公共卫生研究摘要 (2025-10-09)
共收录 54 篇研究文章
1. Risk of Seizure Associated With Concomitant Use of Tramadol and Antidepressants in Older Nursing Home Residents.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Concomitant use of tramadol and antidepressants with potent inhibition of the cytochrome P450 2D6 (CYP2D6) enzyme is postulated to increase risk of seizures in older adults; yet, such an association has not been empirically tested in populations. We aimed to examine the association of concomitant tramadol and CYP2D6-inhibiting vs CYP2D6-neutral antidepressant use and the risk of seizures among older nursing home (NH) residents. This population-based cohort study was conducted using a 100% Medicare NH sample from January 2010 to December 2021. We included long-term residents aged 65 years or older who initiated antidepressants on existing tramadol use (tramadol-antidepressant users) or initiated tramadol on existing antidepressant use (antidepressant-tramadol users). Patients were followed up until the end of 1 year, NH discharge, death, or study end. The key exposure was concomitant use of tramadol with CYP2D6-inhibiting vs CYP2D6-neutral antidepressants. The key outcome was incident rates of medical encounters with a diagnosis of seizure and analyzed using negative binomial or Poisson regression models adjusted for baseline covariates (e.g., pain status and depressive, physical, and cognitive function) through the inverse probability of treatment weighting. We identified 11,162 concomitant tramadol-antidepressant users (mean [SD] age, 86.2 [8.5] years; 9,077 [81.3%] female) and 58,994 concomitant antidepressant-tramadol users (mean [SD] age, 85.3 [8.4] years; 47,053 [79.8%] female). The incidence rate of seizures was 16.10 and 20.17 per 100 patient-years, respectively, for the tramadol-antidepressant and antidepressant-tramadol group. In both subgroups, co-use of tramadol with CYP2D6-inhibiting (vs with CYP2D6-neutral) antidepressants was associated with higher adjusted incidence rate ratios of seizures (1.09 [95% CI 1.02-1.18] and 1.06 [95% CI 1.03-1.10]). Findings were corroborated by a negative control exposure analysis in which co-use of hydrocodone with CYPD2D6-inhibiting (vs CYP2D6-neutral) antidepressants was not associated with risk of seizures. Concomitant use of tramadol with CYP2D6-inhibiting vs CYP2D6-neutral antidepressants was associated with increased risk of seizures. Findings are only generalizable to long-term NH populations and are subject to residual confounding. Clinicians should be mindful of seizure risk in older patients who use tramadol concomitantly with antidepressants, particularly CYP2D6-inhibiting antidepressants. This study provides Class II evidence that the combination of tramadol and CYP2D6-inhibiting antidepressants is associated with a higher risk of seizures compared with the combination of tramadol and CYP2D6-neutral antidepressants.
2. Firearm Violence Prevention in Peril: A Call to Defend Our Public Safety Infrastructure.
期刊: American journal of public health 发表日期: 2025-Nov 链接: PubMed
摘要
3. Serum Neurofilament Light Chain Correlates With Clinical Severity and Predicts Mortality in Anti-IgLON5 Disease.
期刊: Neurology(R) neuroimmunology & neuroinflammation 发表日期: 2025-Nov 链接: PubMed
摘要
Anti-IgLON5 disease manifests by various neurologic symptoms, the severity of which can be evaluated using the anti-IgLON5 composite score (ICS). This study assessed the correlation of neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) with the ICS and investigated these biomarkers as predictors of long-term clinical severity and mortality in anti-IgLON5 disease. Patients diagnosed with anti-IgLON5 disease at a national reference center (2016-2024) with available serum and CSF samples were included. NfL and GFAP concentrations were measured in these samples using Simoa assay Neurology 2-Plex B Kit. The severity of symptoms was classified according to the ICS, which was retrospectively evaluated at diagnosis, at last clinical evaluation, and at any other timepoint when samples were collected. Thirty patients (60% male, median age 72 years) were included. Serum NfL concentration was significantly correlated with the total ICS (rho = 0.38, p = 0.025) and its partial bulbar score (rho = 0.39, p = 0.020); serum GFAP concentration was significantly correlated only with the bulbar ICS (rho = 0.34, p = 0.044). CSF NfL and GFAP concentrations were not significantly correlated with the total ICS nor any of its partial scores. Anti-IgLON5 antibody CSF titers, but not serum titers, showed a significant inverse correlation with the total ICS (rho = -0.44, p = 0.04). In 26 patients sampled <4 months after diagnosis, neither NfL nor GFAP predicted the total or partial ICS at last clinical evaluation (median 18 months after diagnosis), but serum NfL increased the risk of 1-year mortality independently of age (hazard ratio for each 10 pg/mL increase: 2.05, 95% CI [1.21-3.45], p = 0.007). In patients with bulbar involvement (n = 22), serum NfL concentration was lower than in 10 controls with bulbar amyotrophic lateral sclerosis (median interquartile range [IQR] 26 pg/mL [21-51] vs 158 pg/mL [100-340], p < 0.001) and higher than in 10 controls with bulbar myasthenia gravis (median [IQR] 15 pg/mL [8-26], p = 0.040). In anti-IgLON5 disease, serum NfL and GFAP are elevated and correlate with the clinical severity, especially of bulbar symptoms. In clinical practice, serum NfL could be useful for disease monitoring and to predict the risk of death.
4. Pandemic-Era Increases in SNAP Benefits Reduced Food Insufficiency.
期刊: American journal of public health 发表日期: 2025-Nov 链接: PubMed
摘要
5. Falling Further Over the US Safety Net Benefits Cliff After COVID-19.
期刊: American journal of public health 发表日期: 2025-Nov 链接: PubMed
摘要
6. A Call for Formal Reporting Standards for Legal Research in Public Health Studies.
期刊: American journal of public health 发表日期: 2025-Nov 链接: PubMed
摘要
7. The Supreme Court's 2024-2025 Term: Eroding Public Health, Health Equity, and Access to Justice.
期刊: American journal of public health 发表日期: 2025-Nov 链接: PubMed
摘要
8. Standing Up for Core Principles in Departments of Social and Behavioral Sciences in Public Health: Department Chairs Speak Out.
期刊: American journal of public health 发表日期: 2025-Nov 链接: PubMed
摘要
9. Applying the Supporting Features for MOGAD Diagnosis to Patients With Multiple Sclerosis.
期刊: Neurology(R) neuroimmunology & neuroinflammation 发表日期: 2025-Nov 链接: PubMed
摘要
In the 2023 diagnostic criteria, supporting clinical/MRI features are required to diagnose myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in patients at high risk of false MOG-IgG positivity (low/unavailable titer, cerebrospinal fluid-restricted), to help differentiation from multiple sclerosis (MS). However, overlap is possible and determining the frequency of the MOGAD supporting features at MS onset may help prevent misdiagnosis. We assessed the frequency of the MOGAD supporting features and potential risk of misdiagnosis at first attack of MS/clinically isolated syndrome (CIS). In this observational study, we retrospectively identified consecutive patients hospitalized between 2021 and 2024 at 2 Italian centers, with: (1) relapsing-remitting MS/CIS, and (2) first attack MRI available. The frequency of the MOGAD supporting features was assessed at MS/CIS presentation, and potential risk of misdiagnosis determined based on the probability of concurrent false MOG-IgG positivity. Other clinical-MRI features typical of MOGAD but not included in the 2023 diagnostic criteria were also evaluated. A total of 244 patients with MS/CIS were included (median age, 34 [range, 13-78] years; 66% were female). Overall, 65/244 (27%) patients with MS/CIS showed at least 1 MOGAD supporting feature during the presenting attack. “Central cord lesion” (27/82 [33%]) and “deep gray nuclei involvement” (24/86 [28%]) were more represented than other supporting features (0%-7%); p < 0.001. MOG-IgG was tested in 207/244 (85%) patients, showing false positivity in 3 (1.4%) patients. The combined probability of detecting a false MOG-IgG positivity and meeting 1 of the MOGAD supporting features was 0.4%. Among other typical MOGAD features not included in the diagnostic criteria, the following had a 0% frequency at MS/CIS presentation: (1) encephalopathy, (2) marked CSF pleocytosis (>50 cells/mm3), (3) wheelchair need during myelitis, and (4) MRI T2-lesion resolution postattack. Although the MOGAD supporting features can be met in one-fourth of patients at MS/CIS presentation, the risk of misdiagnosis in similar unselected cohorts remains low. Future refinements of the MOGAD supporting features should take into account their relative frequency in MS/CIS and possible integration with additional clinical-MRI features that are more specific for MOGAD.
10. Transpupillary in vivo two-photon imaging reveals enhanced surveillance of retinal microglia in diabetic mice.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Oct-14 链接: PubMed
摘要
The retina, located outside the cranium, serves as an ideal structure for investigating information processing within the central nervous system due to its well-organized neurovascular unit comprising diverse cell types, including neurons, glial cells (such as microglia, Müller glia, and astrocytes), pericytes, and vascular endothelial cells. Disrupted retinal homeostasis contributes to various ocular diseases such as diabetic retinopathy, age-related macular degeneration, glaucoma, and retinitis pigmentosa. However, noninvasive in vivo imaging methods to study the pathogenesis of these disorders remain limited. Here, we developed a two-photon microscopy technique for real-time, transpupillary in vivo visualization of the retinal neurovascular unit in mice. Our approach integrates systematic head fixation, a custom-made polymethyl methacrylate contact lens, and a glycerin immersion objective lens with an extended working distance and a higher numerical aperture, specifically designed for two-photon microscopy. This method enabled us to visualize dynamic microglial process activity around retinal blood vessels. Our results revealed that retinal microglia exhibit enhanced surveillance under diabetic conditions, which is undetectable by static confocal microscopy. Furthermore, we demonstrated that liraglutide, a glucagon-like peptide-1 receptor agonist commonly used for the treatment of diabetes and obesity, reversed the enhanced microglial behaviors in the diabetic retina. Our simple yet effective approach mitigates the need for advanced optical systems like adaptive optics, providing an effective tool for real-time imaging of the retina. This method offers a valuable resource for visual neuroscience research and holds great potential for clinical applications, particularly in the early diagnosis, intervention, and monitoring of retinal diseases.
11. Atmospheric water cluster-catalyzed formation of nitroaromatics as a secondary aerosol source.
期刊: Science advances 发表日期: 2025-Oct-10 链接: PubMed
摘要
Nitroaromatic compounds (NACs) are an abundant class of compounds in atmospheric particulate matter, exerting considerable impacts on air quality, climate, and public health. They are typically derived from secondary formation, which is generated through atmospheric chemical reactions involving precursor compounds, such as phenolic compounds. However, information on NAC formation mechanisms remains limited. Here, we found that particulate-phase NAC concentrations were notably affected by relative humidity (RH) in field observations. Smog chamber experiments indicated that RH could influence NAC formation via changes in gaseous water concentration, rather than solely through aerosol liquid water content. Theoretical calculations further clarified that water clusters (WCs), formed from gaseous water, can notably lower reaction energy barriers along the NAC formation pathway, rendering this pathway competitive under atmospheric conditions. Hence, we propose a potential mechanism in which WCs catalyze NAC formation, offering a previously unidentified perspective on atmospheric secondary aerosol formation.
12. Dysfunction of the paraventricular thalamus-prelimbic cortex circuit underlies maternal separation-induced deficits in contagious pain.
