公共卫生研究摘要 (2025-10-04)
共收录 57 篇研究文章
1. Efficacy of stimulus discrimination training for reducing unwanted memories in student journalists.
期刊: European journal of psychotraumatology 发表日期: 2025-Dec 链接: PubMed
摘要
Background: Journalists are frequently exposed to traumatic images and events, which may contribute to poor mental health, especially in those starting in the profession. Evidence-based preventative tools are needed to reduce the effects of exposure to these occupational stressors. Previous research demonstrates that the strategy journalists most commonly apply to traumatic images is suppression.Objective: This experiment investigated whether stimulus discrimination, a technique used in cognitive therapy for PTSD (CT-PTSD; Ehlers et al., 2005. Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43(4), 413-431) for reducing intrusive trauma memories, is more effective than memory suppression.Methods: Student journalists were randomly allocated to one session of online training in stimulus discrimination (N = 34; Mage = 23.65, SD = 4.18; 24 female) or suppression (N = 34; Mage = 24.26, SD = 4.55; 24 female) before exposure to analogue trauma film clips. Participants then completed daily diaries of intrusive memories of the film clips for one week and completed PTSD symptom measures at one-week follow-up.Results: Compared to participants trained in memory suppression, those trained in stimulus discrimination reported significantly fewer intrusive memories, less distress associated with intrusions and lower PTSD symptom severity at follow-up. There were no training-specific effects associated with depression or resilience at follow-up.Conclusions: The study found that student journalists can be trained in stimulus discrimination and that this CT-PTSD tool significantly reduced intrusive memories and associated PTSD symptoms after post-training exposure to traumatic images. Working as a journalist can involve exposure to traumatic events and increase risk for mental ill health.Journalists most often respond to intrusions of stressful experiences using strategies, such as memory suppression, that are understandable but may be unhelpful.Training journalists in stimulus discrimination prior to exposure to analogue trauma led to significantly fewer intrusive memories, less associated distress and fewer self-reported PTSD symptoms at 1 week follow-up compared to journalists trained in memory suppression.Stimulus discrimination effectively reduced intrusive memories and associated symptoms.Stimulus discrimination may offer protective benefits against developing PTSD and may have promise as a prevention tool.
2. Co-designing a novel intervention for prison staff affected by moral injury: a protocol.
期刊: European journal of psychotraumatology 发表日期: 2025-Dec 链接: PubMed
摘要
Background: Exposure to potentially morally injurious events (PMIEs) can contribute towards serious mental disorders. Prisons are uniquely challenging environments where staff must fulfil competing roles of security, care, and rehabilitation. Currently no manualised intervention for moral injury-related distress exists for prison staff. Here we describe the ‘Co-designing a program for Addressing staff wellbeing and Reducing moral injury Experiences’ (CARE) study protocol, which aims to co-develop an intervention to prevent and respond to moral injury-related ill health.Methods: Data will be collected from current and ex-prison staff. Current staff will be recruited from at least three prisons across the UK. We will survey a cross-section of prison staff exploring the prevalence of PMIEs and the impact of exposure on wellbeing, before carrying out qualitative interviews to explore the lived experiences staff moral injury. In addition, we will conduct interviews with ex-prison staff to understand the impact of PMIEs on wellbeing. These data will feed into the co-design of an intervention programme, designed to reduce distress among staff with PMIEs. Further feedback on the programme protocol will be sought from interview participants to ensure the co-developed programme is acceptable, and feasible to implement in future.Results: Quantitative staff survey data will be cross-sectional and will be analysed using multilevel regression models to explore associations between relevant factors. Qualitative data will be analysed using thematic analysis.Conclusions: Dissemination will include presentations at conferences, publication in academic journals, and free training events. By providing information about prison staff experiences, findings will not only inform the development of an evidence-based approach for staff in prison settings affected by moral injury but may also help inform broader approaches to providing support to other high-risk occupational groups. There is a lack of research on moral injury amongst prison staff despite the challenging, resource-limited nature of prison environments.Providing effective targeted support to prison staff affected by moral injury could improve staff wellbeing and help improve their occupational effectiveness including improving their interactions with prisoners.This protocol outlines the co-design process underpinning a novel intervention (the CARE programme) designed to reduce distress among prison staff with PMIEs.CARE will be informed by a comprehensive survey of moral injury amongst staff who work in UK prisons, interviews with stakeholders and (ex-) prison staff, and feedback from prison staff, including management and governors.
3. Longitudinal Association of a Polygenic Risk Score for Plasma T-Tau With Incident Alzheimer Dementia and Mild Cognitive Impairment.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Elevated levels of total tau (t-tau) are a key biomarker of neurodegeneration, often seen in Alzheimer disease (AD). Identifying individuals at increased risk of AD using minimally invasive biomarkers can enable early intervention. We developed a polygenic risk score (PRS) for plasma t-tau and examined its association with the risk for developing clinical endophenotypes of AD pathology. This longitudinal cohort study used data from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) study, involving individuals aged 65 years or older, free of AD, or amnestic mild cognitive impairment (aMCI-an AD prodrome) at baseline. Our primary exposure was PRStau, a PRS based on common genetic variants linked to plasma tau levels. The primary outcome was aMCI or AD incidence. We assessed the association between PRStau levels and aMCI/AD risk using Cox regression models adjusted for age, sex, education, APOE ε4 allele carriership, and population structure. We sought replication in a sample of UK Biobank (UKB) participants aged 60 years or older without prevalent dementia. In the HELIAD sample, among 618 cognitively healthy participants (mean age 73.37 years, 58.4% female), followed for 2.92 ± 0.80 years, 73 developed AD/aMCI. A 1 SD increase in PRStau was linked to a 29% higher AD/aMCI risk (hazard ratio [HR] 1.290, 95% CI 1.006-1.654). Stratified analyses revealed greater effect estimates in women (HR 1.451, 95% CI 1.023-2.058) and younger participants (HR 1.866, 95% CI 1.175-2.962), whereas results in men and older participants did not reach statistical significance. In the UKB sample (n = 142,637, mean age 64.2 years, 52% female), 2,737 participants developed AD over 12.9 ± 2.4 years of follow-up. Higher PRStau was also linked to increased AD risk (HR 1.046, 95% CI 1.007-1.086). These results support the potential utility of PRS for plasma t-tau in predicting AD/aMCI incidence. The relationship between genetic predisposition for elevated plasma t-tau levels and AD pathology might be influenced by sex and age, suggesting that these factors should be considered in AD genetic risk modeling. PRS could serve as an early indicator of genetic propensity for tau pathology, enhancing existing AD diagnostic and risk stratification algorithms.
4. Anti-Inflammatory Therapies for Atherosclerotic Stroke Prevention.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Ischemic stroke caused by atherosclerosis is associated with the highest risk of recurrence among stroke etiologies, highlighting a residual risk that current secondary prevention strategies fail to address. Multiple lines of research implicate inflammation in the pathogenesis of atherosclerosis, including recent large cardiovascular outcome trials demonstrating that anti-inflammatory therapies can lower residual vascular risk in patients with coronary artery disease. Notably, low-dose colchicine, a long-used anti-inflammatory drug, has received approval for cardiovascular risk reduction in patients with atherosclerosis. However, translation of anti-inflammatory treatments to patients with ischemic stroke has been challenging, with the first colchicine trials showing neutral or conflicting results. In this study, we review the preclinical, genetic, and epidemiologic literature linking inflammation to atherosclerotic stroke; examine key findings of cardiovascular outcome trials for stroke prevention; and summarize completed and ongoing stroke-specific trials. We discuss the etiologic heterogeneity of ischemic stroke that may obscure anti-inflammatory treatment effects, highlighting the need for precision medicine approaches targeting patients with established atherosclerosis and vascular inflammation. Finally, we provide an overview of the emerging anti-inflammatory therapeutics that are under development for atheroprotection and outline a translational roadmap to accelerate clinical impact in stroke prevention.
5. Inflammatory Cytokine Signatures Are Associated With Disease Burden and Comorbidity of Episodic Migraine and Endometriosis.
期刊: Neurology(R) neuroimmunology & neuroinflammation 发表日期: 2025-Nov 链接: PubMed
摘要
The aim of this study was to characterize inflammatory cytokine profiles in women diagnosed with episodic migraine, endometriosis, or both conditions and to determine how these cytokine patterns relate to symptom severity and functional impact, to identify potential biological markers distinguishing comorbid cases from single-diagnosis cases. Female patients with only episodic migraine, only endometriosis, or both conditions were enrolled. Plasma levels of proinflammatory cytokines were measured, and correlations with clinical parameters were analyzed. Women with episodic migraine had elevated levels of IL-1β, IL-6, and TNF-α compared with healthy controls, with even higher levels in those with both migraine and endometriosis, indicating a synergistic effect on systemic inflammation. IL-1β correlated with headache frequency and disability while IL-6 and TNF-α were linked to migraine severity and pain. Women with endometriosis alone did not show similar cytokine elevations, suggesting that inflammation is particularly amplified in comorbidity. Changes in leukocyte distribution further supported a unique immune activation profile in the comorbid group. These findings reveal novel biological evidence of a shared inflammatory endotype in women suffering from both conditions, which may contribute to the increased burden and comorbidity, highlighting the need for integrative diagnostic and management approaches.
6. Identifying Varying Influences on Eliminating Hepatitis C Across Medical Specialties.
期刊: Journal of viral hepatitis 发表日期: 2025-Nov 链接: PubMed
摘要
To identify specialty-specific influences in administering HCV treatment among primary care, gastroenterology/hepatology, infectious diseases, and addiction specialties, and strategies to potentially eliminate HCV. Qualitative study using remote interviews with healthcare providers in New York and Alabama who treated or screened patients for HCV, purposefully sampling for specialty, clinical setting, and HCV treatment experience. Data sources and Analytic Sample: Interviews occurred 9/2021-8/2022. Transcripts were analyzed using a hybrid inductive-deductive approach; a content analysis identified codes arising uniquely within specialties. Thirty-six providers were interviewed: primary care (n = 9), addiction medicine (n = 12), infectious diseases (n = 9), and gastroenterology/hepatology (n = 6). Distinct challenges and facilitators emerged across specialties. Primary care and addiction providers similarly emphasized the convenience and usual practice of referring patients to specialists for HCV treatment, while infectious disease and gastroenterology noted challenges with patients not completing the referrals. Primary care providers expressed wanting training and peer support related to treatment provision. Addiction providers described structural barriers, such as lacking on-site phlebotomy services and patients’ competing health concern prioritization, but highlighted strategies to improve treatment access, including trust-building. Infectious disease providers highlighted using patient navigators to overcome logistical barriers, while gastroenterologists emphasized collaborative relationships, particularly with addiction specialists. Specialty-specific opportunities emerged regarding training, collaboration, navigation, and infrastructure. Eliminating HCV requires addressing specialty-specific concerns for providers managing HCV. Potential opportunities include dissemination of specialty-tailored training, facilitating interdisciplinary care and desired cross-specialty collaborations, and overcoming unique infrastructural needs. Future research should evaluate implementation strategies addressing these specialty-specific needs.
7. Comparing the Prevalence of Anxiety and Depressive Symptoms During Pregnancy.
期刊: Journal of psychosocial nursing and mental health services 发表日期: 2025-Oct-07 链接: PubMed
摘要
To compare the prevalence of anxiety symptoms with that of depressive symptoms among pregnant individuals. In this secondary data analysis, we compared anxiety and depressive symptoms throughout pregnancy using the Edinburgh Postnatal Depression Scale among 50 pregnant individuals who were recruited at their initial prenatal appointment. We compared anxiety and depressive symptoms by conducting bivariate analyses. Anxiety and depressive symptoms were reported by 40% (n = 20) and 28% (n = 14) of pregnant individuals, respectively. One half (50%, n = 10) of pregnant individuals with clinically significant anxiety symptoms did not report depressive symptoms. Depressive symptom screening alone may lead to missed cases of clinically significant anxiety symptoms. Clinical providers need to concurrently screen for anxiety and depressive symptoms during pregnancy based on recently revised policy recommendations. Future research should address barriers to current screening practices.
8. Combined pesticide pollution enhances the dissemination of the phage-encoded antibiotic resistome in the soil under nitrogen deposition.
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
Phage-mediated dissemination of antibiotic resistance genes (ARGs) intensifies health threat in the environment. Increasing amounts of pesticides are entering the soil ecosystem, yet their potential influence on phage-mediated ARG spread, particularly under conditions of global change, remains poorly understood. In this study, we performed a long-term field experiment simulating pesticide contamination under nitrogen deposition and examined the role of soil phages in ARG spread and host adaptation using metagenomic and viromic sequencing. Combined pesticide markedly elevated the abundance of phage-encoded ARGs under nitrogen deposition. By enhancing phage-host interactions and increasing the co-occurrence of auxiliary metabolic genes with ARGs, phages may further facilitate the transfer of ARGs to bacterial hosts, conferring hosts a competitive edge in intensified microbial competition driven by combined pesticide exposure under nitrogen deposition. The phage-driven mechanism was supported by in vitro cultivation experiments, demonstrating that phages harboring ARGs, shaped by long-term combined pesticide exposure under nitrogen deposition, can infect bacterial hosts and confer resistance. Collectively, our findings underscore the pivotal role of phages in ARG mobilization under environmental stressors, reinforcing the importance of accounting for phage activity in ARG risk assessments under global change.
9. "It's Hard to Struggle Alone...": A Qualitative Study on Working Experiences of Individuals With Bipolar Disorder.
