公共卫生研究摘要 (2025-10-03)
共收录 62 篇研究文章
1. Feasibility, acceptability, and effectiveness of a package of interventions to improve the performance of health workers in the Democratic Republic of Congo to deliver adolescent and youth sexual and reproductive health services.
期刊: Global health action 发表日期: 2025-Dec 链接: PubMed
摘要
Adolescents and youth (AY) in the Democratic Republic of Congo (DRC) face significant sexual and reproductive health (SRH) challenges and require access to quality health services. This study assesses the feasibility, acceptability, and effectiveness of a package of interventions to improve the performance of health workers (HWs) providing SRH services to AY in the DRC. This mixed-methods process and outcome evaluation was conducted between January and July 2021 in 30 health facilities in Mbuji-Mayi and Kinshasa. Data were collected through interviews with 25 health facility managers, surveys of 54 HWs, focus groups with 29 HWs, and interviews with 16 AY mystery clients and 18 female AY (10-24 years) health facility service users. Qualitative and quantitative data were analyzed using thematic content analysis and descriptive statistics respectively. Health facility managers reported that the package of interventions was feasible to implement, with concerns about resource shortcomings which were outside the scope of the implementation. From both quantitative and qualitative findings, health facility managers and HWs perceived the package of interventions as acceptable and effective in improving HW competencies, building positive attitudes towards providing SRH services to AY, building HW motivation, and fostering an enabling work environment as illustrated by improved communication, mentorship and constructive feedback between managers and HWs, and motivation, confidence and collaboration among HWs. AY clients reported overall satisfaction with the services they received, but some reported experiencing inappropriate comments and judgmental attitudes. The package of interventions was perceived as feasible and acceptable by health facility managers and HWs, and effective in improving HW knowledge, skills, attitudes and motivation, and ultimately in providing SRH services to AY. Future efforts are needed to validate the findings in different contexts and with other professionals, e.g. teachers, and to strengthen and amplify the package of interventions. Main findings: The findings indicate that the health facility managers, health workers and AY reported that the package of interventions was feasible to implement, with concerns about shortcomings in terms of resources which were not intended to be included in the implementation, as well as acceptable and effective in improving health worker performance to provide quality SRH services to AY.Added knowledge: This study found that it is still possible to improve health worker performance to provide quality SRH services without providing financial incentives, but with a comprehensive package of interventions including job descriptions, training and refresher training sessions, desk reference tools, supportive supervision and collaborative learning sessions.Global health impact for policy and action: We expect that the insights from our study on enhancing the competencies and attitudes of health workers, as well as fostering a supportive physical and social environment, could provide valuable guidance for health programs aimed at improving the knowledge, attitudes, skills, competencies, motivation and performance of health workers to provide quality SRH services for AY.
2. Chemobiological synthesis of benzene, toluene, ethylbenzene, and xylene from glucose or glycerol.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Oct-07 链接: PubMed
摘要
Benzene, toluene, ethylbenzene, and p-xylene (BTEX) are key aromatic hydrocarbons widely used in fuels, polymers, and industrial chemicals, yet their production remains heavily dependent on fossil resources, raising environmental and public health concerns. To promote de novo production of BTEX from renewable feedstocks, we developed a chemobiological platform that integrates microbial biosynthesis with chemical deoxygenation. Four metabolically engineered Escherichia coli strains were constructed to produce one of four oxygenated precursors of BTEX-phenol, benzyl alcohol, 2-phenylethanol, or 2,5-xylenol-from glucose or glycerol. After in situ two-phase extractive fermentation of the individual engineered strains using isopropyl myristate (IPM) as the organic solvent, the organic phase containing one of the oxygenated precursors was separated from the aqueous phase and subjected to distinct chemical deoxygenation reactions to reduce the precursor to the corresponding BTEX compound. This modular approach, based on the compatible organic solvent, streamlines biotransformation and consecutive chemical derivatization, providing a practical and viable route to sustainable BTEX production. The platform is extensible and provides a generalizable framework for integrating biosynthesis with chemical deoxygenation in hybrid bioprocessing.
3. Ultrasonography-Based Measurements of Endometrial Thickness in Patients With p53 Abnormal Endometrial Carcinomas.
期刊: Obstetrics and gynecology 发表日期: 2025-Oct-02 链接: PubMed
摘要
To evaluate prediagnostic endometrial thickness measured by transvaginal ultrasonography (TVUS) in a cohort of patients with endometrial cancer stratified by p53 status to assess accuracy of endometrial thickness as a screening tool in this patient population. We conducted a retrospective cohort study of patients diagnosed with endometrial cancer who underwent prediagnostic TVUS between 2004 and 2017. Using a tissue microarray, we categorized cases as p53 abnormal (p53abn) or p53 wild type (p53wt) according to the presence or absence of p53 aberrant immunohistochemistry staining. Cases were stratified according to established screening thresholds of 4-mm or less endometrial thickness used to evaluate postmenopausal bleeding. Clinical data were manually abstracted. All patients included underwent surgical staging, including hysterectomy. Student t, χ2, and Fisher exact tests were performed to assess for variables associated with p53abn endometrial carcinoma. Multivariate logistic regression was performed to assess variables associated with cases of endometrial cancer, with false-negative TVUS screening results defined as an endometrial thickness of 4 mm or less. Of the 133 patients identified, 60 (45.1%) were classified as p53abn and 73 (54.9%) as p53wt. The median age of the cohort was 66 years (interquartile range 58-74 years), and median body mass index (BMI) was 31.3 (interquartile range 26.8-37.3). Median endometrial thickness was 16 mm (interquartile range 9-22 mm), and 48 patients (36.1%) had submucosal or intramural leiomyomas identified on TVUS. Patients diagnosed with p53abn endometrial cancers were more likely to have thinner endometrial measurements compared with p53wt cases (10 mm [interquartile range 5-18.5 mm] vs 18 mm [interquartile range 13-23 mm], P<.001). At a threshold of 4 mm or less, patients with p53abn endometrial cancer were more likely to screen negative compared with patients with p53wt endometrial cancer (25% vs 4.1%, P<.001). In multivariate analysis, a threshold of 4 mm or less for endometrial thickness, lower BMI (odds ratio [OR] 0.906, 95% CI, 0.833-0.986, P=.023), and p53 status (OR 9.415, 95% CI, 2.441-36.309, P=.001) remained significant predictors of false-negative screening results. Endometrial thickness assessed by TVUS does not appear to be a reliable screening method in patients diagnosed with p53abn endometrial cancers. The use of endometrial thickness as a screening test for endometrial cancer may miss a significant portion of p53abn cases because of false-negative results. In the presence of postmenopausal bleeding, endometrial tissue sampling should be strongly considered.
4. Feasibility, Safety, and Impact of the Probiotics Lactiplantibacillus plantarum and Bifidobacterium longum subspecies infantis in Papua New Guinean Infants: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Oct-02 链接: PubMed
摘要
Childhood mortality in low- or middle-income countries (LMICs) remains a major public health concern, with infections being a leading cause of infant death. Probiotics have shown promise in reducing infection-related morbidity and mortality in preterm infants, but their use in newborns born at or near term in LMICs requires further investigation. This study aims to assess the feasibility, safety, and initial outcomes of administering 1 of 2 synbiotic formulations or a placebo to newborns in the Eastern Highlands Province of Papua New Guinea. Following ethics approvals in 2018 and 2019, and receipt of the synbiotic preparations in September 2020, healthy neonates (<72 h old; n=244) were recruited between October 2020 and June 2023 and randomly assigned in a double-blind manner (1:1:1) to receive an oral preparation containing Lactiplantibacillus plantarum, Bifidobacterium longum subspecies infantis, or placebo for 7 consecutive days. Follow-up continued for 6 months, with rectal swabs, stool, blood, saliva, and nasopharyngeal swabs collected before the intervention; on day 7; at age 2 weeks; and at ages 1, 3, 4, and 6 months. Ongoing analyses will assess probiotic gut colonization, bacterial nasopharyngeal carriage, and antibody responses to routine childhood vaccines (Hemophilus influenzae type b; hepatitis B; 13-valent pneumococcal conjugate vaccine; and diphtheria, tetanus, and whole-cell pertussis) as well as hospitalization and infection rates among the intervention groups compared to the placebo group. Recruitment began in October 2020, with the target sample size expanded from 195 to 240 in March 2023 owing to higher-than-anticipated loss to follow-up during the COVID-19 pandemic. Of the 244 enrolled infants, 218 (89.3%) completed the full 7-day synbiotic or placebo course, and 169 (69.3%) completed the study. All follow-up visits concluded in December 2023. Disruptions due to the COVID-19 pandemic led to family relocations outside the study area, preventing some infants (75/244, 30.7%) from completing the study. High rates of sample collection were achieved, with rectal swabs (1452/1474, 98.1%), nasopharyngeal swabs (1255/1262, 99.44%), saliva samples (881/882, 99.9%), and blood samples (876/882, 99.3%) successfully obtained at multiple time points. Data analysis is ongoing and expected to be completed by the end of 2025. This study demonstrates that probiotic supplementation is feasible and safe in healthy infants in an LMIC such as Papua New Guinea. The findings from this study will inform the design of larger trials of probiotics and synbiotics to complement existing efforts to reduce infection-related infant mortality in LMICs, while also providing insights into their clinical, immunological, and microbiological impacts in infants. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001369910; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620001369910. DERR1-10.2196/73926.
5. The Use of Repetitive Transcranial Magnetic Stimulation to Improve Cognitive Impairment in Patients With Stroke Based on rs-fMRI Findings: Protocol for a Meta-Analysis.
期刊: JMIR research protocols 发表日期: 2025-Oct-02 链接: PubMed
摘要
Poststroke cognitive impairment (PSCI) is a chronic form of poststroke cognitive dysfunction that affects approximately one-third of the survivors of stroke. PSCI significantly increases the rates of mortality and functional disabilities, such as limitations in motor function, speech, and activities of daily living. Therefore, effective treatments are needed for patients with PSCI. Repetitive transcranial magnetic stimulation (rTMS) has been shown to exert beneficial behavioral effects in patients with PSCI. More importantly, a limited number of neuroimaging studies with small sample sizes have reported the beneficial effects of rTMS on brain plasticity and its reciprocal influence on cognitive and behavioral performance. Resting-state functional magnetic resonance imaging (rs-fMRI) has been widely used to study changes in brain activity, but there is no consensus regarding which brain regions play pivotal roles in rTMS for patients with PSCI. This study aims to explore the therapeutic effects of rTMS on changes in the brain activity of patients with PSCI, thereby providing robust evidence to elucidate its neuroimaging mechanisms. In this meta-analysis, we will systematically search the PubMed, Embase, Cochrane Library, Web of Science, China Biology Medicine, and China National Knowledge Infrastructure databases, VIP Chinese Science and Technology Periodical Database, and the China WanFang Database up to December 2024 to identify randomized controlled trials comparing active rTMS with sham stimulation conditions or conventional control conditions in patients with PSCI. The primary outcomes will include the amplitude of low-frequency fluctuation, fractional amplitude of low-frequency fluctuation, regional homogeneity, and functional connectivity across the whole brain. The secondary outcomes will include the Montreal Cognitive Assessment and Mini-Mental State Examination scores. Statistical analyses will be conducted via Review Manager (version 5.4), Seed-based d Mapping with Permutation of Subject Images (version 6.23), and Stata (version 18.0) software to assess study quality, evaluate the risk of bias, and analyze the outcome measures. The study will offer a comprehensive analysis of the available evidence on the use of rTMS to improve cognitive impairment in patients with stroke based on rs-fMRI findings. The meta-analysis will be conducted from July 2024 to April 2026, following this predefined protocol. The process encompasses database searching and study screening (to be concluded by October 2025), data extraction and synthesis (to be completed by December 2025), and subsequent manuscript preparation and submission (anticipated by April 2026). This meta-analysis will provide insights into the therapeutic potential of rTMS to improve cognitive impairment in patients with stroke. It will also highlight the strengths and limitations of the existing literature and suggest directions for future research. Ultimately, our study may aid future clinical decision-making concerning PSCI rehabilitation programs and provide evidence-based medical insights into the neuroimaging mechanisms of rTMS treatment for PSCI. DERR1-10.2196/77931.
6. Comparative Effectiveness of Titanium Platelet-Rich Fibrin and Connective Tissue Graft Harvested from the Tuberosity Area Via Modified Vestibular Incision Supraperiosteal Tunnel Access for Managing Gingival Recession: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Oct-02 链接: PubMed
摘要
Periodontal surgery has traditionally relied on connective tissue grafts (CTGs) obtained from the tuberosity site to correct gingival recession abnormalities. However, there are challenges to be addressed, including insufficient graft quantity and patient susceptibility. Consequently, titanium-prepared platelet-rich fibrin, or T-PRF, has emerged as a competitive alternative. By combining T-PRF with the modified vestibular incision supraperiosteal tunnel access (M-VISTA) approach, a more conservative way is provided, which may improve the course of treatment. The objective of this study is to compare the effectiveness of T-PRF and CTGs from the tuberosity area in managing gingival recession defects using the M-VISTA technique. The study aims to evaluate improvements in clinical outcomes, including pocket probing depth (PPD), clinical attachment level (CAL), relative gingival margin level (RGML), recession depth (RD), and width of keratinized gingiva (WKG), as well as plaque and bleeding indices. The proposed methodology entails conducting a randomized clinical trial over 2 years with 24 participants, each presenting with multiple gingival recessions (>2 mm, Miller’s Class I or II) on the buccal or labial aspects of teeth in the maxilla or mandible. Participants will be randomly allocated into 2 groups: the test group and the control group. The M-VISTA technique will be used for root coverage using T-PRF in the test group and tuberosity CTG in the control group as regenerative materials. Their effectiveness will be compared by evaluating PPD, CAL, RGML, RD, and WKG. Additionally, the plaque index will be calculated by dividing the total plaque index score of all teeth by the number of teeth examined, and the papillary bleeding index will be assessed using a periodontal probe with scores evaluated on a scale of 0-4 based on bleeding potential. Data will be analyzed using Student paired and unpaired t tests to compare results from baseline to 3 and 6 months for each group. Recruitment, participant selection, baseline data collection, and randomization of groups concluded in September 2024, and the intervention phase is scheduled to end in December 2025. The study is expected to be completed by July 2026, with final evaluation, data analysis, and publication preparation taking place between June and July 2026. Based on existing evidence, we anticipate that the M-VISTA technique with T-PRF will provide superior root coverage compared to tuberosity CTG because no second surgical site is involved. Evidence suggests that T-PRF may offer comparable clinical benefits to CTG, particularly in clinical attachment gain, RD reduction, and gingival thickness, supporting the advancement of minimally invasive periodontal plastic surgery. Clinical Trials Registry of India CTRI/2024/07/071619; https://tinyurl.com/ypfe34b5. DERR1-10.2196/67168.
