公共卫生研究摘要 (2025-10-11)
共收录 60 篇研究文章
1. Surgical Complications of Deep Brain Stimulation in Children Across Targets and Indications: Multicenter Analysis of the CHILD-DBS Registry.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Deep brain stimulation (DBS) is considered off-label and investigational in pediatric populations with some exceptions. There are limited data on the relative rates of complications after DBS across different indications and targets in children. This study aimed to evaluate the safety of DBS surgery for children with movement disorders (MDs; dystonia, chorea, or tic disorders), drug-resistant epilepsy (DRE), or neurodevelopmental disorders, namely, self-injurious behavior (SIB). Data were collected both prospectively and retrospectively from children implanted with DBS through the North American multicenter Child and Youth CompreHensIve Longitudinal Database for Deep Brain Stimulation and included demographic, clinical, operative, and postoperative variables. Complications included infection, noninfectious surgical site findings (dehiscence or seroma), hardware-related issues (disconnection or impedance change), intracranial injury, or other complications. The primary outcome was major complications, defined as any adverse event causing permanent neurologic injury or requiring surgical intervention. The secondary outcome was minor complications, defined as nonmajor complications. Generalized linear models were used to assess for any significant associations with complications. A total of 130 children and youth (mean age 12.2 ± 4.2; range 3-18) years and weighing 12.5-126.6 kg underwent DBS. The most common indication was MD (77, 59.2%), followed by DRE (47, 36.2%) and SIB (6, 4.6%). Major complications occurred in 11.5%, with a greater likelihood in MD (n = 12, 15.6%) compared with DRE (n = 2, 4.3%; odds ratio [OR] 3.55, 95% CI 2.66-4.73, p < 0.001) and significantly associated with lower weight at surgery (p < 0.001) and urgent intervention (p = 0.028). These included infection (6.2%), hardware malfunction (3.1%), and wound dehiscence (0.8%). Minor complications were also higher with MD compared with DRE (OR 1.83, 95% CI 1.16-2.89, p = 0.010) occurring in 22 participants (16.9%; 14 MD, 7 DRE, 1 SIB), including infection (6.2%), high impedance (1.5%), unrelated hydrocephalus (0.8%), perioperative worsening of symptoms (3.8%), incidental tract hemorrhage (2.3%), and noninfectious peri-electrode cystic changes (0.8%). DBS-associated complications were low across multiple pediatric indications and targets, with MD associated with higher risk of major complications. Limitations include a focus on surgical postoperative complications and not stimulation-related adverse outcomes. These findings demonstrate the safety profile of DBS in children in a large cohort.
2. Machine Learning Models to Predict Withdrawal of Life-Sustaining Therapy in Patients With Severe Traumatic Brain Injury.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Over half of all deaths after traumatic brain injury (TBI) follow the decision to withdraw life-sustaining therapy (WLST). Despite recent improvements in TBI mortality, rates of WLST have remained unchanged, potentially reflecting outdated prognostic misconceptions. Determinants of the decision to WLST are multifaceted and complex, spanning just beyond clinical prognosis, which is reflected in the significant variability in WLST rates between centers. We aimed to create a machine learning (ML) model that could accurately predict the decision to WLST and hypothesized that facility WLST rate would emerge as a highly impactful WLST determinant. This observational study analyzed data from the American College of Surgeons Trauma Quality Improvement Project National Trauma Databank (2017-2021). Patients with severe TBI, defined by a maximum Abbreviated Injury Scale-Head ≥1 and presenting Glasgow Coma Scale (GCS) <9, were included. Burns, unspecified injury mechanisms, emergency room discharges, deaths, transfers, and patients with missing WLST data were excluded. ML models were developed to predict WLST using variables available at different time points. The performance of each model in predicting WLST was optimized for area under the receiver operating curve (AUROC). The most impactful determinants of WLST were assessed using Shapley additive explanation scores. Of 5,481,046 patients, 155,639 met inclusion criteria, with 32,385 (20.8%) undergoing WLST. The mean age was 43 ± 22 years, 26.5% of patients were female, and the median time to WLST was 46.4 hours. The AUROC of 0.875 (95% CI 0.871-0.879) in the admission model improved to 0.896 (95% CI 0.892-0.900) in the total length-of-stay model. Age, highest emergency department GCS, and facility WLST rate were the most important factors in prediction of WLST. In this study of using ML to predict WLST after severe TBI, our models reliably predict the decision to WLST. We found that institutional withdrawal culture is a strong independent determinant of WLST, irrespective of clinical condition. As TBI care improves, our findings underscore the importance of refining prognosticating tools to prevent premature WLST decisions which may be influenced by biases associated with self-fulfilling prophecies and institutional practice patterns.
