviewed. These include medication, mental exercises, physical activity, diet changes, and combined approaches. Based on scientific recommendations, a plan is proposed to include prevention strategies in routine care.The key steps in this plan are: Regularly checking cognitive skills, along with possible risk factors.Educating PwPD about ways to lower their risks.Using combined intervention approaches to help slow cognitive loss.Offering cognitive and physical training to support cognitive skills.Preventing cognitive decline in PwPD requires teamwork between different medical experts. These efforts should be organized in special PD care networks to provide the best support.
31. An inactivated trivalent virion-based vaccine protects against aerosol challenge with encephalitic alphaviruses in mice and macaques.
期刊: Science translational medicine 发表日期: 2025-Oct 链接: PubMed
摘要
Venezuelan (VEEV), Eastern (EEEV), and Western (WEEV) equine encephalitis viruses are mosquito-transmitted alphaviruses in the family Togaviridae with the potential to cause fatal neuroinvasive disease in humans. These viruses can also be infectious when aerosolized and, thus, are potential biothreat agents. Human infection can progress rapidly to encephalitis, with fatality rates of 1 to 10% in symptomatic VEEV and WEEV infections and 30 to 70% in symptomatic EEEV infections. Currently, there are no antiviral agents or vaccines approved for encephalitic alphaviruses. An investigational live-attenuated VEEV vaccine was generated more than 40 years ago but is highly reactogenic, poorly immunogenic, and causes disease in up to 20% of recipients. Formalin-inactivated vaccines for EEEV and WEEV are also poorly immunogenic and no longer available. Here, we developed a trivalent vaccine against VEEV, EEEV, and WEEV using a combination of attenuated chimeric Sindbis-VEEV/EEEV/WEEV viruses to streamline production and an H2O2 inactivation treatment for enhanced safety and virion surface epitope preservation. The vaccines were adjuvanted with alum and tested for immunogenicity and protection in mouse and nonhuman primate models of lethal, aerosolized alphavirus infection. Two doses conferred complete protection in mice, and a similar regimen showed substantial or complete protection in nonhuman primates when administered at low and high doses, respectively. These results suggest that this inactivated vaccine is effective against the three encephalitogenic alphaviruses and may meet the need to counter the public health threat and biothreat posed by these viruses.
32. FphA Positively Regulates Fungal Development and AFB1 Biosynthesis and Phosphorylates Ypd1 in Aspergillus flavus.
期刊: Journal of agricultural and food chemistry 发表日期: 2025-Oct-01 链接: PubMed
摘要
Aspergillus flavus is a ubiquitous fungus capable of producing aflatoxin B1 (AFB1), a potent carcinogen that threatens food safety and human health. Here, we identified and characterized histidine kinase FphA as a positive regulator of fungal development and AFB1 biosynthesis. Deletion of fphA impaired mycelial growth and markedly reduced AFB1 production, accompanied by downregulation of cluster regulators aflR and aflS and multiple structural genes. Transcriptomic and phosphoproteomic analyses revealed significant transcriptional and phosphorylation changes in MAPK signaling components (e.g., Hog1 and SskA) in the ΔfphA strain. Although yeast two-hybrid assays showed no direct interaction between FphA and MAPK proteins, in vitro kinase assays demonstrated that FphA phosphorylates phosphotransfer protein Ypd1, suggesting regulation via the FphA-Ypd1-MAPK cascade. These findings establish FphA as a key regulator linking environmental sensing with fungal development and toxin biosynthesis, providing potential molecular targets for controlling aflatoxin contamination in agricultural products.
33. Probiotics, psychobiotics, and postbiotics: a therapeutic modality for the management of schizophrenia.
期刊: Nutritional neuroscience 发表日期: 2025-Oct-01 链接: PubMed
摘要
Schizophrenia is a debilitating, chronic neuropsychiatric disorder, a multifactorial disorder combining genetic, neurodevelopmental, immunological, and environmental factors. Common antipsychotic treatments may be effective against positive symptoms, but still lack when dealing with negative symptoms, cognitive defects, and side effects of medication. Recent innovations show how the gut-brain axis is an important modulator of neuropsychiatric health, identifying microbial dysbiosis as a cause of schizophrenia. This review examines the therapeutic potential of such treatments of probiotics, psychobiots, and postbiotics as an adjunctive or alternative treatment targeting the way of modulating neuroinflammation, neurotransmitter synthesis, experience, and maintenance of blood-brain barrier integrity. Probiotics, which are live beneficial microbes, have immunomodulatory and neuroactive effects; psychobiotics, a subclass that has specific mental effects, modify stress-response systems and neurotrophic factors. Postbiotics, consisting in turn of microbial metabolism like short-chain fatty acids, present improved safety and stability with anti-inflammatory and antioxidant functions. Available clinical and preclinical evidence suggests the ability of these agents to attenuate the symptoms of schizophrenia and cognitive impairment, as well as to increase the tolerability of treatment. Regarding the conclusive presumptions, however, strain-specific variability and inconsistent methodologies confined by the sparse large-scale trials limit them. New technologies of nanocarrier systems, artificial intelligence, and personalized microbiome profiling might provide the best precision of the therapy. In this review, pitfalls in mechanistic insights, progress reports on translational studies, and future research prospects are deconstructively examined to support microbiota-based interventions as promising paradigms of holistic schizophrenia management.
34. Investigating the release of active compounds and cytotoxicity of thymol/gallic acid/β-cyclodextrin bio-nanocomposite: a targeted strategy with the approach of disrupting the genes involved in the quorum sensing system and biofilm formation in P. aeruginosa (PAO1).