7. Expanding the Design Space for Fall Prevention in Acute Orthopedic Hospital Care: Human-Centered Design Study.
期刊: JMIR human factors 发表日期: 2025-Oct-02 链接: PubMed
摘要
In-hospital fall prevention is a complex phenomenon most efficiently addressed via a wide range of multifactorial interventions. Technology may contribute, but research in this field has so far mainly focused on detecting falls. As a result, new knowledge from a system perspective is needed regarding when and how new technologies may support fall prevention among patients who have been hospitalized. This study aimed to explore and describe clinical practices in an acute orthopedic hospital ward for fall prevention from a system perspective; determine the needs and possibilities related to support for clinical practices for fall prevention; and test whether a framework for studying interactions between people, activities, contexts, and technologies can be used to support observations of complex phenomena such as clinical fall prevention. This qualitative study followed the principles of human-centered design while combining focused ethnography with a workshop. Eight health care professionals representing different staff categories in an acute hospital ward of an orthopedic clinic participated in on-site interviews or were observed in their clinical practice. Data from these events were subjected to qualitative content analysis to describe the clinical practices for fall prevention observed in terms of people, activities, context, and tools. In a workshop, a larger group of clinic personnel provided their views on fall prevention, described the activities and tools they observed to prevent falls, and discussed needs for further support. This study determined that health personnel considered fall prevention in all their interactions with patients, which included a wide range of activities for fall prevention wherein staff categories played complementary roles. These staff-patient meetings were goal oriented, responsive, and patient centered. The staff often served as key “tools” in assessment, communication, and coaching, while digital tools (mainly computer-based software programs) were used for information retrieval, documentation, and communication. The personnel worked to prevent patient falls both during hospitalization and after discharge. They believed that the long-term perspective was much more difficult to address in their clinical practice, and they expressed a need for more homelike environments in the hospital. The view on technology-based in-hospital fall prevention can be broadened not only to mainly include monitoring and alarm systems, information systems in general, or computer-based information in particular systems but also to support activities performed by health personnel that engage patients in fall prevention. For example, tools such as these can be implemented in training involving daily activities and mobility within safe yet more homelike clinical contexts.
8. Identifying Optimal Testing Modalities to Increase COVID-19 Testing Access in Baltimore, Maryland: Protocol for a Household Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Oct-02 链接: PubMed
摘要
The COVID-19 pandemic disproportionately affected low-income and racial and ethnic minority populations. Testing plays a critical role in disrupting disease transmission, but complex barriers prevent optimal testing access, particularly for Black and Latinx communities. There is limited evidence regarding the optimal testing modalities to increase testing access for these populations. This study aimed to define the optimal COVID-19 testing modalities for maximizing testing acceptance, uptake, and timeliness of receipt of results. The Community Collaboration to Combat COVID-19 (C-FORWARD) trial was a household randomized comparative effectiveness trial conducted in a representative sample of an urban population. Households across 653 census block groups were sampled using a probability proportional to size approach. The primary outcome was the completion of SARS-CoV-2 or COVID-19 testing within 30 days of randomization. Between February 2021 and December 2022, a total of 1083 individuals were enrolled, including 881 (81.35%) index participants and 202 (18.65%) household members. The mean age of participants was 51 (SD 18) years.Of the total sample, 43% (n=460) of participants identified as Black or African American, 48.6% (n=526) as White, and 9% (n=91) as other, including Asian, American Indian, Native Hawaiian or Pacific Islander, and multiple races; 4.8% (n=48) of participants identified as Hispanic or Latino. At the time of enrollment, 51.1% (n=553) were currently working either full time or part time, and 32.9% (n=342) of participants had an advanced degree. In total, 80% (n=809) of participants had been tested for COVID-19 previously, with 22.3% (n=179) reporting a prior positive test for COVID-19, and 86.8% (n=890) reporting receiving at least one COVID-19 vaccination before enrollment. Data from the C-FORWARD trial will be used to address important questions regarding COVID-19 testing acceptance and uptake in an urban population. RR1-10.2196/68600.
9. Gender Differences in the Digital Divide, Digital Back-Feeding, and Health-Related Quality of Life Among Rural Older Adults: Cross-Sectional Study.
期刊: JMIR aging 发表日期: 2025-Oct-02 链接: PubMed
摘要
The digital divide has loomed as a global public issue in recent years. However, evidence is limited regarding whether the digital divide is associated with health-related quality of life (HRQOL) and whether digital back-feeding would buffer this association. This study aims to explore the role of digital back-feeding in the relationship between the digital divide and HRQOL among older men and women living in rural China. We used data from wave 3 of the Shandong Rural Elderly Health Cohort, conducted in 2022. A total of 3242 (n=1946, 60.02% women) rural older adults were included in the analysis. Moderating effect analysis was performed using Tobit regression models and margins plots. A total of 71.01% (2302/3242) of the participants reported experiencing digital divide. Participants experiencing digital divide were significantly associated with lower HRQOL as measured by EQ-5D-5L scores (β=-0.020; P<.001). We found that digital back-feeding buffered the relationship between digital divide and HRQOL (β=0.024; P=.02). Furthermore, gender-stratified analyses revealed divergent moderation patterns; a significant buffering role was observed in women (β=0.031; P=.02), whereas no substantially significant moderating role emerged in men. Our study established a significant inverse association between the digital divide and HRQOL among rural adults. Digital back-feeding emerged as a measurable protective buffer mitigating this adverse relationship. Furthermore, this buffering effect was only observed among older women. Policy implications underscore the necessity of gender-tailored digital inclusion strategies, particularly advocating for technology-proficient adult offsprings to prioritize digital engagement with their mothers in digitally marginalized rural communities.
10. Effect of Lifestyle Modification Through Web-Based Telerehabilitation Monitoring Combined With Supervised Sensorimotor Training After Total Knee Arthroplasty: Randomized Controlled Trial.
期刊: JMIR mHealth and uHealth 发表日期: 2025-Oct-02 链接: PubMed
摘要
Total knee arthroplasty (TKA) is commonly performed to manage end-stage knee osteoarthritis, yet postsurgical recovery varies significantly among patients. Lifestyle modification and rehabilitation interventions play a critical role in optimizing outcomes. While telerehabilitation has shown promise in enhancing accessibility and compliance, its role in supporting lifestyle behavior change alongside supervised sensorimotor training remains underexplored. This study aimed to evaluate the effects of a home-based lifestyle modification program delivered through web-based telerehabilitation monitoring in addition to supervised sensorimotor training, in improving physical function, pain, balance, quality of life (QOL), and adherence in patients undergoing TKA. A single-blinded randomized controlled trial was conducted among 52 participants undergoing primary TKA, who were randomly assigned to either the intervention group (IG) (supervised sensorimotor training plus a telerehabilitation-supported lifestyle modification program) or the control group (CG) (supervised sensorimotor training alone and a traditional home exercise plan). The intervention lasted 22 weeks, and participants were assessed at baseline (presurgery), 14 weeks, and 22 weeks postsurgery. Outcome measures included joint position sense (JPS), musculoskeletal ultrasound of the rectus femoris muscle, Berg Balance Scale, knee function using the Knee Injury and Osteoarthritis Outcome Score, and QOL via EuroQol 5-dimension 5-level questionnaire. Significant improvements were observed in the IG across all outcomes compared with the CG. Notably, the IG showed greater improvements in musculoskeletal ultrasound thickness. JPS showed superior accuracy in the experimental group (baseline [3.2 degrees] to 22 wk postsurgery [0.05 degrees]) compared with the CG (baseline [3.1 degrees] to 22 wk postsurgery [1.8 degrees]), with significant improvements noted (P=.001, Cohen d=3.1 vs 0.7), Knee Injury and Osteoarthritis Outcome Score subscales (pain, symptoms, activities of daily living, sport, and QOL), and JPS (mean absolute error 0.05 vs 1.8 degrees). Berg Balance Scale demonstrated significant gains in balance for the experimental group (baseline [34] to 22 wk postsurgery [53]) relative to the CG (baseline [37] to 22 wk postsurgery [48]), with substantial differences observed (P=.001, Cohen d=1.8 vs 0.4). The EuroQol 5-dimension 5-level questionnaire health-related QOL scores were markedly higher for the experimental group (baseline [45.4] to 22 wk postsurgery [88.1]) compared with the CG (baseline [42.8] to 22 wk postsurgery [70.9]), indicating substantial gains in overall health status (P=.001, Cohen d=2.4 vs 1.3). The IG also reported higher compliance, with 81.8% (18/22) achieving over 90% adherence compared with 68.18% (15/22) in the CG. Home-based lifestyle modification program through telerehabilitation monitoring significantly improved functional and patient-reported outcomes in individuals following TKA. These findings support the integration of lifestyle modification programs through telerehabilitation monitoring into post-TKA recovery pathways to optimize rehabilitation outcomes.
11. Parallel Corpus Analysis of Text and Audio Comprehension to Evaluate Readability Formula Effectiveness: Quantitative Analysis.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-02 链接: PubMed
摘要
Health literacy, the ability to understand and act on health information, is critical for patient outcomes and health care system effectiveness. While plain language guidelines enhance text-based communication, audio-based health information remains underexplored, despite the growing use of digital assistants and smart devices in health care. Traditional readability formulas, such as Flesch-Kincaid, provide limited insights into the complexity of health-related texts and fail to address challenges specific to audio formats. Factors like syntax and semantic features significantly influence comprehension and retention across modalities. This study investigates features that affect comprehension of medical information delivered via text or audio formats. We also examine existing readability formulas and their correlation with perceived and actual difficulty of health information for both modalities. We developed a parallel corpus of health-related information that differed in delivery format: text or audio. We used text from the British Medical Journal (BMJ) Lay Summary (n=193), WebMD (n=40), Patient Instruction (n=40), Simple Wikipedia (n=243), and BMJ journal (n=200). Participants (n=487) read or listened to a health text and then completed a questionnaire evaluating perceived difficulty of the text, measured using a 5-point Likert scale, and actual difficulty measured using multiple-choice and true-false questions (comprehension) as well as free recall of information (retention). Questions were generated by generative artificial intelligence (ChatGPT-4.0). Underlying syntactic, semantic, and domain-specific features, as well as common readability formulas, were evaluated for their relation to information difficulty. Text versions were perceived as easier than audio, with BMJ Lay Summary scoring 1.76 versus 2.1 and BMJ journal 2.59 versus 2.83 (lower is easier). Comprehension accuracy was higher for text across all sources (eg, BMJ journal: 76% vs 58%; Patient Instructions: 86% vs 66%). Retention was better for text, with significant differences in exact word matching for Patient Instructions and BMJ journal. Longer texts increased perceived difficulty in text but reduced free recall in both modalities (-0.23,-0.25 in audio). Higher content word frequency improved retention (0.23, 0.21) and lowered perceived difficulty (-0.20 in audio). Verb-heavy content eased comprehension (-0.29 in audio), while nouns and adjectives increased difficulty (0.20, 0.18). Readability formulas’ outcomes were unrelated to comprehension or retention, but correlated with perceived difficulty in text (eg, Smog Index: 0.334 correlation). Text was more effective for conveying complex health information, but audio can be suitable for easier content. In addition, several textual features affect information comprehension and retention for both modalities. Finally, existing readability formulas did not explain actual difficulty. This study highlighted the importance of tailoring health information delivery to content complexity by using appropriate style and modality.
12. A Feasibility Study for Mapping Ovarian Sentinel Lymph Nodes: A Memorial Sloan Kettering Cancer Center Team Ovary Study.
期刊: Obstetrics and gynecology 发表日期: 2025-Oct-02 链接: PubMed
摘要
To evaluate four methods of injecting indocyanine green (ICG) around the adnexa and identify the optimal technique for ovarian sentinel lymph node (SLN) mapping. Patients presenting for management of an adnexal mass were prospectively enrolled. Patients with peritoneal carcinomatosis were excluded. Four injection methods were evaluated: 1) intratubal, 2) paraovarian peritoneum, 3) infundibulopelvic (IP) ligament after resection of the adnexal mass, and 4) IP ligament before resection of the adnexal mass. Two mL of ICG was injected, and at least 10 minutes of transit time was allowed. The ipsilateral and contralateral pelvic and para-aortic lymph node beds were evaluated for ICG uptake. Retroperitoneal nodal resection was performed if indicated. Forty patients were enrolled, 10 in each group. For method 1, 20.0% of SLNs mapped, all to the ipsilateral para-aortic lymph node bed. For method 2, 10.0% mapped, only to the ipsilateral para-aortic lymph node bed. For method 3, 50.0% mapped to the ipsilateral para-aortic lymph node bed (n=3), contralateral para-aortic lymph node bed (n=1), or ipsilateral pelvic lymph node bed (n=1). For method 4, 70.0% mapped to the ipsilateral para-aortic lymph node bed (n=5) or ipsilateral pelvic lymph node bed (n=2). Surgeons reported methods 1 and 2 as cumbersome, and excessive peritoneal staining made SLN identification difficult. No injection-related complications were reported. Injection of ICG into the IP ligament before or after adnexal mass resection led to similar rates of SLN mapping and was deemed feasible by surgeons. Only one SLN was identified contralateral to the adnexal mass, and all but three mapped to the para-aortic region. Injection into the IP ligament should be evaluated in patients with likely adnexal malignancy, including SLN resection.