3. Diffusion MRI Tractography to Reduce Risks of Postoperative Neurologic Deficits: A Systematic Review and Meta-Analysis.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Despite informing on the location of functionally relevant white matter tracts, diffusion MRI tractography is not routinely used to guide neurosurgical procedures. The potential of tractography to help avoid postoperative neurologic deficits is not yet fully established. The objective of our study was to assess whether surgeries that incorporated tractography, either alone or in conjunction with other modalities, are associated with a lower risk of long-term postoperative neurologic deficits in patients undergoing resective/ablative intracranial procedures. We performed a systematic review with meta-analysis, searching through EMBASE and PubMed databases for all peer-reviewed articles published in English up until December 2024. Studies were included if they reported on intracranial resective or ablative surgeries, if they compared tractography-assisted against non-tractography-assisted approaches, and if they assessed new postoperative neurologic deficits. No restrictions were placed on the age of patients. Studies were assessed for inclusion by 2 independent reviewers, and disagreements were settled by a third. Data extraction was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, quality of studies was evaluated using the GRADE framework, and risk of bias was assessed through a modified version of the Newcastle-Ottawa Quality Assessment Scale for Cohort Studies. Data were pooled using a random-effects model with a Mantel-Haenszel method for estimating risk ratios. The primary outcome consisted in any neurologic deficits present at the last follow-up (≥3 months). Of 5,335 studies initially identified, 8 were included after all stages of review, all of which consisted of resective surgeries. A meta-analysis of 629 patients revealed a 55% risk reduction of postoperative neurologic deficits when tractography was incorporated in the neurosurgical workflow. This benefit was consistent when assessing studies where tractography was exclusively used preoperatively. Furthermore, the incorporation of tractography into intraoperative neuronavigation systems was associated with lower proportions of postoperative neurologic deficits, compared with exclusively preoperative tractography. These benefits were found to be present in several additional subgroup and sensitivity analyses. The addition of tractography is associated with a reduced risk of postoperative neurologic deficits in intracranial resective surgeries. Tractography can complement gold standard brain mapping methods such as direct electrical stimulation during awake surgeries or serve as a helpful alternative when electrical stimulation is contraindicated.
4. Temporal Association Between Dengue Outbreaks and Neurologic Autoimmune Diseases in French Guiana.
期刊: Neurology(R) neuroimmunology & neuroinflammation 发表日期: 2025-Nov 链接: PubMed
摘要
Recent decades have witnessed the emergence of arbovirus infections, such as dengue, chikungunya, and Zika viruses, which are responsible for neurologic complications such as Guillain-Barré syndrome (GBS). To date, it has mainly been demonstrated that these neurologic complications occur concomitantly with infectious processes. We hypothesized that arbovirus infections may also influence the incidence of autoimmune diseases of the central or peripheral nervous system. This was a retrospective, observational, single-center study conducted between January 2002 and January 2024 at the Cayenne Hospital in French Guiana including patients with autoimmune encephalitis, neuromyelitis optica spectrum disorders (NMOSDs), GBS, chronic inflammatory demyelinating polyneuropathy, and myasthenia gravis (MG). This series was compared with the incidence of arbovirus infections recorded by the French Public Health Agency during the same period. We observed a significant correlation between dengue infection and the incidence of NMOSD (Spearman rho = 0.88 [p = 0.03]) and MG (Spearman rho = 0.82 [p = 0.048]). GBS was significantly associated with chikungunya (Spearman rho = 0.97 [p = 0.01]), but not with other arbovirus infections. In addition, the mean estimated incidence of NMOSD was high at 5.08 (95% CI 3.03-7.13) per million person-year, approaching the world’s highest incidence observed in the French West Indies. This study reports the epidemiology of neurologic autoimmune diseases in French Guiana. We found a high incidence of NMOSD, like that reported in the French West Indies. Multicenter studies involving countries in the tropical zone are needed to better elucidate the relationship between dengue outbreak and NMOSD and MG.
5. Germinal center-mediated broadening of B cell responses to SARS-CoV-2 booster immunization.
期刊: Science immunology 发表日期: 2025-Oct-17 链接: PubMed
摘要
Germinal centers (GCs) are key sites for antibody diversification and affinity maturation. SARS-CoV-2 messenger RNA (mRNA) vaccines elicit robust GC B cell responses in humans, but how these responses influence the breadth of immunity against viral variants remains unclear. We analyzed GC B cell responses in nine healthy adults after mRNA booster immunization. We show that 77.8% of the B cell clones in the GC expressed representative monoclonal antibodies (mAbs) recognizing the spike protein, with 37.8% of these targeting the receptor binding domain (RBD). One RBD-targeting mAb, mAb-52, neutralized all tested SARS-CoV-2 strains, including the recent XEC variant. mAb-52 used the IGHV3-66 public clonotype, protected hamsters challenged against the EG.5.1 variant, and targeted the class I/II RBD epitope, closely mimicking the binding footprint of ACE2. Its broad reactivity was driven by extensive somatic hypermutation, underscoring the critical role of GC reactions in shaping cross-variant B cell immunity after SARS-CoV-2 booster vaccination.