期刊: Preparative biochemistry & biotechnology 发表日期: 2025-Oct-01 链接: PubMed
摘要
The quorum sensing (QS) system and cell-to-cell communication have had a significant impact on biofilm formation and virulence factor increase in Pseudomonas aeruginosa (P. aeruginosa), making this opportunistic pathogen a global concern and potentially life-threatening agent. The present study aimed to create an innovative pharmaceutical bio-nanocomposite (BNC) comprising thymol (THY) and gallic acid (GA) based on β-cyclodextrin (β-CD), which was used to investigate the release kinetics of active compounds, the level of cytotoxicity, antibacterial and anti-biofilm potential, and measuring the expression of genes effective in QS in the strain PAO1 pays P. aeruginosa. Based on this, physicochemical characteristics of the synthesized BNC were determined using Fourier transform infrared spectroscopy analysis (FTIR), UV-vis measurement, dynamic light scattering (DLS), zeta potential, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). The BNC’s antibacterial and anti-biofilm capabilities were assessed using the PAO1 reference strain of P. aeruginosa and the expression level of QS-effective genes (rhlI, rhlR, lasI, and lasR) in bacteria was also evaluated in the presence of the synthesized BNC. The results of FTIR spectroscopy show the formation of intramolecular hydrogen bonds between THY, GA and β-CD. Absorption peaks of the UV-vis spectroscopy spectrum of the synthesized BNC at wavelengths of 217 and 272 nm are confirmed successful encapsulation of the THY and GA into the β-CD. The maximum size of the synthesized BNC was recorded as 356.3 nm with a polydispersity index (PDI) of 0.816. SEM and TEM micrographs show the presence of THY/GA active compounds in the pores in β-CD and the formation of a dense polymer network. After 360 minutes of release kinetics, more than 70% of the complex’s active chemicals had been released. The biological complex’s low toxicity is indicated by average cell survival of more than 65% and the ability to preserve the spindle shape of normal fibroblast cells at high concentrations. The PAO1 strain has minimum inhibitory concentrations (MIC) of 323 and 199.6 μg/mL for minimal biofilm inhibition concentration 50% (MBIC50). The decrease in rhlI and rhlR gene expression relative to the control group (without treatment) suggests that the active chemicals released from the biological complex interact and disrupt the QS pathway. Overall, the synthesized pharmaceutical complex has promise as a clever and effective option for future research and practical advances, as well as the development of complementary therapies.
35. Effects of Perfluorobutane Sulfonate (PFBS) on Female Reproduction, Pregnancy, and Birth Outcomes.
期刊: Obstetrical & gynecological survey 发表日期: 2025-Oct 链接: PubMed
摘要
Perfluorobutane sulfonate (PFBS) is a short-chain per- and polyfluoroalkyl substance (PFAS) that has emerged as a significant public health concern due to its widespread environmental contamination and persistent nature. While PFBS is considered to have a shorter half-life in the environment and human body compared to other PFAS compounds, there are still growing concerns about its potential impacts on human health, particularly on female reproduction and birth outcomes. This literature review critically examines the impact of PFBS exposure on female reproductive health, pregnancy outcomes, and fetal development, synthesizing the most recent data from both human and animal studies. A comprehensive literature search was conducted using data from peer-reviewed articles, clinical trials, animal models, and regulatory reports. These studies suggest that PFBS may have adverse effects on fertility, pregnancy health, and fetal development. It also explores the current regulatory landscape for PFBS, focusing on policies in Europe, the United States, and Asia while emphasizing the growing global efforts to establish more stringent guidelines and develop effective treatment technologies to mitigate PFBS exposure. Given the bioaccumulative properties of PFBS and its increasing detection through environmental surveillance, ongoing research, especially targeted studies in human populations, is urgently needed to fully elucidate its reproductive toxicity, including its potential transgenerational effects. This review underscores the importance of understanding PFBS mechanisms of action at the molecular and epigenetic levels, as this knowledge will be essential for informing public health strategies, shaping regulatory policies, and developing interventions to reduce human and environmental exposure.
36. Epigenetic Mechanisms in Childhood Obesity.
期刊: Annals of the New York Academy of Sciences 发表日期: 2025-Oct-01 链接: PubMed
摘要
Epigenetic mechanisms, including DNA methylation, histone modification, and activity of noncoding RNAs (nc RNAs), affect the regulation of gene expression. These mechanisms are regulated by numerous environmental factors and are critical at specific windows of biological development, when organs and systems plasticity is increased. Evidence suggests that exposure to factors influencing these mechanisms may have an effect on health, including the risk for obesity at early stages of life. This study analyzed published evidence on the association between epigenetic mechanisms and childhood obesity. We searched for studies using untargeted detection methods followed by validation of associations between epigenetic mechanisms and obesity in children. Fifteen studies were found: two meta-analyses on DNA methylation, seven original studies on DNA methylation, one systematic review on microRNAs, and five studies on nc RNA. No studies on histone modifications were identified. Most studies were conducted in blood cells or blood-derived fluids. DNA methylation in different tissues was associated with childhood and adolescent obesity or related phenotypes, although comparison across studies is difficult due to technical differences. Nc RNA differed between children with and without obesity. Research on the role of factors regulating epigenetic mechanisms associated with childhood obesity is highly needed.