期刊: Science advances 发表日期: 2025-Oct-10 链接: PubMed
摘要
Contagious pain is considered one of the most common forms of emotional contagion observed in animal models. Nevertheless, little is known about the precise neural mechanisms governing the regulation of contagious pain in response to diverse environmental stressors. Here, we report that early life maternal separation (MS) precipitates impairments in the pain contagion between familiar partners. Specifically, we identify the indispensable role of glutamatergic projections from the paraventricular thalamus (PVT) to the prelimbic cortex (PrL) for the development of vicarious pain hypersensitivity. MS dampens activation of the PVT → PrL pathway during social interactions between observer and painful demonstrator. Augmenting the excitability or activity of the PVT → PrL circuit through chemogenetic interventions or tactile stimulation resembling social touch significantly ameliorates the MS-evoked contagious pain deficits. Collectively, our findings delineate a neural circuitry substrate underlying the loss of contagious pain stemming from MS and propose a potential therapeutic avenue for mitigating empathic impairments associated with early life adversity.
13. The loss of a ClC anion channel increases life span, health span, and stress resistance by alkalinizing a pair of glial cells in C. elegans.
期刊: Science advances 发表日期: 2025-Oct-10 链接: PubMed
摘要
Aging depends on genetic and environmental factors, but the specific cell types and mechanisms that coordinate aging of the entire organism are not yet fully understood. Glial cells regulate ionic homeostasis, which is essential for neuronal function and survival. Here, we investigated the role of glial ion channel CLH-1, which is a glial pH regulator, in aging. We found that loss of clh-1 extends life span, improves stress resistance, reduces neuronal damage, and extends health span. These effects are linked to protective pathways, including those for oxidative stress and autophagy, and depend on the DAF-16/FoxO transcription factor. Notably, by knocking down and overexpressing the carbonic anhydrase cah-4, we show that it is the glial alkalinization caused by loss of clh-1 that mediates these protective effects. This work highlights the crucial role of glial pH in regulating life span and health span.
14. Randomized Trial of Targeted Indoor Spraying to Prevent Aedes-Borne Diseases.
期刊: The New England journal of medicine 发表日期: 2025-Oct-09 链接: PubMed
摘要
Targeted indoor residual spraying focuses insecticide applications on common resting surfaces of Aedes aegypti mosquitoes (an arboviral disease vector) in houses, such as exposed lower sections of walls and under furniture. We conducted a two-group, parallel, unblinded, cluster-randomized trial in Merida, Mexico, to quantify the efficacy of targeted indoor residual spraying for preventing aedes-borne diseases (chikungunya, dengue, or Zika). Children 2 to 15 years of age were enrolled from households in 50 clusters of five-by-five city blocks. Households in 25 clusters received an annual application of targeted indoor residual spraying (intervention) before each season of aedes-borne disease (July through December). All clusters received routine Ministry of Health vector control. The primary end point was laboratory-confirmed, symptomatic aedes-borne disease. Community effects were assessed with the use of geolocated national surveillance data. A total of 4461 children were monitored for up to three seasons (2021, 2022, and 2023). The indoor density of A. aegypti mosquitoes was 59% (95% confidence interval [CI], 51 to 65) lower with the intervention than with control. A total of 422 cases of aedes-borne disease were confirmed, primarily dengue in 2023. In the per-protocol analysis of cluster centers, 91 cases occurred among 1038 participants in the intervention group and 89 cases among 1037 participants in the control group (efficacy, -12.8%; 95% CI, -60.7 to 23.0). In an intention-to-treat analysis of entire clusters, 198 cases occurred among 2239 participants in the intervention group and 199 cases among 2222 participants in the control group (efficacy, 3.9%; 95% CI, -28.1 to 26.7). Adjustment of analyses for mobility or demographic characteristics did not change results. On the basis of 150 cases in the intervention clusters and 202 in the control clusters that were geolocated, the estimated community effect of the intervention was 24.0% (95% CI, 6.0 to 38.6). Two cases of multisymptom adverse events (e.g., nausea, watery eyes, diarrhea, and vomiting) were associated with the intervention. Despite lower entomologic indexes with targeted indoor residual spraying than with routine vector control, the cumulative incidence of aedes-borne diseases was not significantly lower with targeted indoor residual spraying. (Funded by the National Institutes of Health and the Innovative Vector Control Consortium; ClinicalTrials.gov number, NCT04343521.).
15. Diphtheria Outbreak among Migrants in Europe. Reply.
期刊: The New England journal of medicine 发表日期: 2025-Oct-09 链接: PubMed
摘要
16. Completion Rates for Ecological Momentary Assessments of Food Intake During Pregnancy and Post Partum: Descriptive Study.
期刊: JMIR human factors 发表日期: 2025-Oct-08 链接: PubMed
摘要
The collection of dietary behavior data is crucial in childbearing populations. In addition to observed inequities in perinatal dietary intake and quality, burdensome assessment methods (eg, 24-h dietary recall) may limit research participation for some groups. Ecological momentary assessment (EMA) is associated with reduced recall bias and participant convenience, but there is a dearth of studies with diverse cohorts. Our aim is to describe participant completion of food intake items in EMA surveys, overall and across individual characteristics (eg, prepregnancy BMI). Using secondary EMA data from participants in a longitudinal study, we report average completion rates of survey items regarding dietary behavior (eg, number of meals eaten in a day) across individual demographic variables (eg, age) and combined strata (eg, race+age) during late pregnancy and throughout 12 months post partum. In our analytic sample (N=310), the average completion rate was 52.4% (SD 27.8%) during pregnancy, rising to 59.1% (SD 22.0%) after giving birth. Participants who were older (>30 y), overweight before pregnancy, self-identified as White, working, or earning higher annual income (>US $50,000) had higher average completion rates than their counterparts. Examining combined strata, we found some variation in survey completion within racial groups. Black participants using a study phone had higher average completion rates during pregnancy and post partum, but this relationship was reversed for White participants. Our secondary analysis showed relatively stable engagement with EMA surveys in a childbearing cohort across 15 months. Increased completion rates among privileged groups (eg, White, higher income) may demonstrate the impact of socioeconomic advantages on individual health behaviors. Investigators should consider how intersections between race and other factors (eg, employment) may impact participation and data collection.
17. Training Gaps in Digital Skills for the Cancer Health Care Workforce Based on Insights From Clinical Professionals, Nonclinical Professionals, and Patients and Caregivers: Qualitative Study.
期刊: JMIR medical education 发表日期: 2025-Oct-08 链接: PubMed
摘要
The integration of digital technologies is becoming increasingly essential in cancer care. However, limited digital health literacy among clinical and nonclinical cancer health care professionals poses significant challenges to effective implementation and sustainability over time. To address this, the European Union is prioritizing the development of targeted digital skills training programs for cancer care providers, the TRANSiTION project among them. A crucial initial step in this effort is conducting a comprehensive gap analysis to identify specific training needs. The aim of this work is to identify training gaps and prioritize the digital skill development needs in the oncology health care workforce. An importance-performance analysis (IPA) was conducted following a survey that assessed the performance and importance of 7 digital skills: information, communication, content creation, safety, eHealth problem-solving, ethics, and patient empowerment. A total of 67 participants from 11 European countries completed the study: 38 clinical professionals (CP), 16 nonclinical professionals (NCP), and 13 patients or caregivers (PC). CP acknowledged the need for a comprehensive training program that includes all 7 digital skills. Digital patient empowerment and safety skills emerge as the highest priorities for both CP and NCP. Conversely, NCP assigned a lower priority to digital content creation skills, and PC assigned a lower priority to digital information and ethical skills. The IPA also revealed discrepancies in digital communication skills across groups (H=6.50; P=.04). The study showcased the pressing need for comprehensive digital skill training for cancer health care professionals across diverse backgrounds and health care systems in Europe, tailored to their occupation and care setting. Incorporating PC perspectives ensures a balanced approach to addressing these training gaps. These findings provide a valuable knowledge base for designing digital skills training programs, promoting a holistic approach that integrates the perspectives of the various stakeholders involved in digital cancer care.
18. Detection of Vascular Mild Cognitive Impairment in Southeast Asia Using the Visual Cognitive Assessment Test: Machine Learning Analysis From the BIOCIS (Biomarkers and Cognition Study, Singapore).
期刊: JMIR aging 发表日期: 2025-Oct-08 链接: PubMed
摘要
Vascular mild cognitive impairment (VMCI) is a significant global health concern, particularly in Asia. The visual cognitive assessment test (VCAT) has shown promise as a language-neutral screening tool for cognitive impairment. This study aims to assess the effectiveness of the VCAT in detecting VMCI and compare its diagnostic performance with the widely used and validated Montreal Cognitive Assessment (MoCA). Cross-sectional data from 524 community-dwelling participants were analyzed from the BIOCIS (Biomarkers and Cognition Study, Singapore) and classified into cognitively unimpaired, non-VMCI, and VMCI groups. The participants underwent neuropsychological assessments and 3-T magnetic resonance imaging. The random forest technique and multivariable logistic regression were applied to assess the discriminative properties of the tests. Participants with VMCI exhibited significantly lower performance across various neuropsychological tests (P<.001) and higher rates of vascular risk factors (P<.001). At a cutoff of 27, the VCAT achieved near-perfect accuracy in discriminating the VMCI group from the cognitively unimpaired group (area under the receiver operating characteristic curve=1; sensitivity=1; specificity=0.991). For differentiating the VMCI group from the non-VMCI group, both the VCAT and the MoCA showed optimal performance at a cutoff of 25 (area under the receiver operating characteristic curve=1.00; sensitivity=1.00; specificity=1.00). The VCAT could be a valuable tool for detecting VMCI, particularly in diverse, multilingual populations. Its comparable or even superior performance to the MoCA, combined with its language-neutral design, positions the VCAT as a strong addition to cognitive assessment toolkits for VMCI. However, the complex nature of cognitive processing in VMCI suggests that a multifaceted approach that integrates both visual and verbal assessments may ultimately offer the most comprehensive evaluation. RR2-10.14283/jpad.2024.89.
19. Evaluating the Efficacy of a Mobile Phone App in Enhancing Menopause Knowledge and Shared Decision-Making: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Oct-08 链接: PubMed
摘要
Menopause symptoms are common but often inadequately addressed by primary care clinicians due to limited time for discussions and resources. Mobile health apps can play a crucial role in symptom identification and management; yet, many existing menopause-focused apps lack evidence-based content and medical expertise. The aim of this study is to describe the protocol study design and methodology of a randomized controlled trial to evaluate the effectiveness of the emmii mobile app for improving menopause-related knowledge and shared decision-making compared to a traditional menopause education pamphlet. This randomized controlled trial will recruit women aged 45-55 years with upcoming primary care appointments at Mayo Clinic within 3 weeks of the date of initial outreach. Eligible patients must be English-speaking, able to provide informed consent, and report a Menopause Rating Scale score ≥5, which indicates that they are experiencing significant menopause-related symptoms. Patients will be randomized to have access to either the emmii app (intervention, n=200) or an evidence-based menopause education pamphlet (control, n=200). The emmii app is developed with direct input from primary care clinicians certified by The Menopause Society and offers symptom tracking, personalized treatment recommendations based on a protocol, and a discussion guide to support communication between patients and their primary care clinicians. Outcomes will include a postappointment survey sent to the patients and their primary care clinicians within 1-3 weeks of the appointment, and assessment of patient knowledge, clinical treatment plans, and both the patient and clinician experience. The study will also compare prescribing rates of hormonal and nonhormonal therapies for menopause symptoms between the emmii intervention and control groups to assess for influence on treatment patterns. Data will be analyzed using descriptive statistics, including chi-square tests, Wilcoxon rank sum tests, and multivariable modeling. Data collection is scheduled to begin in April 2025. This protocol outlines the design and methodology of a randomized controlled trial that aims to assess the impact of the emmii app in facilitating menopause care through primary care clinician-patient communication and shared decision-making. ClinicalTrials.gov NCT06919887; https://clinicaltrials.gov/ct2/show/NCT06919887. PRR1-10.2196/76536.