期刊: Journal of psychosocial nursing and mental health services 发表日期: 2025-Oct-07 链接: PubMed
摘要
To explore the working experiences of individuals with bipolar disorder (BD). This study was conducted using a qualitative phenomenological design. Personal in-depth interviews were conducted with 10 individuals diagnosed with BD who were actively employed. Data were collected face-to-face through semi-structured interviews and examined using content analysis. Four main themes and eight subthemes were revealed. Themes were Current (subthemes: stigmatization, mobbing), Rudder (subthemes: social rhythm, symptom management), Sail (subthemes: coworkers, family), and Anchor (sub-themes: career development, empowerment). Individuals with BD can be supported by increasing the number of sheltered workplaces and enhancing regulations made by the state for their employment. Increased efforts for occupational rehabilitation could provide functional recovery and a satisfactory life for this population.
10. Regional Disparities in the Use and Demand for Digital Health Services for Autism Spectrum Disorder in China: Cross-Sectional Survey of Stakeholder Perspectives.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-03 链接: PubMed
摘要
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition, the prevalence of which is increasing in China and worldwide. Digital health technologies offer promising solutions for improving screening, diagnosis, and rehabilitation of children with ASD, particularly in resource-limited settings. However, digital health technologies for ASD have not been adopted in China. Understanding utilization patterns, influencing factors, and user needs is essential to inform equitable, effective digital health strategies. This study aimed to assess the current use, influencing factors, and perceived needs of digital health services among parents of children with ASD and rehabilitation therapists in 2 distinct provinces in China. A cross-sectional survey was carried out between November 2023 and February 2024 in Heilongjiang and Fujian provinces. Purposive sampling recruited a total of 780 parents and 745 rehabilitation therapists to complete a structured questionnaire. Data were analyzed using descriptive statistics, stepwise multivariable logistic regression, and multiple response analysis. The use of digital health services was low among parents (46/780, 5.9%) and rehabilitation therapists (161/745, 21.6%), although the demand was substantially higher (621/780, 79.6% and 671/745, 90.0%, respectively). Among parents, higher use was positively associated with younger age (20-29 years), employment, lower income (≤CNY 3000/month [US $421.247/month]), and delayed ASD diagnosis (7-12 years old). Among rehabilitation therapists, male, special education background, and autism-specific training experience predicted higher use (all P<.05). Demand was significantly greater in Fujian than in Heilongjiang and was positively associated with higher education levels in parents and rehabilitation therapists (P<.05). Parents and rehabilitation therapists valued a greater understanding of ASD behaviors and development and easier access to resources as primary benefits. Common barriers to the use of digital health services included high cost, need for additional equipment, and usability challenges. The smartphone-WeChat mini-program was the preferred device and platform, respectively. Parents prioritized access to rehabilitation courses, remote guidance, and policy information, while rehabilitation therapists favored personalized plans and professional skills training. Despite a strong demand, digital health services are underused in ASD care across China, with adoption of digital health services influenced by regional disparities and sociodemographic factors. This study, as the first comparative analysis of parents and rehabilitation therapists in 2 Chinese provinces, provides stakeholder-specific insights to guide targeted, locally relevant interventions. Bridging the digital divide through inclusive policies, training, and cross-sector collaboration will be essential for equitable integration into ASD care pathways.
11. Low Risk Perception of Harm From Substance Use and Sexual Behaviors Among Online Help-Seeking Sexual and Gender Minoritized People in San Francisco, California: Cross-Sectional Survey.
期刊: JMIR formative research 发表日期: 2025-Oct-03 链接: PubMed
摘要
Substance use and HIV epidemics have disproportionately affected sexual and gender minoritized (SGM) communities, with heightened risks among men who have sex with men (MSM) and transgender women of color due to intersecting challenges like poverty, mental health issues, and discrimination. Despite overall declines in substance use and sexual risk behaviors in the general population, these issues persist within SGM communities, exacerbated by stigma and systemic barriers to care. Digital health interventions have emerged as promising tools to address these disparities, offering accessible and stigma-reducing alternatives to traditional care, particularly effective among younger individuals and in underserved areas. This study seeks to examine the social correlates of substance use and sexual risk perception among an online sample of help-seeking MSM and transgender women in San Francisco, California. We recruited 409 help-seeking MSM and transgender women by using social media advertisements on Facebook, Instagram, and Grindr in 2022-2024. Participants provided informed consent and completed a baseline assessment. Utilization of testing resources for HIV and hepatitis was high among the participants (401/409, 98.04% and 360/409, 88.02%, respectively). Knowledge of HIV or other sexually transmitted infection health services was also high (379/409, 92.67%). Fewer participants (264/409, 64.55%) were knowledgeable about substance use-related services. Although many participants reported that using substances posed a high risk of harm, some perceived engaging in condomless sex, using prescription opioid drugs without a prescription, and using substances during sex as low risk (122/409, 29.83%, 41/409, 10.02%, and 60/409, 14.67%, respectively). Participants who reported experiencing unstable housing were more likely to report perceiving sharing needles (adjusted odds ratio [aOR] 7.20, 95% CI 1.99-27.80) and nonprescription opioid use (aOR 4.02, 95% CI 1.08-14.90) as low risk. Participants who reported an income below the federal poverty level were more likely to report perceiving sharing needles (aOR 6.35, 95% CI 1.84-23.40), prescription opioid use (aOR 2.89, 95% CI 1.32-6.18), and substance use during sex (aOR 2.29, 95% CI 1.14-4.48) as low risk. Participants who have not been tested for hepatitis in the past have 3.31 times the odds of perceiving prescription opioid use as low risk compared to counterparts who have been tested for hepatitis before (95% CI 1.36-7.68). This study underscores the importance of social determinants in shaping low risk perception of the harm associated with substance use behaviors among online help-seeking SGM people in San Francisco. These systemic inequities structure participants’ perceptions, access, and utilization of preventive and public health services. Our findings identify critical opportunities for outreach and preventative efforts needed to serve vulnerable populations.
12. A Dual In-Person and Remote Assessment Approach to Developing Digital End Points Relevant to Autism and Co-Occurring Conditions: Protocol for a Multisite Observational Study.
期刊: JMIR research protocols 发表日期: 2025-Oct-03 链接: PubMed
摘要
Research priorities for autistic people include developing effective interventions for the numerous challenges affecting their daily living, for example, mental health problems, sleep difficulties, and social well-being. However, clinical research progress is limited by a lack of validated objective measures that represent target outcomes for improvement. Digital technologies, including wearable devices and smartphone apps, provide opportunities to develop novel measures that may reflect everyday experience and complement key clinical assessments. However, little is known about the acceptability and feasibility of implementing digital data collection in this population. The primary objective of this study is to evaluate the usability, acceptability, adherence, and feasibility of a dual in-person and remote (ie, at-home) protocol. Secondarily, we aim to explore the properties of certain resulting data with a view to developing novel digital end points for key target outcomes, including social communication, sleep, and mental health. Eligible autistic and nonautistic in the AIMS Longitudinal European Autism Project were invited to participate in a digitally augmented in-person Autism Diagnostic Observation Schedule-2 (ADOS-2) and a 28-day remote measurement (RM) protocol involving wearing a Fitbit device, downloading a passive smartphone data collection app, and using 2 active reporting apps. The first AIMS Longitudinal European Autism Project study participants were enrolled in September 2021 (in-person component) and March 2022 (RM component). To date, 190 participants have taken part in the digitally augmented ADOS-2 component, and 86 participants have been enrolled for the RM protocol. Recruitment is now complete with some RM data collection ongoing until August 2025. Data analysis has commenced, including qualitative framework analysis of feedback interview data coproduced with autism community members, exploration of acceptability and feasibility metrics, pipeline development for ADOS-2 speech analysis, and RM sleep measures. This study lays important groundwork in understanding the acceptability and feasibility of in-person and remotely implemented digital measurement procedures to capture meaningful outcomes in domains important to improving everyday life for autistic people. DERR1-10.2196/71145.
13. Decoding the Public's Real-Time Emotional and Cognitive Responses to the Changing Climate on Social Media: Computational Analysis Using Weibo and Meteorological Data.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-03 链接: PubMed
摘要
Climate change poses a significant threat to mental health and well-being worldwide. Existing research on the associations between climate change-related events and mental well-being primarily focuses on clinical outcomes and often measures associations at single time points. The long-term effects and variability of the changing climate on more subtle nonclinical but widespread mental well-being remain relatively unexplored. Additionally, the underlying mechanisms that link changing climate events to real-time emotional well-being and pro-environmental actions have rarely been studied. Revealing real-time nonclinical mental well-being and its underlying mechanism is crucial for the early detection of at-risk individuals. This knowledge can also inform future interventions aimed at improving the public’s risk perception and empowering communities to manage related challenges effectively. This study aimed to understand the association between the changing climate and expressed emotional well-being by integrating multiple data sources, including social media posts about climate change on Weibo (N=76,514), 20 years of regional meteorological data (N=216,476 records), and regional vulnerability data in China. This study proposed and tested a new mechanism that connects meteorological factors with expressed emotional well-being through three cognitive responses identified from social media posts: thinking styles, social affiliations, and somatosensory experiences. Psycholinguistic analysis, structural equation modeling (SEM), and multiple regression models were used to examine the mediation of these three conceptual factors, as well as the moderating effects of regional vulnerability and seasonal changes on the influence of climate change on the public’s expressed emotional well-being and downstream pro-environmental tendencies. The SEM results revealed that extreme hot days are associated with decreased emotional well-being when talking about climate change (total effect=-0.712, 95% CI -0.894 to -0.531, P<.001), and these effects were mediated by three proposed mediators: social affiliations (indirect effect=-0.445, 95% CI -0.537 to -0.347, P<.001), analytical-intuitive thinking style (indirect effect=-0.100, 95% CI -0.126 to -0.073, P<.001), and somatosensory experiences (indirect effect=0.022, 95% CI 0.005-0.041, P=.02). Additionally, regression analysis indicated that the association between increased temperatures and expressed emotional well-being is moderated by seasonal changes (β=-.091, 95% CI -0.159 to -0.023, P=.009) and regional population density (β=-.068, 95% CI -0.118 to -0.018, P=.007). In the crude model examining associations between weather indices and expressed pro-environmental tendencies, the results showed that extreme hot days are associated with reduced pro-environmental tendencies (odds ratio [OR]=0.802, 95% CI 0.747-0.861, P<.001). However, after controlling for expressed emotional well-being and cognitive responses, such associations were less pronounced. The findings highlight the need for interventions that promote mental well-being in response to climate change and the importance of cognitive responses in developing positive coping strategies and enhancing emotional resilience. This approach could empower individuals to create a positive self-reinforcing cycle that encourages pro-environmental behaviors.
14. Identification of Syndrome Types in Patients With Pancreatic Cancer From Free Text in Electronic Medical Records: Model Development and Validation.
期刊: JMIR formative research 发表日期: 2025-Oct-03 链接: PubMed
摘要
Syndrome differentiation is crucial in traditional Chinese medicine (TCM) diagnosis and treatment, but it heavily relies on expert experience, limiting systematic standardization. This study developed and validated a BERT (bidirectional encoder representations from transformers)-based model, the traditional Chinese medicine pancreatic cancer syndrome differentiation bidirectional encoder representations from transformers (TCMPCSD-BERT), using in-house pancreatic cancer medical records, to digitalize expert knowledge and support standardized syndrome differentiation in TCM. A retrospective dataset of pancreatic cancer cases (2011-2024) from Fudan University Shanghai Cancer Center was annotated into 4 TCM syndrome types by 2 experts (Cohen κ=0.913). The proposed TCMPCSD-BERT model was compared with conventional models (long short-term memory and text convolutional neural network) embedded in TCM diagnostic tools and with large language models (LLMs; ChatGPT-4o, Kimi, Ernie Bot 4.0 Turbo, and Zhipu Qingyan) under a prompt engineering framework. Performance evaluation on in-house data was supplemented with attention visualizations and integrated gradients analyses for interpretability. The McNemar test assessed classification accuracy differences, while bootstrap 95% CIs quantified statistical uncertainty and stability. The Welch t test (2-tailed) was used to evaluate mean differences between TCMPCSD-BERT and the comparator models. Among 6830 records, case counts were damp-heat syndrome (n=1694), spleen-deficiency syndrome (n=1185), damp-heat with spleen-deficiency syndrome (n=1178), and others (n=2773). On the test set, McNemar test showed significantly higher accuracy for TCMPCSD-BERT than the 3 baseline models and generally better performance than LLMs. In all comparisons, TCMPCSD-BERT achieved higher mean macroprecision, macrorecall, macro-F1-score, and accuracy, with nonoverlapping 95% bootstrap CIs and significant Welch t test results (P<.01). The model achieved a macroprecision of 0.935 (95% CI 0.918-0.951), macrorecall of 0.921 (95% CI 0.900-0.942), macro-F1-score of 0.927 (95% CI 0.908-0.945), and accuracy of 0.919 (95% CI 0.899-0.939). Attention visualizations suggested the model could capture less common TCM term associations, while integrated gradients highlighted high-attribution diagnostic features (eg, “gray-white stool” 0.933 in damp-heat syndrome; “indigestion” 1.204 in spleen-deficiency syndrome). Misclassification analyses indicated challenges in handling overlapping or atypical symptom presentations. Compared with LLMs, web-based platforms, and diagnostic instruments, TCMPCSD-BERT appeared to provide relatively higher accuracy, interpretability, and efficiency in processing long unstructured texts for syndrome differentiation. The TCMPCSD-BERT model shows potential for automated syndrome differentiation from unstructured clinical texts and broader application in TCM. Based on this study, it appears to improve operability over 4-diagnostic instruments and web-based platforms, and offers greater stability and accuracy than LLMs in specific tasks. However, these findings should be interpreted cautiously, given the subjectivity of syndrome definitions, data imbalance, and reliance on preprocessed, expert-annotated data. Further studies involving larger and more diverse populations are needed to validate its generalizability and support its broader application in real-world settings.