13. Use of a Checkbox Format for Electronic Remote Symptom Monitoring After Surgery.
期刊: JCO oncology practice 发表日期: 2025-Oct-02 链接: PubMed
摘要
Comparative studies demonstrate that patients who use electronic patient-reported outcomes (ePROs) experience better outcomes; however, research comparing ePRO designs to determine optimal strategies for routine clinical practice is limited. We aimed to determine the impact of a novel checkbox format for presenting items in a postoperative symptom-assessment ePRO tool. Patients undergoing prostatectomy, nephrectomy, mastectomy, hysterectomy, or thyroidectomy at a tertiary cancer hospital ambulatory surgery center through July 2024 were included. All patients were assigned the ePRO tool for 10 days postoperatively to assess surgical recovery. Historically, patients were asked to rate severity of all symptoms in the tool. An updated checkbox format was then implemented that asked if symptoms were present (yes/no) before eliciting qualitative severity ratings only for selected symptoms. An interrupted time-series design was used to compare patient engagement and psychometric properties before and after implementation of the checkbox format. 31,702 patients undergoing 38,929 operations were assigned the ePRO tool with (n = 17,432) or without (n = 21,497) the checkbox format. Without checkboxes, 75% of patients completed at least one questionnaire; mean completion time was 2 minutes. With checkboxes, completion rates improved by an adjusted absolute difference of 13% (95% CI, 12% to 14%; P < .001) and completion times decreased by 44 seconds (95% CI, 42 to 46; P < .001). Symptom scores were lower in the checkbox group and had better correlation with known predictors. Presenting ePRO items in a conditional checkbox format improved patient engagement, reduced survey burden, and was associated with better psychometric properties. The checkbox format should be standard for ePRO delivery in settings such as after surgery, where patients are likely to report only a subset of possible symptoms.
14. Unmet Health Care Use Among Socially Withdrawn Youth (Hikikomori) in South Korea: Cross-Sectional Survey Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Oct-02 链接: PubMed
摘要
Hikikomori, a condition of severe social withdrawal, is a global public health issue characterized by prolonged isolation. Despite its growing prevalence, little is known about the health care needs and use patterns of socially withdrawn youth. The study aimed to examine the association between hikikomori status and unmet health care use to inform targeted interventions. Data were obtained from the 2022 Korean Youth Living Conditions Survey, a nationally representative cross-sectional survey of 14,966 participants aged 19 to 34 years. Survey weights were applied to account for the sampling design. Hikikomori status was classified based on self-reported withdrawal behaviors, stratified by severity and duration. Unmet health care use in physical and mental health was assessed. Adjusted prevalence ratios (aPRs) with 95% CIs were estimated using generalized estimating equation models, and logistic regression was applied for subgroup analyses. The weighted prevalence of perceived need for mental health services was 63.9% in the hikikomori group versus 50.5% in the non-hikikomori group (aPR 1.27, 95% CI 1.15-1.41). Unmet health care use was higher among individuals with hikikomori for physical care (aPR 3.33, 95% CI 2.16-5.13) and mental health care (aPR 4.46, 95% CI 2.92-6.81). Associations strengthened with greater severity and longer duration: for unmet mental health care use, aPRs were 4.14 (95% CI 2.64-6.49) for stage 1 and 9.52 (95% CI 3.67-24.65) for stage 2; by duration, aPRs were 2.57 (95% CI 1.11-5.96) for pre-hikikomori and 5.44 (95% CI 3.44-8.58) for hikikomori. Effect modification was observed by labor force participation, with higher risks among those not in the labor force (P for interaction <.05). Hikikomori is strongly associated with unmet health care use, particularly in mental health, with risks amplified by severity and duration. Tailored policies, including community-based outreach and remote health care interventions, are urgently needed to address these gaps.
15. A modest article about brilliant care.
期刊: Health sociology review : the journal of the Health Section of the Australian Sociological Association 发表日期: 2025-Oct-02 链接: PubMed
摘要
While the discourse on care is largely pessimistic, brilliance happens, demonstrated by instances when care exceeded expectation. To advance brilliant care scholarship, this article asks, what are the domains that enable it? Through a reflexive analysis of ten publications on brilliant care, four domains were constructed and justified - namely: a relational orientation to care; attentive engagement; working with and beyond the technical aspects of healthcare; and shared responsibility. This article concludes with an invitation to those who receive, deliver, manage, develop policies that are relevant to, or conduct research on health service management - namely, to consider how these domains can be improved and how they can be systematised and translated into policy and practice, without compromising their dynamic quality.
16. The escalation of prosocial commitment: How the B corporation movement catalyzes social impact.
期刊: The Journal of applied psychology 发表日期: 2025-Oct-02 链接: PubMed
摘要
Organizations have embraced sustainability certifications as a way of demonstrating their prosocial commitments. These certifications are often rigorous and resource-intensive, and yet some certified organizations increase their efforts beyond receiving the certification. To understand why, we revisit the literature on escalation of commitment to theorize the escalation of prosocial commitment. We test our framework by analyzing why B Corporations (B Corps)-businesses that have been certified for their prosocial commitments-would participate in an initiative that challenged them to improve their diversity, equity, and inclusion (DEI) practices and whether their efforts have any effect. Our framework emphasizes three organization-level drivers of escalation of prosocial commitment: image and identity, internal and external context, and urgency to demonstrate impact. Our findings largely support these drivers. Furthermore, escalation of prosocial commitment leads to improvements in both DEI practices and sustainability practices more generally and has collective spillover benefits, including reduced certification attrition rates and a positive shift in the DEI profiles of new B Corps that certified for the first time after the conclusion of the initiative. We also find a surprising outcome-what we call a paradox of inclusivity: B Corps with less emphasis on DEI practices, despite being strong in other sustainability areas, were more likely to exit the B Corp movement after the initiative. Our research contributes to the escalation of commitment literature, reveals practice implications for certifying bodies and organizations seeking to foster social impact, and offers insights to policymakers about potential levers for remaking capitalism. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
17. Prostate-Specific Membrane Antigen PET for Patients With Postoperative Recurrence of Prostate Cancer.
期刊: JAMA oncology 发表日期: 2025-Oct-02 链接: PubMed
摘要
18. Prevalence of youth type 2 diabetes in global Indigenous populations: a systematic review.
期刊: Diabetologia 发表日期: 2025-Oct-02 链接: PubMed
摘要
We aimed to synthesise global prevalence estimates of type 2 diabetes among Indigenous youth aged under 25 years, and examine age- and gender-specific differences and secular trends. We searched MEDLINE, Embase, CINAHL and Cochrane, and bibliographies of included studies, from 1 January 1980 to 14 September 2024. We included cross-sectional observational studies that reported diabetes point prevalence estimates (per 1000) and prevalence trends in Indigenous youth aged under 25 years from all regions. Age- and gender-specific analysis and secular trends were reported. Study quality was assessed using a modified Newcastle-Ottawa Scale adapted for Indigenous health research. From 2342 records and 27 additional references, 49 studies were retained for data extraction. Total type 2 diabetes prevalence, reported in 33 of 49 studies from 36 distinct populations across six countries and two self-governing states, varied widely (0-44 per 1000), with 75% (27/36) of the populations reporting a prevalence of over 1 per 1000. Age-specific data, available in 44 studies, showed increased prevalence with age: 0-4 per 1000 at age <10 years; 0-44 per 1000 at age 10-19 years; and 0-64 per 1000 at age 15-25 years. Of 22 studies with gender-specific data, 77% showed a female predominance. Secular trends, examined in 12 studies since 1981, showed a rising prevalence in young adults (aged 15-25 years) in eight of ten studies, and in youth aged under 15 years in six of nine studies. Heterogeneity in study design, diagnostic criteria, and incomplete age- and gender disaggregation precluded meta-analysis. Youth type 2 diabetes prevalence in Indigenous populations is very high, particularly in young adulthood, and among the female sex. Prevalence has increased over time. Future research should stratify data by age and pubertal status, and identify both protective and risk factors to inform targeted prevention strategies. Indigenous-led, community-specific approaches that actively engage youth are critical in the development and implementation of diabetes surveillance, prevention and management programmes. PROSPERO registration no. CRD42021278418.
19. Narrative, moral and institutional effects of childhood ADHD: Listening to teachers and mothers of diagnosed children.
期刊: Health (London, England : 1997) 发表日期: 2025-Oct-02 链接: PubMed
摘要
Building on research on the critical role of laypeople in medicalization and the multi-dimensional character of this process, this study explores the effects and meanings of the ADHD category for mothers and teachers of diagnosed children. Based on interviews with 27 schoolteachers from two different schools and 42 mothers of children diagnosed with ADHD, we show that despite the growing acceptance of ADHD as a medical diagnosis, it exhibits only minor narrative, institutional, and moral effects in school and family arenas. The diagnostic label attributed to children does not resolve blame games and uncertainty about the source of children’s difficulties and does not provide many pragmatic benefits for either mothers or teachers. We argue that these limited narrative, moral and institutional effects are shaped by the moral positionings available to mothers and teachers, the institutional status of ADHD as a category of disability, and educational policy. We distinguish medicalization’s institutional and interpersonal dimensions and explore their complex interrelations. Our analysis resonates with recent moves in medical sociology toward more pragmatic and practice-based analyses of the effects of medical categories, particularly when enacted outside traditional healthcare settings.
20. Rethinking the nature of medicine: limits of the inquiry thesis through the case of African traditional medicine.
期刊: Theoretical medicine and bioethics 发表日期: 2025-Oct-02 链接: PubMed
摘要
This paper critically evaluates Alex Broadbent’s Inquiry Thesis, which defines medicine by the core competencies of prediction and understanding. While the thesis seeks to avoid parochialism by identifying features that could apply across traditions, its applicability falters when examined against African traditional medicine (ATM). Using ATM as a test case, this paper demonstrates that legitimate medical systems can operate coherently and enjoy broad social legitimacy without consistently exercising prediction or understanding in Broadbent’s sense. This challenges the Inquiry Thesis both as a general account of medicine and as an inclusive framework. Accordingly, this paper tentatively advances a Refined Curative Thesis (RCT), which shifts the unifying criterion from competencies to aims: medicine is defined as the organized, socially recognized effort to restore or maintain health through interventions directed at beneficial change. RCT accommodates epistemic diversity, preserves conceptual discipline, and avoids collapsing into unstructured pluralism. By centring the curative aim, this revised account offers a more inclusive, philosophically robust, and culturally sensitive definition of medicine. The analysis deepens philosophical understanding of medicine while also bearing practical significance for global health policy, intercultural dialogue, and the recognition of diverse medical systems.
21. Pregnancy-Related Deaths Due to Infection: Pregnancy Mortality Surveillance System, 2012-2019.
期刊: Obstetrics and gynecology 发表日期: 2025-Oct-02 链接: PubMed
摘要
Infection has been a leading cause of pregnancy-related death in the Centers for Disease Control and Prevention’s Pregnancy Mortality Surveillance System since 1987, when reporting began. For this descriptive study, we used 2012-2019 data from the Pregnancy Mortality Surveillance System. Specific subclassifications of infection deaths were analyzed by sociodemographic characteristics, and pregnancy-related mortality ratios (pregnancy-related deaths per 100,000 live births) were calculated for each infection subclassification. The overall pregnancy-related mortality ratio for infection was 2.23. Sepsis was the most frequent subclassification (46.4%) of pregnancy-related infection deaths, followed by other nonpelvic infections (25.2%). Endocarditis deaths had the largest relative increase in pregnancy-related mortality ratio among pregnancy-related infection deaths between 2012 (0.10) and 2019 (0.56). Reporting subclassifications of pregnancy-related infection deaths could improve the ability to focus interventions for reducing pregnancy-related deaths and assessing progress over time.
22. Targeted genome editing of ZKSCAN3 mitigates the neurotoxicity caused by mutant HTT (huntingtin) in a Huntington disease animal model and three-dimensional cell culture of Huntington disease.
期刊: Autophagy 发表日期: 2025-Oct-02 链接: PubMed
摘要
Huntington disease (HD) is a neurodegenerative disease caused by the expression of a mutant form of HTT (huntingtin; mHTT), caused by an abnormal expansion of polyglutamine in HTT. In HD, macroautophagy/autophagy dysfunction can cause mHTT accumulation. Moreover, the promotion of autophagy is considered a therapeutic strategy for the treatment of HD. ZKSCAN3 (zinc finger with KRAB And SCAN domains 3) has been identified as a transcriptional repressor of TFEB (transcription factor EB), a master regulator of autophagy and lysosomal functions. In this study, we conducted CRISPR-Cas9-based gene ablation to disrupt ZKSCAN3 in HD animal models and HD patient-induced pluripotent stem cell (iPSC) -derived three-dimensional (3D) spheroids. In animal models of HD, targeted in vivo zkscan3 ablation via a single adeno-associated virus (AAV) mediated CRISPR-Cas9 approach resulted in reduced mHTT levels, leading to improvements in both behavioral symptoms and the brain environment. Furthermore, CRISPR-Cas9 mediated ablation of ZKSCAN3 in 3D spheroids from HD patient-derived iPSC resulted in increased autophagy and lysosomal function, along with reduced mHTT accumulation. Specifically, in iPSC-derived neurons from HD patients, ZKSCAN3-depleted neurons demonstrated increased lysosomal function and reduced oxidative stress compared to controls. Additionally, transcriptional analysis of ZKSCAN3-edited neurons revealed an increased expression of genes involved in synaptic function and transporter activity. Taken together, these results suggest that in HD treatment strategies for improving neuronal function and the brain environment, ZKSCAN3 downregulation in neurons by autophagy activation may improve the brain environment through neuronal self-repair.