20. The Potential of AI in Nursing Care: Multicenter Evaluation in Fall Risk Assessment.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-08 链接: PubMed
摘要
With 28%-35% of individuals aged 65 years and older experiencing incidents of falling, falls are the second leading cause of unintentional injury-related deaths globally. Limited availability of clinical staff often impedes the timely detection and prevention of potential falls. Advances in artificial intelligence (AI) could complement existing fall risk assessment and help better allocate nursing care resources. Yet, many studies are based on small datasets from a single institution, which can restrict the generalizability of the model, and do not investigate important aspects in AI model development, such as fairness across demographic groups. This study aimed to provide a comprehensive empirical evaluation of the potential of AI in nursing care, focusing on the case of fall risk prediction. To account for demographic and contextual differences in fall incidences, we analyze data from a university and a geriatric hospital in Germany. To the best of our knowledge, these are the largest fall risk prediction datasets to date with heterogeneous data distributions. We focus on 3 key objectives. First, does AI help in improving fall risk prediction? Second, how can AI models be trained safely across different hospitals? Finally, are these models fair? This study used 2 datasets for fall risk prediction: one from a university hospital with 931,726 participants, 10,442 of whom experienced falls, and another from a geriatric hospital with 12,773 participants, 1728 of whom have fallen. State-of-the-art AI models were trained with 3 approaches, including 2 decentralized learning paradigms. First, separate models were trained on data from each hospital; second, models were retrained on the respective other dataset; and federated learning (FL) was applied to both datasets. The performance of these models was compared with the rule-based systems as implemented in clinical practice for fall risk prediction. Additional analyses were conducted to test for model fairness. Our findings demonstrate that AI models consistently outperform rule-based systems across all experimental setups, with the area under the receiver operating characteristic curve of 0.735 (90% CI 0.727-0.744) for the geriatric hospital, and 0.926 (90% CI 0.924-0.928) for the university hospital. FL did not improve the fall risk prediction in this setting. Our fairness analysis ruled out disparities in model performance between different sex groups, but we found fairness infringements across age groups. This study demonstrates that AI models consistently outperform traditional rule-based systems across heterogeneous datasets in predicting fall risk. However, it also reveals the challenges related to demographic shifts and label distribution imbalances, which limited the FL models’ ability to generalize. While the fairness analysis indicated fair results across sex subgroups, age-related disparities emerged. Addressing data imbalances and ensuring broader representation across demographic groups will be crucial for developing more fair and generalizable models.
21. Quality of Cancer-Related Information on New Media (2014-2023): Systematic Review and Meta-Analysis.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-08 链接: PubMed
摘要
New media have become vital sources of cancer-related health information. However, concerns about the quality of that information persist. This study aims to identify characteristics of studies considering cancer-related information on new media (including social media and artificial intelligence chatbots); analyze patterns in information quality across different platforms, cancer types, and evaluation tools; and synthesize the quality levels of the information. We systematically searched PubMed, Web of Science, Scopus, and Medline databases for peer-reviewed studies published in English between 2014 and 2023. The validity of the included studies was assessed based on risk of bias, reporting quality, and ethical approval, using the Joanna Briggs Institute Critical Appraisal and the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklists. Features of platforms, cancer types, evaluation tools, and trends were summarized. Ordinal logistic regression was used to estimate the associations between the conclusion of quality assessments and study features. A random-effects meta-analysis of proportions was conducted to synthesize the overall levels of information quality and corresponding 95% CIs for each assessment indicator. A total of 75 studies were included, encompassing 297,519 posts related to 17 cancer types across 15 media platforms. Studies focusing on video-based media (odds ratio [OR] 0.02, 95% CI 0.01-0.12), rare cancers (OR 0.32, 95% CI 0.16-0.65), and combined cancer types (OR 0.04, 95% CI 0.01-0.14) were statistically less likely to yield higher quality conclusions compared to those on text-based media and common cancers. The pooled estimates reported moderate overall quality (DISCERN 43.58, 95% CI 37.80-49.35; Global Quality Score 49.91, 95% CI 43.31-56.50), moderate technical quality (Journal of American Medical Association Benchmark Criteria 46.13, 95% CI 38.87-53.39; Health on the Net Foundation Code of Conduct 49.68, 95% CI 19.68-79.68), moderate-high understandability (Patient Education Material Assessment Tool for Understandability 66.92, 95% CI 59.86-73.99), moderate-low actionability (Patient Education Materials Assessment Tool for Actionability 37.24, 95% CI 18.08-58.68; usefulness 48.86, 95% CI 26.24-71.48), and moderate-low completeness (34.22, 95% CI 27.96-40.48). Furthermore, 27.15% (95% CI 21.36-33.35) of posts contained misinformation, 21.15% (95% CI 8.96-36.50) contained harmful information, and 12.46% (95% CI 7.52-17.39) contained commercial bias. Publication bias was detected only in misinformation studies (Egger test: bias -5.67, 95% CI -9.63 to -1.71; P=.006), with high heterogeneity across most outcomes (I²>75%). Meta-analysis results revealed that the overall quality of cancer-related information on social media and artificial intelligence chatbots was moderate, with relatively higher scores for understandability but lower scores for actionability and completeness. A notable proportion of content contained misleading, harmful, or commercially biased information, posing potential risks to users. To support informed decision-making in cancer care, it is essential to improve the quality of information delivered through these media platforms. PROSPERO CRD420251058032; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251058032.
22. Quantifying Maternal Health Using Digital Phenotyping: Protocol for a Longitudinal Observational Study.
期刊: JMIR research protocols 发表日期: 2025-Oct-08 链接: PubMed
摘要
We present a digital phenotyping protocol designed to continuously and objectively measure behavioral, physiological, and contextual data during pregnancy and the postpartum period using passive sensing from Garmin smartwatches and smartphones, along with active ecological momentary assessments (EMAs). This novel protocol uniquely adapts to the unpredictable timing of childbirth, spanning from the third trimester through 6 weeks post partum, to accurately capture critical temporal changes and maternal-infant outcomes. By providing high-frequency real-time data, this methodology offers comprehensive insights into pregnancy-related behaviors and physiological processes, overcoming the limitations of traditional retrospective self-report methods. We aim to develop a protocol for longitudinal data collection supporting digital phenotyping that is optimized for pregnancy and the postpartum period. This protocol leverages the pregnant population’s heightened interest in health and tracking. It aims to minimize the burden on the participants, increase retention, and assess the value of wearables compared to smartphones to determine the appropriate data collection methods. Data will be collected from 30 nulliparous participants from the start of the third trimester through 6 weeks post partum. This protocol uses 3 distinct 1-time surveys, alongside daily and weekly EMAs, to capture real-time maternal experience data. Passive maternal data-such as activity, vitals, sleep, and location-are collected via smartphones and Garmin smartwatches. Participants are expected to log data about the newborn after delivery through the mobile app Huckleberry. This protocol was developed in collaboration with the Northeastern University Sath Laboratory, which focuses on digital phenotyping and longitudinal data collection, and the Tufts Medical Center’s obstetrics and gynecology department, which has expertise in working with the pregnant population. This study was funded in August 2024. Data collection is projected to run from October 2025 to July 2026. As of September 2025, the study has been approved, and recruitment and data collection are to begin. The results are expected to be published by August 2026. We plan to assess the retention rates, survey and EMA completion rates, wear time of the smartwatch without intervention, and data volume logged in the Huckleberry app. In addition, we will perform digital phenotyping to determine whether the data collected during pregnancy can be used to predict breastfeeding outcomes, delivery outcomes, and maternal-infant well-being. This protocol integrates the use of digital phenotyping in pregnancy and postpartum research, providing a novel method for capturing real-time indicators of maternal well-being. It will determine the expected rates of data completion and appropriate sample size using a power analysis for a more extensive future study. By integrating smartphone and wearable sensor data, this protocol has the potential to transform the way maternal health clinical interventions are designed and implemented in the future. PRR1-10.2196/77175.
23. The Alongside Digital Wellness Program for Youth: Longitudinal Pre-Post Outcomes Study.
期刊: JMIR formative research 发表日期: 2025-Oct-08 链接: PubMed
摘要
Youth are increasingly experiencing psychological distress. Schools are ideal settings for disseminating mental health support, but they are often insufficiently resourced to do so. Digital mental health tools represent a unique avenue to address this gap. The Alongside digital program is one such tool, intended as a universal prevention and early intervention. The platform includes social-emotional learning and self-help wellness features as well as an artificial intelligence-powered chatbot designed to build coping skills. This evaluation aimed to examine the near-term impact of Alongside app use on students’ self-reported mental health outcomes. We conducted a nonrandomized pilot pragmatic evaluation leveraging anonymized user data. All data came from current Alongside users attending public middle and high schools in Texas and New Mexico, between 10 and 18 years old. Schools were actively engaged in partnership with Alongside and approved all procedures. Users were asked to complete mental health questionnaires upon app registration and at 1 and 3 months post registration. We conducted preregistered analyses as well as exploratory analyses to determine how symptoms changed over time and what factors (eg, demographic and app use) predicted changes in distress. Analyses revealed statistically significant within-person decreases in overall distress (Young Person’s CORE; primary outcome) from baseline to 1 month with a small effect size (t42=2.21, P=.03, r=0.34); however, there was no evidence that scores significantly decreased from baseline to 3 months (W=1821, n=85, P=.16). We found that at 3 months, identifying as part of the lesbian, gay, bisexual, transgender, queer, and questioning community predicted greater decreases in distress; otherwise, no demographic factors were significant predictors. In a nonregistered exploratory analysis of a subsample of users who reported elevated distress at baseline, decreases in distress were seen at both 1 month (W=128, n=20, P=.02, r=0.52) and 3 months (W=682, n=42, P=.004, r=0.45). There may be short-term benefits associated with using the Alongside digital program. Further studies are required to determine potential preventative effects.
24. Sustainability of Digital Home Care and Health Care Services in 2 Case Studies in Finland: Combined Climate and Social Impact Assessment.
期刊: JMIR rehabilitation and assistive technologies 发表日期: 2025-Oct-08 链接: PubMed
摘要
Digitalization is seen as a way to reduce the negative environmental impacts of health care production, but research is still limited. This study focuses on the assessment of the sustainability aspects of digital services in home care and health care. It demonstrates the approach to identify the climate impacts and social impacts-both positive and negative-on a selection of digital home care and health care services, such as medicine robot services for older home care clients, through 2 Finnish case studies. Impacts are identified from interviews and statistical data collected from public service providers and technology suppliers using both quantitative and qualitative assessments. While a well-planned and well-implemented digital service is likely to be a climate-friendly option, every digitalization action carries at least some negative impacts. The design, architecture, and practical implementation of these services greatly affect their climate and social impacts. This study uses a novel combination of impact assessment methods, highlighting the importance of qualitative understanding alongside quantitative approaches for interpreting results, especially when numerical data are limited. Advocating for multimethod impact assessments is crucial to properly capturing the service context and promoting holistic sustainability thinking.