15. A Tailored mHealth Intervention for Improving Antenatal Care Seeking and Its Determinants Among Pregnant Adolescent Girls and Young Women in South Africa: Pilot Randomized Controlled Trial.
期刊: JMIR mHealth and uHealth 发表日期: 2025-Oct-03 链接: PubMed
摘要
Adolescent pregnancy is of public health concern due to high rates of pregnancy-related complications and lower antenatal attendance among adolescent girls and young women. Mobile health (mHealth) interventions have the potential to improve pregnancy health behaviors and thereby birth outcomes. This pilot randomized controlled trial with pre-post design evaluated user acceptability and preliminary efficacy of an mHealth intervention to improve antenatal appointment attendance and its determinants among pregnant adolescent girls and young women in South Africa. The “Teen MomConnect” intervention entailed both fixed and 2-way tailored SMS text messages about antenatal appointment keeping and pregnancy health behaviors. The intervention content and functionality were adapted from MomConnect, a national mHealth program that sends fixed SMS text messages to pregnant women in South Africa. Pregnant adolescent girls and young women aged 13-20 years were recruited from health facilities and community networks in Cape Town during May-December 2018. Simple 1:1 randomization was used to allocate participants into the control group that received the standard MomConnect maternal health messages or the experimental group that received the Teen MomConnect intervention. A subset of experimental group participants received an in-person motivational interviewing session. Questionnaires were administered at baseline and after the end of the participants’ pregnancies. Appointment attendance data were obtained from clinic records. ANOVA, ANCOVA, and logistic regression models assessed the differences in appointments attended, awareness of HIV status, and the psychosocial determinants of antenatal attendance between the control and experimental groups. Overall, 412 adolescent girls and young women were enrolled, of which 254 (62%) completed the posttest survey (64% control, 59% intervention). Patient record data were obtained for 222 of the 412 (54%; in both control and intervention) participants. A total of 84% (63/75) and 72% (54/75) rated the intervention messages highly regarding their content value and their motivational nature for behavior change, respectively. Participants responded to an average of 20% of the 2-way messages they received. Mean appointment attendance did not differ significantly between the experimental (4.86, SD 1.76) and control (4.79, SD 1.74; P=.79) groups. Appointment attendance was higher among intervention participants who responded to ≥50% of messages (“high-responders”; 5.08, SD 1.66) than intervention participants who responded to fewer messages (4.82, SD 1.79) and control participants (4.79, SD 1.74; P=.86). The mean increase in knowledge scores was significantly higher among experimental group high-responders (2.1, SD 3.17) than the control group (0.7, SD 2.73; β=1.50; P=.045). Engagement with the intervention’s 2-way messaging was low, which could have impacted the outcomes. However, the intervention content was deemed acceptable. Appointment attendance did not vary significantly between the intervention and control groups. More intensive intervention may be needed to impact appointment adherence. Pan African Clinical Trial Registry (PACTR) PACTR201912734889796; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9565. RR2-10.2196/43654.
16. Association Between Age and Severity at Disability Onset and All-Cause Mortality: Longitudinal Observational Study From the Health and Retirement Study.
期刊: JMIR aging 发表日期: 2025-Oct-03 链接: PubMed
摘要
Disability is a global public health challenge, with its prevalence increasing, particularly among older adults, and it exerts a profound impact on both health outcomes and mortality rates. This study investigates the associations between age at disability onset, severity at disability onset, and all-cause mortality in community-dwelling adults. We analyzed data from waves 10 to 16 (2010-2023) of the Health and Retirement Study, a nationally representative longitudinal survey of US adults aged ≥51 years. Participants without disabilities in activities of daily living (ADLs) or instrumental activities of daily living (IADLs) from the Health and Retirement Study were followed biennially until December 31, 2023. During the follow-up period, 4500 participants developed ADL disability and 4260 developed IADL disability. For each case participant, a control participant matched for age (+1 to -1 y) and sex was randomly selected. Multivariable Cox proportional hazards models were used to assess hazard ratios (HRs) for all-cause mortality among participants with new-onset disabilities, stratified by age groups and severity at disability onset. Over a median follow-up duration of 8.58 years, 1709 (37.98%) deaths occurred in the ADL group and 1832 (43%) deaths occurred in the IADL group. Individuals who developed ADL disability before the age of 55 years exhibited the highest all-cause mortality risk compared to matched controls (HR 3.12, 95% CI 1.85-5.26), which further increased with severe disability (HR 4.07, 95% CI 2.03-8.19). The mortality risk was inversely associated with age at onset. A parallel trend was identified in the IADL cohort. Notably, men demonstrated a significantly elevated mortality risk compared to women, emphasizing the need for gender-specific interventions. Early and severe disability onset significantly increases mortality risk, with men experiencing a disproportionately higher risk. Preventive strategies aimed at addressing early-onset and severe disability, with consideration of gender differences, are essential for improving long-term outcomes in affected populations.
17. Gender Differences in Psychosocial Pathways to Depression and Anxiety: Cross-Sectional and Bayesian Causal Network Study.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-03 链接: PubMed
摘要
Depression and anxiety are widespread disorders with documented gender differences in symptom progression and associated psychosocial factors. However, the complex interrelationships between childhood trauma, self-esteem, social support, emotion regulation, and their gender-specific impacts on the development of depression and anxiety remain unclear. The objective of this study was to investigate the network structures of depression, anxiety, and psychosocial factors and to examine the pathways contributing to the development of depression and anxiety, with a focus on gender-specific differences. This study included 6105 participants from across China, collecting their sociodemographic characteristics and psychological scale data. Cross-sectional network analysis was used to explore the complex relationships between depression, anxiety, insomnia, somatic symptoms, childhood trauma, self-esteem, social support, and emotional regulation. Subsequently, Bayesian network analysis was used to infer potential causal pathways. Gender differences in the network structures were specifically examined. Network analysis revealed strong associations among depression, anxiety, insomnia, and somatic symptoms. Network strength centrality exhibited the highest stability across overall networks (CS-C=0.75), with high predictability for depression (R²=72.4%) and anxiety (R²=64%), supporting the robustness of the model. The network structure invariance test between male and female participants was significant (P=.001). Furthermore, the Bayesian network analysis showed gender-specific symptom progression, where anxiety preceded depression in male participants, while depression preceded anxiety in female participants (with edges retained in nearly 100% of bootstrap samples). Self-esteem, social support, and insomnia were central nodes in female participants, whereas emotion regulation was more influential in male participants. Additionally, childhood trauma influenced depression or anxiety indirectly through self-esteem and social support in both male and female participants. This study presents a novel application of network analyses to delineate distinct gender-specific pathways in the development of depression and anxiety. The findings underscore insomnia, self-esteem, and social support as intervention targets for women and emotion regulation for men. Findings support gender-sensitive mental health strategies and emphasize the need for longitudinal validation.
18. Epidemiological and economic burden of dementia in the Middle East and North African region.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Oct-03 链接: PubMed
摘要
BackgroundDementia is a global health challenge projected to nearly triple by 2050, especially in the Middle East and North Africa (MENA). Understanding its epidemiology and economic impact is vital for public health planning.ObjectiveThis systematic review aims to synthesize evidence on dementia, particularly the prevalence of Alzheimer’s disease, its economic burden, and caregiving in MENA countries, to facilitate informed policy-making and effective resource allocation.MethodsWe performed a random-effects meta-analysis to determine the pooled prevalence of dementia from studies published between 2014 and 2025 in PubMed, Scopus, and Google Scholar. Two reviewers independently selected and extracted data, assessing bias risk with the Cochrane Risk of Bias Tool. This review followed PRISMA 2020 guidelines and is registered in PROSPERO (CRD42024550935).ResultsTwelve studies met the criteria, showing dementia prevalence in MENA countries from 1.1% to 7.9%, with higher rates in Iran, Israel, and Lebanon, highlighting the need for public health campaigns. The annual estimated cost for those aged 50 and older is about USD 8.18 billion. Caregiving mainly fell to female family members, with larger socioeconomic impacts than in other regions.ConclusionsDementia is a growing public health concern in MENA, requiring improved healthcare infrastructure, increased caregiver support, and targeted research to fill knowledge gaps.
19. West Nile virus vaccine candidates attenuated by dinucleotide enrichment are immunogenic and protective against lethal infection.
期刊: PLoS pathogens 发表日期: 2025-Oct-03 链接: PubMed
摘要
West Nile virus (WNV) poses a global public health threat. This study demonstrates that the WNV RNA tolerates CpG and UpA dinucleotide enrichment in different genomic regions resulting in attenuation of CpG- and CpG/UpA-enriched variants. Attenuation was zinc finger antiviral protein 1 (ZAP)-dependent, and ZAP knockout (ZAP-KO) cells were used to generate high-titer stocks. Ten enriched variants, with permuted control and wild-type (WT) viruses, were screened in immunocompetent mice upon intraperitoneal injection. In contrast to lethal WNV-WT and permuted viruses, the E-MAX variant, with the RNA region encoding envelope (E) protein enriched both with CpG and UpA, caused no mortality. E-MAX was immunogenic and protective against lethal challenge. Stability of enriched dinucleotides was confirmed upon serial passaging in ZAP-WT and ZAP-KO cells, with only minor (17-21%) reversion at a single site in ZAP-WT condition. E-MAX upregulated interferon (IFN) signaling genes in human cells, suggesting that the combination of CpG/UpA-mediated attenuation, and concurrent activation of IFN responses potentially driven by CpG/UpA enrichment, may contribute to E-MAX immunogenicity. Evaluation using footpad injection in mice showed E-MAX had a promising safety and immunogenicity profile, although brain infection was occasionally detected. Then, we developed the E-MAX+ FR variant by combining CpG/UpA enrichment with two amino acid substitutions in functional domains of the E protein. This strategy eliminated neuroinvasion while maintaining immunogenicity and protection. Altogether, CpG/UpA dinucleotide enrichment in the genomic E region in combination with amino acid substitutions in the E protein yields a promising platform for vaccine development against WNV and potentially other flaviviruses.
20. A Bayesian model for repeated cross-sectional epidemic prevalence survey data.
期刊: PLoS computational biology 发表日期: 2025-Oct-03 链接: PubMed
摘要
Epidemic prevalence surveys monitor the spread of an infectious disease by regularly testing representative samples of a population for infection. State-of-the-art Bayesian approaches for analysing epidemic survey data were constructed independently and under pressure during the COVID-19 pandemic. In this paper, we compare two existing approaches (one leveraging Bayesian P-splines and the other approximate Gaussian processes) with a novel approach (leveraging a random walk and fit using sequential Monte Carlo) for smoothing and performing inference on epidemic survey data. We use our simpler approach to investigate the impact of survey design and underlying epidemic dynamics on the quality of estimates. We then incorporate these considerations into the existing approaches and compare all three on simulated data and on real-world data from the SARS-CoV-2 REACT-1 prevalence study in England. All three approaches, once appropriate considerations are made, produce similar estimates of infection prevalence; however, estimates of the growth rate and instantaneous reproduction number are more sensitive to underlying assumptions. Interactive notebooks applying all three approaches are also provided alongside recommendations on hyperparameter selection and other practical guidance, with some cases resulting in orders-of-magnitude faster runtime.
21. Towards a transcriptomic biomarker for the classification of melanocytic neoplasms.
期刊: PLoS genetics 发表日期: 2025-Oct-03 链接: PubMed
摘要
Histopathologic diagnosis of thin, invasive cutaneous melanoma (CM) is only 34-62% accurate. Therefore, we sought to develop a transcriptomic biomarker to distinguish benign from malignant melanocytic neoplasms. We generated a targeted RNA-Sequencing dataset (TempO-Seq) of benign nevi (BN; n = 50) and CM (Breslow depth ≤ 1.0 mm; n = 51) and demonstrated enrichment of immune-related pathways among the 450 differentially expressed genes. Next, we trained a putative transcriptomic biomarker in two datasets, including BN and CM, and one dataset with CM in association with a nevus, macrodissected into CM and nevus regions. We refer to the nevus portion of CM in association with a nevus as progressing nevi (PN), since these nevi progressed to CM. Principal component analysis showed that PN samples clustered in a component intermediate to BN and CM. Ordinal regularized regression selected PYGL, AP000845.1, PHYHIP, WSCD1, FBXO7, TRPM1, SLC4A4, NALCN, FRMD4B, HHATL, COL1A1, CRYM, EPOP, RGS1, KRT6C, IGHG1, CNTN1, MMP11, GZMM, AP001880.1, TTYH3, TMEM132A, and PRAME; these genes were consistently selected in 1000 models using data from bootstrap resamples and had a single model predictive accuracy of at least 0.90 (area under the receiver operator characteristics curve). Linear regression models fit with these 23 genes in the TempO-Seq data, and publicly available microarray datasets from BN, dysplastic nevi, and CM, showed high consistency in the magnitude and directionality of gene expression differences between nevi and CM. Furthermore, immunohistochemical staining showed consistent protein-level changes in MMP11 and PYGL. These results illuminate the potential for a transcriptomic biomarker to differentiate benign from malignant melanocytic neoplasms and improve the accuracy of melanoma diagnosis.