37. Rehabilitation goals for hand and upper extremity function after cervical spinal cord injury: A retrospective study.
期刊: The journal of spinal cord medicine 发表日期: 2025-Oct-01 链接: PubMed
摘要
Patient goals are critical when determining surgical options for restoration of hand function in spinal cord injury (SCI). We characterized the discussion of goals specific to hand function during acute rehabilitation admission at a single Canadian center following cervical SCI, before the introduction of a hand surgery program for the tetraplegia population. A retrospective chart review of a single-center adult rehabilitation hospital from 2012 to 2022 of traumatic cervical SCI admissions was conducted. Charts were reviewed for discussion of specific goals that require hand function and recorded for analysis. Hand function goals were categorized and mapped to Canadian Occupational Performance Measures (COPM) domains, and patterns were analyzed on a population level. Over ten years, 134 individuals with acute traumatic SCI were admitted, 88 met study inclusion criteria with documented goals requiring hand function, and 32 unique goal types were recorded. The most common goal domain across all AIS categories was functional mobility. Motor complete patients primarily had self-care goals. Leisure and productivity goals were overall rarely captured. Most documented goals focused on basic activities of daily living (ADLs). We observed a historical emphasis on hand function goals of ADLs, but not capturing the depth and breadth of other domains where hand function is essential. With the development of hand surgery programs in the tetraplegia population, standardized tools and detailed discussion of hand function goals may better capture patient priorities, including productivity and leisure, and improve our discussion of functional outcomes when evaluating the success of surgery.
38. Bariatric Surgery, Employment, and Productivity Outcomes: A Systematic Review.
期刊: JAMA surgery 发表日期: 2025-Oct-01 链接: PubMed
摘要
Bariatric surgery is widely recognized for its health benefits; however, its association with work productivity and employment participation, though frequently reported, has not been systematically synthesized. This evidence is crucial to inform the economic evaluation of bariatric surgery. To systematically analyze the evidence on occupational outcomes of bariatric surgery. A systematic literature search was conducted in 5 online databases to identify empirical studies on bariatric surgery-related employment and productivity outcomes published up to April 2024. Two coauthors independently screened the literature, and all coauthors contributed to data extraction and validation. Differences in occupational outcomes were compared before vs after surgery and between surgery vs nonsurgery groups. Comparisons were categorized into 3 groups: improvement, no difference, and worse. Where possible, summary values of occupational outcomes (eg, the average employment rate) were synthesized for each observational time point. Reported barriers and enablers to employment return or productivity were also identified. A total of 42 studies from 15 countries were included. Studies were published between 1977 and 2023, with most conducted in high-income countries. Roux-en-Y gastric bypass was the most frequently studied procedure. The most commonly evaluated metrics were employment and unemployment rates and absenteeism and sick leave. Bariatric surgery was associated with improvements in presenteeism and work hours and ability and short-term absenteeism and employment rates. However, the long-term employment rate followed a reversed U-shape trajectory, with employment rates initially increasing postsurgery but returning to baseline levels after about 5 years. Key barriers to improved occupational outcomes included insufficient weight loss, female sex, older age, preoperative comorbidities, lower quality of life, and a lack of prior work experience. Bariatric surgery demonstrates positive short-term impact on productivity and employment, but its long-term occupational benefits remain uncertain. Certain subgroups, such as females and older adults, may require tailored postsurgery support to sustain employment and productivity gains. These findings highlight the critical need for long-term strategies to sustain the occupational benefits postsurgery and to develop targeted interventions for at-risk populations.
39. Stratifying lung adenocarcinoma risk with multi-ancestry polygenic risk scores in East Asian never-smokers.
期刊: Journal of the National Cancer Institute 发表日期: 2025-Oct-01 链接: PubMed
摘要
Lung adenocarcinoma (LUAD) in never-smokers is a major public health burden, especially among East Asian women. Polygenic risk scores (PRSs) are promising for risk stratification but are primarily developed in European-ancestry populations. We aimed to develop and validate single- and multi-ancestry PRSs for East Asian never-smokers to improve LUAD risk prediction. PRSs were developed using genome-wide association study summary statistics from East Asian (8,002 cases; 20,782 controls) and European (2,058 cases; 5,575 controls) populations. Single-ancestry models included PRS-25, PRS-CT, and LDpred2; multi-ancestry models included LDpred2+PRS-EUR128, PRS-CSx, and CT-SLEB. Performance was evaluated in independent East Asian data from the Female Lung Cancer Consortium (FLCCA) and externally validated in the Nanjing Lung Cancer Cohort (NJLCC). We assessed predictive accuracy via AUC, with 10-year and (age 30-80) absolute risks estimates. The best multi-ancestry PRS, using East Asian and European data via CT-SLEB (clumping and thresholding, super learning, empirical Bayes), outperformed the best East Asian-only PRS (LDpred2; AUC = 0.629, 95% CI:0.618,0.641), achieving an AUC of 0.640 (95% CI : 0.629,0.653) and odds ratio of 1.71 (95% CI : 1.61,1.82) per SD increase. NJLCC Validation confirmed robust performance (AUC =0.649, 95% CI: 0.623, 0.676). The top 20% PRS group had a 3.92-fold higher LUAD risk than the bottom 20%. Further, the top 5% PRS group reached a 6.69% lifetime absolute risk. Notably, this group reached the average population 10-year LUAD risk at age 50 (0.42%) by age 41, nine years earlier. Multi-ancestry PRS approaches enhance LUAD risk stratification in East Asian never-smokers, with consistent external validation, suggesting future clinical utility.