25. Association of 2024-2025 Covid-19 Vaccine with Covid-19 Outcomes in U.S. Veterans.
期刊: The New England journal of medicine 发表日期: 2025-Oct-08 链接: PubMed
摘要
Amid the declining clinical severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and diminishing public uptake of annual coronavirus disease 2019 (Covid-19) vaccines, contemporary evidence on vaccine effectiveness against clinically relevant outcomes is needed. We conducted an observational study that used the electronic health records of the Department of Veterans Affairs to evaluate the effectiveness of the 2024-2025 Covid-19 vaccine among veterans who received the Covid-19 and influenza vaccines on the same day (164,132 participants) and in an active-comparator group of veterans who received the influenza vaccine only (131,839 participants), between September 3 and December 31, 2024. Participants were followed for 180 days or until the occurrence of an outcome, whichever came first. We used inverse-probability-weighted models to estimate vaccine effectiveness (calculated as 1 minus the risk ratio) against Covid-19-associated emergency department visits, hospitalizations, and deaths at 6 months. At 6 months of follow-up, the estimated vaccine effectiveness was 29.3% (95% confidence interval [CI], 19.1 to 39.2) against Covid-19-associated emergency department visits (risk difference per 10,000 persons, 18.3; 95% CI, 10.8 to 27.6), 39.2% (95% CI, 21.6 to 54.5) against Covid-19-associated hospitalizations (risk difference per 10,000 persons, 7.5; 95% CI, 3.4 to 13.0), and 64.0% (95% CI, 23.0 to 85.8) against Covid-19-associated deaths (risk difference per 10,000 persons, 2.2; 95% CI, 0.5 to 6.9). Vaccine effectiveness against a composite of these outcomes was 28.3% (95% CI, 18.2 to 38.2), with a risk difference per 10,000 persons of 18.2 (95% CI, 10.7 to 27.5). The Covid-19 vaccine was associated with decreased risks of these outcomes across prespecified subgroups defined according to age (<65 years, 65 to 75 years, and >75 years), the presence or absence of major coexisting conditions, and immunocompetence status. In this national cohort of U.S. veterans, the receipt of the 2024-2025 Covid-19 vaccine was associated with decreased risks of severe clinical outcomes. (Funded by the Department of Veterans Affairs.).
26. Organizing Telemonitoring-Decision-Making Between Centralized and Distributed Models in the Netherlands, Using the Non-Adoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework: Case Study.
期刊: JMIR medical informatics 发表日期: 2025-Oct-08 链接: PubMed
摘要
Telemonitoring can be implemented using either centralized or distributed organizational models. However, few published studies explore which conditions make one model preferable over the other, or how to choose between these two. This study aimed to investigate the decision-making factors across several domains (eg, technological, personal, and organizational) when selecting the telemonitoring model. We conducted a multiple case study across 4 purposively sampled hospitals to gain a range of perspectives on organizational models for telemonitoring. Selection criteria included: (1) type of organizational model, (2) type of collaborating partners, (3) task division of handling notifications, and (4) it had to be implemented at scale, rather than being in an exploratory phase. Data was collected in a document study, 13 semistructured interviews, and a focus group. The topic list was based on the domains of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) framework. Interviewees (n=13) were 5 project leaders, 2 tele-nurses, 4 health care professionals, and 2 clinical informaticians. Data analysis was performed iteratively and included reflective thematic analysis. A member-checking focus group was organized to verify and reflect on the findings. Various preferential factors based on the seven domains of the NASSS framework were explored for both centralized and distributed telemonitoring models: (1) Condition: the choice of objective, usually based on organizational strategy, determines whether telemonitoring will be centralized or distributed. (2) Technology: the preference for a model is determined by the anticipated number of notifications the application generates for a specific patient group. (3) Value proposition: the perceived cost-effectiveness and overall value to the patient shape the value proposition for each model. (4) Adopters: the new role of tele-nurse emerged in centralized monitoring centers (CMCs), necessitating new competencies, task redistribution, and shifts in responsibility. The importance of trust among staff became evident in the context of task redistribution. (5) Organization: CMCs are typically organized regionally, in partnerships or network arrangements, which can be time-consuming yet offer significant potential for impact. (6) Wider system: The existing Dutch reimbursement system does not incentivize CMCs because the payment structure is still based on a per-treatment model. (7) Adaptation over time: with advancements in technology, including artificial intelligence, organizing telemonitoring through CMCs is likely to gain popularity. Our study highlights that when decision makers are choosing which telemonitoring model-centralized or distributed-to implement in their organization, deciding on the suitability of the model depends on multiple contextual factors. Our findings illustrate that decisions made for patient group selection, technology design, and value proposition significantly influence each other. It is therefore crucial for decision makers to understand these interactions and corresponding dynamics to better align their strategies with the operational realities of their organization.
27. Does Neighborhood Deprivation Impact Readmission and Associated Costs After Hip Fracture Surgery?
期刊: Journal of the American Geriatrics Society 发表日期: 2025-Oct-08 链接: PubMed
摘要
In the context of value-based care, the influence of racial and socioeconomic factors on hip fracture care outcomes remains underexplored. This study investigates the association of the area deprivation index (ADI) on readmission rates and Centers for Medicare and Medicaid Services (CMS) payments following hip fracture surgery. We conducted an analysis using United States Medicare fee-for-service claims from 2019 to 2021, identifying patients hospitalized for hip fracture surgery based on Diagnosis-Related Groups criteria. Our primary outcomes were 90-day unplanned readmissions and CMS payments. ADI was our primary exposure of interest, calculated at the census block level. The analysis adjusted for multiple factors using logistic regression models. The study included 248,691 patients with an average age of 82.3 ± 8.5 years. We noted a 20.7% (51,603/248,691) rate of 90-day unplanned readmissions. Adjusted findings showed a modest, independent association between unplanned readmission and neighborhood deprivation, especially in the most deprived groups (OR: 1.26 [95% CI 1.19, 1.35]). Fully adjusted analysis showed a null association between CMS payments and neighborhood deprivation. Black race had a stronger association with unplanned 90-day readmissions (OR: 1.06 [95% CI 1.00, 1.13]) compared to White race. Males had a stronger association with readmission (OR: 1.26 [95% CI 1.24, 1.29]) and higher CMS payments (OR: 1.07 [95% CI 1.06, 1.07]) compared to females. Neighborhood deprivation is independently associated with higher odds of unplanned 90-day readmission after hip fracture surgery, though no significant association with CMS payments was identified. These findings support the need to address social drivers of health in clinical care and inform value-based payment and policy reform aimed at reducing disparities.
28. Prevalence and correlates of smoking, drinking, and exercise among men in Dak Lak, Vietnam.
期刊: Journal of ethnicity in substance abuse 发表日期: 2025-Oct-08 链接: PubMed
摘要
In this study, we aimed to investigate the prevalence and determinants of health behaviors, including cigarette smoking, alcohol drinking, and physical exercise among men in Dak Lak, Vietnam. The dataset for the research comprised 1,557 men (aged 16 or above) drawn from a household interview survey in 2022. To assess correlates of health behaviors, we employed a multivariate probit model that considered the potential correlations between these behaviors, which previous research generally overlooked. The main findings revealed that individuals between 35 and 44 years old had the highest prevalence rates of smoking, drinking, and the co-occurrence of both. In addition, members in labor exchange groups possessed higher rates of smoking and drinking, while those from poor households not only reported higher rates of smoking and drinking but also participated in physical exercise less frequently. Moreover, variables such as family influence, age, ethnicity, income, and membership in labor exchange groups were significant determinants. The findings highlighted the need for education, integrated public health interventions, particularly targeting low-income and ethnic minority populations, and emphasized the promotion of healthy behaviors among influential family members.
29. Text Messaging Between Patients With Inflammatory Rheumatic Diseases and Pharmacists to Solve Drug-Related Problems: Prospective Feasibility Study.
期刊: JMIR human factors 发表日期: 2025-Oct-08 链接: PubMed
摘要
Patients with inflammatory rheumatic diseases often experience drug-related problems (DRPs). As these can result in negative health consequences, DRPs should be identified and addressed in a timely manner. Text messaging between patients and pharmacists at the initiative of the patient has the potential to deliver support with DRPs more continuously, increase accessibility and efficiency, and enhance patient involvement in the process of identifying and solving DRPs. This study aimed to assess the feasibility of text messaging from both the patients’ and health care practitioners’ perspectives before a large-scale implementation. Adult patients using a disease-modifying antirheumatic drug were given access to text messaging with pharmacists to discuss DRPs for a period of 8 weeks. Patients received a response from a pharmacist within 4 working hours. Feasibility was evaluated based on five domains of Bowen’s framework for designing feasibility studies: (1) demand: actual use, expressed interest (user version of the Mobile Application Rating Scale - section E), and factors impacting future use; (2) limited efficacy: number of DRPs solved, DRPs resulting in follow-up, and DRPs warranting involvement of health care provider; (3) implementation: degree of execution (number of conversations answered within service level) and resources needed (pharmacists’ time investment per conversation); (4) acceptability: satisfaction and appropriateness (theoretical framework of acceptability); and (5) practicality: ability to carry out intervention activities (System Usability Scale). Data were collected by means of usage data and a questionnaire. In total, 45 patients (median age 57, IQR 52-65 y; n=31, 69% female) and 5 pharmacists (median age 41, IQR 26-47 y; n=1, 20% female) actively participated in this study. In the demand domain, 158 unique DRPs were raised in 133 conversations, with a median of 3 (IQR 2-4) unique DRPs per patient. Expressed interest was rated high by patients (median 4, IQR 4-5), and 90% (37/41) of patients would recommend text messaging to others. In the limited-efficacy domain, all DRPs were solved, and 77% (122/158) of DRPs warranted involvement of a health care provider. In the implementation domain, 87% (116/133) of conversations were answered within the promised timeframe with a median time investment of 4:15 (IQR 2:21-7:27) minutes per conversation. Acceptability was rated high by patients (median 4, IQR 4-5) and pharmacists (median 5, IQR 4-5). Finally, in the practicality domain, System Usability Scale was scored above average for patients (mean 72, SD 18) and pharmacists (mean 81, SD 16). Text messaging with pharmacists at the initiative of patients with rheumatic diseases seems feasible for discussing DRPs in terms of limited efficacy, implementation, acceptability, demand, and practicality for patients and pharmacists.
30. Hyperosmolar Dehydration in Sepsis: Implications for Initial Fluid Management.
期刊: Critical care medicine 发表日期: 2025-Oct-08 链接: PubMed
摘要
Patients with sepsis are prone to hypovolemia which can lead to hyperosmolar dehydration and result in intracellular volume depletion. This study aimed to assess the effect of hyperosmolar dehydration on the clinical outcomes of patients with sepsis and its potential as an indicator of optimal initial fluid management. A nationwide propensity score-matched cohort study analyzing data prospectively collected between September 2019 and December 2021. Twenty tertiary- or university-affiliated hospitals in South Korea. Adult patients with sepsis or septic shock admitted to the ICU. None. Hyperosmolar dehydration was defined as serum osmolarity greater than or equal to 295 mOsm/L. The primary outcome, 30-day mortality, was compared using logistic regression adjusted for key prognostic factors in a 1:1 propensity score-matched cohort. Restricted cubic-spline models were used to analyze the clinical outcomes using the pre-ICU fluid volume as a continuous variable. Of the 4,487 patients, 2,605 (58.1%) had hyperosmolar dehydration. After matching, 1,537 pairs were analyzed. The 30-day mortality was higher in the hyperosmolar dehydration group (29.9%) than in the non-dehydration group (27.3%) (adjusted odds ratio, 1.18; 95% CI, 1.00-1.39). Liberal fluid management (greater than30 mL/kg) before ICU admission was associated with improved lactate levels in the hyperosmolar dehydration group (p = 0.009) without increasing sequential organ failure assessment score (p = 0.111). Among patients without dehydration, liberal fluid management was associated with an increased Sequential Organ Failure Assessment score (p = 0.034) and a higher risk for mechanical ventilation (p < 0.001), and without improving lactate levels (p = 0.388). Hyperosmolar dehydration at the diagnosis of sepsis was associated with increased 30-day mortality. A liberal fluid management benefits patients with hyperosmolar dehydration by improving lactate levels without increasing sequential organ failure assessment score. These findings highlight the importance of individualized fluid management based on the dehydration status in sepsis management.