23. A multi-component intervention (NEXpro) reduces neck pain: a randomized controlled trial among Swiss office workers.
期刊: Scandinavian journal of work, environment & health 发表日期: 2025-Oct-02 链接: PubMed
摘要
This study aimed to investigate the effect of a 12-week multi-component intervention on neck pain among Swiss office workers. Between January 2020 and April 2021, we conducted a stepped-wedge cluster randomized controlled trial involving 120 office workers (18-65 years) without severe neck problems from two Swiss companies. Participants started in the control condition and sequentially transitioned to the intervention condition by their cluster. The 12-week intervention included neck exercises, health-promotion workshops, and workplace ergonomics. Neck pain was assessed by intensity [numeric rating scale (NRS) 0=no pain, 10=maximum pain], frequency (days with neck pain in the past 28 days), and disability [Neck Disability Index (NDI) 0%=no disability, 100%=maximum disability). Mixed-effects models were used to assess the intervention’s effect on neck pain intensity, frequency, and disability. This analysis includes 517 observations (295 control, 222 intervention). At baseline, the mean age was 43.7 years [standard deviation years (SD) 9.8], and 71.7% were female. The average neck pain intensity was NRS 2.4 (SD 2.0), frequency 6.8 days (SD 8.0), and disability 11.8% (SD 9.9). A statistically significant effect favoring the multi-component intervention was found for neck pain frequency, with a marginal predicted mean reduction of 1.55 days [95% confidence interval (CI) -2.84–0.26], and neck disability, with a marginal predicted mean reduction of NDI 2.23% (95% CI -2.96–1.68). This study provides evidence of the effectiveness of a 12-week multi-component intervention in reducing neck pain among office workers. Specifically, office workers experienced neck pain less frequently and with a milder impact on daily activities. Further research is needed to investigate long-term effects.
24. A Model of How LGBTQ+ Youth Suicide Attempts Occur: Empirically Linking LGBTQ+ Specific vs. Non-Specific Factors.
期刊: Journal of homosexuality 发表日期: 2025-Oct-02 链接: PubMed
摘要
This research delves into the processes and personal meanings behind suicide attempts among LGBTQ+ youth in Switzerland, aiming to distinguish between LGBTQ+-specific and general factors. Conducted between 2021 and 2024, the study involved interviews with LGBTQ+ individuals aged 14-28 who had attempted suicide, as well as with people from their social environment (family members, friends, etc.) if possible, using Grounded Theory Methodology. The participant pool consisted of 41 individuals: 7 bisexual/lesbian cis women, 4 bisexual/gay cis men, 15 trans/non-binary individuals, 3 heterosexual cis people; and 12 from their social environment. The results indicated that sexual orientation and gender identity (SOGI) influenced the suicidal processes in different ways. For some participants, SOGI was a central factor, with significant issues such as lack of acceptance and obstacles to gender-affirming care being prominent. For others, suicidality was primarily linked to non-SOGI factors such as unsafe family environments or sexualized violence, with SOGI-related issues intensifying these situations. Additionally, a mixed type was identified where both SOGI and non-SOGI factors were both equally influential. The study underscores the need for customized health promotion, suicide prevention, and early intervention strategies that address the varied types of suicidal processes among LGBTQ+ youth.
25. Solid-phase extraction of ethyleneamines in river water prior to their determination by high-performance liquid chromatography with ultraviolet detection.
期刊: Analytical sciences : the international journal of the Japan Society for Analytical Chemistry 发表日期: 2025-Oct-02 链接: PubMed
摘要
A method based on solid-phase extraction (SPE) has been developed for the preconcentration of three kinds of ethyleneamines (EAs) [ethylenediamine (EDA), diethylenetriamine (DETA), and triethylenetetramine (TETA)] in river water for their high-performance liquid chromatographic (HPLC) determination by using on-line complexation with Cu(II) ion and ultraviolet (UV) detection. EAs, which are protonated in acidic and neutral conditions, could be concentrated by using cation-exchange SPE. However, inorganic cations and humic substances, often present in river water, interfered with this preconcentration. Inorganic cations, such as Ca and Mg ions, compete with EAs in cation-exchange processes. This interference could be reduced by masking them with ethylenediaminetetraacetic acid. Humic substances, such as humic acid and fluvic acid, seem to be due to the electrostatic interaction of EAs with them in the sample solution. This interference was reduced by passing the sample solution through an anion-exchange cartridge before the cation-exchange SPE. The interacted EAs remained in the anion-exchange cartridge; they could be eluted by washing out the anion-exchange cartridge with diluted HCl. In this washing process, although fulvic acid was eluted at the same time, it could be removed by passing the eluate through a reversed-phase cartridge connected in a series. After removing these interferences, EAs could be extraced with the cation-exchange SPE and quantitatively eluted by passing Cu(II) solution through the cartridge. The proposed method of including the HPLC-UV combined with the SPE was available for the determination of EAs in river water at concentrations as low as 0.015 µM for EDA and DETA and 0.05 µM for TETA. The high recoveries (83%-103%) and repeatabilities (RSD 1.2%-4.3%) were obtained for EAs from two river water samples spiked with two different concentrations of EAs. The proposed method was applied to analyses of river water samples taken from four rivers in Toyama Prefecture, Japan.
26. Podocytes in health and disease: from development to regeneration.
期刊: Human cell 发表日期: 2025-Oct-02 链接: PubMed
摘要
Podocytes are highly specialized epithelial cells that are essential for maintaining the glomerular filtration barrier. They originate from the metanephric mesenchyme during kidney development, with differentiation tightly regulated by transcription factors, such as Wt1, MafB, and Lmx1b, as well as signaling pathways, including Wnt and Notch. Mature podocytes form intricate foot processes and slit diaphragms, coordinating membrane proteins, such as nephrin and podocin, with the actin cytoskeleton to ensure selective filtration. Owing to their limited regenerative capacity, podocyte injury caused by genetic mutations, mechanical stress, metabolic disorders, or inflammation leads to proteinuria, glomerulosclerosis, and the progression of chronic kidney disease. Recent studies have elucidated diverse injury mechanisms, including apoptosis, necroptosis, ferroptosis, and cytoskeletal dysregulation, highlighting aging and lipid metabolism as key modulators of podocyte vulnerability. Advances in stem cell technology and kidney organoids have enabled the modeling of podocyte development and disease, paving the way for regenerative strategies. This review provides a comprehensive overview of podocyte biology, injury mechanisms, and emerging therapeutic approaches, emphasizing translational opportunities for protecting and restoring podocyte function in kidney diseases.
27. Pregnancy in Patients With Cystic Fibrosis.
期刊: Obstetrics and gynecology 发表日期: 2025-Oct-02 链接: PubMed
摘要
Cystic fibrosis (CF) is an autosomal recessive, monogenic disorder that affects individuals of all races and ethnicities. It was historically viewed as a pediatric disease, but with comprehensive care and therapeutic advances, adults with CF now outnumber children living with CF in the United States, and the median predicted life expectancy is approximately 61 years. Since 2010, a new drug class called CF transmembrane conductance regulator (CFTR) modulators has emerged and led to improved health outcomes for most people with CF in the United States. These new medications have likely contributed to a doubling of pregnancies among women with CF in recent years. In the setting of increased fertility, people with CF should consider contraception when pregnancy is not desired. For people with CF who are seeking pregnancy, preconception consultation with expertise in maternal-fetal medicine and genetics and a dedicated CF team is important because of the increased morbidity among pregnant people with CF. Breastfeeding is possible and encouraged when taking CFTR modulators, although the pediatrician should monitor the infant for possible side effects given established transfer through breast milk. Single-gene noninvasive prenatal testing is emerging and offers a new strategy to screen for fetal CF, which is increasingly important with emerging evidence that transplacental transfer of CFTR modulators may delay, prevent, or reverse multiple CF manifestations for the fetus with CF. Research is ongoing to study pregnancy and parenthood in the modern era in people with CF.
28. SERPINB5-TGF-β signalling modulates desmoplakin membrane localization and ameliorates pemphigus vulgaris skin blistering.
期刊: JCI insight 发表日期: 2025-Oct-02 链接: PubMed
摘要
Impairment of desmosomal cell-cell adhesion leads to life-threatening diseases such as the autoimmune skin blistering disorder pemphigus vulgaris (PV). Disease management strategies that stabilize intercellular adhesion, in addition to the existing immunosuppression therapies, may result in improved clinical outcomes. Previous findings showed that the serine protease inhibitor SERPINB5 promotes intercellular adhesion by binding to and regulating the localization of the desmosomal adapter molecule desmoplakin (DSP) at the plasma membrane. We here show that SERPINB5 overexpression prevents PV-IgG-mediated loss of cell-cell adhesion and DSP dissociation from the cell membrane. We mechanistically demonstrate that SERPINB5 loss deregulates TGF-β signalling, a pathway known to destabilize DSP in keratinocytes. TGF-β signalling was also activated in skin biopsies of PV patients and keratinocytes treated with PV autoantibodies, suggesting a contribution to disease. Inhibition of TGF-β signaling ameliorated PV-IgG-mediated loss of cell-cell adhesion, increased DSP membrane expression, and prevented PV-IgG-induced blister formation in a human ex-vivo skin model. Together, SERPINB5 modulates DSP and intercellular adhesion through the regulation of TGF-β signalling. Further, TGF-β signalling was identified as a potential target for pemphigus treatment.
29. Atomically Dispersed Magnesium Centers on Carbon Nitride for H2O2 Production and Synergistic In Situ Water Disinfection.
期刊: Environmental science & technology 发表日期: 2025-Oct-02 链接: PubMed
摘要
Safe drinking water is vital to human health and developing efficient water disinfection technologies, especially for resource-limited regions, is a pressing environmental challenge. Photocatalytic in situ generation of hydrogen peroxide (H2O2) offers a promising, sustainable approach for water disinfection. However, its practical implementation is restricted by reliance on sacrificial electron donors. In this work, we address this limitation through an innovative design of a photocatalyst by embedding atomically dispersed magnesium (Mg) sites within ultrathin graphitic carbon nitride (g-C3N4) nanosheets. Such a design draws inspiration from natural systems, specifically the light-harvesting function of chlorophyll and the catalytic efficiency of Mg-containing enzymatic cofactors. The engineered catalyst achieves a remarkable H2O2 production rate of 889 μmol g-1 h-1 under visible light irradiation without sacrificial agents. Comprehensive mechanistic studies, including in situ Fourier-transform infrared spectroscopy, pump-probe spectroscopy, and density functional theory calculations, reveal that the Mg sites function as effective proton reservoirs, facilitating water activation and enabling efficient two-electron oxygen reduction for H2O2 formation. Importantly, such a well-designed system demonstrates exceptional in situ bactericidal performance, achieving complete disinfection of model Escherichia coli (99.9999% sterilization efficiency) within 80 min. This nature-inspired catalyst design not only represents an advance in green synthesis methods for single-atom catalysts but also highlights significant potential for environmentally benign water disinfection, addressing critical global needs in water safety and sustainability.
30. Inhibiting the release of polyvinyl chloride nanoplastics via superoxide ion-induced self-flocculation during polyvinyl chloride microplastics degradation.
期刊: Environmental technology 发表日期: 2025-Oct-02 链接: PubMed
摘要
Microplastics (MPs) and nanoplastics (NPs) have attracted widespread attention due to their detrimental effects on the ecosystem and human health. NPs, which are smaller and more harmful than MPs, are generated during the degradation of MPs. The present study aimed to inhibit the release of polyvinylchloride NPs (PVC-NPs) generated during the degradation of PCV-MPs, by using Ultraviolet/ sulphite (UV/SO32-) in the presence of O2 (UV/SO32-/O2). Under optimal conditions, the dechlorination rate and weight loss of PVC-MP were 72.4% and 61.7%, respectively. The chemical changes of the treated PVC-MPs and the intermediates during the degradation of PVC-MPs were investigated. It was confirmed that PVC-NPs form during the degradation PVC-MPs. In addition, PVC-NPs were successfully removed from the water by superoxide ion (O2-)-induced self-flocculation, resulting in a reduced release of PVC-NPs into the water. The weight of the self-flocculation containing PVC-NPs was 5.2 mg. Self-flocculation was investigated by scanning electron microscopy, Fourier transform infrared, and X-ray photoelectron spectroscopy. Numerous C-O-C groups were identified in the self-flocculation. The results indicate a potential process for the removal of PVC-NPs by self-flocculation. This study introduces a new method of degradation of PVC-MPs while simultaneously reducing the release of PVC-NPs.
31. Nanoparticles in food: formation during cooking, migration from packaging, and nanoplastics release-food safety implications.
期刊: Food additives & contaminants. Part A, Chemistry, analysis, control, exposure & risk assessment 发表日期: 2025-Oct-02 链接: PubMed
摘要
This review examines the influence of cooking and processing on the formation, migration, properties, and potential health impacts of nanoparticles (NPs) in food, with a particular focus on the research gap in food nanotoxicology. It emphasises the formation of food-derived nanoparticles (FDNPs), primarily fluorescent carbon nanoparticles (CNPs), during thermal processing, the migration of engineered nanoparticles (ENPs) from food packaging, and the release of nanoplastics during food preparation. The review also addresses exposure through food additives containing nanoparticles, such as titanium dioxide (TiO2). Cooking processes, especially at high temperatures, generate CNPs with varying sizes and compositions, influencing their biodistribution and potential toxicity. Migration studies show that nanosilver transfers from packaging into food simulants, with rates increasing with temperature and storage time but typically remaining below regulatory limits. The review highlights the need for standardised analytical methods, mechanistic studies, and long-term exposure studies to fully understand the health implications of FDNPs and the differences between industrial processing and home cooking.