40. Art as an Agent of Wellbeing and Social -Participation for Mental Health: A Qualitative Study.
期刊: Community mental health journal 发表日期: 2025-Oct-01 链接: PubMed
摘要
Art provides a space for expression and personal growth, promoting well-being and reducing stigma, particularly for individuals with mental illness. Museums have shifted to create inclusive experiences for marginalized groups. This study aimed to explore the experiences of people with mental illness who participated in an Art and Museum Intervention program, examining the meanings they attributed to social participation and meaningful occupations through art. A qualitative descriptive study was conducted with 18 participants from a Psychosocial and Occupational Rehabilitation Center in A Coruña, Spain, using purposeful sampling. Data were gathered through focus groups, in-depth interviews, and participant observation, followed by thematic analysis. Participants actively engaged in the study, sharing their experiences of art as a means of social integration. The collaboration between the museum and the rehabilitation center ensured a community-based approach. Two main themes emerged: (1) Art as an agent of socialization, including teamwork, building support networks, community integration, and overcoming stigma; and (2) Well-being and empowerment through meaningful occupation, with subthemes of positive emotions, empowerment, and art as a meaningful activity. The study highlights how museum-led art interventions enhance well-being and social participation, positioning art as a valuable tool in mental health recovery and community inclusion.
41. Relationship between self-compassion, assertiveness at work and job satisfaction among teachers.
期刊: International journal of occupational medicine and environmental health 发表日期: 2025-Oct-01 链接: PubMed
摘要
In the study, the authors aimed to explore the relationship between self-compassion, assertiveness and job satisfaction among teachers. Specifically, they examined whether assertiveness mediated the relationship between self-compassion and job satisfaction, filling a gap in the existing research on teachers’ well-being. A total of 208 teachers (192 women, 16 men) aged 24-64 years, with an average teaching experience of 21 years, participated in the study. The participants were recruited using snowball sampling. Self-compassion was measured with the Self-Compassion Scale (SCS), assertiveness with the Teacher Assertiveness Questionnaire, and job satisfaction with the Job Satisfaction Scale. Statistical analyses included descriptive statistics, Spearman’s correlation and mediation analysis using Process tool (model 4). Self-compassion was positively correlated with both assertiveness (r = 0.21, p < 0.01) and job satisfaction (r = 0.18, p < 0.05). Assertiveness was also positively related to job satisfaction (r = 0.21, p < 0.01). Mediation analysis demonstrated a total mediating effect of assertiveness in the relationship between self-compassion and job satisfaction, with the model explaining 8.3% of the variance in job satisfaction. The findings suggest that selfcompassion promotes teachers’ assertiveness, which in turn increases job satisfaction. This highlights the importance of supporting self-compassion and assertiveness as resources protecting against occupational stress and burnout. However, the cross-sectional nature of the study limits causal inference, so future research should consider longitudinal models and different educational contexts. These findings provide practical insights for the design of interventions aimed at promoting teacher well-being. Int J Occup Med Environ Health. 2025;38(4).
42. Absence from work in the 12 months following mild traumatic brain injury in Europe: a CENTER-TBI cohort study.
期刊: Annals of physical and rehabilitation medicine 发表日期: 2025-Sep-30 链接: PubMed
摘要
Most of the prior research on absence from work after a mild traumatic brain injury (mTBI) was of a small sample size and had a limited number of follow-up assessments. Therefore, this study investigated the prevalence of absence from work, trajectories, and associated factors in the 12 months following mTBI in Europe. Data from a European cohort (CENTER-TBI) were used. Absence from work was assessed at 2 weeks, 3 months, 6 months, and 12 months after mTBI. Associated factors included sociodemographic factors, current psychoactive substance use, pre-injury medical history, injury-related factors, medical care, complications, and discharge, and 2-week follow-up questionnaires. Inferential analyses relied on generalized estimating equations. This study included 1080 adults with mTBI who were working at the time of the injury (median [IQR] age, 46.0 [23.0] years; 69 % men). Absence from work decreased from 32 % at 2 weeks to 20 % at 12 months after the injury (P < 0.001). Around 76 % of adults returned to work within the first 3 months, whereas > 43 % of those absent from work at 3 months remained absent at 12 months. The 3 factors with the strongest association with absence from work were admission to hospital wards (OR = 2.57) or intensive care units (OR = 4.76), the presence of a pre-injury psychiatric disorder (OR = 2.55), and older age (OR = 1.61). One-fifth of workers with mTBI were absent from work 12 months after the injury. Early identification of those at particular risk for not returning to work should be a clinical priority. NCT02210221 (https://clinicaltrials.gov/).
43. A Single Bout of High-Intensity Running Exercise Transiently and Reversibly Increases Intestinal Permeability and Neutrophil Recruitment in the Mouse Intestine.
期刊: Medicine and science in sports and exercise 发表日期: 2025-Sep-30 链接: PubMed
摘要
Although the health benefits of exercise are well-documented, intense exercise can induce gastrointestinal symptoms, potentially due to disruption of the intestinal barrier. This disruption allows foreign substances to enter the intestine and circulation, triggering immune system activation and inflammation. In this study, we investigated the effects of a single bout of running exercise at different intensities on intestinal permeability and systemic immune cell responses. Male C57BL/6J mice were assigned to a control group, a low-intensity exercise group (10 m/min, Ex-low), and a high-intensity exercise group (20 m/min, Ex-high). The exercise lasted 60 min, while the control group remained sedentary. Immediately after exercise, intestinal permeability was assessed using FITC-Dextran. Immune cells were isolated from the lungs, blood, small intestinal lamina propria (siLP), and large intestinal lamina propria (liLP), while neutrophils, macrophages, eosinophils, B cells, and T cells were quantified by flow cytometry. The Ex-high group exhibited significantly increased intestinal permeability and neutrophil infiltration in the siLP compared with both the control and Ex-low groups. No significant differences in other immune cell types were observed between the groups. Furthermore, the Ex-high group demonstrated elevated neutrophil counts in the liLP, lungs, and blood. The expression of inflammatory cytokines (Il-1β and Il-6) and chemokines (Cxcl1 and Cxcl2) was also significantly higher in the small intestines of the Ex-high group. A single bout of high-intensity exercise increases intestinal permeability and neutrophil infiltration in both the intestines and systemic tissues, highlighting a potential mechanism by which intense exercise induces intestinal and systemic inflammation.