31. Sarcoid liver disease - A review article.
期刊: Hepatology (Baltimore, Md.) 发表日期: 2025-Oct-08 链接: PubMed
摘要
Sarcoidosis is a multisystemic inflammatory disease characterized by heterogeneous clinical manifestations and granuloma formation in the organs involved. Diagnosing systemic sarcoidosis requires a multidisciplinary approach and the exclusion of other pathologies; after diagnosis, organ involvement and disease extent are further assessed. Genetic factors influence not only the risk of sarcoidosis development but also the disease course, which is highly variable and unpredictable. The clinical course of systemic sarcoidosis is highly variable, ranging from a self-limited disease that does not require long-term therapy to a rapidly progressive, symptomatic disease requiring immunosuppression. The liver is a commonly affected organ in sarcoidosis; while most patients with systemic sarcoidosis have hepatic granulomas, a minority will experience significant liver disease. In hepatic sarcoidosis, granulomas can cause a cholestatic liver injury, exemplified by elevated serum alkaline phosphatase and gamma-glutamyl transferase, though neither is pathognomonic and there are no hepatic sarcoid-specific biomarkers to monitor disease activity. Patients with ongoing hepatic inflammation require the initiation of the disease-modifying agents to prevent fibrosis and decompensation. This review article summarizes the existing literature on etiology, risk factors, pathogenesis, clinical features, and the management of hepatic sarcoid.
32. Sprayable extracellular matrix hydrogel reduces postoperative adhesion formation and protects healing tissues in preclinical models.
期刊: Science translational medicine 发表日期: 2025-Oct-08 链接: PubMed
摘要
Tissue trauma initiates inflammation that can lead to fibrotic complications such as postoperative peritoneal adhesions, which contribute to chronic pain, infertility, and bowel obstruction. Despite their prevalence and impact, effective interventions to prevent adhesion formation remain limited. In this study, we evaluated a sprayable extracellular matrix (ECM) hydrogel as a barrier to protect healing tissues and reduce adhesion formation after abdominal surgery. In both mouse and rabbit models of colorectal and gynecologic procedures, ECM hydrogel application resulted in a substantial reduction in adhesion severity. Mechanistic studies demonstrated that the hydrogel promotes preservation or restoration of the mesothelial lining while modulating early local inflammation. Treated tissues exhibited reduced expression of inflammatory cytokines, including IL-1β, and maintained an intact mesothelial surface with fewer activated myofibroblasts compared with synthetic hydrogel and controls. Immunohistochemical analysis, transcriptomic profiling of mesothelial cells, and in vitro mechanical stretch experiments revealed that the ECM hydrogel mitigates mesothelial-to-mesenchymal transition. These findings suggest that the hydrogel not only provides a physical barrier but also serves as a biological modulator, shielding tissue from mechanical and inflammatory cues that drive adhesion formation. Overall, this study identifies a dual-function, biologically active ECM hydrogel capable of protecting healing tissues and reducing adhesion development in preclinical surgical models. These results support the potential of ECM hydrogel as a clinically translatable, biocompatible strategy for improving postsurgical healing outcomes and reducing adhesion-related complications.
33. Indocyanine Green-Labeled Antibody-NOTCH2 as a New Fluorescent Molecular Imaging Probe for Gastric Cancer.
期刊: Bioconjugate chemistry 发表日期: 2025-Oct-08 链接: PubMed
摘要
Gastric cancer is a malignant tumor that seriously threatens human health. Its high mortality is mainly due to delayed diagnosis, which makes early detection important for improving patient prognosis. Near-infrared (NIR) fluorescence imaging, with its high signal-to-noise ratio and good sensitivity, has been widely applied in biomedical research and clinical diagnosis. NOTCH2 is often overexpressed in gastric cancer and may serve as a useful target for diagnosis and treatment. In this study, we constructed a NOTCH2-targeted single-chain variable fragment (scFv) conjugated with indocyanine green (ICG) and evaluated its application in gastric cancer imaging in vitro and in vivo. The ICG-scFv probe showed similar photophysical properties to free ICG and was specifically taken up by MKN45 gastric cancer cells. In NIR imaging, ICG-scFv selectively accumulated in tumor tissue, achieved tumor-specific imaging, and maintained fluorescence signals for a longer time, which was further confirmed by colocalization analysis. These results indicate that the targeted fluorescent probe ICG-scFv may have potential value in the diagnosis and treatment of gastric cancer.
34. Breathprints of the Barn: The Future of Livestock Research and Monitoring with Exhalomics.
期刊: Annual review of animal biosciences 发表日期: 2025-Oct-08 链接: PubMed
摘要
Livestock farming faces increasing demands for sustainability and improved animal welfare. Noninvasive approaches for monitoring animal health and physiology are of growing interest. Exhaled breath analysis, or exhalomics, has emerged as a promising tool for detecting volatile organic compounds and gases associated with metabolism, disease states, physiological processes, and microbiome in livestock. This review synthesizes current advancements in breath sampling and analytical technologies and evaluates applications in disease diagnostics, nutritional assessment, and physiological and microbial profiling across livestock species. Although progress is evident, key challenges remain, including sampling variability, incomplete metabolite annotation, and limited scalability for field use. Future efforts should prioritize standardizing protocols; expanding livestock-specific spectral libraries; and developing affordable, real-time sensors for on-farm deployment. Integrating exhalomics with multi-omics and artificial intelligence-driven analytics holds potential to enable earlier disease detection, improve production efficiency, and reduce environmental impacts, ultimately advancing precision livestock farming and animal welfare over the coming decade.
35. Timing Return-to-Work Counseling: An Observational Study Into the Effect of Time to First Consultation on Return to Work.
期刊: Journal of occupational rehabilitation 发表日期: 2025-Oct-08 链接: PubMed
摘要
Return-to-work (RTW) counseling is a critical part of rehabilitation of sick-listed employees with common mental disorders (CMD). In the Netherlands it is mandatory that RTW counseling with an occupational physician (OP) starts within two weeks, but current literature and guidelines provide little empiric support. This study aims to answer the questions “Is starting RTW counseling within two weeks associated with faster RTW?” and “Is there a dose-response effect (i.e. the earlier the better)?”. In an observational design, sick-listed employees (n = 12,169) seen by an OP within two weeks of onset of sick leave were compared to those seen later using Cox proportional hazards analysis. Next, per week effects were examined, reporting pairwise comparisons of weeks 1 through 6 if the omnibus test was significant. Earlier RTW counseling was associated with earlier RTW (HR: 0.89, 95%CI: 0.86-0.93). There was a dose-response effect (LLR χ2: 46.08, df = 5, p < 0.001) with significant earlier RTW when RTW counseling was started in week 1 versus week 3 (HR: 0.90(95%CI 0.85-0.96), p < 0.001), week 1 versus week 5 (HR: 0.88(95%CI 0.81-0.94), p < 0.001), week 1 versus week 6 (HR: 0.82(95%CI 0.77-0.88), p < 0.001), and week 2 versus week 6 (HR: 0.84(95%CI 0.79-0.89), p < 0.001). However, subgroup analyses showed these findings only held for employees with adjustment disorders. There is a modest benefit to starting RTW counseling earlier. However, this effect is limited to those seen very early and there are no significant differences between weeks 2 through 5. Whether these modest benefits warrant strict adherence to a two-week deadline should be re-evaluated.
36. From checkups to change: Longitudinal changes in lifestyle-related factors following repeated occupational health assessments among 106 005 Swedish workers.
期刊: Scandinavian journal of work, environment & health 发表日期: 2025-Oct-08 链接: PubMed
摘要
We investigated changes in weight, exercise frequency, and perceived health from the first to last health profile assessment (HPA) and between the number of tests within five years. We examined whether sociodemographic factors, or baseline values influenced these changes. Data from 106 005 employees with ≥2 HPA (1990-2021) were included. Change between the first and last HPA within a five-year period was analyzed. Baseline age, sex, education, occupation, and baseline values of each outcome were included as predictors. XGBoost models assessed changes in the outcomes, and performance was evaluated via root mean squared error, mean absolute error, and R-squared. We employed Shapley Additive Explanations and forward marginal effects to interpret dose-response relationships and subgroup differences. Predictive performance was low, suggesting that the included variables only partially explained observed changes. Nonetheless, longer intervals between the first and last HPA correlated with greater weight gain, while a higher number of tests predicted slightly lower weight gain and modest improvements in perceived health and exercise frequency, compared to the average change. Younger participants had larger weight increases, whereas those with higher education showed smaller declines in exercise frequency. Infrequent HPA alone did not appear to substantially influence the lifestyle-related factors studied. However, more frequent HPA, coupled with enhanced feedback and support, may yield small improvements in weight, perceived health, and exercise frequency compared to the average change.
37. Access to assistive technology and related services in Latin American Countries: A systematic review.
期刊: Assistive technology : the official journal of RESNA 发表日期: 2025-Oct-08 链接: PubMed
摘要
Assistive technology(AT) presents potential for the improvement of public health and the achievement of fundamental human rights, however the use and access to AT, especially in Latin American Countries is still a neglected field of research and practice. This study aims to systematically review the evidence on access to Assistive Technology and related services in Latin American Countries. Literature was searched in 5 web-based databases (EMBASE, CINAHL, Web of Science, LILACS and PUDMED). Studies carried out in Latin American countries addressing AT and its related services were included. The 33 included articles were primarily focused on service delivery, assistive device outcome and satisfaction, with only a few projects focusing on AT design, evaluation, provision and training. While some assistive devices (e.g. hearing aids, mobility aids, vision aids) are available in Latin American Countries, other aids designed to prevent impairment, disability, and other health outcomes, such as cognitive and augmentative communication devices, have received little attention. Despite the availability of some assistive devices, significant barriers to access persist, including limited awareness, insufficient training for professionals, and a lack of systematic, equitable approaches to provision.