22. Pilot study of social media promotion of home-based self-testing for syphilis.
期刊: Sexually transmitted diseases 发表日期: 2025-Oct-03 链接: PubMed
摘要
We promoted home-based syphilis self-testing via social media to persons with factors linked to increased syphilis risk in Los Angeles County and San Bernardino. Users found the First to Know Syphilis Test easy and were likely to recommend it, indicating strong interest in self-testing and potential to enhance syphilis prevention.
23. Healthy behaviors and quality of life of disabled elders using home care services during the COVID-19 pandemic.
期刊: Chronic illness 发表日期: 2025-Oct-03 链接: PubMed
摘要
ObjectivesQuality of life (QoL) is a significant health outcome for the older adults, especially during the COVID-19 pandemic. The demand for health care from older adults who use home care services often increases sharply due to a lack of healthy behaviors, which harms their QoL to various degrees. Thus, this study aimed to examine the predictors of the QoL of disabled older adults using home care services during the COVID-19 pandemic.MethodsA cross-sectional survey study was conducted. A total of 214 older adults were collected from five home care support centers in the central region of Taiwan from October 1, 2021, to July 8, 2022.ResultsStepwise multiple regression analysis showed that the health promotion of healthy behavior (11.9%), financial status (8.6%), activities of daily living (4.5%), community care services (3.5%), and could explain 28.5% of the variance in predicting the overall QoL.DiscussionMaintaining health-promoting behaviors, having a better financial status, engaging in suitable activities of daily life level, and receiving daycare services could effectively improve the QoL.
24. Cross-cultural comparison of factors influencing sustainable dietary behaviors among Japanese and German adults.
期刊: Nutrition and health 发表日期: 2025-Oct-03 链接: PubMed
摘要
BackgroundThe concept of integrated sustainable dietary behaviors (SDBs) focuses on a series of dietary behaviors from food choice, storage and preservation, preparation (cooking), consumption, and disposal, as well as dietary patterns.ObjectivesThis study qualitatively describes the factors influencing the implementation of SDBs in Japanese and German adults and quantitatively compares the factors between the two cultures.MethodsThe online survey targeted 700 Japanese and 235 German adults, while the oral interview focused on 16 Japanese participants, recruited by a web-research company in 2021. Manifest content analysis, alongside chi-square and Fisher’s exact tests, was used.ResultsThe participants’ mean (SD) ages were 40.5 (10.9; Japanese; questionnaire), 26.2 (8.1; German; Questionnaire), and 38.1 (12.6; Japanese; interview), respectively. The 2515 codes (Japanese: 930; German: 1585) that emerged from the content analysis were divided into five main categories: (1) intrapersonal, (2) interpersonal, (3) food environment, (4) government, local governments, and research institutions, and (5) other. Compared to the Germans, the Japanese participants had a higher percentage of references to the “intrapersonal” and “government, local government, and research institution” categories. Japanese participants were more likely to cite psychological factors, portion size, and other factors, whereas German participants frequently referenced biology, skills of SDB, local access to sustainable food, and neighborhood characteristics.ConclusionCultural differences were found in the perceived factors for implementing SDBs. This study provides insight into the factors in implementing SDBs and can assist the development of promotion strategies that consider the cultural backgrounds of target populations.
25. A Smartphone App (WExercise) to Promote Physical Activity Among Cancer Survivors: Randomized Controlled Trial.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-03 链接: PubMed
摘要
Cancer survivors face unique health challenges that may be addressed through physical activity (PA) interventions. Technology-based tools provide innovative, resource-efficient alternatives to traditional approaches, delivering PA interventions. This study aimed to examine the effectiveness of a smartphone app (WExercise) in promoting PA among cancer survivors. This study was an assessor-blind, 2-arm randomized controlled trial. The intervention group used WExercise, which consisted of automated weekly lessons developed based on the multi-process action control (M-PAC) framework. The control group received written PA recommendations. Ninety-eight physically inactive cancer survivors who had completed curative treatment were recruited from an oncology clinic and the community. Outcomes included exercise behavior (primary), exercise capacity, quality of life, and M-PAC constructs. The majority (81/98, 82.7%) of participants remained in the study. The proportion of participants completing at least 75% of lessons was 69.44%. For exercise behavior, mixed findings were identified: the intervention group had a significantly greater increase in self-reported moderate-to-vigorous PA compared to the control group at postintervention (mean difference in change 89.02 minutes, 95% CI 34.87-143.16) and 3 months postintervention (mean difference in change 49.37 minutes, 95% CI 8.63-90.10; group × time interaction; P=.003), while no significant effect on ActiGraph-measured moderate-to-vigorous PA was observed at postintervention (mean difference in change -8.54 minutes, 95% CI -36.19 to 19.11) and 3 months postintervention (mean difference in change 2.56 minutes, 95% CI -27.29 to 32.41; group × time interaction; P=.74). WExercise was also effective in increasing cancer survivors’ exercise capacity but not their quality of life or M-PAC constructs. WExercise demonstrated a significant effect on increasing self-reported PA, but this was not corroborated with ActiGraph-measured PA. The application may be a useful addition for clinicians aiming to promote physical activity in people with cancer.
26. The Impact of Active Augmented Reality Games on Physical Activity and Cognition Among Older Adults: Feasibility Study.
期刊: JMIR serious games 发表日期: 2025-Oct-03 链接: PubMed
摘要
Physical activity (PA) enhances physical health as well as cognitive and brain health, yet motivating older adults to initiate and sustain PA remains challenging, a difficulty exacerbated by the COVID-19 pandemic. Active augmented reality (AAR) games, integrating digital gameplay with real-world physical movement, provide an enjoyable and accessible means for PA promotion among older adults in independent living environments, mitigating barriers such as poor weather and unfavorable neighborhood environments. However, limited research has explored the feasibility and impact of AAR interventions in this population. This feasibility study examines the acceptability, safety, and preliminary effects of AAR games to enhance PA levels and cognitive functions among older adults, as well as their user experiences. We also examined the practicality of home-based AAR gameplay using minimal equipment and constrained physical space. Sixteen independent-living older adults aged 65-85 years (mean 74.6, SD 3.73) participated in a single-session AAR intervention using the Active Arcade game set by playing four 10-minute AAR games. PA levels were assessed using ActiGraph wGT3x-bt accelerometers and Polar H10 heart rate monitors. Cognitive function was evaluated pre- and post-gameplay using NIH Toolbox’s visual reasoning test and Flanker inhibitory control and attention tests. Surveys of PA intention and motivation as well as the gaming experience questionnaire, along with semistructured interviews, were conducted afterwards, providing both quantitative and qualitative insights into the feasibility and appeal of AAR gameplay from the target population. All participants completed the study protocol without adverse events, demonstrating high feasibility and acceptability. Participants engaged in moderate-to-vigorous PA during 20%-30% of the gameplay, as measured by accelerometers and heart rate monitors. Of the 16 participants, 7 were taking beta blockers. The mean values of average %HRMax suggest that those not on beta blockers generally met the moderate-intensity threshold, whereas those on beta blockers tended to fall slightly below it. Cognitive assessments revealed significant improvements in visual reasoning postintervention, with the effect sustained after adjustment for age and education (P=.03), suggesting potential cognitive benefits from a single bout of AAR gameplay. Survey responses indicated high levels of PA intention (mean 4.15/5, SD 0.59), motivation (mean 5.67/7, SD 1.24), high positive affect (mean 4.35/5, SD 0.80), and low negative affect (mean 1.30/5, SD 0.46) associated with AAR gameplay. Around 75% of gameplay occurred within a 4×4 ft area (mean 29.77/40 min, SD 2.46), indicating suitability for home environments. Thematically analyzed interview feedback emphasized participants’ enjoyment, ease of use, desire for progressive difficulty, and the need to cater to diverse physical abilities and individual preferences. AAR games are a feasible, accessible, and enjoyable alternative for PA and cognitive engagement among older adults. Future research should investigate the long-term effects, sustainability, and broader applicability of AAR interventions to fully realize their potential in aging populations.
27. Facilitators and Barriers to Implementing French-Canadian Lifestyle Redesign® in Occupational Therapy Practice.
期刊: Canadian journal of occupational therapy. Revue canadienne d’ergotherapie 发表日期: 2025-Oct-03 链接: PubMed
摘要
Background. Although Lifestyle Redesign® is an important preventive occupational therapy approach fostering meaningful routines to support health and well-being, little data exists to support its implementation in new sociocultural contexts. Purpose. To explore facilitators and barriers to a future implementation of the French-Canadian Lifestyle Redesign® (Remodeler sa vie®) in occupational therapy practice, as perceived by occupational therapists (OTs), occupational therapy students, decision makers and community partners. Method. Guided by the Consolidated Framework for Implementation Research, this action-research study involved 58 purposefully selected participants trained in the approach. Eleven focus groups were conducted using three semi-structured interview guides and facilitation tools. Findings. Participants (86.2% women, aged 20 to 72; mean = 43.2, SD = 12.5) identified 36 influential factors, with public sector OTs facing the most barriers. Key facilitators included the approach’s strong evidence base, its relevance to aging populations, key actors’ openness and engagement, and new social trends. Barriers stemmed from the approach’s complexity, resource constraints, socio-political challenges, implementation efforts and uncertainty about older adults’ engagement in this approach. Equitable access to the approach was a common concern. Conclusion. By addressing the factors influencing the implementation of Remodeler sa vie®, this study advances knowledge on integrating preventive approaches to promote healthy aging in Canada and internationally.
28. How Many Blastocysts Are Needed for PGT-A to Benefit RPL Patients? A 7-Year Retrospective Cohort Study.
期刊: Reproductive sciences (Thousand Oaks, Calif.) 发表日期: 2025-Oct-03 链接: PubMed
摘要
The efficacy of preimplantation genetic testing for aneuploidy (PGT-A) in couples with unexplained recurrent pregnancy loss (uRPL) may vary according to the number of good-quality blastocysts available. This study is to determine whether PGT-A could improve the cumulative live birth rate (CLBR) among couples experiencing uRPL as the number of high-quality blastocysts increases. A retrospective study involving 1073 couples with uRPL was conducted at a university-affiliated reproductive center. Patients were divided into two groups: 813 participants who underwent PGT-A and 260 participants who underwent conventional in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). A stratified analysis was conducted, which categorized the female participants into three subgroups based on the number of high-quality blastocysts: 1-3, 4-6, and ≥ 7. A binary logistic regression model was used to evaluate the associations between the number of high-quality blastocysts and the cumulative pregnancy outcomes. Among uRPL patients undergoing PGT-A or IVF/ICSI, there were respectively 421 vs. 129 with 1-3 blastocysts, 252 vs. 69 with 4-6 blastocysts, and 140 vs. 62 with ≥ 7 blastocysts. In 1-3 blastocysts subgroup, CLBR was 23.52% after PGT-A vs. 33.33% after IVF/ICSI (adjusted OR 1.005, 95% CI 0.604-1.674, p = 0.984). In 4-6 blastocysts subgroup, CLBR was 53.17% after PGT-A vs. 75.36% after IVF/ICSI (adjusted OR 0.398, 95% CI 0.197-0.802, p = 0.010). In ≥ 7 blastocysts subgroup, CLBR was 73.57% after PGT-A vs. 66.13% after IVF/ICSI (adjusted OR 1.660, 95% CI 0.729-3.799, p = 0.227). In these three subgroups, clinical pregnancy loss rates were all similar between the two treatment methods. In women with uRPL, PGT-A did not improve CLBR, irrespective of the number of high-quality blastocysts available. Routine use of PGT-A in this population is therefore not recommended. Future high-quality randomized controlled trials may better define its appropriate indications.
29. Frailty Trajectories and Influencing Factors in Patients With Non-Hodgkin Lymphoma During Chemotherapy: Protocol for a Longitudinal Mixed Methods Study.
期刊: JMIR research protocols 发表日期: 2025-Oct-03 链接: PubMed
摘要
High-intensity chemotherapy for non-Hodgkin lymphoma (NHL) has been shown to improve survival outcomes. However, its substantial toxicity may induce or exacerbate patient frailty, which is strongly associated with treatment interruptions, increased adverse effects, and reduced survival rates. Despite this, the dynamic progression of frailty and its specific contributing factors among patients with NHL undergoing chemotherapy remain poorly understood. This study aims to investigate the heterogeneity of frailty trajectories and explore their risk factors in patients with NHL. We seek to generate insights into the dynamic relationship between frailty and disease course. The findings may offer health care professionals dynamic insights into frailty progression and could help inform strategies for the early identification of high-risk populations through the systematic assessment of key factors. Ultimately, this work seeks to contribute to the evidence base for developing interventions that could mitigate or prevent frailty. This longitudinal mixed methods study will recruit 250 patients newly diagnosed with NHL from multicenter hospitals in China. Quantitative data will be collected at 3 time points: before chemotherapy, during the third cycle of chemotherapy, and at the end of chemotherapy. We will use validated questionnaires (ie, the Tilburg Frailty Indicator) to gather information on sociodemographics, frailty, cognition, physical condition, health literacy, anxiety, and nutrition. Qualitative data will be collected via semistructured interviews and observations at the end of chemotherapy. The growth mixture model and logistic regression analysis will be used to analyze quantitative data, and the diachronic analysis method and the directed content analysis method will be used for the qualitative data. Both types of data will be analyzed in parallel and separately. Finally, we will integrate the datasets to identify areas of confirmation, complementation, or discordance. The research protocol and informed consent form were approved by the Medical Ethics Committee of the First Affiliated Hospital of Henan University of Science and Technology (2024-03-K171). Recruitment began in January 2025, with 168 participants enrolled as of September 2025. The data collection and analysis processes are expected to be finalized by March 2026. Data management is still ongoing; therefore, data analysis has not yet been conducted. As a pilot trial, this research is primarily designed to assess the feasibility of our methods and generate preliminary data on frailty progression. The findings could offer initial insights and help inform the development of future strategies for the early identification of high-risk populations through systematic screening, with the ultimate goal of informing interventions that may prevent frailty.