44. Increased Skeletal Muscle Oxidative Capacity Augments the Myokine Response to Whole Body Vibration.
期刊: Medicine and science in sports and exercise 发表日期: 2025-Sep-30 链接: PubMed
摘要
The role of skeletal muscle health on preventing and ameliorating chronic disease is emerging. The improvements in skeletal muscle metabolism are likely mediated by myokines, such as myostatin, IL-6, and decorin. Whether or not basal skeletal muscle health contributes to the myokine response to Whole body vibration (WBV), an exercise mimetic, has yet to be elucidated. Data from Sixty-three young adults (32.5± 0.7 years, 57.1% female, 42.9% non-Hispanic Black) were included from a longitudinal twin cohort study. Skeletal muscle oxidative capacity (SMOC) was determined using near-infrared spectroscopy by measuring the rate of skeletal muscle oxygen consumption after stimulation and was represented as a rate constant averaged over three trials (AvgRC). The acute WBV protocol consisted of 10 cycles of 1 min of vibration exercise followed by 30s of standing rest. Blood was collected at baseline (PRE), immediately post, and 1h, 3h, and 24h post WBV and myokine concentrations of IL-6, myostatin, and decorin were measured at each of these timepoints. Participants were divided into two groups by SMOC: low skeletal muscle oxidative capacity (AvgRC < 1.82) and high skeletal muscle oxidative capacity (AvgRC > 2.13). Participant characteristics including age, BMI, body fat percentage, handgrip, and skeletal muscle index (SMI) were similar between groups. SMOC was positively associated with myostatin at baseline (ß= 564.6, SE=232.4, p=0.045) and 24H following WBV (ß= 661.0, SE=189.4, p=0.029). In addition, a significantly higher overall myostatin (p=0.026) and IL-6 response (p=0.001) to WBV was observed in in the high skeletal muscle oxidative capacity group when compared to the low skeletal muscle oxidative capacity group. Higher skeletal muscle oxidative capacity is associated with a greater myostatin and IL-6 response to acute WBV. These data suggest that a higher SMOC at baseline may positively impact the myokine response to WBV, independent of adiposity, and demonstrates the importance of skeletal muscle health on preventing and ameliorating chronic disease.
45. Sensitivity and Specificity of the Brachial Plexus Outcome Measure Activity Scale: A Retrospective Cohort Study.
期刊: The Journal of hand surgery 发表日期: 2025-Sep-30 链接: PubMed
摘要
Upper limb impairments occur after incomplete recovery from brachial plexus birth injury (BPBI). Reconstructive surgeries are offered to address specific joint-level impairments; however, complete restoration is not possible. Thus, surgical decisions must carefully consider the goal of improving activity function within the child’s life context. The Brachial Plexus Outcome Measure (BPOM) Activity scale is an outcome measure of upper limb activity limitation in children with BPBI. It measures the upper limb function on a 5-point ordinal scale, where a score of ≤3 is theoretically an indicator of surgical candidacy; however, no studies have validated this cutoff score. This study aimed to determine whether the BPOM Activity scale score of ≤3 can accurately identify children with BPBI who may benefit from reconstructive surgery. A retrospective cohort study was conducted on children with BPBI (4-18 years). Two independent researchers screened the diagnostic, surgical, and outcome data from the health records and a BPBI database. Sensitivity, specificity, and receiver operating characteristic area under the curve (AUC) of ≤3 scores for shoulder, elbow/forearm, and wrist surgeries were used to identify discriminating ability. These analyses were repeated for all scores (≤1 to ≤5) to determine the best cutoff score. Of the 502 patients screened, 251 were included. The sensitivity and specificity of ≤3 scores had acceptable to excellent discriminating ability for shoulder (90%, 72%, 0.81 AUC), elbow/forearm (89%, 90%, 0.89 AUC), and wrist (80%, 93%, 0.86 AUC) surgeries. Sensitivity, specificity, and AUC were the highest at the ≤3 score compared with other cutoff scores. The BPOM Activity scale ≤3 cutoff score was able to identify children with BPBI who may benefit from upper limb reconstructive surgery. These findings indicate that the BPOM Activity scale can help support shared decision-making for interventions to optimize upper limb function after BPBI.
46. Spray paint-derived microplastics influence soil properties and microbial activity through their composite composition.
期刊: Journal of hazardous materials 发表日期: 2025-Sep-29 链接: PubMed
摘要
Paint-derived microplastics (MPs) are increasingly recognized as an overlooked but potentially significant source of terrestrial pollution. To investigate their ecological effects on soil health, we conducted a controlled six-week soil incubation experiment using 10 commercially available spray paints with varying polymer compositions and colors. Paint-derived MPs were applied at environmentally relevant concentrations (0.01 % and 0.4 % w/w). Soil pH, water-stable aggregates, soil respiration, and enzyme activities related to carbon, nitrogen, and phosphorus cycling were measured. Results showed that paint-derived MPs increased soil pH at the high concentration and reinforced the stability of water-stable aggregates. Paints with distinct polymeric compositions generated MPs with different size distributions upon application; these paint-derived MPs modulated soil respiration dynamics. The influence of color on the toxicity of paint-derived MPs appears to be primarily associated with metal pigments. In particular, paint-derived MPs containing copper consistently showed significant negative effects on all measured parameters. Furthermore, paint-derived MPs exhibited concentration-related toxicity patterns, which may be attributed to the various additives embedded in their formulations. This study provides new insights into the environmental risks of paint-derived MPs and highlights the role of their composite composition in determining their ecological impact on soil ecosystems. These findings underscore the importance of greater transparency in paint formulations and stricter regulation of hazardous components.