38. Work-break interventions for preventing musculoskeletal symptoms and disorders in healthy workers.
期刊: The Cochrane database of systematic reviews 发表日期: 2025-Oct-08 链接: PubMed
摘要
Work-related musculoskeletal disorders are amongst the leading causes of occupational sick leave worldwide and account for a high share of absenteeism. For example, in the UK in 2021 to 2022, musculoskeletal disorders were estimated to account for around 27% of all work-related illnesses and result in 6.6 million lost working days. Several workplace interventions are available for reducing the high prevalence of work-related musculoskeletal disorders. We focused on work-breaks as an organisational intervention for primary prevention. This is an update of a Cochrane review first published in 2019. To assess the effects of different work-break interventions for preventing work-related musculoskeletal symptoms and disorders in healthy workers, when compared to conventional or alternative work-break interventions. We searched for randomised controlled trials in CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, SCOPUS, Web of Science, ClinicalTrials.gov, and the WHO ICTRP, up to 31 May 2024. We included randomised controlled trials (RCTs) of work-break interventions at workplaces for preventing work-related musculoskeletal symptoms and disorders amongst workers. The studies were eligible for inclusion if they intervened on work-break frequency, duration, or type, compared to conventional or alternative work-break interventions, and when the investigated population included healthy adult workers who were free of musculoskeletal complaints during study enrolment, without any restrictions on sex or occupation. Our critical outcomes were newly diagnosed musculoskeletal disorders or symptoms, and intensity of musculoskeletal symptoms (including pain, discomfort, or physiological fatigue). Our important outcomes were productivity or work performance, and workload as a measure of strain. We judged the risk of bias in the outcomes of the included studies using the Cochrane RoB 2 tool. Two review authors independently screened search records or full texts for study eligibility, extracted data, and assessed risk of bias. We contacted authors for additional data where required. We used the random-effects model for meta-analyses, producing risk ratios (RR) for dichotomous outcomes and mean differences (MD) or standardised mean differences (SMD) for continuous outcomes. We rated the certainty of evidence using GRADE. We included nine RCTs (three of which were new in this update) with 626 workers (at least 75% of whom were female, and 98% of whom were office workers). The trials were conducted in high-income or higher-middle-income countries. Four of the RCTs used a parallel design; two used a cross-over design; one was a mixture of parallel and cross-over; and two were cluster-RCTs. Intervention periods ranged from one day to six months. Six studies investigated work-break frequencies, two investigated work-break types, and one investigated both. None of the studies investigated work-break durations. One study could not be included in the meta-analyses because no detailed results were reported or available. We judged all outcomes to have some bias concerns or to be at high risk of bias. We assessed the evidence available for all comparisons and outcomes as ‘very low certainty’. Changes in frequency of work-breaks Compared to conventional work-breaks, additional work-breaks may make little to no difference to the new onset of musculoskeletal neck pain (RR 0.82, 95% CI 0.53 to 1.28; 1 study, 147 participants) or back pain (RR 0.58, 95% CI 0.30 to 1.11; 1 study, 147 participants), but the evidence is very uncertain. Likewise, additional work-breaks may make little to no difference to the intensity of musculoskeletal overall pain (MD -1.01, 95% CI -2.84 to 0.82; 1 study, 39 participants) or the intensity of musculoskeletal back discomfort (SMD -0.04, 95% CI -0.24 to 0.17; 5 studies, 372 participants), but the evidence is very uncertain. Additional work-breaks may reduce the intensity of musculoskeletal back pain (MD -0.91, 95% CI -1.45 to -0.38; 1 study, 147 participants), but the evidence is very uncertain. Intensity of overall physiological musculoskeletal fatigue and adverse effects were not measured in the studies investigating frequency of work-breaks. Additional higher-frequency work-breaks may make little to no difference to the intensity of musculoskeletal back discomfort, compared to additional lower-frequency work-breaks (MD 18.60, 95% CI -47.07 to 84.27, 1 study, 10 participants), but the evidence is very uncertain. Our other critical outcomes were not measured in this study. Changes in type of work-breaks The studies that evaluated different types of work-breaks assessed only one of our critical outcomes. Active work-breaks may make little to no difference to the intensity of physiological musculoskeletal fatigue compared to conventional work-breaks (SMD -0.23, 95% CI -0.55 to 0.10; 2 studies, 146 participants), but the evidence is very uncertain. Cognitive work-breaks may make little to no difference to the intensity of physiological musculoskeletal fatigue compared to conventional work-breaks (SMD -0.18, 95% CI -0.57 to 0.21; 2 studies, 141 participants), but the evidence is very uncertain. Active work-breaks may make little to no difference to the intensity of physiological musculoskeletal fatigue compared to conventional work-breaks (SMD -0.03, 95% CI -0.37 to 0.30; 2 studies, 137 participants), but the evidence is very uncertain. The evidence is very uncertain about the effect of additional work-breaks on the intensity of musculoskeletal back and neck pain and on productivity. The evidence is very uncertain about the effect of different work-break types on newly diagnosed musculoskeletal symptoms and on the intensity of musculoskeletal symptoms. Further high-quality studies are needed to determine the effectiveness of different frequencies, durations, and types of work-breaks amongst workers for preventing musculoskeletal disorders and symptoms, with much larger sample sizes than the studies included in this review. Furthermore, studies should consider worker populations other than office workers. This Cochrane review update was internally funded by institutional resources. Original review (2019): https://doi.org/10.1002/14651858.CD012886.pub2 Original protocol (2017): https://doi.org/10.1002/14651858.CD012886.
39. Digital Competence and Cognitive Reserve in Relation to Different Domains of Cognitive Functioning in Older Adults and Factors Modulating This Association: A Cross-Sectional Study of a Randomized Clinical Trial.
期刊: Geriatrics & gerontology international 发表日期: 2025-Oct-08 链接: PubMed
摘要
This study examines the role of digital competence and cognitive reserve (CR) in cognitive functioning among older adults. Specifically, it investigates how these factors influence different cognitive domains and whether their effects vary based on specific cognitive tasks. Understanding these relationships can inform targeted interventions to promote cognitive resilience in aging populations. A cross-sectional analysis was conducted using baseline data from a randomized clinical trial. The sample included 101 older adults (mean age = 71.4 years, 77% female) with normal cognition. Cognitive functioning was assessed using the MEC-35, Stroop test, and TAVEC, while digital competence was measured with the MDPQ-16. CR was estimated based on educational attainment, occupational complexity, and engagement in cognitively stimulating activities. Multiple linear regression analyses were performed to examine associations between digital competence, CR, and cognitive performance. Higher digital competence was significantly associated with better executive functioning and attention (Stroop test) but was inversely related to verbal learning capacity (TAVEC). CR was positively linked to calculation skills, but its benefits plateaued at moderate levels. These findings suggest that digital competence and CR impact cognitive domains differently, highlighting potential cognitive trade-offs. Digital competence may serve as a protective factor for specific cognitive functions in aging, offering a promising target for interventions aimed at enhancing cognitive resilience. Future research should explore the effectiveness of computerized cognitive training in strengthening both digital skills and CR to support cognitive health in older adults. ClinicalTrials.gov: NCT06279325.
40. The Differential Toxicity of Three Different Oxidized Nickel Compound Nanoparticles and the Effects of Particle Surface Ligands in Mouse Alveolar Macrophages.
期刊: Toxicological sciences : an official journal of the Society of Toxicology 发表日期: 2025-Oct-08 链接: PubMed
摘要
Nickel-compound engineered nanomaterials (Ni-X NP) have diverse applications, yet their continued use raises concerns for potential health impacts on exposure. This study investigated three structurally distinct Ni-X-NP -pure NiO (NCZ), NiO@Ni(OH)2 (SIG), and Ni@NiO@Ni(OH)2 (AA)-to determine how core composition and surface functionalization contribute to bioactivity. Each Ni-X NP was modified with surface moieties (-OH, -COOH, and -CH3) to assess efficacy of surface modifications reducing bioactivity. Ni-X NP were thoroughly characterized for structure, surface chemistry, and Ni2+ ion release in simulated lysosomal fluid. Red blood cells (RBC) were used to evaluate hemolytic capabilities of the nanoparticles and primary murine alveolar macrophages (AM) and cultured murine ex vivo alveolar macrophages (mexAM) were used to assess uptake, cytotoxicity, IL-1β release, and lysosomal membrane permeability (LMP). Results showed that NiO@Ni(OH)2 nanoparticles induced the greatest hemolysis in RBC, elicited the greatest IL-1β response in AM and mexAM, and produced the most LMP in mexAM. The Ni@NiO@Ni(OH)2 nanoparticle released the most Ni2+ and caused profound reductions in AM cell viability but failed to cause RBC hemolysis or LMP. Pure NiO nanoparticles exhibited minimal bioactivity and low Ni2+ release. Surface modification with (-COOH) or (-CH3) effectively reduced bioactivity in LMP-mediated inflammation but had minimal effect on Ni2+-driven toxicity. This study reveals that Ni-X NP bioactivity depends on both core composition and surface chemistry, and that surface functionalization reduces inflammation only when lysosomal damage is the primary driver. These findings underscore the need for careful design and evaluation of engineered nanomaterials.
41. Does physician recruitment impact access and health of rural residents? Evidence from the 2014 recruitment of 6000 physicians in Bangladesh.
期刊: Rural and remote health 发表日期: 2025-Oct 链接: PubMed
摘要
We analyze a 2014 policy that increased physician supply in rural Bangladesh and assess its impact on access to care and health outcomes for rural residents. We use data from the Household Income and Expenditure Survey for 2005-2016 and employ a difference-in-differences model. Our analysis focuses on five key outcome categories: access to providers, access to medicine, cost of care, health status, and travel time to reach healthcare providers. Rural residents’ likelihood of visiting a government doctor increased by 14 percentage points, while visits to private doctors decreased by 15 percentage points. Rural residents are more likely to receive medication from public facilities, and their total monthly cost of care has decreased. We found a rise in reported cases of chronic conditions like heart disease and arthritis among rural residents. Our findings indicate that increasing physician availability in rural Bangladesh positively impacted healthcare access and utilization.
42. Minimal Stiffness After Rotator Cuff Repair With Bioinductive Collagen Implants.
期刊: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews 发表日期: 2025-Oct-01 链接: PubMed
摘要
Bioinductive collagen implants (BCIs) have been growing in popularity for use in rotator cuff repair (RCR) over the past several years, but recent literature has raised concerns about the implants contributing to postoperative stiffness. The purpose of this study was to investigate the incidence of stiffness over a decade of experience with the BCI. A retrospective review was conducted of all cases of RCR using a BCI performed between September 2014 and December 2023. The primary outcome measure was postoperative range of motion, with significant stiffness defined by parameters in the existing literature. The secondary outcome measure was any revision procedure for stiffness. After application of inclusion and exclusion criteria to 522 cases of RCR, there were 432 cases (390 individual patients) available for outcome analysis with an average follow-up of 34.9 months (range, 6 months to 9.25 years). There were only 12 cases (2.8%) of significant postoperative stiffness. All of them required additional operative intervention for stiffness, and all but two patients had at least one risk factor for stiffness. Stiffness rates were 4 of 291 (1.4%) for full-thickness tears and 8 of 141 (5.7%) for partial-thickness tears (P = 0.0149). This study, the largest single cohort to date analyzing BCIs in RCR, found a low incidence of significant postoperative stiffness in cases associated with the use of the implant. Stiffness rates were markedly higher for repairs of partial-thickness tears. To further improve understanding of postoperative stiffness after RCR with BCI, better definitions and prospective comparative studies across larger groups are needed. Level IV, retrospective cohort with no comparison group.
43. Cancer Health Disparities Among Patients With Early-Stage Estrogen Receptor-Positive Breast Cancer: Impact of Public Versus Private Health Care on Diagnosis-to-Treatment Interval in Brazil.