30. Characteristics associated with breakthrough congenital syphilis in Florida and Arizona, 2018-2022.
期刊: Sexually transmitted diseases 发表日期: 2025-Oct-03 链接: PubMed
摘要
Congenital syphilis (CS) can occur despite timely identification and adequate treatment of maternal syphilis (breakthrough CS). We examined associations between maternal characteristics and prevalence of breakthrough CS. Having primary/secondary syphilis, a higher maximum non-treponemal titer, and treatment initiation closer to delivery were associated with higher prevalence of breakthrough CS.
31. Population characteristics in patients accepting versus declining HIV pre-exposure prophylaxis after targeted offer in large public hospital in the US south.
期刊: International journal of STD & AIDS 发表日期: 2025-Oct-03 链接: PubMed
摘要
BackgroundPre-exposure prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) is safe and effective, but its implementation is suboptimal with the US South having disproportionately high numbers of new HIV infections and low PrEP use.MethodsParkland Health in Dallas, Texas has implemented interventions to improve PrEP uptake. A retrospective review was conducted of targeted PrEP offers in 2022 to eligible patients aged >=16 years to compare differences between those who accepted versus declined PrEP.ResultsOf 2,219 patients offered PrEP, 287 were excluded. Of the remaining 1,932, 195 (10%) accepted a PrEP offer. Those who accepted were more likely to be from a younger age group (16-25 vs > 55 years, p-value <0.01), men who have sex with men (p-value <0.01), and transgender females with male partners (p-value <0.01). Other positive predictors of PrEP acceptance included being insured (p-value 0.01), sero-discordant partner (p-value <0.01), and pregnancy (p-value <0.01). Patients who accepted were more likely to have received multiple interventions (145/195 (74.36%) vs 580/1737 (33.39%), p-value <0.01).ConclusionsA multipronged approach to increasing PrEP uptake in a health system in the South reached a variety of eligible patients. Future efforts should focus on improving PrEP engagement for Black, uninsured, heterosexual, and older individuals.
32. Mobile Technologies in Infectious Disease Monitoring: Benefits and limitations.
期刊: Przeglad epidemiologiczny 发表日期: 2025-Oct-03 链接: PubMed
摘要
Infectious diseases, such as the COVID-19 pandemic, Zika virus, malaria, and Ebola, pose a serious threat to public health worldwide. Their impact on society can be significant, especially in the context of globalization, migration, and climate change. These diseases can spread quickly and efficiently, which requires the use of modern monitoring and control tools. In this context, mobile technologies can play a crucial role in preventing and controlling the spread of infectious diseases. This article will discuss both the benefits and limitations of using mobile technologies in monitoring and combating infectious diseases, such as contact-tracing apps, systems for collecting epidemiological data, and platforms supporting health education. Choroby zakaźne, takie jak pandemia COVID-19, wirus Zika, malaria, czy Ebola, są poważnym zagrożeniem dla zdrowia publicznego na całym świecie. Ich wpływ na społeczeństwo może być znaczny, zwłaszcza w kontekście globalizacji, migracji oraz zmian klimatycznych. Choroby te mogą rozprzestrzeniać się szybko i efektywnie, co wymaga zastosowania nowoczesnych narzędzi monitorujących i kontrolujących. W tym kontekście, technologie mobilne mogą odegrać kluczową rolę w zapobieganiu oraz kontrolowaniu rozprzestrzeniania się chorób zakaźnych. W artykule tym omówione zostaną zarówno korzyści, jak i ograniczenia wynikające z wykorzystania technologii mobilnych w monitorowaniu i zwalczaniu chorób zakaźnych, takich jak aplikacje do śledzenia kontaktów, systemy gromadzenia danych epidemiologicznych oraz platformy wspierające edukację zdrowotną.
33. National Electronic Health Record Coverage in Pacific Island Countries and Territories: Environmental Scan.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-03 链接: PubMed
摘要
Pacific Island countries and territories (PICTs) face unique challenges in delivering health care and sustaining digital health systems. These challenges include geographically dispersed populations and service delivery points, workforce shortages, and poor infrastructure. National electronic health records (EHRs) can strengthen health systems by facilitating continuity of care but are only available in 47% of countries worldwide. The status of national EHRs in PICTs has not been previously described in the published literature. This study aimed to map national EHR coverage in 14 PICTs of the World Health Organization (WHO) Western Pacific Region classified as Small Island Developing States (SIDS). This included the presence or absence of a national EHR; identification of EHR software used; coverage nationally and across primary, secondary, and tertiary facilities; presence or absence of supporting digital health or health information system strategies and policies; comparison of national EHR coverage in PICTs with national EHR coverage globally; and exploration of a relationship between EHR coverage and country income in PICTs. Given the absence of peer-reviewed literature on EHRs in PICTs, an environmental scan methodology was selected to review gray literature sources. We conducted a 3-stage environmental scan to systematically search publicly available websites across government, bilateral, multilateral, and philanthropic organizations for documents describing the status of national EHR implementations in the aforementioned 14 PICTs. Of the 14 PICTs assessed, 12 countries (86%) have an EHR implemented at some level of the public health system, and 8 (57%) have a single national system implemented at more than one facility. Although this is higher than national EHR coverage rates globally (57/122, 47%), average coverage across the 12 PICTs using EHRs was only 39% (median 16%). We also identified a positive relationship between EHR coverage and country income status and generally medium to high EHR coverage across tertiary hospitals (19/41, 46%) and secondary care facilities (29/77, 38%) but low implementation at primary care facilities (61/4158, 1.5%). EHR coverage across all facilities in the 14 countries assessed was 2.5% (108/4267). EHR software used includes Tamanu (Nauru, Palau, Samoa, Kiribati, Fiji [Aspen Medical public-private partnership hospitals]), Medtech (Cook Islands, Niue), Vesalius (Tonga), PATIS Plus (Fiji), and custom systems. Our findings demonstrate, for the first time, that EHRs are being implemented in PICTs, including at scale in some settings. Despite high apparent coverage in some PICTs, the success of implementation and health worker usage remains unclear. Gray literature indicates that some EHRs currently available are failing or incapable of scaling nationally. To support sustainability of national EHRs in PICTs, governments should prioritize the implementation of fit-for-purpose, open-source, and scalable EHRs, and future studies should assess the success of EHR adoption and impact in the region.
34. Can a comic book superhero protect us from diseases? Assessment of an educational tool on immunizations among adolescents.
期刊: Przeglad epidemiologiczny 发表日期: 2025-Oct-03 链接: PubMed
摘要
Due to the increasing phenomenon of medical misinformation, unfavourable health behaviours have emerged, including the rise in the number of rejections of mandatory vaccination. Educational interventions are necessary to build public awareness. The main purpose of the study was to check students’ attitudes towards vaccination, during assessment of the comic titled ‘Vigor Fervorous versus The Spreaders of Nonsense’-an electronic educational tool used during lessons-in terms of its educational effectiveness and students’ opinions. A pilot quasi experimental study was conducted among 172 students aged 12-16, from primary and secondary schools located in the Masovia, including municipal and district schools, consisting of three stages: pretest, intervention (a lesson with the usage of the comic in e-book format), and posttest. Participants’ attitudes towards vaccination, changes in knowledge levels (before-after), clarity and comprehensibility of the comic and attractiveness of the tool were analysed. Based on Principal Component Analysis, four distinct attitude groups were identified, differing in self-assessed knowledge and the need for further education. Before the intervention, 22.7% of participants demonstrated low level of knowledge, 46.5% medium, 30.8% high. After the intervention, a relative average score increase of 11 percentage points was observed, with greater gains among secondary school students (15 p.p.) than primary students (9 p.p.). A single common factor was identified, termed “positive assessment of the comic.” The strongest associations were with: “more people should read this comic” (r = 0.876), “it supplemented my vaccination knowledge” (r = 0.844), and “it is an interesting way to convey knowledge” (r = 0.823). Weaker but still significant correlations were found for reduced fear of vaccination and content comprehensibility. The results proved the comic to be an effective and attractive tool for increasing knowledge about vaccination. The identified groups of attitudes confirm the need to tailor educational tools to the needs of target groups. Z uwagi na narastające zjawisko dezinformacji medycznej, w ostatnich latach pojawiają się niekorzystne zachowania zdrowotne, takie jak wzrost liczby odmów szczepień obowiązkowych. Interwencje edukacyjne są konieczne w celu budowania świadomości społeczeństwa. Głównym celem badania było sprawdzenie postaw uczniów wobec szczepień podczas oceny komiksu pt. “Wigor Swada kontra Siewcy Nonsensów” – elektronicznego narzędzia edukacyjnego wykorzystywanego podczas lekcji – pod kątem jej skuteczności edukacyjnej i opinii uczniów. Przeprowadzono quasi-experimentalne badanie pilotażowe wśród 172 uczniów w wieku 12–16 lat ze szkół podstawowych i licealnych znajdujących się na terenie województwa mazowieckiego, uwzględniających szkoły miejskie i powiatowe, obejmujące trzy etapy: pretest, interwencję (lekcję z wykorzystaniem komiksu w formie e-booka) oraz posttest. Analizowano stosunek uczestników do szczepień, zmiany poziomu wiedzy (przed i po), zrozumiałość komiksu, jego atrakcyjność oraz ocenę atrakcyjności narzędzia. W oparciu o Principal Component Analysis wyodrębniono 4 grupy postaw różniące się w zakresie samooceny wiedzy oraz potrzeby dalszej edukacji na temat szczepień. Przed interwencją niski poziom wykazywało 22,7% uczestników, średni 46,5%, wysoki 30,8%. Po interwencji zaobserwowano względny przyrost średniej zdobytych punktów w części merytorycznej o 11 punktów procentowych, przy czym większy przyrost odnotowano wśród uczniów liceum (15 p.p.) niż uczniów szkół podstawowych (9 p.p.). Zidentyfikowano wspólny czynnik, określony „pozytywna ocena komiksu”. Najsilniejsze powiązania zaobserwowano dla stwierdzeń: „uważam, że więcej osób powinno przeczytać dany komiks” (r = 0,876), „komiks uzupełnił moją wiedzę o szczepieniach” (r = 0,844) oraz „to ciekawy sposób przekazywania wiedzy na temat szczepień” (r = 0,823). Słabsze, lecz nadal istotne statystycznie korelacje dotyczyły zmniejszenia obaw przed szczepieniem oraz zrozumiałości treści. Wyniki pilotażu wskazują na skuteczność i atrakcyjność komiksu w zakresie podniesienia poziomu wiedzy na temat szczepień. Wyodrębnione grupy postaw potwierdzają konieczność dostosowania narzędzi edukacyjnych do potrzeb grup docelowych.
35. Assessment of the effects of the measles, mumps and rubella vaccination programme in the child population in Poland in 2014-2021.
期刊: Przeglad epidemiologiczny 发表日期: 2025-Oct-03 链接: PubMed
摘要
Immunizations represent a critical component of contemporary preventive measures. Their primary function is to safeguard against the development of diseases and the ensuing complications. The objective of this study is to evaluate the effects of the measles, mumps, and rubella immunization program on the population of children in Poland from 2014 to 2021. The vaccination rate against measles, mumps and rubella in the population aged 1-19 years was calculated. The numerator was the number of children vaccinated in a given year and the denominator was the number of children born in a given year. The rate of missed vaccinations was calculated, where the numerator was the difference between the number of children born in a given year and the number of children vaccinated in a given year, and the denominator was the number of children born in a given year. The incidence rate was calculated for the vaccinated and unvaccinated populations (per 1 million population). The numerator constituted the number of reported cases in a given calendar year, whilst the denominator represented the number of individuals in the vaccinated or unvaccinated population in an age group. In the subsequent years a gradual decrease in vaccination coverage was observed among the youngest age groups: 1-year-olds (from 77.8% to 70.7%) and 2-year-olds (from 94.8% to 89.5%). In the population vaccinated against measles, the highest incidence of the disease was observed among 1-year-olds. A decline in the incidence of rubella can be observed in subsequent years, both in the vaccinated and unvaccinated populations. A lower incidence of diseases was observed in 2020 and 2021 in all age groups. A significant decrease in the incidence of measles, mumps and rubella has been observed between 2014-2021 in the vaccinated population in comparison to the unvaccinated population. Szczepienia ochronne mają kluczowe znaczenie we współcześnie podejmowanych działaniach profilaktycznych. Ich zadaniem jest ochrona przed zachorowaniem oraz wystąpieniem powikłań w przebiegu zachorowania. Celem pracy jest ocena efektów realizacji programu szczepień ochronnych przeciwko odrze, śwince i różyczce w populacji dzieci w Polsce na przestrzeni lat 2014 – 2021. Obliczono stan zaszczepienia przeciwko odrze, śwince i różyczce w populacji dzieci w wieku 1-19 r.ż., w którym licznik stanowiła liczba dzieci zaszczepionych w danym roku, a mianownik – liczba dzieci urodzonych w danym roczniku. Dodatkowo obliczono stan niewykonanych szczepień ochronnych w populacji, gdzie licznik stanowiła różnica między liczbą dzieci urodzonych w danym roku a liczbą dzieci zaszczepionych z danego rocznika, natomiast mianownik – liczba dzieci urodzonych w danym roku. Współczynnik zapadalności obliczono dla populacji zaszczepionej i niezaszczepionej, a wyniki wyrażono jako liczbę zachorowań na 1 milion ludności. Licznik stanowiła liczba zgłoszonych przypadków zachorowań w danym roku kalendarzowym, natomiast mianownik – liczba osób w populacji szczepionej lub nieszczepionej w danej grupie wiekowej. Dokonano analizy porównawczej, uwzględniając liczbę zgłoszonych przypadków zachorowań na odrę, świnkę i różyczkę w populacji dzieci zaszczepionych oraz niezaszczepionych. W analizowanym okresie, w kolejnych latach, wskaźnik stanu zaszczepienia ulegał stopniowemu obniżeniu w najmłodszych grupach wiekowych: 1 r.ż. (z 77,8% do 70,7%) i 2 r.ż. (z 94,8% do 89,5%). W populacji dzieci zaszczepionych w większości analizowanych lat najwyższa zapadalność na odrę obserwowana była w populacji dzieci w 1 r.ż. Można zauważyć obniżającą się w kolejnych latach zapadalność na różyczkę, zarówno w populacji zaszczepionej, jak i niezaszczepionej. Zaobserwowano niższą zapadalność na odrę, świnkę i różyczkę w latach 2020 i 2021 we wszystkich rocznikach, w porównaniu z poprzednimi latami. Wykazano, że na przestrzeni lat 2014 – 2021 odnotowano znacznie niższą zapadalność na odrę, świnkę i różyczkę w populacji dzieci szczepionych w porównaniu z populacją dzieci, które nie otrzymały szczepienia.