32. Interdisciplinary Process Improvement for Behavior Management of Acute Brain Injury.
期刊: Rehabilitation nursing : the official journal of the Association of Rehabilitation Nurses 发表日期: 2025-Oct-02 链接: PubMed
摘要
Following a traumatic brain injury (TBI), 70% or more of patients display disruptive behaviors including verbal or physical aggression, wandering, nonadherence or care refusal, social withdrawal, and socially inappropriate behavior. These behaviors often worsen over the first few years after a TBI and place a significant strain on caring relationships. Our brain injury program aimed to refine our inpatient rehabilitation programming approach, using the evidence base and provider expertise, to address disruptive behaviors among patients with TBI. We formed an interdisciplinary committee, conducted one-on-one interviews and surveys, and participated in staff meetings. We based interventions on the premise that our TBI patients in the early stages of recovery required consistent environmental and interactional changes maintained by all members of the interdisciplinary team. We illustrate this approach with a case example. Our approach led to increased evidence-based behavior tracking, new health care assistant and nurse training, and improved team communication. Training was well received. Self-reported knowledge increased for all learners [t (119)=-7.36, p<.001]. We saw increased event reporting on challenging behaviors, suggesting improved awareness of the need and opportunity for intervention. The Oversight Committee also received positive feedback about improved collaboration across disciplines.
33. mzPeak: Designing a Scalable, Interoperable, and Future-Ready Mass Spectrometry Data Format.
期刊: Journal of proteome research 发表日期: 2025-Oct-02 链接: PubMed
摘要
Advances in mass spectrometry (MS) instrumentation, including higher resolution, faster scan speeds, and improved sensitivity, have dramatically increased the data volume and complexity. The adoption of imaging and ion mobility further amplifies these challenges in proteomics, metabolomics, and lipidomics. Current open formats such as mzML and imzML struggle to keep pace due to large file sizes, slow data access, and limited metadata support. Vendor-specific formats offer faster access but lack interoperability and long-term archival guarantees. We here lay the groundwork for mzPeak, a next-generation community data format designed to address these challenges and support high-throughput, multidimensional MS workflows. By adopting a hybrid model that combines efficient binary storage for numerical data and both human- and machine-readable metadata storage, mzPeak will reduce file sizes, accelerate data access, and offer a scalable, adaptable solution for evolving MS technologies. For researchers, mzPeak will support complex workflows and regulatory compliance through faster access, improved metadata, and interoperability. For vendors, it offers a streamlined, open alternative to proprietary formats. mzPeak aims to become a cornerstone of MS data management, enabling sustainable, high-performance solutions for future data types and fostering collaboration across the mass spectrometry community.
34. Mapping the environmental risk of coccidioidomycosis in Sonora, Mexico: a Bayesian spatiotemporal perspective (2010-2022).
期刊: International journal of environmental health research 发表日期: 2025-Oct-02 链接: PubMed
摘要
Coccidioidomycosis, a fungal disease caused by Coccidioides spp. is endemic in arid regions of the Americas. Although northern Mexico shows increasing incidence, its environmental determinants remain understudied. This research examines the association between coccidioidomycosis and environmental factors in Sonora, Mexico, from 2010 to 2022. We integrated municipal-level hospital discharge data with mean annual temperature, total annual precipitation, wind speed and direction, soil moisture, vegetation index and land use (human settlements and agriculture). Using a Bayesian hierarchical spatiotemporal model with a second-order random walk structure, we estimated posterior relative risk. Results indicate that higher mean annual temperature, total annual precipitation, and wind patterns were associated with increased hospitalization rates, whereas greater vegetation cover and soil moisture were associated with reduced rates. Spatial heterogeneity in posterior relative risk was substantial, with hotspots detected in municipalities such Hermosillo, Cajeme and Caborca showing marked increases. These results contribute to a better understanding of the dynamic environmental factors influencing coccidioidomycosis acquisition, which can inform more effective public health strategies. However, to improve future risk prediction and disease prevention, it will be necessary to also consider immunological, genetic, and lifestyle factors among populations living in endemic areas.
35. Biodefluorination of Unsaturated Perfluorinated Carboxylic Acid by Anaerobic Digestion Sludge: Who and How?
期刊: Environmental science & technology 发表日期: 2025-Oct-02 链接: PubMed
摘要
Per- and polyfluoroalkyl substances (PFAS) are widespread environmental pollutants that are notoriously recalcitrant to biodegradation. We explored the biotransformation and defluorination of (E)-perfluoro-4-methylpent-2-enoic acid (PFMeUPA), a perfluorinated compound with diverse C-F bonds, using municipal anaerobic digestion sludge. Defluorination was stimulated with various substrate amendments and characterized by the release of fluoride (F-) and the formation of corresponding byproducts. Methanol, formate, acetate, and lactate enhanced reductive defluorination as electron donors. However, the addition of vitamin B12 (a cobalt-corrin complex), which commonly enhances reductive dehalogenation, had no effect. The methanogenesis inhibitor 2-bromoethanesulfonate had no significant effect, ruling out direct participation by methanogens. After 80 days of incubation, Sulfurospirillum and Asaccharospora exhibited significantly higher relative abundance in all substrate-amended treatment groups compared to those in both the original inoculum and control groups (no substrate or no PFAS added), indicating selective enrichment under defluorinating conditions. Comparative analysis of genomes that were enriched relative to the inoculum and that harbored the fluoride exporter crcB gene (n = 23) versus genomes lacking crcB (n = 233) revealed two novel defluorinating candidates belonging to the Sulfurospirillum genus (A_bin.69 and M_bin.68). Overall, these findings advance the understanding of anaerobic PFAS biodegradation and suggest crcB as an auxiliary biomarker to discover putative defluorinating species.
36. Effects of Technology-Assisted Rehabilitation After Spinal Cord Injury: Pilot Randomized Controlled Crossover Trial.
期刊: JMIR rehabilitation and assistive technologies 发表日期: 2025-Oct-02 链接: PubMed
摘要
Technology-assisted and robotic rehabilitation methods are increasingly used in neurorehabilitation. Still, scarce evidence exists on their effects on upper extremity functioning after spinal cord injury, especially at the chronic stage. The present study aims to evaluate the effects of a 6-week intervention focusing on technology-assisted upper extremity rehabilitation in adults 1-8 years after incomplete cervical spinal cord injury. In this pilot randomized controlled crossover trial, 20 participants (10 men, 34-73 y of age) were recruited by mail and randomized into 2 sequences (AB: n=10 and BA: n=10). All participants received a 6-week rehabilitation intervention in Period 1 or Period 2, with a 4-week washout period in between. The intervention was delivered 3 times a week for 6 weeks (18 sessions) by occupational therapists specialized in spinal cord injuries. Each 1-hour therapy session included a minimum of 30 minutes of technology-assisted upper extremity rehabilitation using interactive and task-specific AMADEO, DIEGO, or PABLO devices. Other occupational therapy activities were allowed to complete the 1-hour therapy session. The effects of the 6-week rehabilitation intervention were compared with 6 weeks of no intervention, and the analyses were based on paired data. Each participant served as their own control. Hand and arm function were evaluated using the Action Research Arm Test, the American Spinal Injury Association-Upper Extremity Motor Score (ASIA-UEMS), grip strength, pinch strength, and the Spinal Cord Independence Measure-Self Report. Rehabilitation goal attainment was evaluated by the Goal Attainment Scale. Face-to-face assessments were conducted at baseline, after Period 1, after Period 2, and at 6 months, except for the Goal Attainment Scale, which was used at the beginning and immediately after the rehabilitation intervention. The effects of the rehabilitation intervention compared to no intervention were statistically insignificant, except for the ASIA-UEMS (median change 1, IQR 0-2 point versus 0, IQR -2 to 0 point) in participants in sequence BA (n=7) who received the rehabilitation intervention during Period 2 (P=.04). The rehabilitation intervention showed good feasibility and tolerability in adults with incomplete cervical spinal cord injury. Of 20 participants (median age 62, IQR 58-66 y), 19 enrolled in the study, and 17 completed at least 80% of the rehabilitation sessions. Fourteen out of 16 participants included in the final analysis attained their rehabilitation goals. The goals were mainly focusing on “fine hand use” and “hand and arm use” related to self-care and domestic life. Results of this pilot study suggest that technology-assisted upper extremity rehabilitation provided by occupational therapists is safe and has potential for broader clinical use in adults with incomplete cervical spinal cord injury. The rehabilitation intervention showed good feasibility and positive outcomes in rehabilitation goal attainment. This study was left unpowered, and the results need to be confirmed in a larger randomized controlled trial.
37. Exercise-induced ventricular arrhythmias and subclinical ischemia risk in firefighters: exploratory results from a pilot study.
期刊: European journal of applied physiology 发表日期: 2025-Oct-02 链接: PubMed
摘要
This pilot study aimed to systematically evaluate exercise-induced electrocardiographic (ECG) responses in professional firefighters and to explore the association between premature ventricular complexes (PVCs) and myocardial ischemia in this high-risk occupational group. This pilot cross-sectional study enrolled 21 male firefighters (mean age 43.4 ± 7.18 years) from a single municipal fire department. Participants underwent comprehensive cardiovascular assessment including anthropometric measurements, biochemical analyses (lipid profile, testosterone), submaximal exercise testing (Bruce protocol), and 24-h Holter ECG monitoring. Statistical analyses included Mann-Whitney U tests and effect size calculations. No exercise-induced ST-segment changes indicative of myocardial ischemia were observed. However, PVCs were detected in 33% of participants (7/21), with exercise testing revealing 18 simple and 2 multiform PVCs, while Holter monitoring recorded 25 simple and 1 multiform PVC. PVC-positive firefighters were significantly older (median 49 vs. 40 years, p = 0.019, r = 0.514). Mean exercise capacity was 12.45 METs, with 81% achieving moderate fitness levels. Post-exercise heart rate recovery (HRR1: 24 ± 11.5 bpm; HRR2: 35.4 ± 11.5 bpm) showed normal patterns. The findings of this pilot study indicate the need for larger-scale investigations, supported by advanced diagnostic modalities, to clarify the clinical relevance of exercise-induced premature ventricular complexes (PVCs) in firefighters. Although no ischemic changes were observed, the presence of subclinical coronary artery disease cannot be definitively excluded. These results provide a meaningful preliminary foundation for developing targeted screening approaches to improve early cardiovascular risk detection in high-physical-demand occupational groups.
38. Associations of Subjective Cognition With Community Participation and Health Conditions in Middle-Aged and Older Adults.
期刊: OTJR : occupation, participation and health 发表日期: 2025-Oct-02 链接: PubMed
摘要
Understanding factors associated with subjective cognition in middle-aged and older adults is important. The objective of this study was to investigate the extent to which community participation, health conditions, and demographics increase the risk of subjective cognitive decline (SCD) in adults aged 45 and older, as well as how these factors are associated with self-perceived executive ability in those with SCD. A cross-sectional study was conducted with 93 community-dwelling participants, categorized into those with SCD (N = 42) and those without SCD (N = 51). Logistic and multivariable linear regression models were built. The results showed that depressive symptoms and concerns about executive ability significantly increased the risk of SCD in the logistic model. The linear model indicated that lower levels of community participation and education were associated with greater concerns about executive ability among those with SCD. Conclusion: Addressing depressive symptoms and executive ability in SCD is crucial; occupational therapy should facilitate community participation to support those with SCD. Associations of Subjective Cognition with Community participation, Health Conditions, and Demographic Factors in Middle-Aged and Older AdultsIt is important to understand the factors influencing self-perceived cognitive abilities in middle-aged and older adults to prevent further cognitive deterioration. This study investigated whether community participation, health conditions, and demographics increased the risk of having self-perceived cognitive decline in adults aged 45 and older and how these factors were associated with self-perceived executive ability in those with subjective cognitive decline (SCD). We examined 93 community-dwelling individuals, categorizing them into those with self-perceived cognitive decline (42 people) and those without self-perceived cognitive decline (51 people). The results indicated that the presence of depressive symptoms and concerns about executive ability significantly increased the risk of self-perceived cognitive decline. In addition, lower levels of community participation and education were associated with greater concerns about executive ability among those with self-perceived cognitive decline. Addressing depressive symptoms and concerns about executive ability is essential for individuals experiencing self-perceived cognitive decline. Moreover, occupational therapy practitioners need to devise effective intervention strategies that address challenges in participating in community life, thereby alleviating concerns about executive abilities for individuals with self-perceived cognitive decline.
39. Harnessing Machine Learning to Predict Nurse Turnover Intention and Uncover Key Predictors: A Multinational Investigation.
期刊: Journal of advanced nursing 发表日期: 2025-Oct-02 链接: PubMed
摘要
To predict nurses’ turnover intention using machine learning techniques and identify the most influential psychosocial, organisational and demographic predictors across three countries. A cross-sectional, multinational survey design. Data were collected from 1625 nurses in the United States, Türkiye and Malta between June and September 2023 via an online survey. Twenty variables were assessed, including job satisfaction, psychological safety, depression, presenteeism, person-group fit and work engagement. Turnover intention was transformed into a binary variable using unsupervised machine learning (k-means clustering). Six supervised algorithms-logistic regression, random forest, XGBoost, decision tree, support vector machine and artificial neural networks-were employed. Model performance was evaluated using accuracy, precision, recall, F1 score and Area Under the Curve (AUC). Feature importance was examined using logistic regression (coefficients), XGBoost (gain) and random forest (mean decrease accuracy). Logistic regression achieved the best predictive performance (accuracy = 0.829, f1 = 0.851, AUC = 0.890) followed closely by support vector machine (polynomial kernel) (accuracy = 0.805, f1 0.830, AUC = 0.864) and random forest (accuracy = 0.791, f1 = 0.820, AUC = 0.859). In the feature importance analysis, job satisfaction consistently emerged as the most influential predictor across all models. Other key predictors identified in the logistic regression model included country (USA), work experience (6-10 years), depression and psychological safety. XGBoost and random forest additionally emphasised the roles of work engagement, group-level authenticity and person-group fit. Job-stress-related presenteeism was uniquely significant in XGBoost, while depression ranked among the top predictors in both logistic regression and random forest models. Machine learning can effectively predict turnover intention using multidimensional predictors. This methodology can support data-driven decision-making in clinical retention strategies. This study provides a data-driven framework to identify nurses at risk of turnover. By integrating machine learning into workforce planning, healthcare leaders can develop targeted, evidence-based strategies to enhance retention and improve organisational stability. This study adhered to STROBE reporting guideline. This study did not include patient or public involvement in its design, conduct or reporting.