期刊: JCO global oncology 发表日期: 2025-Oct 链接: PubMed
摘要
In 2013, Brazil implemented a federal law (Law 12.732/2012) mandating cancer treatment to begin within 60 days of diagnosis. Among women with newly diagnosed estrogen receptor-positive (ER+) nonmetastatic breast cancer, we describe the diagnosis-to-treatment interval, patient and tumor characteristics, and the type of treatment received, and we assess these metrics by public versus private health care setting. The study included patients with early-stage ER+ breast cancer from 14 centers in Brazil who had completed locoregional care and received >6 months of adjuvant endocrine therapy (ET). Patient, tumor, and treatment characteristics were abstracted from clinical documentation and collected in REDCap. Qualitative variables were compared between groups using the chi-square or Fisher exact tests. For quantitative variables, the nonparametric Mann-Whitney test was used. P < .05 was considered significant. From June 2021 to March 2024, 774 women enrolled in the study. The mean age at diagnosis was 56.5 years, and 55.2% received public health care. Women who received care at public institutions were more likely to be premenopausal at diagnosis (45.3% public v 29.2% private, P < .0001), living with no partner (45.6% public v 34.7% private, P = .002), and have lower educational levels (43.6% public v 6.8% private, P < .0001). Women treated in the public sector had more advanced disease with stage III tumors (29.3% public v 13.5% private, P < .0001) and were more likely to receive mastectomies (36.8% public v 29.8% private, P = .0003), axillary dissections (43.1% public v 18.1% private, P < .0001), chemotherapy (73.8% public v 58.5% private, P < .0001), and radiotherapy (87.0% public v 78.7% private, P = .002). Regarding adjuvant ET, women treated in the public sector had lower ovarian function suppression (6.8% public v 18.8% private, P < .0001) and higher tamoxifen use (52.4% public v 29.4% private, P < .0001). The diagnosis-to-treatment interval was longer in the public versus private system (93 v 41 days, P < .0001). Our study revealed significant disparities in cancer care between patients with stage I to III ER+ breast cancer treated in public versus private health care systems in Brazil. Law 12.732/2012 has proven ineffective for patients treated in the public sector and is not being adequately observed or enforced by Brazilian authorities.
44. Social Determinants of Self-Reported Health in Vulnerable Populations During a Polycrisis in Lebanon.
期刊: JAMA network open 发表日期: 2025-Oct-01 链接: PubMed
摘要
In the context of a polycrisis, which is characterized by multiple interconnected and mutually reinforcing crises, humanitarian and health needs increase. It is therefore crucial to identify social determinants impacting health and well-being of vulnerable populations to better inform appropriate interventions. To assess the association between social determinants and pain frequency, self-rated health, and depression over time among vulnerable populations during a polycrisis in Lebanon. In this population-based longitudinal cohort study, data were collected in Sin-El-Fil, a suburb of Beirut, Lebanon, in 4 waves: June 28 to October 26, 2022; September 8 to December 22, 2022; January 24 to April 28, 2023; and April 8 to July 5, 2024. Data for this analysis were extracted from a parent study around populations at high risk of COVID-19 infections, morbidity, and mortality and included a sample of Syrian refugees and migrants, pregnant women, older adults, and people of low socioeconomic status. Participants were selected via a multistage stratified sampling design. For this substudy, only individuals residing in neighborhoods with socioeconomic deprivation were considered. Food insecurity, nationality, wealth, educational level, and sex. The outcomes were pain frequency (days per week), self-rated health (poor or fair, good, or very good or excellent), and depression (measured using the Patient Health Questionnaire-9). Survey-weighted generalized linear regression models were fitted for each outcome-exposure pair, and odds ratios (ORs) and 95% CIs were computed to report mean marginal estimates and time-specific estimates. The study included 1986 individuals at baseline (mean [SD] age, 44.7 [17.4] years); 1055 (53.1%) were female, 664 (33.4%) were Syrian refugees or migrants, 1025 (51.6%) had no high school degree, and 1451 (73.1%) had food insecurity. The exposure variables were significantly associated with elevated odds of reporting more pain, worse self-rated health, and more depression over time, with mean marginal ORs ranging from 1.03 (95% CI, 1.01-1.06) for worse self-rated health among women compared with men to 1.50 (95% CI, 1.46-1.55) for worse self-rated health among people with vs without food insecurity. The sole exception was for participant sex and depression, between which there was no association (OR, 0.99; 95% CI, 0.97-1.02). In this cohort study, Syrian refugees and migrants, women, and individuals with food insecurity, lower wealth, and less education compared with other residents within the low socioeconomic status areas reported worse physical and mental health challenges, suggesting they carried an additional burden of disadvantage. The findings underscore a need for targeted interventions that focus on reducing health disparities within vulnerable communities, especially in contexts of polycrises.
45. A Hybrid Chatbot to Promote Pneumococcal Vaccination Among Older Adults: A Randomized Clinical Trial.
期刊: JAMA network open 发表日期: 2025-Oct-01 链接: PubMed
摘要
There are few robust evaluations assessing the efficacy of chatbots to improve pneumococcal vaccination (PV) uptake among adults 65 years of age or older. To evaluate the relative efficacy of a hybrid chatbot in increasing PV uptake among Hong Kong residents aged 65 years or older. This partially masked, parallel-group randomized clinical trial was conducted between May 1, 2023, and November 30, 2024 in Hong Kong, China. Participants were aged 65 years or older, had a Hong Kong identity card, could speak and comprehend Cantonese, were smartphone and WhatsApp users, and had no prior PV uptake. Participants were recruited through random telephone calls and were randomized to either the stage of change group or the standard intervention group. In the stage of change group, the rule-based component of the hybrid chatbot assessed participants’ stage of change regarding PV uptake and then delivered stage of change-tailored interventions at months 0, 1, 2, and 3. The natural language processing component of the hybrid chatbot provided real-time answers to participants’ PV-related questions. In the standard intervention group, the chatbot sent participants a link to access a standard online video covering PV information at months 0, 1, 2, and 3. The primary outcome was self-reported PV uptake at month 12, which was validated by the research team. The secondary outcome was participants’ stage of change measured at month 0 and month 12 by using validated questions, with a score of 1 = precontemplation, 2 = contemplation, 3 = preparation, and 4 = action. A total of 374 participants (213 female [57.0%]; mean [SD] age, 69.6 [3.1] years) were randomized to either the stage of change group (n = 187) or the standard intervention group (n = 187). The intention-to-treat analysis showed that the validated PV uptake rate was higher in the stage of change group than in the standard intervention group (29.4% vs 18.7%; P = .01). The mean (SD) stage of change score was higher in the stage of change group than in the standard intervention group (2.2 [1.3] vs 1.9 [1.1]; P = .02). More participants in the stage of change group than in the standard intervention group completed at least 1 intervention session (79.7% vs 57.8%; P < .001). In this randomized clinical trial, the hybrid chatbot was more efficacious than the standard intervention in increasing PV uptake among older adults in Hong Kong. A hybrid chatbot may be a sustainable PV promotion for older adults. ClinicalTrials.gov Identifier: NCT05772117.
46. Interaction Between Immigration, Physical Activity, Mental Health, and All-Cause Mortality Among US Adults.
期刊: JAMA network open 发表日期: 2025-Oct-01 链接: PubMed
摘要
Immigration, physical activity, and mental health have been reported to affect mortality risk. Nonimmigrants, people who lack physical activity, and those with mental health conditions are at a higher mortality risk. However, the joint association of immigration, physical activity, and mental health with mortality risk is unclear. To estimate the interaction among immigration status, physical activity status, and serious psychological distress (SPD) and its association with all-cause mortality risk among US adults during a 22-year follow-up. In this national cohort study, public-use data from the 1998-2018 National Health Interview Surveys were linked to the prospective 2018-2019 National Death Index data. This population-based study included a nationally representative sample of civilian noninstitutionalized US adults 18 years or older. Data were collected from January 1, 1998, to December 31, 2019, and analyzed from August 10, 2023, to July 15, 2025. Immigration status (immigrant or nonimmigrant), physical activity (inactive or insufficiently active or physically active), and SPD (determined using the 6-item Kessler Psychological Distress Scale, with a total score of ≥13 indicating SPD). All-cause mortality status (deceased or alive) constituted the primary outcome. Cox proportional hazards regression models were used to examine mortality risk associated with the exposures. A total of 587 931 adults were included in the analysis. Weighted proportions included 37.2% (95% CI, 37.0%-37.4%) aged 35 to 54 years, 51.9% (95% CI, 51.8%-52.1%) female, 83.8% (95% CI, 83.5%-84.1%) nonimmigrant, 53.7% (95% CI, 53.4%-54.0%) with insufficient physical activity, and 96.8% (95% CI, 96.7%-96.8%) with no SPD. The Cox proportional hazards regression analysis showed a significant 3-way interaction among immigration status, physical activity, and SPD (Wald F4 = 14.12; P < .001). There was a lower expected mortality risk among immigrants with SPD who engaged in physical activity (HR, 6.08; 95% CI, 3.97-8.19) compared with immigrants with SPD who lacked physical activity (HR, 10.50; 95% CI, 8.93-12.08) as well as nonimmigrants who lacked physical activity regardless of SPD status (No SPD HR, 13.03; 95% CI, 12.16-13.90 and SPD HR, 14.13; 95% CI, 13.04-15.21) or who engaged in physical activity with SPD (HR, 11.44; 95% CI, 9.89-12.99). There were no significant differences between immigrants without SPD who engaged in physical activity or immigrants without SPD who lacked physical activity and nonimmigrants who engaged in physical activity without SPD. In this population-based cohort study, the results showed a joint association of immigration status, physical activity, and SPD with all-cause mortality. Immigrants and especially nonimmigrants might benefit from tailored behavioral health interventions aimed at increasing physical activity and reducing SPD to mitigate disparities in mortality risk.
47. Enterovirus-associated deafness and myositis in an immunocompromised patient with in vivo and in vitro efficacy of intravenous immunoglobulins and remdesivir: Case report.
期刊: Antiviral therapy 发表日期: 2025-Oct 链接: PubMed
摘要
Enteroviruses can cause severe, chronic infections in patients with primary and secondary humoral immunodeficiencies. These patients may benefit from anti-enteroviral therapy. Here, we report a patient with mantle cell lymphoma treated with chemotherapy followed by autologous stem cell transplantation and rituximab maintenance therapy, who presented with echovirus 7-associated deafness and myositis leading to severe disability. She showed marked clinical improvement and enterovirus clearance from faeces and blood after treatment with intravenous immunoglobulins (IVIgs) followed by remdesivir. We demonstrated efficacy of IVIg and remdesivir against echovirus 7 using virus neutralization and cell culture assays, which supports a potential contribution to the treatment success for both therapies.
48. Seroprevalence of Hepatitis B, C and HIV infection in healthcare personnel in Turkey.
期刊: Journal of infection in developing countries 发表日期: 2025-Sep-30 链接: PubMed
摘要
This study aimed to investigate the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) infections among health care workers in Zonguldak Gynecology and Pediatrics Hospital. The records of healthcare personnel working in the hospital between 2023 and 2024 were retrospectively analyzed through the hospital information management system (HIMS) and periodic examination forms. Age, gender, job, and test results for Hepatitis B surface antigen (HBsAg), Hepatitis C antibody (anti-HCV), Hepatitis B surface antibody (anti-HBs), and HIV antibodies (anti-HIV/1-2) were all recorded. A total of 364 healthcare personnel, including 25 doctors, 135 nurses, 14 technicians, 39 cleaning staff, and 151 other personnel, were included in the study. The staff comprised 266 (73%) female and 98 (27%) male workers, and the mean age was 37.69 ± 9.95 years. The HBsAg positivity rate was found to be 0.8%, and the anti-HBs positivity rate was noted to be 82.9%. Significant differences were determined for age, gender, and anti-HBs among occupational groups (p < 0.001). The prevalence of anti-HBs was markedly elevated in the group of doctors (p < 0.001). The anti-HBs value was statistically significantly different between occupational groups (p < 0.001). No staff members tested positive for anti-HCV or anti-HIV. Differences in infection rates and immunological responses were seen among various occupational groups, emphasizing the necessity for targeted medical attention within this population. Healthcare personnel should have screening for HBV, HCV, and HIV, and individuals susceptible to HBV should receive vaccination.