47. Nicotinamide metabolic dysregulation plays a key role in Benzo[a]pyrene-induced adverse birth outcomes: Evidence from multi-omics profiling, experimental and epidemiological validation.
期刊: Journal of hazardous materials 发表日期: 2025-Sep-28 链接: PubMed
摘要
Prenatal exposure to Benzo[a]pyrene (BaP) has been shown to increase the risk of adverse birth outcomes, potentially through disruption of maternal metabolic homeostasis. However, the underlying pathways and mechanisms remain unclear. To address this knowledge gap, we employed a multi-omics approach combining experimental and epidemiological investigations. In the mouse model, untargeted metabolomics profiling revealed niacinamide (NAM) metabolism as the most significantly altered pathway in both maternal serum and placenta following BaP exposure. Mechanistically, BaP exposure reduced nicotinamide adenine dinucleotide (NAD+) synthesis while increasing its catabolism through activation of poly (ADP-ribose) polymerase 1 (PARP1) in placental tissue. Subsequent transcriptomic analysis showed that BaP-induced NAD+ depletion led to sirtuin 1 (SIRT1) suppression and consequent exacerbation of the NF-κB-mediated inflammatory response. These experimental findings were substantiated in human populations through targeted metabolomic analysis of a Chinese birth cohort, where significant NAM metabolic disturbances were observed in women with high BaP exposure experiencing preterm delivery. Our study provides novel mechanistic evidence that BaP-induced dysregulation of NAM metabolism mediates adverse birth outcomes through NAD+ deficiency and subsequent inflammatory response. These findings not only identify potential therapeutic targets but also highlight the urgent need for evidence-based environmental policy interventions and nutritional supplementation strategies to protect maternal-fetal health in high-risk populations.
48. Association between microplastic exposure and macrolide resistance in mycoplasma pneumoniae pneumonia among younger children: A cross-sectional study in China.
期刊: Journal of hazardous materials 发表日期: 2025-Sep-27 链接: PubMed
摘要
Microplastics (MPs) are emerging environmental contaminants that pose potential health risks through inhalation, ingestion, and dermal contact. However, data on MP exposure and its impact on the pediatric respiratory system remain limited. This study aimed to assess MP levels in bronchoalveolar lavage fluid (BALF) and evaluate their associations with macrolide resistance in children with Mycoplasma pneumoniae pneumonia (MPP). BALF samples from 195 children aged 1-16 years were analyzed using Laser Direct Infrared (LDIR) spectroscopy and Pyrolysis-Gas Chromatography/Mass Spectrometry (Py-GC/MS). Six types of MPs were identified: Polyamide 66 (PA66) (92.31 %), Polyvinyl Chloride (PVC) (81.54 %), Polystyrene (PS) (78.97 %), Polyethylene (PE) (51.28 %), Polymethyl Methacrylate (PMMA) (21.02 %), and Polypropylene (PP) (11.28 %). MPs were detected in 194 out of 195 samples, with an overall detection rate of 99.48 %. Logistic regression showed that moderate exposure to PE (0.32-1.05 µg/mL) significantly increased the odds of macrolide-resistant MPP compared to low exposure (OR = 1.39; 95 % CI: 1.01-1.92; P < 0.05). Among children aged ≤ 6 years, high PE exposure was strongly associated with odds of macrolide-resistant MPP (OR = 2.62; 95 % CI: 1.37-5.02; P < 0.05), with a significant dose-response trend (P trend = 0.004). These findings provide the first evidence linking lower respiratory tract MP exposure with antibiotic resistance in pediatric MPP, particularly among younger children, and underscore the importance of minimizing environmental MP exposure in vulnerable populations.
49. The effects of Lycium barbarum polysaccharide on oxidative stress and sperm health in varicocele patients: A randomized clinical trial.
期刊: Tissue & cell 发表日期: 2025-Sep-25 链接: PubMed
摘要
Varicocele is an abnormal enlargement of scrotal veins, significantly contributing to male infertility. The plant Lycium barbarum, known for its high antioxidant properties, may enhance fertility quality. This study examines the protective and antioxidant effects of Lycium barbarum polysaccharide on sperm health in patients with varicocele. In a double-blind clinical trial conducted in 2022 at Afzalipoor Hospital in Kerman, 80 patients with varicocele were randomly assigned to either an intervention group (n = 40) or a control group (n = 40). After collecting demographic, blood, and semen samples, the intervention group received 400 mg of Lycium barbarum extract orally for two months, while the control group received a placebo. Blood and semen samples were re-evaluated 90 days post-treatment for markers such as Superoxide dismutase, Glutathione peroxidase, Malondialdehyde, and Testosterone, as well as sperm health parameters. Before treatment, the Mann-Whitney test showed no significant difference between the groups (P < 0.05). The intervention group exhibited effective enhancement in antioxidant enzyme activity (Superoxide dismutase, Glutathione peroxidase). The intervention with Lycium barbarum resulted in a significant decrease in Malondialdehyde (MDA) levels, indicating a reduction in oxidative stress. Significant improvements in Testosterone level and sperm count, motility, and morphology, indicating the intervention’s positive impact on male fertility indicators, excluding semen volume (P < 0.05). The volume of semen following the intervention with Lycium barbarum showed a slight increase post-intervention. In conclusion, the results suggest that Lycium barbarum polysaccharide has a positive effect on oxidative stress and sperm health. Further research with larger sample sizes is recommended to enhance the generalizability of these findings.