40. Between Two Grammatical Gender Systems: Exploring the Impact of Grammatical Gender on Memory Recall in Ukrainian-Russian Simultaneous Bilinguals.
期刊: Cognitive science 发表日期: 2025-Oct 链接: PubMed
摘要
This study examines the impact of grammatical gender on memory recall among simultaneous bilinguals with two three-gendered languages (Ukrainian and Russian). Ukrainian-Russian bilinguals and English monolingual controls were tested on their ability to remember names assigned to objects with either matching or mismatching grammatical genders across their two languages. Results showed that bilinguals recalled names more accurately when the biological sex of the names was congruent with the grammatical gender of objects in both languages (e.g., recalling a male name assigned to a noun with masculine grammatical gender in both L1s, rather than a female name). English monolinguals, in contrast, showed no difference in recall. However, when grammatical gender mismatched across Ukrainian and Russian, the expected influence of the more proficient language on recall accuracy was not observed. These findings suggest that converging grammatical information from two L1s creates stronger memory associations, enhancing recall accuracy of simultaneous bilinguals. Conversely, mismatching grammatical genders appear to negate this effect. Taken together, these findings highlight the interconnected nature of bilingual conceptual representation.
41. OncovigIA: Artificial Intelligence for Early Lung Cancer Detection and Referral in a Chilean Public Hospital.
期刊: JCO clinical cancer informatics 发表日期: 2025-Oct 链接: PubMed
摘要
Lung cancer is a leading cause of death in Chile, where late-stage diagnoses and high mortality rates prevail. Here, we describe the development of OncovigIA, a novel digital tool powered by natural language processing that enhances the identification of potential lung cancer cases by surveilling computed tomography (CT) reports in a large public Hospital in Santiago, Chile. We combined natural language processing and large language models with state-of-the-art machine learning techniques and approaches to treat unbalanced data sets and determine the best solution to implement in OncovigIA. Focusing on key sections of the reports and using various machine learning models, including a balanced Random Forest, the tool achieved high performance with 0.90 accuracy and 0.84 F1-score on the test set. When applied to 13,326 CT chest reports from 2022, it successfully identified 377 CTs of patients with suspected lung cancer previously undetected and not managed by the multidisciplinary local lung cancer team. This study underscores the potential of artificial intelligence in early cancer detection and highlights the importance of its integration into local health care ecosystems. By promptly increasing the number of patients referred for specialized management, the tool OncovigIA offers a promising path toward improving lung cancer survival rates in Chile and beyond. Moreover, this article provides avenues for its broader implementation, extending it to other cancer types and/or health care-related texts for continuous surveillance, aiming at the early referral and treatment of cancer in low-resource settings.
42. Interactive Use of Cox Model-Predicted Survival Curves: An Application Using ACS10 Score and Age to Personalize Treatment of Pediatric AML.
期刊: JCO precision oncology 发表日期: 2025-Oct 链接: PubMed
摘要
Analyses in oncology frequently include Cox proportional hazards models for survival outcomes, but reported results typically only include hazard ratios and respective inference. Cox model predictions of survival functions may help to provide a greater clinical meaning from fitted Cox models for precision oncology research. We created a publicly available software library, shinyCox, that can generate user-friendly interactive applications to visualize survival outcome predictions of fitted Cox models. To illustrate the benefits of this software, we analyzed data from AML02 and AML08, randomized clinical trials for pediatric patients with AML. Building on a recent article, we assessed how baseline factors and a pharmacogenomics score (ACS10) can affect the predicted overall survival (OS) and event-free survival (EFS) between patients assigned to induction regimens of clofarabine plus cytarabine or daunorubicin and etoposide combined with low-dose cytarabine or high-dose cytarabine. Our model outcome prediction visualization application highlights previously reported associations of ACS10 with EFS and OS, while also providing a better understanding of how other prognostic factors amplify or mitigate prognostic implications of ACS10. It is informative to better understand the practical clinical outcomes in terms of predicted survival probabilities to complement the insights gained from hazard ratio tables. Using shinyCox, we generated visualization applications that let us identify complex relationships between the ACS10 score, age, and the predicted OS and EFS probabilities after AML therapy. This article shows how shinyCox will facilitate model interpretation and accelerate the development of personalized therapies in oncology.
43. Reply to: Dihydropyrimidine Dehydrogenase Enzyme-Guided Dosing of 5-Fluorouracil: Prioritizing Precision Over Dose Reduction.
期刊: JCO precision oncology 发表日期: 2025-Oct 链接: PubMed
摘要
44. Symptom Network Analysis of Attention-Deficit/Hyperactivity Disorder and Emotional Symptoms in Adults: Results From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
期刊: The Journal of clinical psychiatry 发表日期: 2025-Oct-01 链接: PubMed
摘要
Objective: The diagnosis of attention-deficit/hyperactivity disorder (ADHD) is based on a set of symptoms and 2 main dimensions (impulsive/hyperactive and attentional). While the relationships between ADHD symptoms and emotional dysregulation (ED) have been widely studied, the interactions between individual symptoms have rarely been examined. The purpose of this study was to assess which symptoms are most influential (central) and which symptoms connect (bridge) the 2 main dimensions of ADHD and ED. Methods: Data from wave II (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II) were utilized, which included a large, nationally representative sample of the US population (N=33,546). Eighteen ADHD symptoms were examined based on DSM-5-TR criteria, along with 4 variables related to ED. Symptom network analyses were conducted to explore the relationships between ADHD and ED symptoms. Results: The prevalence of ADHD was found to be 10.12% (N=3,397). Among all ADHD and ED symptoms, ED symptoms had the lowest influence (centrality) values. In terms of bridging the 2 ADHD dimensions, 2 ED symptoms were among the 4 most influential. Conclusions: The low centrality of ED symptoms supports the traditional focus on the 2 main dimensions of ADHD. However, the significant role of ED symptoms in connecting the impulsive/ hyperactive and attentional dimensions highlights their importance within the ADHD framework. These findings have potential implications for the epidemiology, public health, research, and clinical understanding of ADHD.
45. [Not Available].
期刊: Recenti progressi in medicina 发表日期: 2025-Oct 链接: PubMed
摘要
The MedWriter project aims to create an AI-based clinical decision support system for automated discharge letter generation. Co-funded through Italian Sustainable Growth Fund and the EU, the project will utilize 1.3M patient records from HL7/FHIR-compliant SISWEB platform. The system will employ hybrid neural architectures including CNNs, transformers, and reinforcement learning for accurate clinical narrative synthesis.
46. Body Composition and Cardiometabolic Risk in Children.
期刊: JAMA network open 发表日期: 2025-Oct-01 链接: PubMed
摘要
Understanding secular patterns in body composition and cardiometabolic risk factors (CMRFs) is essential for identifying early-life determinants of cardiovascular health, guiding public health policies, and developing early prevention strategies. To examine secular patterns in the prevalence of underweight, overweight, obesity, and CMRFs among schoolchildren in Spain from 1992 to 2022. Repeated cross-sectional study analyzing data from 7 time points over a 30-year period in public primary schools from the Cuenca province in Spain. Participants were children aged 8 to 11 years (fourth to fifth grade) from 7 cohorts studied in 1992, 1996, 1998, 2004, 2010, 2018, and 2022. Data were analyzed from April 2024 to May 2025. Prevalence of weight status (underweight, normal weight, overweight, and obesity), lipid parameters, glycemic markers, and resting systolic blood pressure (SBP) and diastolic blood pressure (DBP). In a total of 4280 participants (mean [SD] age, 9.6 [0.7] years; 2137 [50.0%] girls), patterns in the prevalence of weight status show that increases in obesity appear to have slowed down and plateaued since 2018 (13.4%; 95% CI, 11.5% to 15.5% in 2010; 8.1%; 95% CI, 6.0% to 10.5% in 2018; 10.4% 95% CI, 8.1% to 13.2% in 2022; P < .001). A statistically significant decrease in mean (SD) total cholesterol (184.6 [27.4] to 160.3 [27.4] mg/dL) and low-density lipoprotein cholesterol (113.6 [24.0] to 90.1 [24.0] mg/dL) was observed, which was reflected in a reduction in non-high-density lipoprotein cholesterol (HDL-C) (125.3 [26.2] to 99.8 [26.1] mg/dL) from 1992 to 2022. Mean (SD) serum HDL-C appear to have peaked from 1998 to 2004 (66.2 [13.3] vs 66.9 [13.3] mg/dL, respectively), and its levels have decreased since then (60.5 [13.4] mg/dL in 2022; P < .001). Mean (SD) resting blood pressure showed a substantial decrease over the study period (SBP: 113.5 [9.6] to 101.0 [9.7] mm Hg and DBP: 70.4 [7.2] to 60.7 [7.3] mm Hg; P < .001). However, mean (SD) insulin levels show a significant rise from 2004 to 2022 (6.3 [5.3] to 8.7 [5.2] μIU/mL; P < .001). This repeated cross-sectional study provides a picture of the evolution of CMRFs in children over the last 30 years, showing that, in Spain, despite the concerning prevalences of excess weight, lipid parameters and blood pressure have improved over the studied period.
47. Making the case for digital twins: Italian healthcare needs AI-driven predictive modeling for personalized medicine.
期刊: Recenti progressi in medicina 发表日期: 2025-Oct 链接: PubMed
摘要
Precision medicine seeks to tailor care by integrating genetic, clinical, and environmental data. Digital twins, dynamic, virtual replicas of patients that are updated with longitudinal information, represent a significant step in this direction. Enabled by artificial intelligence, they allow in silico experimentation to simulate therapies, disease trajectories, and adverse events, reducing risk and sharpening personalization. By bridging data and decisions, digital twins can promote earlier diagnosis, targeted treatments, and faster drug discovery, supporting a shift from reactive to predictive and participatory care. Nonetheless, challenges surrounding data integration, privacy, regulation, and equity persist and necessitate collaborative solutions. This viewpoint examines the opportunities and system-level requirements to integrate digital twins into Italian healthcare. Digital twins redefine medicine by turning episodic encounters into continuous, adaptive care. They can anticipate clinical events, simulate individualized treatments, and support shared decision-making, advancing the vision of predictive, preventive, personalized, and participatory medicine. Realizing this potential requires robust governance, interoperable infrastructures, and clinician training, alongside ethical frameworks that protect autonomy and fairness. Public-private partnerships and international collaboration will be crucial for the responsible, inclusive, and transparent adoption of these initiatives. Ultimately, digital twins inaugurate a paradigm in which simulation and clinical reality converge, fostering innovation that is both scientifically rigorous and deeply human.
48. Low Back Pain among Healthcare Workers in University Hospital in Tunisia.
期刊: Current rheumatology reviews 发表日期: 2025-Oct-01 链接: PubMed
摘要
Low back pain is a real public health issue. It is a common musculoskel-etal disorder linked to work among health professionals. The objective of this study is to deter-mine the frequency of low back pain among healthcare workers and to study the associated risk factors. This is a cross-sectional study conducted over a period of 6 months during the year 2022 involving a sample of the healthcare staff at Mahdia University Hospital. An anonymous self-administered questionnaire was completed by the healthcare staff, including anthropometric, socio-economic, professional lifestyle habits, and the characteristics of low back pain. A total of 96 participants responded to the questionnaire. The population was mostly fe-male (75.3%) with an average age of 36.21 ± 8.78 years. The average BMI was 27.7 kg/m2 ± 4.5 kg/m2, with nurses being the most numerous group, followed by midwives. The professional ac-tivities were mainly care activities (76.7%). The frequency of low back pain was estimated at 82.2% (n=79). In univariate analysis, a significant association was observed between the low back pain and age (p < 0.001), marital status (p = 0.027), physical activity (p = 0.03), job seniori-ty (p = 0.001), care activities (p = 0.03), sitting position (p = 0.04) and weight carried (p = 0.003). The prevalence of low back pain in our study was 82.2%. This finding aligns with results from studies conducted in Egypt at Zigazig Hospital (79%) and in Rwanda at Kanombe Military Hospital (78%). In this study, multiple factors linked to low back pain were identified, most of which are modifiable, highlighting the need to implement effective preventive measures to reduce the prevalence of low back pain and limit the socio-economic damage it generates.
49. Biocontrol of Aflatoxigenic Maize Molds Using Lactobacillus spp.-Based Formulations.
期刊: Food science & nutrition 发表日期: 2025-Oct 链接: PubMed
摘要
Food contamination by mold is a serious and difficult problem to manage, leading to enormous economic losses. Mycotoxins have been recognized as one of the most dangerous contaminants in food. They can be toxic to humans and animals when they reach a certain ingestion threshold. These mycotoxins include aflatoxins, produced mainly by Aspergillus section Flavi, the most frequently isolated from food being A. flavus and A. parasiticus. Current control methods, mainly physical and chemical, are showing their limitations due to the environmental problems caused, resistance developed by pathogens, and the food organoleptic quality deterioration. Other control alternatives based on biocontrol can be explored. This present study aimed to isolate Lactobacillus spp. from local foods that can inhibit aflatoxigenic molds’ growth and reduce aflatoxins production. To this end, four (04) strains (04) collection namely GNc, GNd, F3a, and G3Lab1 from fura and gapal, selected on the basis of their high antifungal potential, were co-cultured with fungi reference strains (UBOCC-A-111042, UBOCC-A-106031, T1, and T2) and on maize aflatoxigenic molds (AF1, AF2, AF3, AP1, and AP2). Bioassays in vitro demonstrated that Lactobacillus spp. strains significantly inhibited fungal radial growth. Further tests were conducted on eleven (11) highly contaminated maize samples, showing a maximum reduction rate of 68% in the fungal flora. Analysis and quantification of residual aflatoxins B1, B2, G1, and G2 in maize grains using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS) revealed a decrease and, in some cases, complete suppression of aflatoxin B1, B2, G1, and G2 production in grains detoxified with Lactobacillus extracts.
50. [Hypocomplementemic urticarial vasculitis in SLE: between urticaria and autoimmunity].