49. Digitalization and physical activity in the aspects of health and physiotherapy. Using digital methods to improve physical fitness.
期刊: Folia medica Cracoviensia 发表日期: 2025-May-30 链接: PubMed
摘要
An important task also faces “lifestyle medicine”, in connection with the development of IT services and digital possibilities. Practicing physical activity is an important basis for improving the physical and mental condition of patients. The aim of the work was to determine the usefulness of remote and digital forms to improve physical fitness in currently diverse groups of respondents. A review of scientific literature was conducted based on popular science databases Medline, PubMed. Only articles from the last 8 years (2017-2025.03) were taken into account. The search criteria were the following phrases: digital health, sport, physiotherapy, activity. 32 studies containing the above phrases in keywords and article content were included in the study. Papers not related to physical activation or physiotherapy through digital or remote form were rejected. Almost all studies indicated the usefulness of digital physical activation and, through it, improving physical fitness in various types of subjects. Two of the studies indicated that digital activation should be additionally personalized for specific groups of subjects and that the integration of e-exercise with the stationary form should be improved or e-coaching should be used. One study did not ultimately confirm the effectiveness of the digital physical activation program due to COVID-19. It is necessary to optimize the recommendations of online exercise programs and expand existing programs for different groups of exercisers. Digital activation of movement: improves physical fitness, eliminates stress, helps to shape movement habits, is a form of relaxation or fun, is a form of encouragement and motivation, allows to monitor changes or progress of health.
50. Saliva - the gatekeeper at the entrance to the gastrointestinal tract - a remarkable biofluid, its proteins, and the upper part of the alimentary tract.
期刊: Folia medica Cracoviensia 发表日期: 2025-May-30 链接: PubMed
摘要
Saliva, a seemingly unpretentious secretion, is actually a multifaceted and multipurpose biofluid. Performing numerous functions, far exceeding only lubrication of oral mucosa, it is essential for general health. Saliva’s remarkable properties are primarily due to its constituents, mainly peptides and proteins. Excreted at the entrance to the gastrointestinal tract, this biofluid-active in the oral cavity-also affects other sections of the canal alike, particularly esophagus, where its active components do not undergo degradation. Animal models employing sialoadenectomy consistently with clinical data of patients afflicted with issues related to insufficient salivation, clearly demonstrate how indispensable proper saliva secretion is. In this paper we briefly summarize current perspectives on saliva, with a focus on its protein components and its impact on the upper part of the alimentary tract, particularly on oral and esophageal mucosa. The practical aspects of the modern proteomic research of saliva being at the forefront of salivaomics progress are also discussed, and the current state-of-the-art proteomic methodology is outlined.
51. Iranian livestock breeders' knowledge, attitude, practice, and behavioral determinants related to brucellosis prevention.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Brucellosis is a zoonotic disease that affects animals and humans. Its transmission to humans occurs through various routes such as consumption of infected animal products or unprotected close contact with secretions or different parts of live or dead infected animals. This study aims to report Iranian livestock breeders’ awareness, attitude, practice, and behavioral determinants related to Brucellosis prevention. A cross-sectional study was conducted in 2019 among 450 livestock breeders in Beyraq, a suburb of Tabriz city. The Brucellosis Prevention Questionnaire (BPQ) was used to collect data. Statistical analysis performed using SPSS-23. The BPQ, consisting of 53 items, had acceptable psychometric properties (Content Validity Index = 0.90, Content Validity Ratio = 0.74, Impact Score = 4.30, Intra-class Correlation Coefficient = 0.885, Composite Reliability = 0.895, and Standard Error of Measurement = 5.448). The study surveyed 450 livestock breeders, with an average age of 51.68 ± 16.4 years.. Participants with a history of brucellosis reported that their last occurrence of the disease, on average, was 7.03 ± 5.83 years ago.Livestock breeders had moderate knowledge levels (mean score = 17.13) and positive attitudes (mean score = 3.86) towards Brucellosis prevention, but their practice level was relatively low (mean score = 15.9). Significant differences were observed in awareness (p-value <0.001), attitude (p-value = 0.03), and practice (p-value <0.001) scores between those who had undergone previous prevention measures compared to those who did not. Participants with a higher education level had higher awareness, attitude, and practice scores. An analysis of variance test (ANOVA) showed that job level had a significant effect on awareness (p-value <0.001) and practice (p-value <0.001) scores, with free jobs having higher scores than other jobs. Findings suggest that Iranian livestock breeders have insufficient knowledge about Brucellosis prevention despite positive attitudes and practices. To prevent the spread of Brucellosis, it is necessary to increase awareness and educate livestock breeders about preventive measures.
52. Efficacy of peat-based bioformulation of microbial co-inoculants with silicon for growth promotion of rubber plants.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Recently, microbial consortia of rhizobacteria and arbuscular mycorrhizal fungi (AMF) had demonstrated the potential as plant growth promoting microbes in sustainable agriculture. This study aimed to investigate the effect of a peat moss-based formulation of Enterobacter sp. UPMSSB7, Glomus mosseae, and silicon (Si) on the survival of microbial inoculants under storage conditions for 24 weeks. The study further assessed the potential of this bioformulation to promote the growth of rubber plants in a glasshouse trial. The Enterobacter sp. UPMSSB7 isolated from rubber tree’s rhizosphere, can solubilize silicates and has plant growth promoting properties. G. mosseae is an AMF, having symbiotic relationship with majority of cultivated crops. The application of Si has emerged as a sustainable strategy for crop health. It improves soil fertility through nutrient maintenance and also alleviates various biotic and abiotic stresses. Results from laboratory test revealed that bioformulation of co-inoculants with Si sustained a high survivability of Enterobacter sp. (18 × 108 CFU g-1) and G. mosseae (35 spores per 10 g) in formulation for up to 24 weeks of storage. Results from the glasshouse experiment revealed that 24 weeks after treatment with bioformulation of co-inoculants with Si increased the stem height, girth, leaf area, dry weight of shoot and root, chlorophyll content, microbial population of Enterobacter sp. (1.4 × 108 CFU g-1 soil) and G. mosseae (78 spores/10 g soil) in rhizosphere and also increased N, P, K and Si contents in rubber seedlings than bioformulation of single inoculant with Si and control. Our findings indicate that peat moss-based formulation of co-inoculants Enterobacter sp. UPMSSB7 and G. mosseae added with Si proved to be the most effective. This formulation not only maintained good microbial survivability but also significantly enhanced the rubber plants growth compared to the bioformulation of single inoculants. This promising approach using a peat moss-based formulation of microbial co-inoculants with Si, could be further explored for growth enhancement of rubber trees under field conditions.
53. Trends in incidence, mortality and disability-adjusted life years of colorectal cancer in East Asia (1990-2021): An analysis of the Global Burden of Disease study 2021.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Colorectal cancer (CRC) poses a significant health challenge in East Asia. This study examined long-term trends in CRC incidence, mortality and disability-adjusted life years (DALYs) and their key drivers across five East Asian countries (China, Japan, South Korea, North Korea and Mongolia) from 1990-2021. Using Global Burden of Disease Study 2021 data, we assessed temporal trends using joinpoint regression, age/period/birth cohort effects through age-period-cohort analysis, and key drivers via decomposition analysis; we also evaluated associations between CRC burden and the Socio-Demographic Index (SDI). Between 1990 and 2021, descriptive analysis showed CRC age-standardised incidence rates (ASIRs) increased in all East Asian countries, while age-standardised mortality rates (ASMRs) and age-standardised DALY rates (ASDRs) generally declined, although 95% uncertainty intervals (UIs) overlapped in some countries. Joinpoint regression revealed overall increasing ASIR trends, with South Korea showing the largest average annual percentage changes (AAPCs) (males 2.18%, females 1.41%). ASMRs and ASDRs generally decreased, particularly among females; however, Mongolian males experienced slight increases (ASMR AAPC = 0.50%; ASDR AAPC = 0.44%). Relative risks for CRC incidence, mortality and DALYs increased with age, peaking in older groups. Period effects increased approximately linearly, while cohort effects decreased for younger generations. Decomposition analysis showed ageing and population growth were the main contributors to increased CRC burden. SDI showed an overall positive association with CRC burden, with heterogeneity by country and sex. Joinpoint analysis (1990-2021) demonstrated increases in CRC incidence (predominantly males) and declines in mortality/DALY rates (especially females) across most East Asian countries; however, substantial changes (non-overlapping UIs) were limited to few groups, warranting cautious interpretation. Despite progress, the persistent overall burden remains substantial, mainly driven by ageing and population growth. These findings underscore the need for country- and sex-specific prevention, screening, and lifestyle strategies.
54. Pooled prevalence and factors of overweight/obesity among women of reproductive age in low and middle-income countries with high maternal mortality: A multi-level analysis of recent demographic and health surveys.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Due to the increased magnitude of overweight/obesity in many countries, the World Health Organization (WHO) has identified it as a significant public health crisis, particularly affecting women of reproductive age in developing nations. Despite obesity/overweight among women of reproductive age being widely acknowledged as a pressing public health issue, there has been limited investigation into its pooled prevalence and various associated factors in low and middle-income countries (LMICs) with high maternal mortality. Thus, the objective of our study was to assess the pooled prevalence and associated factors of overweight/obesity among reproductive-age women in low and middle-income countries with high maternal mortality. We analyzed secondary data using recent Demographic and Health Survey datasets from 21 low and middle-income countries with high maternal mortality. A weighted sample of 64,076 women of reproductive age was included in the analysis. The variables were extracted from the IR file, and the data were cleaned, recoded, and analyzed using STATA version 14.2 software. A multilevel binary logistic regression model was applied, and adjusted odds ratios (AOR) with 95% confidence intervals and a p-value of ≤ 0.05 were used to identify statistically significant associated factors. Model fitness and comparison were assessed using the ICC, MOR, PCV, and deviance (-2LLR). In this study, the pooled prevalence of overweight/obesity among women of reproductive age was 32% (95% CI: 27% - 37%), with a significant variation between countries, ranging from 10% in Burundi to 53% in Mauritania. Women of reproductive age with overweight/obesity showed a significant positive association with various factors compared to those with a normal BMI. Accordingly, women’s age, women’s educational status, women’s occupation, women’s marital status, households’ income levels, number of living children, frequency of watching television, using the internet, sex of household head, and sources of drinking water were identified as individual-level factors. On the other hand, residence, community poverty, and community-level media usage were found to be significantly associated with community-level variables. More than three out of ten women of reproductive age were overweight/obese in low and middle-income countries with high maternal mortality. Individual-level and community-level factors were associated with overweight/obesity. Special attention is recommended to older women, those with formal education, non-working women, individuals who spend time watching television and using the internet, urban residents, and female household heads. Furthermore, since higher household income is associated with an increased likelihood of weight gain, it is important to provide appropriate health interventions for women from the wealthiest households.