36. Does environmental enrichment mitigate parasite infection by reducing stress in Masu Salmon Oncorhynchus masou?
期刊: Journal of aquatic animal health 发表日期: 2025-Oct-03 链接: PubMed
摘要
Captive animals are exposed to various stressors originating from their artificial environment. Although stress can initially be an adaptive physiological response, persistent stress generally decreases immune function and makes animals more susceptible to pathogens. Environmental enrichment is a strategy that has been widely used to mitigate excessive stress and enhance animal welfare, but the effectiveness of individual enrichment components remains controversial. Hence, this study aimed to reveal the effect of shelter enrichment on stress levels and parasite infections in Masu Salmon Oncorhynchus masou. By using a single component, the study will help to provide a better understanding of the underlying mechanism of the enrichment effect. We explored whether shelter-enriched conditions relieved stress in Masu Salmon by evaluating plasma cortisol levels. Fish provided with shelters were expected to experience less aggression from conspecifics and less stress from human disturbance. Moreover, we conducted a parasite challenge test using Ichthyobodo sp. to determine whether the presence of shelters inhibited infection by mitigating stress levels. Fish in enriched tanks had significantly lower basal cortisol levels than those in control tanks, suggesting that they were less affected by stressors. Although the difference was not significant, fish in enriched tanks also tended to experience less infection by the parasites than fish in control tanks. Given these results, simple shelter enrichment appears to be an effective method for mitigating stress among captive fish and reducing stress intensity or frequency. In addition, shelter enrichment could be used to inhibit infectious diseases, although further work is needed to prove the effect. These findings confirm that shelter enrichment has measurable effects on the factors related to fish welfare, which should encourage the adoption of enrichment in fish farms. Although environmental enrichment has been used to improve fish welfare, its effectiveness is inconsistent due to varieties of enrichment types. Our results clearly show that fish in enriched tanks experienced lower stress levels and tended to be less infected by parasites.
37. Vaccination-induced T cell responses maintain polyclonality with high antigen receptor avidity.
期刊: Science immunology 发表日期: 2025-Oct-03 链接: PubMed
摘要
Clonal expansion is a hallmark of adaptive immunity and has been challenging to investigate in humans in a standardized manner compared with animal models. We studied a cohort of 29 healthy individuals who received three mRNA vaccinations against SARS-CoV-2 before a breakthrough infection. We characterized the magnitude, phenotype, and clonal composition of CD8 T cell responses against 16 epitope specificities by ELISpot; flow cytometry; and single-cell RNA, protein, and T cell receptor (TCR) sequencing. One hundred six TCRs from five epitope-specific repertoires were reexpressed and tested for peptide sensitivity. Whereas vaccination-recruited T cell repertoires were enriched for high-avidity TCRs, differential clonal expansion was not linked to fine avidity differences. Instead, maintenance of polyclonality ensured robustness in counteracting viral mutational escape through altered epitopes. Deciphering the functionality of human antigen-specific T cell repertoires instructs our understanding of human T cell biology and may guide the development of vaccines and other immunotherapies.
38. An update on the World Trade Center cancer tissue biobank: a scientific resource for molecular and mechanistic studies on WTC-related cancer.
期刊: Carcinogenesis 发表日期: 2025-Oct-03 链接: PubMed
摘要
World Trade Center (WTC) responders were exposed to a complex mixture of toxins and carcinogens through dust, fumes, and smoke at ground zero. Since then, studies have indicated that WTC responders have elevated cancer rates compared to the general population. While studies have detailed the overarching connection between WTC exposure and cancer, a tissue biobank is needed to enable molecular and mechanistic studies on WTC-related cancers. The cohort includes responders involved in rescue, recovery, or cleanup enrolled in the World Trade Center Health Program (WTCHP) who consented to participate in research. Responders with cancer were identified through WTCHP certification. WTCHP provided data with patients’ demographic information, contact details, and cancer diagnoses. Potential participants were contacted by mail, email, or phone for consent and procedure location. If consented, samples were requested from pathology departments. A biobank of cancer tissues from WTC responders has been established with 551 distinct primary cancers from 521 patients. Of these, prostate makes up 39.0%, thyroid 9.8%, melanoma 8.9%, kidney 6.5%, bladder 6.0%, colorectal 5.8%, breast 5.6%, lung 4.7%, head and neck 4.7%, and other cancers 9%. An additional 343 patients have consented for biobank projects and their samples are being requested. To date, we have created a valuable tissue biobank available to the scientific community for high-impact oncology studies in the unique population of WTC responders. By studying links between carcinogenic exposure and cancer sites, exposure signatures, and markers of cancer aggressiveness, this biobank offers an unprecedented opportunity to advance cancer research in an exposed population.
39. Ukrainian population awareness regarding leptospirosis.
期刊: Przeglad epidemiologiczny 发表日期: 2025-Oct-03 链接: PubMed
摘要
Leptospirosis is one of the most common bacterial zoonoses in the world. However, there is scarce available literature on public awareness of the infection and the main clinical symptoms of leptospirosis. The aim of this study was to assess the level of leptospirosis awareness among the general population and individuals with occupational risk of the disease in Lviv Region, Ukraine. A leptospirosis questionnaire on potential risk factors, routes of transmission and ways of protection along with the demographic data was prepared, posted on Facebook and distributed as a printed version. The statistical analysis was performed using Fisher’s two-sided test. A total of 446 individuals completed the questionnaire. Of these, 364 persons had no occupational risk of acquiring leptospirosis, while 82 of them had it. The study showed the following levels of leptospirosis awareness among the participants: 193 out of 446 (43.3%) individuals knew what leptospirosis was, with 158/364 (43.4%) representing general population (Group 1) and 35/82 (42.7%) representing individuals with an occupational risk of acquiring leptospirosis (Group 2), p>0.05. Furthermore, a total of 55.8% of all the participants knew how they could contract leptospirosis: 194/364 (53.3%) in Group 1 and 55/82 (67.1%) in Group 2, p<0.05. The most common risk factors of acquiring leptospirosis observed in both groups were as follows: swimming in ponds and lakes with stagnant water (57.69% in Group 1and 79.26% in Group 2, p<0.01), and the presence of rodents in houses, basements and utility rooms as well as periodic visits to these premises by respondents (45.6% of the respondents in Group 1 and 58.53% of the respondents in Group 2, p<0.01). Outreach campaigns should be implemented to raise the awareness of leptospirosis, both among the general population and among the individuals at increased risk of exposure.
40. Health economic studies in clinical rehabilitation: A new collection of papers and a discussion of issues involved in research.
期刊: Clinical rehabilitation 发表日期: 2025-Oct-03 链接: PubMed
摘要
ObjectiveTo review challenges associated with health economic studies in rehabilitation, providing a context for the new Clinical Rehabilitation collection of papers concerned with health economics.RehabilitationAnalysis of the health economic effects associated with rehabilitation must recognise that rehabilitation consists of both a problem-solving process that facilitates the person’s adaptation by providing information, advice, and sometimes specific interventions targeting multiple areas. Second, it operates within a complex, adaptive system, specifically the biopsychosocial model of illness. Third, its goals are to enhance well-being and quality of life through its effects on lower-level systems. Consequently, the effects of rehabilitation are unpredictable and typically manifest in several domains. Comprehensive single or multiple focused outcome measures are needed. As evidence-based selection of people who might benefit from rehabilitation is impossible, evaluative studies should have broad inclusion criteria.SystemsRehabilitation is a healthcare service. Traditionally, it is delivered in series, after the biomedical treatment has ended. This allows researchers, including health economists, to isolate the influence of rehabilitation. However, it will be more effectively delivered in parallel, with biomedical care from the outset, as happens, for example, in trauma and intensive care units. Evaluating individual components of healthcare in isolation is unnecessary. Rehabilitation will always involve non-healthcare services. Conversely, the effects of rehabilitation may significantly reduce non-healthcare costs. This close interrelationship necessitates a societal perspective on the economics of rehabilitation.ConclusionsUsing a combination of a global, comprehensive clinical outcome measure and societal-level health economic data will increase the likelihood of detecting effects.
41. Bridging the gap: Efficacy of combined therapies for cognitive, behavioral, and functional outcomes in Alzheimer's disease - results from a systematic review and network meta-analysis.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Oct-03 链接: PubMed
摘要
BackgroundEvidence regarding efficacy of combined pharmaco- and non-pharmacotherapies and their comparative effectiveness for Alzheimer’s disease (AD) is limited.ObjectiveTo estimate the comparative efficacy of pharmacotherapies, non-pharmacotherapies, and combined therapies for improving cognitive, behavioral, and functional outcomes in patients with AD.MethodsRelevant studies were identified from Medline via PubMed and Scopus databases (March 2021-December 2022). Randomized-controlled trials were eligible if they assessed the efficacy of pharmacotherapies, non-pharmacotherapies, or combined therapies in patients aged 60 years or older, and measuring cognitive, behavioral, or functional outcomes. A network meta-analysis was conducted to estimate relative treatment effects, and interventions were ranked using surface under the cumulative ranking (SUCRA) curve. Confidence in the findings was evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework.ResultsA total of 153 randomized-controlled trials were analyzed. Compared to placebo/usual care, donepezil plus cognitive therapy and rivastigmine plus cognitive rehabilitation significantly improved Mini-Mental State Examination scores. Behavioral outcomes were improved by rivastigmine plus cognitive stimulation, brain stimulation plus exercise, and occupational therapy. Functional status improved significantly with rivastigmine plus cognitive stimulation and exercise. Based on SUCRA ranking, rivastigmine plus cognitive rehabilitation ranked highest for cognitive improvement (92.8%), brain stimulation plus exercise ranked highest for the behavioral outcome (93.1%), and rivastigmine plus cognitive stimulation ranked highest for functional improvement (94.1%).ConclusionsDonepezil plus cognitive therapy and rivastigmine plus cognitive rehabilitation were the most effective treatments for improving cognitive outcomes. Rivastigmine plus cognitive stimulation ranked highest for both behavioral and functional outcomes, while exercise remains an important strategy for supporting daily functioning in patients with AD.
42. Adolescent sleep disturbances and road traffic noise: a Swiss cohort study.
期刊: International journal of hygiene and environmental health 发表日期: 2025-Oct-02 链接: PubMed
摘要
Sleep is essential for adolescents’ health, yet research on transportation noise and adolescent sleep is limited. This study investigated the relationship between night-time road traffic noise exposure and self-reported sleep disturbances in adolescents, considering individual factors like noise annoyance and sensitivity. A cohort of 887 adolescents (mean age 14.03 ± 0.86 years) was recruited in Switzerland, with follow-up after one year. Night-time road traffic noise exposure (Ln) was modelled at the most exposed façade of participants’ residences using three-dimensional propagation models. Sleep disturbances, noise annoyance, and sensitivity were assessed via self-report questionnaires. Associations were examined using mixed logistic regression, adjusting for potential confounders and environmental co-exposures. Longitudinal changes were assessed using the interaction between Ln and follow-up time. Participants’ average Ln exposure was 44.6 ± 7.7 dB (range: 25.0-67.4). At baseline, 267 adolescents (30.3 %) reported being at least slightly annoyed by road traffic noise, and 205 (24.3 %) were highly noise sensitive. Higher Ln was associated with increased sleep disturbances, particularly at Ln ≥ 55 dB (OR vs Ln ≤ 44 dB = 2.43, 95 % CI: 1.20-4.91), and with higher odds of reporting at least slight annoyance (OR per interquartile range increase in Ln = 2.27, 95 % CI: 1.77-2.92). No changes in sleep outcomes were observed after one year in relation to noise exposure. Road traffic noise was associated with increased self-reported sleep disturbances and noise annoyance in adolescents. These findings add to the growing evidence linking transportation noise to non-auditory health effects in youth.
43. The Impact of Urinary Incontinence, Sexual Dysfunction, and Depressive Symptoms on Health-Related Quality of Life Over the 12-Month Postpartum Period.