50. Characterization of Spirometric Response to Standard-of-care Treatment in Lung Allograft Recipients With Bronchiolitis Obliterans and the Utility of Spirometric Criteria for Rescue Therapy: Implications for the Design of Risk-stratified Clinical Trials.
期刊: Transplantation 发表日期: 2025-Sep-24 链接: PubMed
摘要
The spirometric response to standard-of-care (SOC) immunosuppressive therapy for the management of bronchiolitis obliterans syndrome (BOS) has been sparsely reported in the literature. Data from a Medicare-approved Registry were analyzed to characterize the effectiveness/durability of a wide range of SOC interventions to manage the decline of lung function and to validate the study spirometric criteria for initiation of rescue therapy. Lung transplant recipients with refractory BOS at 21 US collaborating centers were enrolled in the Registry. Data included both nonspirometric (eg, demographic, Immunosuppressive Regimens for management of BOS) and spirometric parameters (ie, FEV1 measurements and derived indices). The utility of study forced expiratory volume in 1 s (FEV1) criteria for treatment (ie, statistically significant rate of FEV1 decline >30 mL/mo) was evaluated by comparing the spirometric course between participants who met or did not meet this criterion. Only 21% of participants treated with SOC therapy had >50% decrease (76 ± 25% decrease) in the rate of FEV1 decline. Although 51% of participants had a partial response (rate of FEV1 decline decreased on average 71%), 49% of participants had a substantial increase (mean increase 224%). The FEV1 criterion for treatment was able to identify 19% of participants (48/258) who achieved durable stabilization (ie, nonsignificant rate of FEV1 <30 mL/mo) with SOC therapy. Patients with BOS have a widely variable response to SOC therapy. Our findings support the use of FEV1 rate of decline to assess response to SOC therapy and to assure appropriate assignment of participants with refractory BOS to rescue therapy treatment cohorts.
51. Bioinformatic-based study to investigate the fluctuations and performance of MYD88 and GRB2 gene expression in gastric cancer; Can they be considered diagnostic biomarkers?
期刊: Cancer treatment and research communications 发表日期: 2025-Sep-19 链接: PubMed
摘要
Gastric cancer (GC) ranks as the fourth most prevalent malignancy and constitutes the second leading cause of cancer-related mortality globally. The elevated mortality rate is linked to molecular heterogeneity, late-stage diagnosis, and the limited efficacy of existing therapies. Recent developments in bioinformatics have facilitated the discovery of new biomarkers and therapeutic targets, essential for enhancing diagnosis, prognosis, and treatment approaches in gastric cancer. This study examines the bioinformatics analysis of two significant genes, GRB2 (Growth factor receptor-bound protein 2) and MYD88 (Myeloid differentiation primary response 88), associated with gastric cancer progression and immune response regulation. We analyzed data from public databases such as GEPIA2, TIMER, GeneMANIA, and Cytoscape to examine the differential expression of GRB2 and MYD88 in gastric cancer tissues versus normal tissues, their roles in protein-protein interaction networks, and their association with immune infiltration. The findings indicate that elevated GRB2 expression correlates significantly with tumor invasion, underscoring its potential as an independent prognostic marker and therapeutic target in gastric cancer. The expression of MYD88 is associated with the activation of the NF-κB signaling pathway, which is induced by Helicobacter pylori infection, thereby contributing to chronic inflammation and tumorigenesis. Functional enrichment analysis, encompassing KEGG and GO, indicated that both genes are involved in essential oncogenic pathways, such as cell proliferation, immune response regulation, and inflammatory signaling. The results indicate that GRB2 and MYD88 may function as significant biomarkers for patient stratification and should be considered in the formulation of targeted therapies for gastric cancer. This study highlights the importance of GRB2 and MYD88 in the progression of gastric cancer and proposes their potential as therapeutic targets to enhance patient outcomes.
52. Metabolic health and body mass index phenotypes in adults.
期刊: Health reports 发表日期: 2025-Sep-17 链接: PubMed
摘要
To better understand the interplay between adiposity and metabolic health, joint phenotypes have been used to categorize people as being metabolically healthy (MH) or metabolically unhealthy (MU) while having a body mass index (BMI) indicative of obesity, overweight, or normal weight. This study examines the prevalence of these phenotypes in adults, the factors associated with them, and their relationship with adverse health outcomes. Three cycles of the Canadian Health Measures Survey (from 2014 to 2019) were combined to characterize adults aged 20 to 79 years as MU if they had at least three out of five measures of elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, or elevated fasting glucose. Measured BMI, categorized as indicative of normal weight, overweight, or obesity, was combined with MH or MU to produce six joint phenotypes. Phenotype prevalence was examined across selected characteristics and separate multivariable logistic regression models estimated the association with self-reported health status and morbidity indicators. One in four Canadian adults was either MU with obesity or MU with overweight. These phenotypes were more prevalent at older ages. Among MH adults, higher BMI was associated with worse self-rated general health. MU adults with obesity were 1.8 times more likely to report worse general health than MH adults with obesity. MU adults with obesity or with overweight were 1.2 times more likely to have higher levels of systemic inflammation than MH adults with obesity or overweight. Higher BMI, regardless of metabolic health, was associated with higher levels of systemic inflammation. Gaining insight into the population prevalence of metabolic health and BMI phenotypes and their association with health risks can help improve awareness and inform health promotion strategies.