期刊: Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993) 发表日期: 2025-Sep-30 链接: PubMed
摘要
Urticarial vasculitis (UV) is a rare entity affecting small blood vessels, characterized by persistent (>24 hours) urticarial lesions with histopathological findings of leukocytoclastic vasculitis. It is classified as normocomplementemic (NUV) and hypocomplementemic (HUV), the latter associated with systemic diseases such as systemic lupus erythematosus (SLE). Its incidence is 0.5 per 100,000 person-years. Clinical presentation: A 66-year-old female with a history of SLE, hypothyroidism, and osteoarthritis developed in 2022. In 2022, she developed a dermatosis disseminated to all four body segments with pruritic wheals lasting up to 72 hours, persisting for more than six weeks, and followed by post-inflammatory hyperpigmentation. No triggering factors were identified. She also presented episodes of palpebral and labial angioedema. Given the clinical features, a skin biopsy and complement measurement were performed. Imaging/laboratory studies: Skin biopsy: Superficial neutrophilic vasculitis (venulitis) with erythrocyte extravasation. Lab results 2023: C3: 79.7 mg/dL. C4: 10.8 mg/dL. This case highlights the importance of considering hypocomplementemic urticarial vasculitis in patients with SLE and persistent urticarial lesions, as well as conducting a targeted history. Given the risk of systemic involvement, close follow-up and a multidisciplinary approach are essential. The diagnosis of UV requires clinical-histopathological correlation, with biopsy recommended for persistent lesions (>24 h), residual bruising, or systemic manifestations. Early identification and appropriate management are essential to prevent systemic complications. Treatment focuses on addressing underlying autoimmune diseases and managing symptoms with antihistamines, corticosteroids, or immunosuppressants, depending on the severity and systemic involvement. La vasculitis urticarial (UV) es una entidad infrecuente que afecta los vasos sanguíneos pequeños, caracterizada por lesiones urticariformes persistentes (>24 horas) con hallazgos histopatológicos de vasculitis leucocitoclástica. Se clasifica en normocomplementémica (NUV) e hipocomplementémica (HUV), esta última asociada a enfermedades sistémicas como el lupus eritematoso sistémico (LES). Su incidencia es de 0.5 por 100 000 personas-año. cuadro clínico: Femenino de 66 años con antecedente de LES, hipotiroidismo y osteoartritis. En 2022 desarrolló una dermatosis diseminada a los cuatro segmentos corporales con ronchas pruriginosas de hasta 72 horas de duración, persistentes por más de seis semanas y seguidas de hiperpigmentación postinflamatoria, no se identificaron factores desencadenantes. Además, presentó episodios de angioedema palpebral y labial. Dadas las características clínicas, se realizó biopsia cutánea y medición de complemento. Estudios de imagen/laboratorio: Biopsia de piel: Vasculitis (Venulitis) neutrofílica superficial con extravasación de eritrocitos. Laboratorios 2023: C3: 79.7 mg/dL. C4: 10.8 mg/dL. El presente caso resalta la importancia de considerar la vasculitis urticarial hipocomplementémica en pacientes con LES y lesiones urticariformes persistentes, así como de realizar un interrogatorio dirigido. Dado el riesgo de afectación sistémica, es fundamental un seguimiento estrecho y un abordaje multidisciplinario. El diagnóstico de UV requiere la correlación clínico-histopatológica, recomendándose biopsia ante lesiones persistentes (>24 h), equimosis residual o manifestaciones sistémicas. La identificación temprana y el manejo adecuado son esenciales para prevenir complicaciones sistémicas. El tratamiento se centra en abordar enfermedades autoinmunes subyacentes y manejar síntomas con antihistamínicos, corticosteroides o inmunosupresores, según la gravedad y afectación sistémica.
51. [Ormond syndrome: a rare diagnosis in a patient with hypogammaglobulinemia secondary to rituximab].
期刊: Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993) 发表日期: 2025-Sep-30 链接: PubMed
摘要
Ormond syndrome, or idiopathic retroperitoneal fibrosis, is a rare disease with an annual incidence of 0.1 to 0.4 cases per 100,000 inhabitants and a prevalence of 1.4 per 100,000 inhabitants. It primarily affects men (2-3:1), with diagnosis between 40 and 60 years of age. It is characterized by the growth of fibroinflammatory tissue in the retroperitoneum, with possible compression of vascular and urinary structures. Its diagnosis is complex and requires ruling out malignancy or other secondary causes. We present a case with a late diagnosis and referral to immunology due to hypogammaglobulinemia secondary to rituximab. A 54-year-old male patient with chronic kidney disease on hemodialysis was diagnosed in 2006 with retroperitoneal fibrosis after findings of ureteral stenosis and periaortic masses. Biopsies were performed, ruling out malignancy and IgG4-RD. In 2023, the patient received rituximab for inflammatory reactivation, with clinical improvement, but developed severe hypogammaglobulinemia (IgG <500 mg/dL), prompting referral to the immunology department. Subcutaneous immunoglobulin was started, with clinical stabilization. A relevant prior finding was low IgG3 levels before rituximab, with no clear relationship to Ormond syndrome. This case highlights the importance of considering Ormond syndrome in unexplained retroperitoneal fibrosis and the need for a multidisciplinary approach. It also underscores the importance of early diagnosis and close follow-up in patients with chronic fibroinflammatory disease, as well as immunological monitoring in those receiving immunosuppression, to prevent and treat associated complications. Given its rarity, it is essential to document more cases to improve understanding and management of this condition. El síndrome de Ormond, o fibrosis retroperitoneal idiopática, es una enfermedad rara con una incidencia anual de 0.1 a 0.4 casos por cada 100,000 habitantes y una prevalencia de 1.4 por cada 100,000 habitantes. Afecta principalmente a hombres (2- 3:1), con diagnóstico entre los 40 y 60 años. Se caracteriza por el crecimiento de tejido fibroinflamatorio en el retroperitoneo, con posible compresión de estructuras vasculares y urinarias. Su diagnóstico es complejo y requiere descartar malignidad u otras causas secundarias. Presentamos un caso con diagnóstico tardío y referencia a inmunología por hipogammaglobulinemia secundaria a rituximab. Paciente masculino de 54 años con enfermedad renal crónica en hemodiálisis, diagnosticado en 2006 con fibrosis retroperitoneal tras hallazgos de estenosis ureteral y masas periaórticas. Se realizaron biopsias, descartando malignidad e IgG4-RD. En 2023, recibió rituximab por reactivación inflamatoria, con mejoría clínica, pero desarrolló hipogammaglobulinemia severa (IgG <500 mg/dL), motivando su envío a inmunología. Se inició inmunoglobulina subcutánea con estabilización clínica. Un hallazgo previo relevante fue la IgG3 baja antes del rituximab, sin relación clara con el síndrome de Ormond. Este caso destaca la importancia de considerar el síndrome de Ormond en fibrosis retroperitoneal no explicada y la necesidad de un abordaje multidisciplinario. Asimismo, subraya la importancia del diagnóstico temprano y del seguimiento estrecho en pacientes con enfermedad fibroinflamatoria crónica, así como la vigilancia inmunológica en aquellos que reciben inmunosupresión, para prevenir y tratar complicaciones asociadas. Dado su baja frecuencia, es fundamental documentar más casos para mejorar el conocimiento y manejo de esta patología.
52. [Omalizumab Withdrawal Protocol for Chronic Spontaneous Urticaria: Clinical Case].
期刊: Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993) 发表日期: 2025-Sep-30 链接: PubMed
摘要
Chronic spontaneous urticaria is characterized by the daily appearance of hives and/or angioedema (Fig. 1) without a specific trigger, lasting more than 6 weeks. Treatment is based on second-generation H1 antihistamines, and in patients with an insufficient response, therapy with omalizumab has been effective; however, it is a costly and long-term treatment. The WAO (World Allergy Organization) has proposed a tapering regimen upon achieving complete remission. A 66-year-old female was referred for evaluation due to generalized hives of 6 years duration under treatment with fexofenadine 180 mg, with a partial response. Triple doses of H1 antihistamines were started, with no improvement, maintaining the UCT (Urticaria Control Test) at 5 points, and omalizumab 300 mg was added every 4 weeks, with an adequate clinical response. After complete remission, omalizumab tapering began in November 2023 according to the WAO protocol (Fig. 2). The final dose was administered in March 2025. We present the case of a patient with chronic spontaneous urticaria. After achieving complete remission with omalizumab, the tapering protocol proposed by the WAO was implemented. During this period, our patient remained asymptomatic, with UCT scores greater than 13, allowing for progressive reduction of antihistamine use. The omalizumab tapering protocol for the treatment of chronic spontaneous urticaria is safe and effective, reduces the risk of disease reactivation, and prevents prolonged treatment. La urticaria crónica espontánea se caracteriza por aparición diaria de habones y/o angioedema (Fig.1) sin desencadenante específico, durante más de 6 semanas. El tratamiento se basa en antihistamínicos H1 de segunda generación y en pacientes con respuesta insuficiente la terapia con Omalizumab ha sido eficaz1, sin embargo es un tratamiento costoso y a largo plazo. La WAO (por sus siglas en inglés, World Allergy Organization) ha propuesto un esquema de descenso al alcanzar la remisión completa. Femenino de 66 años, enviada a valoración por habones generalizados de 6 años de evolución en tratamiento con fexofenadina 180mg, con respuesta parcial. Se inician antihistamínicos H1 a dosis triple, sin mejoría, manteniendo UCT (por sus siglas en inglés, Urticaria Control Test) en 5 puntos por lo que se agrega Omalizumab 300mg cada 4 semanas, con adecuada respuesta clínica. Ante la remisión completa, en noviembre 2023 se inició el descenso de Omalizumab de acuerdo a protocolo de la WAO (Fig.2), en marzo 2025 se aplicó la última dosis. Se presenta el caso de una paciente con urticaria crónica espontánea, donde tras alcanzar la remisión completa con Omalizumab se implementa el protocolo de descenso propuesto por la WAO, periodo en que nuestra paciente permaneció asintomática, con puntajes de UCT superiores a 13 permitiendo reducir progresivamente el uso de antihistamínicos. El protocolo de descenso de Omalizumab en el tratamiento de urticaria crónica espontánea es seguro, eficaz, disminuye el riesgo de reactivación de la enfermedad y evita prolongar el tratamiento.
53. [Case report. Job syndrome as an unusual finding in a pediatric patient].
期刊: Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993) 发表日期: 2025-Sep-30 链接: PubMed
摘要
Job Syndrome is a primary immunodeficiency disorder with an incidence of 1 per million people. It is characterized by elevated IgE levels, eosinophilia, recurrent infections (bacterial and fungal), eczematous dermatitis, musculoskeletal and vascular anomalies. Diagnosis is based on IgE > 1000 IU/ml and eosinophilia. Treatment is multidisciplinary, including bone marrow transplantation, stem cell therapy, and human immunoglobulin. Evolution: We present a 13-year-old male with a history of asthma and atopic dermatitis treated with subcutaneous immunotherapy since 2016. He developed furunculous lesions that progressed to the frontal area, nose, forearms, abdomen, legs, ankles, and feet. Despite treatment with hydroxyzine, mupirocin, tacrolimus, clobetasol, and deflazacort, he showed no improvement. In 2021, he was admitted to the pediatric department, where the diagnosis was confirmed based on Grimbacher criteria. Treatment with human immunoglobulin was initiated, with adequate response. Currently, the patient is in good general condition with persistence of some skin lesions. The therapeutic strategy focuses on the prevention and management of infections and symptoms. It is important to identify complications in the early stages of the disease to treat them effectively. This syndrome, although rare, should be considered a serious condition; early identification of this condition is crucial to improve outcomes in patients with similar presentations. El Síndrome de Job, es un trastorno de inmunodeficiencia primaria, con una incidencia de 1 por millón de personas. Caracterizado por niveles elevados de IgE, eosinofilia, infecciones recurrentes (bacterianas y fúngicas), dermatitis eccematosa, anomalías musculoesqueléticas y vasculares. El diagnóstico se basa en: IgE > 1000 UI/ml y eosinofilia. El tratamiento es multidisciplinario, incluyendo: trasplante de médula ósea, terapia con células madre e inmunoglobulina humana. Evolución: Presentamos a un Masculino de 13 años, con antecedentes de asma y dermatitis atópica tratado con inmunoterapia subcutánea desde 2016, el cual inicia con lesiones forunculosas, las cuales progresan en zona frontal, nariz, antebrazos, abdomen, piernas, tobillos y pies, siendo tratado con hidroxizina, mupirocina, tracolimus, clobetazol, deflazacort al no presentar mejoría acude en 2021 al servicio de pediatría, donde se confirma diagnostico con base en los criterios Grimbacher, se decide iniciar tratamiento con inmunoglobulina humana, con adecuada respuesta. Actualmente se encuentra en adecuadas condiciones generales con persistencia de algunas lesiones cutáneas. La estrategia terapéutica se centra en la prevención y el manejo de infecciones y síntomas. Siendo importante identificar complicaciones en las primeras etapas de la enfermedad para tratarlas de manera eficaz. Este síndrome, aunque poco frecuente, debe considerarse como un padecimiento de importancia, su identificación oportuna de esta condición es crucial para mejorar los desenlaces en pacientes con presentaciones similares.
54. [Effects of air pollution on health following on environmental contingencies in Mexico City].