期刊: The journal of nursing research : JNR 发表日期: 2025-Oct-02 链接: PubMed
摘要
The physical and psychological challenges faced by postpartum women adversely affect their health-related quality of life (HRQoL). However, the influence of urinary incontinence (UI), sexual dysfunction, and depressive symptoms on HRQoL across the first postpartum year remains unclear. This study was designed to investigate the association of UI, sexual dysfunction, and depressive symptoms with HRQoL and to examine changes in HRQoL across the initial 12-month postpartum period. The participants (n=613) completed the study questionnaire at four time points: 4-6 weeks and 3, 6, and 12-months postpartum. The questionnaire was mailed from a medical center maternity unit and included the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form, Female Sexual Function Index, the Center for Epidemiologic Studies Depression Scale, and the 36-item Short-Form Health Survey. Moderate to severe UI (β =-2.99), sexual satisfaction (β =-0.43), and lubrication (β =0.44; all p <.05) were associated with physical HRQoL over the 12-month postpartum period. Mental HRQoL was influenced by moderate to severe UI (β =-1.3), sexual satisfaction (β =0.61; both p <.05), and depressive symptoms (β =-11.07; p <.001). The lowest physical and mental HRQoL scores were identified in the first month postpartum (all p <.001). Physical HRQoL increased more significantly at 6 and 12 months than at 3-months postpartum (both p ≤.001). The first month postpartum represents a critical period for assessing HRQoL, when it is lowest. UI severity, sexual satisfaction, lubrication, and depressive symptoms were all shown to impact HRQoL significantly, indicating the need for proactive evaluations and tailored interventions by healthcare providers. Future research should identify interventions that effectively improve HRQoL during the postpartum period.
44. From inflammation to carcinogenesis: Distinct pathways and clinical implications of IBD-associated colorectal cancer compared with sporadic CRC.
期刊: Pathology, research and practice 发表日期: 2025-Oct-01 链接: PubMed
摘要
Inflammatory bowel disease-associated colorectal cancer (IBD-CRC) represents a distinct clinical and molecular entity compared with sporadic colorectal cancer (CRC). While sporadic CRC arises through the adenoma-carcinoma sequence, IBD-CRC follows an inflammation-dysplasia-carcinoma pathway, characterized by early TP53 alterations, multifocality, and flat lesions that challenge detection. Contemporary epidemiology indicates declining IBD-CRC incidence in high-income regions due to improved surveillance, though risk remains elevated in subgroups with long-standing colitis, primary sclerosing cholangitis (PSC), or persistent inflammation. In contrast, underreporting in low- and middle-income countries obscures the true global burden. Advances in high-definition colonoscopy and chromoendoscopy have improved detection, yet optimal risk-adapted surveillance strategies remain underutilized. Molecular insights highlight differences in genetic alterations, immune evasion, and microbial drivers between IBD-CRC and sporadic CRC. This review synthesizes epidemiologic, pathogenetic, and clinical distinctions, underscores challenges in surveillance and reporting, and discusses emerging technologies-including liquid biopsy, artificial intelligence, and multi-omics-that may refine prevention and early detection. Recognition of IBD-CRC as a separate disease process is essential to optimize individualized risk stratification, surveillance algorithms, and therapeutic strategies.
45. Real-World Outcomes in Anaplastic Lymphoma Kinase-Positive Advanced Non-Small Cell Lung Cancer in Argentina: A Multicenter Retrospective Study (GAOT-ALK001).
期刊: JCO global oncology 发表日期: 2025-Oct 链接: PubMed
摘要
In Argentina, anaplastic lymphoma kinase (ALK) gene rearrangements occur in approximately 6.1% of non-small cell lung cancer (NSCLC) cases. Given the availability of second- and third-generation ALK inhibitors, real-world data are needed to inform optimal treatment strategies. However, access to these therapies remains limited for many patients. We conducted a multicenter retrospective study of patients with metastatic ALK-positive NSCLC (ALKp) treated with first-line tyrosine kinase inhibitors (TKIs) from January 2014 to February 2024. Demographics, treatment patterns, clinical outcomes, and factors affecting treatment accessibility were analyzed. We identified 104 patients with ALKp. The median age was 55 years (IQR, 45-67); 86% had Eastern Cooperative Oncology Group ≤1, 58% were women, and 57% were nonsmokers. Brain metastases were present at diagnosis in 29%, with 50% receiving local treatment. First-line TKIs included alectinib (42%), crizotinib (30%), lorlatinib (16%), and brigatinib (12%). Crizotinib use was frequently due to limited access to new-generation TKIs. Adverse events occurred in 54%, with 21% grade 3 to 4. The objective response rate was 73%. At a median follow-up of 42 months, 48% experienced progression. Crizotinib was associated with higher risk of progression or death compared with newer TKIs (hazard ratio, 3.09 [95% CI, 1.75 to 5.5]; P = .01). CNS progression occurred in 18%, more often with crizotinib (42% v 8%, P = .04). Among those progressing, 82% received second-line therapy, most commonly lorlatinib or alectinib. The overall survival at 24 months was 81%, with 27% of patients deceased at data cutoff. This real-world study describes outcomes and treatment patterns among patients with ALKp in Argentina. It highlights disparities in access to optimal therapies and reinforces the need for equitable access to new-generation ALK inhibitors to improve clinical outcomes.
46. Lessons Learned From 7 Years of Implementing Cervical Cancer Screening and Treatment in Equatorial Guinea.
期刊: JCO global oncology 发表日期: 2025-Oct 链接: PubMed
摘要
This study aimed to assess the results of the Cervical Cancer Screening and Treatment (CCST) project in Equatorial Guinea and the reach of facility-based and community outreach service delivery strategies. The CCST project implemented the single-visit, screen-and-treat approach, using visual inspection with acetic acid (VIA) and treatment with cold coagulation (and referral for further evaluation where needed) for women age 20-60 years. The project deployed two service delivery strategies: in health facilities and through community outreach. The project conducted cascaded training, routine supervision for quality improvement, communication campaigns, and community mobilization efforts. Between 2017 and 2023, 26,998 women were screened. The two strategies reached almost equal numbers of women. Community outreach reached more women in the country’s mainland. It also reached significantly more married women, women with age at first sexual intercourse at or before 16 years, and those who were puerperal, postmenopausal, and multiparous than facility-based screening. VIA positivity rate was 2.6% overall, with higher rates among younger women. Fifty-five percent of VIA-positive women were treated with cold coagulation, 10% were referred for further evaluation, and 18% received no treatment. To our knowledge, this first-ever effort in CCST in Equatorial Guinea has shown that both facility-based and community outreach are effective in implementing the single-visit, screen-and-treat approach and underscores the need to continue and further expand the effort, strengthen the quality of services delivered and data capture, and increasingly transfer the capacity to implement facility-based screening and community outreach to the Ministry of Health.
47. Metastasis-Directed Stereotactic Body Radiation Therapy in Oligometastatic and Oligoprogressive Solid Malignancy: Outcomes and Effect on Systemic Treatment.
期刊: JCO global oncology 发表日期: 2025-Oct 链接: PubMed
摘要
To assess the clinical outcomes and evaluate Freedom from Introduction or Switching of Systemic Treatment (FISST) in patients with oligometastatic (OM) and oligoprogressive (OP) disease undergoing stereotactic body radiotherapy (SBRT). The primary end points were FISST and local control (LC) rates of lesions that received SBRT. The secondary end point was overall survival (OS) after SBRT. To calculate FISST, event was defined as the need to introduce or switch the systemic line of treatment for any reason or inability to provide systemic treatment when needed because of poor performance status (PS) (Eastern Cooperative Oncology Group PS ≥3) or other reasons. OS was a secondary outcome. A total of 200 patients were included. The median age was 60 (IQR, 49-70) years. The most common primary tumors were colorectal (61, 30.5%), breast (30, 15.0%), lung (28, 14.0%), head and neck (23, 11.5%), and prostate (16, 8.0%). A total of 257 metastatic lesions were treated. Bone was the most frequent site (115, 44.7%), followed by the liver (55, 21.4%), lung (44, 17.1%), lymph nodes (25, 9.7%), and adrenal glands (11, 4.3%). The median follow-up was 15 months. FISST at 1 and 2 years were 52% and 39%, respectively. LC at 1 and 2 years were 86.3% and 80%, respectively. OS at 1 and 2 years were 76.5% and 64.8%, respectively. Grade III toxicity was reported in 1.5% of patients overall, with no observed grade IV or V toxicity. SBRT is effective and safe for treating OM and OP solid cancers, prolonging FISST and potentially delaying systemic treatments, particularly in settings with limited access to advanced therapies.
48. Occupational exposure to extremely low-frequency magnetic fields (ELF-MF) and postmenopausal breast cancer risk.
期刊: Journal of occupational and environmental medicine 发表日期: 2025-Oct-01 链接: PubMed
摘要
Estimate the association between occupational exposures to extremely low-frequency magnetic fields (ELF-MF) and postmenopausal breast cancer. Lifetime job histories from a population-based case-control study (2008-2011) of histologically-confirmed breast cancer in Montréal, Canada were linked to a job-exposure matrix to assign geometric mean ELF-MF exposure/workday. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for cumulative, average, maximum, and duration of maximum exposure to ELF-MF (per interquartile range increase), adjusting for individual-level and ecological covariables. Data from 663 cases and 592 controls revealed no association between occupational ELF-MF exposure and postmenopausal breast cancer, though restricting exposures to 0-10 years before interview and to those during breast development, some positive associations was observed, particularly for ER+/PR+ tumours. Our findings suggest no association between occupational ELF-MF exposure and postmenopausal breast cancer risk.
49. Evaluation of molecular mechanisms of (Z)-3-(pentadec-10'-enyl)-catechol (litreol) and synthetic derivatives as inhibitors of human leukotriene biosynthesis.
期刊: Redox biology 发表日期: 2025-Sep-30 链接: PubMed
摘要
5-Lipoxygenase (5-LO) catalyzes the early steps of leukotriene (LT) biosynthesis, making it an attractive target for anti-inflammatory drug development. This study provides a more detailed evaluation of the molecular mechanisms and pharmacological effects of litreol (CI), a natural compound from the Anacardiaceae family, along with its synthetic derivatives (CS, AS, and AI). The synthesis and biological evaluation of litreol analogs have already been previously published. Therefore, the aim of this article is to further explore their mechanisms of action, providing a more thorough investigation into their effects on 5-LO. Using both isolated human recombinant 5-LO in cell-free systems and cell-based assays, we evaluated the impact of the synthesized compounds on 5-LO product formation. Among them, CI and CS emerged as potent inhibitors, exhibiting IC50 values of 0.26 μM and 0.80 μM in neutrophils, and 0.06 μM and 0.15 μM in cell-free assays, respectively. Notably, CI exhibited 2.5- to 3-fold greater potency compared to its hydrogenated analogue, CS. Both compounds also showed inhibitory activity against 12-lipoxygenase (12-LO) with IC50 of 3.15 and 5.10 μM, respectively. Moreover, CI prevented the 5-LO/FLAP protein interaction and blocked both ERK-1/2 and p38 MAP kinase-dependent pathways required for 5-LO activation. Conversely, AS and AI derivatives did not show significant 5-LO inhibitory effects. Computational studies revealed that the differing binding modes and stability of CI and CS at the allosteric site of 5-LO explain their varying inhibitory effects. CI forms a stronger interaction network, supporting its higher potency, while CS shows greater flexibility and weaker interactions, correlating with lower activity. Additionally, the free catechol group is essential for activity, as its acetylation leads to loss of function. Overall, our findings highlight CI as a promising 5-LO inhibitor, in intact human leukocytes accounting for a novel potent anti-inflammatory compound.
50. Isothermal microcalorimetry for scaffold design and characterization: Assessing bacterial and host cell interactions and physicochemical stability.
期刊: Advances in colloid and interface science 发表日期: 2025-Sep-29 链接: PubMed
摘要
Scaffolds used in regenerative medicine are increasingly expected to address personalization, bioactivity, and sustainability, underscoring the need for characterization methods that reliably predict safety and efficacy. Isothermal microcalorimetry (IMC) offers a highly sensitive, label-free, real-time measurement of heat flow from energy-generating or -consuming process at scaffold interfaces. By monitoring microbial activity, host cell metabolism, material stability, and responses to environmental or therapeutic factors, IMC provides physiologically relevant insight into scaffold performance over extended periods. Its non-destructive, low-preparation, and passive nature preserves samples for complementary analyses, making it a versatile yet underutilized tool in biomedical research. This review introduces IMC for scaffold design and characterization, emphasizing its capacity to evaluate vulnerability to biofilm formation and the effectiveness of anti-biofilm strategies. It further explores applications in tracking scaffold formation, assessing host cell-material interactions and tissue development, and probing the antitumor potential of engineered scaffolds. The review concludes with a perspective on IMC’s role in advancing scaffold translation within the evolving regulatory landscape shaped by the FDA Modernization Acts 2.0 and 3.0.
51. Psychosocial and rehabilitation interventions and health gains in older persons in long-term care: A systematic review.