53. Utilizing Learning Communities to Implement a Wellness-in-Action Session in Undergraduate Medical Education.
期刊: Southern medical journal 发表日期: 2025-Sep 链接: PubMed
摘要
Learning communities (LCs) are on the rise in medical education. Key features of LCs include fostering student learning, wellness, and engagement. The ways in which different programs are currently using LCs are still relatively new, however, and literature on this topic is scarce. We developed and incorporated a wellness-in-action session, coined Brian’s Field Day, into our LC curriculum with the aim to improve self-care, camaraderie, and socialization. More than 180 first-year medical students and 20 LC faculty advisors participated in Brian’s Field Day, a large-scale 1-hour wellness-in-action session, in academic years (AYs) 2021-2022 and 2022-2023. The session was divided into different activities, including yoga, meditation, dodgeball, kickball, coloring, pet therapy, board games, walking, improvisation, and Zumba. All students received an electronic survey assessing their perceptions of the activity. The overall response rate was 47% (86/183 students) in AY 2021-2022 and 49% (90/182 students) in AY 2022-2023. Overall, postactivity perceptions were positive with mean scores ranging from 4.00 to 4.61 (standard deviation [SD] range ± 0.69-1.30) for “enjoyment,” “improved camaraderie,” “should continue as part of the curriculum,” and “would like more events like this.” The mean was 3.96 (SD ±1.15) and 3.83 (SD ±1.38) for “improving self-care” in AY 2021-2022 and AY 2022-2023, respectively. Themed qualitative comments also indicated improved student-student and faculty-student bonding and the desire for more similar activities. Academic stress among medical students is high and many schools have incorporated LCs into their curricula to help with socialization and promotion of wellness and community. As more schools adopt LCs, they should consider integrating a wellness-in-action session as a fun way to augment both peer-to-peer and student-faculty relationships.
54. Perceptions and experiences of the prevention, testing, and treatment of anaemia in pregnant women: A qualitative evidence synthesis.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Anaemia during pregnancy is a serious public health problem, inequitably burdening women in low-and middle-income countries. Despite numerous strategies and programs, anaemia prevalence rates have stagnated. We aimed to explore women’s, health workers’, and other key stakeholders’ perceptions of anaemia in pregnant women, or their experiences with its prevention, testing, or treatment. We conducted a qualitative evidence synthesis. We searched MEDLINE (Ovid), Scopus, and CINAHL from inception to 12 November 2024, with no language or geographical restrictions. Data were analysed using thematic synthesis, and confidence in each review finding was assessed using the GRADE-CERQual approach. We included 61 papers from 23 countries. We grouped 25 review findings under four themes: (a) socio-cultural context of anaemia in pregnant women; (b) prevention and/or treatment of anaemia in pregnant women through diet, supplementation, or clinical intervention; (c) testing pregnant women for anaemia; and (d) factors affecting health workers’ engagement in the management of anaemia in pregnant women. Women’s management of anaemia in pregnancy was affected by the socio-cultural context, particularly their limited decision-making power and social position. Many women perceived a nutritious diet as integral to managing anaemia; however, high cost was often a barrier. Reasons women did not adhere to supplements included side-effects and difficulty remembering to take them, with family support improving adherence. Blood transfusion was perceived as treatment for severe anaemia, while intravenous iron was considered for women with iron-deficiency anaemia who were unable to take supplements, attended antenatal care late, or could not receive a transfusion. Health workers described difficulties testing pregnant women for anaemia and structural health-system deficiencies that affected their engagement. Findings may inform future WHO recommendations for managing anaemia in pregnant women. Future research could use review findings alongside implementation science frameworks to develop strategies for improving prevention, testing, and/or treatment of anaemia in pregnant women.
55. The decision uncertainty toolkit: Risk measures and visual outputs to support decision making during public health crises.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
During public health crises such as the COVID-19 pandemic, decision-makers relied on infectious disease models to evaluate policy options. Often, there is a high degree of uncertainty in the evidence base underpinning these models. When there is increased uncertainty, the risk of selecting a policy option that does not align with the intended policy objective also increases; we term this decision risk. Even when models adequately capture uncertainty, the tools used to communicate their outcomes, underlying uncertainty, and associated decision risk have often been insufficient. Our aim is to support infectious disease modellers and decision-makers in interpreting and communicating decision risk when evaluating multiple policy options. We developed the Decision Uncertainty Toolkit by adapting methods from health economics and infectious disease modelling to improve the interpretation and communication of uncertainty. Specifically, we developed a quantitative measure of decision risk as well as a suite of risk visualizations. We refined the toolkit contents based on feedback from early dissemination through conferences and workshops. The Decision Uncertainty Toolkit: (i) adapts and extends existing health economics methods for characterization, estimation, and communication of uncertainty to infectious disease modelling, (ii) introduces a novel risk measure that quantitatively captures the downside risk of policy alternatives, (iii) provides visual outputs for dissemination and communication of uncertainty and decision risk, and (iv) includes instructions on how to use the toolkit, standard text descriptions and examples for each component. The use of the toolkit is demonstrated through a hypothetical example. The Decision Uncertainty Toolkit improves existing methods for communicating infectious disease model results by providing additional information regarding uncertainty and decision risk associated with policy alternatives. This empowers decision-makers to consider and evaluate decision risk more effectively when making policy decisions. Improved understanding of decision risk can improve outcomes in future public health crises.