期刊: Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993) 发表日期: 2025-Sep-30 链接: PubMed
摘要
To analyze the effects of air pollution on the health of a vulnerable population in the Mexico City after the nine environmental contingencies presented in the year 2024. A cross-sectional, descriptive study was conducted among outdoor workers (street vendors). Risk factors and respiratory symptoms were documented, and respiratory function tests were performed. A total of 300 patients were enrolled. The most frequent clinical symptoms were increased expectoration (52%), recurrent respiratory infections (44.3%), headache (39.6%), cough (35%), laryngeal irritation (34%), nasal itching (30%), dyspnea (26%), vertigo (22%), conjunctivitis (20.6%), and chest pain (19.6%). Spirometry results showed: 61.3% with a restrictive pattern, 14.3% with an obstructive pattern, 13.3% with a mixed pattern, and 11% with no abnormalities. Forty-four percent of this group experienced exacerbations of diseases such as asthma and chronic obstructive pulmonary disease. Air pollution constitutes a serious public health problem, especially for low-income people, who live and work in areas with high levels of pollution, as evidenced in our study. Further epidemiological studies are essential to evaluate the impact of ozone and other pollutants on vulnerable groups, to implement more effective preventive measures. Analizar los efectos de la contaminación atmosférica en la salud de una población vulnerable en la Ciudad de México después de las nueve contingencias ambientales ocurridas en el año 2024. Estudio transversal y descriptivo, llevado a cabo en sujetos que trabajan al aire libre (vendedores ambulantes), en quienes se documentaron los factores de riesgo y síntomas respiratorios, y se efectuaron de pruebas de función respiratoria. Se registraron 300 pacientes. Los síntomas clínicos más frecuentes fueron: aumento de la expectoración (52%), infecciones respiratorias recurrentes (44,3%), cefalea (39,6%), tos (35%), irritación laríngea (34%), prurito nasal (30%), disnea (26%), vértigo (22%), conjuntivitis (20,6%) y dolor torácico (19.6%). En cuanto a la espirometría, los resultados mostraron: 61.3% con patrón restrictivo, 14.3% con patrón obstructivo, 13,3% con patrón mixto, 11% de los casos sin alteraciones. El 44% de este grupo tuvo exacerbación de enfermedades, como asma y enfermedad pulmonar obstructiva crónica. La contaminación atmosférica constituye un grave problema de salud pública, especialmente para las personas de bajos ingresos, que viven y trabajan en zonas con altos niveles de contaminación, como se evidenció en nuestro estudio. Deben efectuarse mayor cantidad de estudios epidemiológicos para evaluar el efecto del ozono y otros contaminantes en grupos vulnerables, con el fin de implementar medidas de prevención efectivas.
55. Comparing Prevalence of Burnout in Psychiatric Doctors Before and After the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.
期刊: The Journal of clinical psychiatry 发表日期: 2025-Sep-29 链接: PubMed
摘要
Objective: To determine the prevalence of burnout among psychiatry residents, fellows, and attendings (“psychiatry doctors”) prior to and following the COVID-19 pandemic. Data sources: A systematic search of MEDLINE, Embase, PsycINFO, and PubMed databases was performed to identify studies reporting the prevalence of burnout pre-COVID-19 (pre-March 2020) and post-COVID-19 (post March 2020). The search was limited to articles written in English and published in peer-reviewed journals from January 1, 2010, until June 27, 2024. Study selection: There were 1,825 studies screened by 2 independent reviewers, with 36 eligible for inclusion. Observational studies and randomized controlled trials reporting the prevalence of burnout using validated tools were eligible for inclusion. Data extraction: Prevalence data were independently extracted by 2 authors and pooled using a random effects model. A subgroup analysis was performed, stratifying burnout by country income status. Results: The prevalence of burnout was 37.5% (95% confidence interval [CI], 28.2-47.3; 25 studies; 12,524 psychiatry doctors) prior to the COVID-19 pandemic and 32.0% (95% CI, 18.6-47.0; 12 studies; 7,458 psychiatry doctors) following the COVID-19 pandemic. Almost 1 in 2 psychiatry doctors from middle-income countries reported burnout pre-COVID-19 (49.8% [95% CI, 34.5-65.1]; 3 studies), with no studies reporting the prevalence of burnout in low-income countries. There was significant heterogeneity between studies. Conclusions: Burnout among psychiatry doctors is common, affecting 1 in 3 both prior to and following the COVID-19 pandemic. Additional studies are needed from psychiatrists in low- and middle-income countries to better characterize the prevalence of burnout in this cohort.
56. FAR-BENE Study: pharmacoeconomics and well-being in hemophilia. Monitoring outcomes in light of pharmaceutical expenditure with focus on patients undergoing therapeutic switch.
期刊: Blood transfusion = Trasfusione del sangue 发表日期: 2025-Sep-16 链接: PubMed
摘要
Hemophilia, a rare bleeding disorder, raises significant pharmacoeconomic challenges, particularly with the emergence of innovative therapies. This study evaluates clinical and patient-reported outcomes and expenditures in hemophilia patients focusing on those who underwent therapeutic switches between 2017 and 2023. This retrospective study included severe hemophilia patients. Expenditure was analyzed based on clotting factor consumption, while clinical well-being was assessed using ABR, NRS for pain, joint health scores (HJHS, HEAD-US) and trough plasma levels. Sub-analysis was conducted by applying different therapeutic groups. Statistical significance of differences between paired measures (pre [T0] vs post [T1]) was examined using the Wilcoxon Sum Rank test. Seventy patients were included. Total expenditure was € 12,947,580.44 in 2017 and € 12,967,576.92 in 2023. Among 45 patients who switched therapy, the median number of infusions/year significantly decreased from 156 to 91 (p<0.001), ABR from 1 to 0 (p<0.001) and NRS from 3,5 to 0 (p<0.001). Joint health did not show improvement with a slight but not statistically significant increase (HJHS from 10 to 15; HEAD-US from 7 to 8). Median trough increased from 3 UI/mL to 5 UI/mL (p=0.181). Patients were grouped for analysis based on homogeneous treatment regimens. This study is the first effort to conduct comprehensive analysis of the impact of therapeutic choices on well-being and cost of care in hemophilia Center. The study underscores the need for value-based approach to hemophilia care, integrating expenditure and clinical outcomes. Adopting validated economic weight outcome in future pharmacoeconomic evaluations will be essential for decision making.
57. Management of individuals exposed to multidrug-resistant or rifampicin-resistant tuberculosis.
期刊: The Lancet. Infectious diseases 发表日期: 2025-Jun-05 链接: PubMed
摘要
Individuals exposed to a person with infectious multidrug-resistant or rifampicin-resistant (MDR-RR) tuberculosis are at risk of developing tuberculosis disease. Historically, insufficient empirical evidence for preventive treatment in this group has permitted inadequate guidance for clinical decision making. However, several high-quality studies have been published detailing preventive treatment options for these contacts at high risk. In this Review, we discuss the management of individuals exposed to patients with infectious MDR-RR tuberculosis. We pay particular attention to the entire spectrum of clinical care for this population, including baseline assessment, possible preventive treatments, follow-up, and shared decision making. We discuss the available evidence, the rationales for different management strategies, and the interactions with (and implications of) secondary comorbidities such as HIV or malnutrition.
58. A generic model of life satisfaction: The case study of parkrun.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Parkrun is a free, weekly, timed 5 km run or walk with the aim of creating ‘a healthier, happier planet’. The aim of this study is to use a survey of parkrun to create a model of life satisfaction that can be used by other initiatives seeking (1) to evaluate them using the WELLBY approach, and (2) to create logic models for change in life satisfaction. A cross-sectional survey was sent in autumn 2024-967,478 UK parkrunners producing 78,662 responses. A model was hypothesised and tested using non-linear multiple stepwise regression analysis. Health status was found to have a very large non-linear effect on life satisfaction, primarily related to mental health. Life satisfaction was moderated by age, time registered with parkrun, gender, activity level and index of multiple deprivation. Change in activity level following parkrun participation was found to have a small effect, while the number of runs or walks completed per person had a very small effect. Estimated economic benefits of parkrun to the UK economy were estimated to be £668m. This included £75m for the number of runs or walks completed (£1.92 per run or walk per person), £132m for the increase in activity after participation, and £463m for an estimated improvement to health status of 3% (found in a previous study). The benefit-cost ratio was 53:1 if the estimated increase to health status was included and 16:1 if it was ignored. In terms of health promotion, the model suggested that life satisfaction could be increased most by focussing on sub-populations in the following order: those with very poor, poor and fair health status; those in early middle age; the least active; males; and those from deprived neighbourhoods. Finally, a protocol was described to allow initiatives to create their own simple logic models and their own evaluations.
59. Promoting Health Literacy in Adolescence in Two Public Schools in Rio de Janeiro: Action Research.
期刊: Revista gaucha de enfermagem 发表日期: 2025 链接: PubMed
摘要
to identify health literacy demands among adolescents in public schools and implement co-created digital educational strategies to promote qualified access to health information. Qualitative, descriptive study with an action research approach conducted between May and November 2024. Participatory techniques, such as brainstorming and discussion groups, were used with students aged 14 to 19. After listening to their needs and analyzing informational content, an Instagram® profile was restructured and a TikTok® channel was created with content co-created with the adolescents. The identified literacy needs included conceptual gaps and low critical assessment skills on topics such as mental health, sexuality and gender, nutrition, substance use, violence, bullying, and racism. The intervention involved adapting the language, including new themes, and reformulating communication strategies, resulting in greater engagement and appropriation of the content by the adolescents. the incorporation of the identified demands into digital content and in-person actions reinforces the potential of social media and participatory methodologies in promoting health literacy, indicating the importance of public policies that articulate digital technologies, qualified listening, and youth protagonism.
60. Hematopoietic stem cell transplants in children and adolescents: experiences of suffering in the interdisciplinary team.
期刊: Revista gaucha de enfermagem 发表日期: 2025 链接: PubMed
摘要
To investigate the suffering of healthcare professionals who work in hematopoietic stem cell transplantation in children and adolescents. Qualitative study, inspired by Convergent Care Research, carried out in a transplant unit of a hospital in southern Brazil. Ten professionals from the interdisciplinary team, intentionally selected, participated. The information was collected between May and August 2023, using the Sensitive Creative Method through the “tree of knowledge” dynamic, consisting of four meetings with two to three participants. Initially, the professionals reflected and shared emotional experiences related to work. Afterwards, they discussed the essential characteristics of those who care for children and adolescents undergoing bone marrow transplants, through collective artistic production. The analysis was guided by the perspective of quality of work life. Emotions such as sadness and hopelessness emerged, indicating the presence of compassion fatigue. Two thematic axes were identified: quality of work life, empathy, compassion, and compassion fatigue; and being a professional in the context of transplants. Worker suffering is aggravated by the lack of institutional support. Even so, the care provided is supported by empathy and compassion, revealing efforts by professionals to reframe challenging experiences.
61. OASIS evaluation of the French laboratory diagnostic surveillance system: right people, right techniques but imperfect use.
期刊: Frontiers in veterinary science 发表日期: 2025 链接: PubMed
摘要
Laboratory diagnostic surveillance is the surveillance of incidents and the risk of incidents, resulting from the use of diagnostic tests. The role of this surveillance is to detect the potential mistakes in laboratories’ analytic methods and defects in diagnostic tests. We assessed the diagnostic surveillance system dedicated to five cattle diseases in France: infectious bovine rhinotracheitis (IBR), brucellosis, hypodermosis, bovine viral diarrhea (BVD) and enzootic bovine leukosis, using OASIS, a method developed for the assessment of surveillance systems. Information regarding the organization and functioning was collected during semi-structured interviews with actors taking part in the laboratory diagnostic surveillance system, including staff at national reference laboratories, diagnosis laboratories, veterinarians, diagnostic test manufacturers, cattle owners’ association and veterinary services. A scoring grid of 78 criteria was completed, based on the insights collected during the interviews. This scoring was then used for the calculation of seven surveillance critical control points based on the hazard analysis of critical control points approach and of ten quality attributes of the system. Key performance factors included: good technical management of laboratories, a monitoring of the performance of diagnostic tests by laboratories (intern control charts) and a good level of expertise for all actors. The areas of improvement were related to the lack of formalized bodies (steering committee, scientific and technical committee, coordinators, etc.), the lack of reporting guidelines, insufficient feedback to actors (regarding incidents and functioning of the system), and the absence of a definition of a case in laboratory diagnostic surveillance. In order to address these flaws, we recommend a new organization. Other main proposals for improvement included: establishing guidelines for reporting and investigating; raising the awareness of the actors concerning laboratory diagnostic surveillance; and establishing feedback meetings focused on the events of laboratory diagnostic surveillance. Such an evaluation should be conducted for other diseases and in other countries. It would be useful to share the results, especially within Europe, to implement improvements at the European level.
62. Design, synthesis, antiproliferative assessments, and computational studies of new quinolin-2(1H)-ones as dual EGFR/HER-2 inhibitors.
期刊: Frontiers in chemistry 发表日期: 2025 链接: PubMed
摘要
A novel series of quinolin-2(1H)-one derivative was rationally designed, synthesized, and characterized as potential dual inhibitors of EGFR and HER-2. Structural elucidation was achieved through IR, NMR, mass spectrometry, elemental analysis, and single-crystal X-ray crystallography. The synthesized compounds were screened for antiproliferative activity against four human cancer cell lines. Compound 5a exhibited the most potent antiproliferative profile, particularly against MCF-7 breast cancer cells (IC50 = 34 nM), outperforming erlotinib (IC50 = 40 nM). Kinase inhibition assays further confirmed dual activity of 5a, with IC50 values of 87?nM and 33?nM against EGFR and HER-2, respectively. Compound 5a induced apoptosis via activation of caspase-3, -8, and -9, along with upregulation of Bax, downregulation of Bcl-2, and increased cytochrome c release. Flow cytometry analysis demonstrated that 5a caused significant G0/G1 phase arrest in MCF-7 cells, indicating a cytostatic mechanism of action. Computational studies provided structural validation of the observed biological activities. Molecular docking studies showed a strong binding affinity 5a within the ATP-binding pockets of EGFR and HER-2, supported by key hydrogen bonding and hydrophobic interactions. These findings were further corroborated by 100 ns molecular dynamics simulations, which confirmed the structural stability and compactness of the 5a-HER-2 complex, as evidenced by low RMSD, consistent RMSF, and favorable radius of gyration and potential energy profiles. Additionally, ADME predictions revealed that 5a possesses favorable physicochemical and pharmacokinetic properties. Density Functional Theory (DFT) calculations provided insights into the electronic structure of 5a, highlighting favorable HOMO-LUMO distribution and electrostatic potential surfaces that support its dual-binding behavior.