期刊: International journal of nursing studies 发表日期: 2025-Sep-17 链接: PubMed
摘要
Global aging and the rising global prevalence of multimorbidity contribute to increasingly complex and substantial long-term healthcare needs. Person-centred psychosocial and rehabilitation interventions targeting older adults are essential in addressing these challenges effectively. To identify person-centred psychosocial and rehabilitation interventions targeting older adults in long-term care and the health gains associated with these interventions. Systematic literature review of randomized controlled trials with narrative synthesis. Included studies were: (1) those with older adults (65+) in long term care with multimorbidity; (2) studies comparing person-centred rehabilitation and/or psychosocial interventions with usual care; and (3) those reporting outcomes indicating a positive change or stabilization of health trajectories, including improved mental health, maintained or slowed decline in functioning, and enhanced well-being. The risk of bias was assessed using the Cochrane RoB 2 tool. Database searches (Pubmed, CINAHL ultimate, MedicLatina, SPORTDiscus, MedLine Ultimate, Psychology and Behavioral Sciences Collection, CENTRAL, LILACS, ClinicalTrials.gov and Google Scholar) and manual searches were conducted, with the final search performed in June 2025. Eighteen studies involving 9132 participants were included, identifying and normalizing 51 person-centred interventions using the International Classification for Nursing Practice taxonomy, categorized as psychosocial (15), rehabilitation (15), and complementary (21). Psychosocial interventions demonstrated consistent effectiveness across diverse long term care contexts, notably in improving symptom management in palliative care and health-related quality of life. Rehabilitation interventions, particularly when integrated with psychosocial components, showed robust improvements in health-related quality of life among participants with clear potential for functional stabilization or improvement. Significant heterogeneity was observed among the included interventions, populations, and care settings, limiting direct comparisons and quantitative synthesis. The strongest and most methodologically robust evidence was specifically observed in interventions implemented among frail and complex multimorbid older adults. The identified person-centred interventions effectively address complex health needs in older adults with multimorbidity. Psychosocial approaches demonstrated broad effectiveness, while rehabilitation interventions were most beneficial for participants with clear potential for functional improvement. These findings highlight the importance of integrating these approaches within multidisciplinary long term care models. Key limitations include the inability to conduct a quantitative synthesis due to heterogeneity and a focus on high-income countries. Future research should assess the cost-effectiveness, sustainability, and applicability of these interventions across diverse settings to inform clinical practice and policy development in long term care. PROSPERO, CRD42022363860, registered in October 2022. For older adults (65+) with multimorbidity in long-term care, person-centred psychosocial and rehabilitation interventions lead to significant health gains across multiple domains.
52. Biochemical phenotype of hypophosphatasia in asymptomatic individuals carrying ALPL variants.
期刊: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 发表日期: 2025-Sep-11 链接: PubMed
摘要
Hypophosphatasia (HPP) is the rare metabolic disorder caused by variants in the ALPL gene, resulting in deficient activity of tissue-nonspecific alkaline phosphatase (ALP). This leads to accumulation of substrates contributing to impaired bone mineralization. Hypophosphatasia manifests with a broad clinical spectrum; however, an increasing number of individuals with ALPL variants have been identified presenting the hallmark biochemical feature of HPP of low serum ALP activity, with or without elevated serum pyridoxal-5-phosphate (PLP) or urine phosphoethanolamine (PEA), while remaining asymptomatic. These ALPL carriers may represent a distinct subgroup within the HPP continuum, prompting the need for clearer classification. Using data from the Global ALPL Gene Variant Database, we identified 43 subjects who fulfilled the following criteria: low ALP (adjusted for age/sex), at least one ALPL variant, and no overt or reported HPP-related symptoms. Their median age was 29 yr (range 0-64); 23 were female. Serum ALP activity was reduced in all cases, with 76% of subjects showing levels less than 50% below the lower limit of normal. In 19 of 43 individuals, PLP or PEA was also elevated. Thirty distinct genotypes were observed; 79% of subjects were heterozygous, while 21% harbored homozygous or compound heterozygous variants. The identified variants were largely missense (77%), mostly affecting regions without a specific domain (38%). Five variants showed a dominant-negative effect in vitro, yet produced no clinical manifestations. Some identified genotypes were also linked to adult, childhood, or odontohypophosphatasia phenotypes, underscoring significant genotype-phenotype variability. These findings refine our understanding of the HPP spectrum, identifying a cohort of asymptomatic ALPL carriers with biochemical phenotype of HPP. Recognizing this group is important for improving diagnostic criteria and preventing overdiagnosis and unnecessary treatment. Longitudinal studies are needed to clarify follow-up strategies and determine whether these individuals develop clinical manifestations later in life or remain asymptomatic. Hypophosphatasia (HPP) is a rare inherited condition causing abnormal bone and teeth mineralization, as well as non-skeletal manifestations, due to low levels of an enzyme called alkaline phosphatase (ALP). People with HPP often have weak bones, early tooth loss, muscle weakness, fatigue, and/or chronic pain. However, some individuals reported no obvious symptoms of HPP despite carrying the same genetic change and having low ALP. Our study identified 43 such people, showing that these genetic changes can exist without causing noticeable health problems but still affect important blood markers. Understanding this form will guide medical advice and help determine if these individuals will develop symptoms later. This knowledge will also improve diagnosis, counseling, and care for affected families.
53. Extended Release of rhPDGF-ββ and rhBMP-2 From the Heparin Binding Site of Fibrin: An In Vitro Pilot Study.
期刊: Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) 发表日期: 2025-Sep 链接: PubMed
摘要
The purpose of this pilot study was to determine if recombinant human platelet-derived growth factor-ßß (rhPDGF-ßß) and recombinant human bone morphogenetic protein-2 (rhBMP-2) can be released over an extended timeframe from a biologic fibrin membrane capable of being used in a guided bone regeneration (GBR) procedure. Human venous blood samples were placed into 10 9-ml silica-lined test tubes. Two of the tubes were doped with rhPDGF-ßß, two tubes were doped with rhBMP-2, and two were doped with alpha-2 antiplasmin plus rhBMP-2. Four tubes with no growth factors added served as controls. After centrifugation the blood clots were separated from the red blood cell fraction and platelet poor plasma. The clots were placed into wells with liquid growth medium except for the platelet poor plasma and the serum squeezed from the clots. These solutions were measured directly. One milliliter of growth medium from the clots was removed at 20 minutes, 4 hours, 72 hours, 168 hours, 312 hours, and 336 hours and replaced with 1 ml of fresh growth medium. All samples were analyzed using indirect ELISA assay. Six 9-ml plastic-lined test tubes were filled with venous blood. After centrifugation the uncoagulated plasma was separated from the red blood cell layer and placed into a surgical bowl. Coagulation was initiated with 500 µl of calcium chloride for 30 minutes. The indirect ELISA assay for rhPDGF-ßß at 116 hours showed 1,583 pg/ml compared to 8 pg/ml from the average of the control samples with no growth factor added. The ELISA assay for rhBMP-2 at 324 hours showed 9,606 pg/ml, and for alpha-2 antiplasmin plus rhBMP-2 12,788 pg/ml, compared to no detectable growth factor from the controls. After 30 minutes of incubating the 25 ml of separated plasma, the coagulated clot produced a biologic membrane approximately 40 mm x 45 mm. The current pilot study showed fibrin can bind and release rhBMP-2 and rhPDGF-ßß over a 7- to 14-day period allowing the fibrin matrix to become an osseoconductive scaffold. Both growth factors can be incorporated into fibrin to create a biologic membrane to be used for GBR, sinus augmentation, and ridge augmentation.
54. Prospective long-term follow-up of sexuality and body image in women with primary vulvar cancer.
期刊: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society 发表日期: 2025-Aug-22 链接: PubMed
摘要
To investigate the development of sexual activity, sexual function, and body image in women with primary vulvar cancer from the time of diagnosis to 24 months after the end of treatment. This nationwide prospective cohort study assessed health-related quality of life in women with newly diagnosed vulvar cancer using validated patient-reported outcome measures (EORTC-QLQ-VU34 [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Vulva 34], Supportive Care Needs Survey Short Form) and self-constructed questions at diagnosis, and at 3, 12, and 24 months after the end of treatment. For this study, outcomes concerning sexuality and body image were analyzed. Results were displayed as mean scale scores and proportions. The longitudinal changes of scale and item scores were estimated by linear mixed-effects models with patient random intercept for continuous/numerical outcomes, and by generalized linear mixed models for binary response variables. Between August 2019 and August 2021, 138 of 153 consenting women (90%) returned at least 1 questionnaire, and 90 women (59%) completed the questionnaires at all 4 time points. Sexual activity increased from 9.8% at diagnosis to 22.8% after 24 months (odds of being sexually active at 24 months were 6 times higher than at baseline, p = .003). Vulvar cancer was one of the reasons for not being sexually active for 37.5% of the participants at baseline and 26.9% at 24 months. Most women (73.5%) were not satisfied with their sex life at baseline. At least at one time point, 25.4% of the women found sex important, and 32.6% needed help with changes in sexual feelings. The mean scale scores of sexual functioning and body image did not change over time. Sexual activity was low, largely due to the vulvar cancer diagnosis. Most women were not satisfied with their sex life. A substantial proportion of the women found sex important and expressed a need for help with sexual feelings.
55. Applying Patient Behavioral Assessment to Enhance Dental Implant Treatment Outcomes.
期刊: Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) 发表日期: 2025 链接: PubMed
摘要
The success of dental implant treatment is influenced not only by technical factors but also by patient behavior. Despite its critical role, behavioral assessment remains underutilized due to a lack of standardized tools. Patient-reported outcome measures (PROMs) offer potential for screening prior to implant therapy but are often overlooked in clinical practice. The objective of this study was to synthesize current research on behavioral psychology in dental implant treatment and apply findings to daily practice through a case-based approach. A PubMed search strategy used keywords related to “implant therapy” and “behavioral psychology.” Articles were screened by title and abstract, with full-text review as needed. Additionally, a retrospective case series was conducted at a periodontal office, examining five implant patients categorized by dominant personality traits using the five-factor model (openness, conscientiousness, extraversion, agreeableness, neuroticism). The search yielded 564 articles, with 24 included in the final analysis. Studies highlighted key self-reported factors affecting outcomes, such as patient expectations, perceptions, attitudes, anxiety, and personality traits. Likert scale surveys emerged as promising tools for assessing these factors. The present case series further illustrated the impact of personality traits on treatment experiences. Although patient behavior significantly impacts implant outcomes, limited awareness and inconsistent use of behavioral analysis tools remain challenges that need to be overcome. Standardizing behavioral assessments could enhance provider communication, improve pretreatment screening, and ultimately optimize patient care and treatment success.
56. Using Digital Implant Planning in Assessing Outcomes of Maxillary Sinus Augmentation Procedures: A Retrospective Study.
期刊: Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995) 发表日期: 2025 链接: PubMed
摘要
The aim of this retrospective pilot study was to use digital implant planning to assess radiographic outcomes of maxillary sinus augmentation bone grafting procedures (ideal, excess, or insufficient) in reference to the planned implant. After ethical approval was received, deidentified data for subjects treated for a maxillary sinus elevation procedure was extracted. Patient-specific variables (age group, gender, race, smoking, diabetes, and cardiovascular disease) and site-specific variables (type of bone graft, type of membrane, membrane perforation, and other complications) were collected, as recorded in the electronic health records. For the records that satisfied the inclusion criteria, preoperative and postoperative cone-beam computed tomography scans for lateral sinus augmentation procedures were retrieved, superimposed, and imported into the implant planning software. An ideal implant was planned digitally in a cross-sectional view by an expert in prosthodontics (KV). The implant measurements in apicocoronal (AC) and buccopalatal (BP) dimensions were kept standard for all cases and were confirmed by two previously calibrated co-investigators (GS, ID). Statistical analysis involved descriptive and bivariate analysis. A total of 350 electronic health records were reviewed and 26 were included. Descriptive analysis revealed that in the AC dimension, 40.63% of procedures resulted in insufficient amount of bone graft and 37.50% of procedures resulted in excess bone graft; 21.88% of procedures had ideal amount of bone graft in the AC dimension. For the BP dimension, 81.25% of procedures resulted in ideal and 18.75% in insufficient amounts of bone graft. This study revealed that a limited number of maxillary sinus procedures resulted in ideal bone grafting in both the AC and BP dimensions when considering predetermined restorative guidelines for the final implant position. An excess and/or insufficient amount of bone grafting in at least one dimension resulted most of the times. With the use of technology and an interdisciplinary team of experts, future studies should aim to quantify the amount of bone graft needed for an ideal maxillary sinus elevation for upcoming implant placement.
57. Challenges and Opportunities for Cervical Cancer Prevention Through HPV Vaccination in Ghana: A Public Health Policy Analysis.
期刊: Cancer control : journal of the Moffitt Cancer Center 发表日期: 2025 链接: PubMed
摘要
IntroductionCervical cancer constitutes a critical public health challenge in Ghana, with high morbidity and mortality despite the global availability of effective prophylactic Human Papillomavirus (HPV) vaccines. This study examines the policy discourse surrounding the implementation of a nationwide HPV vaccination program in Ghana, analyzes stakeholders’ perspectives on programmatic promotion, and assesses the extent of institutional prioritization.MethodsEight key informant interviews were thematically analyzed using NVivo; and a cross-sectional online survey of 215 participants was descriptively analyzed using SPSS.ResultsThematic analysis of interviews revealed core policy challenges: weak prioritization, inadequate resource allocation, and policy framings that lacked discourse on the right to health. Survey data demonstrated marked improvement in HPV awareness (76.6%) and substantial interest in vaccination (64.2%), suggesting a shifting public health landscape influenced by media engagement and growing health literacy.ConclusionFindings underscore insufficient prioritization stalled the institutionalization of a national cervical cancer prevention strategy creating a critical implementation gap. However, the relatively late average age of sexual debut offers a strategic window for effective HPV vaccine delivery. Importantly, the convergence of increased public awareness, heightened receptivity to vaccination, and the availability of external funding mechanisms, such as support from Gavi, presents a timely and actionable opportunity for policy advancement. This study highlights the imperative for renewed governmental commitment to cervical cancer prevention, emphasizing the imperative to operationalize HPV vaccination as a core component of Ghana’s public health infrastructure.