6. A midbrain-to-ventral-striatum dopaminergic pathway orchestrates odor-guided insect predation in 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
Foraging and food consumption are fundamental for the survival of animals. In natural environments, wild rodents feed on insects, including moth larvae, and odor-guided evaluation of potential food resources is a critical step in initiating feeding behavior. However, the mechanisms by which rodents seek and feed on insect prey remain poorly understood. Herein, we employed a laboratory-based predator-prey interaction system using mice and cotton bollworm larvae to investigate the neural mechanisms underlying food-seeking and feeding behaviors at both cellular and neural circuit levels. We demonstrate that mice exhibit a strong preference for consuming fed larvae, and this preference is dependent on the main olfactory system. Gas chromatography-mass spectrometry analysis revealed significant differences in the chemical profiles of fed and unfed larvae, with fed larvae containing a higher level of linoleic acid (LA) and a lower level of (Z)-9-tricosene [(Z)-9-TE]. Behavioral assays showed that mice, as well as Brand’s voles and brown rats, are attracted to LA but avoid (Z)-9-TE in a two-choice odor preference test. Furthermore, we identified that the dopaminergic pathway from the ventral tegmental area (VTA) to the medial olfactory tubercle (mOT) plays a central role in mediating this preference. Chemogenetic inhibition of this pathway abolished the preference for LA over (Z)-9-TE, while chemogenetic activation reversed this effect. Additionally, fiber photometry recordings and pharmacology revealed that mOT D1 and D2 spiny projection neurons preferentially mediate attraction to LA and avoidance of (Z)-9-TE, respectively. These findings uncover a neurobiological system in rodents that supports insect predation based upon chemosignals.
7. Cultivating Disaster Preparedness: Scoping Review of Technology's Contribution to Situational Awareness and Disaster Mindset in Disaster Medicine.
期刊: Online journal of public health informatics 发表日期: 2025-Oct-10 链接: PubMed
摘要
Disaster medicine education increasingly emphasizes situational awareness and a proactive disaster mindset as crucial competencies for effective response. Situational awareness involves comprehending the disaster environment to make informed decisions under pressure, while a disaster mindset encompasses psychological resilience and effective functioning amid chaos. Integrating technologies into simulation training allows experiential learning that bridges these theoretical concepts with practical application. This study aims to investigate the current status of teaching these concepts and the use of technology in fostering situational awareness and a disaster mindset within disaster medicine education by reviewing the existing literature. This study used a scoping review of scientific studies (2005-2025), obtained from PubMed, Scopus, and Web of Science databases, complemented by a Google Scholar search. From December 1, 2024, to the end of January 2025, 3 reviewers searched, compiled, reviewed, and selected eligible studies in English, discussing the use of technology in fostering situational awareness and disaster mindset. Out of 217 initially identified records, 49 studies met the inclusion criteria after a 2-stage screening and full-text review process. Of these, 42 were peer-reviewed scientific articles and 7 were official documents. Approximately 86% (42/49) of the studies addressed situational awareness, while only 2% (1/49) explicitly focused on the concept of disaster mindset. Most of the included studies highlighted the use of immersive technologies such as virtual and augmented reality, geographic information systems, and artificial intelligence-driven tools to enhance real-time information processing and decision-making in disaster education contexts. By strategically incorporating these advanced tools into educational frameworks, the divide between theoretical knowledge and practical application can effectively be bridged, fostering essential experiential learning and developing robust psychological readiness for future challenges. Simulation training enhances situational awareness and disaster mindset, bridging the gap between theory and practice through experiential learning. The findings from this review highlight current pedagogical approaches and technological applications, identifying gaps and future directions for enhancing disaster medicine education.
8. Prevalence of Dropout and Influencing Factors in Digital Psychosocial Intervention Trials for Adult Illicit Substance Users: Systematic Review and Meta-Analysis.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-10 链接: PubMed
摘要
Illicit drug use has become a significant global public health issue, and digital interventions offer new approaches to address this challenge. However, there is a gap in existing research on the dropout rate of adult illicit drug users receiving digital psychosocial interventions. This study aims to evaluate the dropout rate of adult illicit drug use following digital psychosocial interventions during treatment and the longest follow-up, as well as its predictive factors. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, studies published up to August 27, 2025, were searched in the Web of Science, PubMed, PsycINFO, Embase, and Cochrane Controlled Trials Register. Randomized controlled trials of digital psychosocial interventions for adult illicit drug users that reported dropout rates were included. Two researchers independently screened studies, extracted data, and assessed bias risk using the Cochrane risk of bias tool (ROB 2.0). A random-effects model in Comprehensive Meta-Analysis software (CMA 4.0) was used for meta-analysis, along with heterogeneity testing, sensitivity analysis, and publication bias assessment. Finally, a moderating analysis was conducted based on the extracted data. A total of 41 studies involving 9693 participants and reporting 48 dropout rates were included. The mean dropout rate in the intervention group after 18 studies was 22% (95% CI 0.13-0.36), which was lower than the control group’s 26% (95% CI 0.16-0.39). High heterogeneity was observed between studies (Q=396.18, df=17, P<.001, I²=96%), and moderating analysis revealed that high heterogeneity in dropout rates was associated with four variables across three major characteristics: (1) participant demographic characteristics: employment rate; (2) participant clinical characteristics: baseline clinical diagnosis and baseline drug use type; and (3) intervention characteristics: intervention frequency. In the 30 studies with the longest follow-up period in the intervention group, the dropout rate was 28.2% (95% CI 0.19-0.39), comparable to the control group’s 27.8% (95% CI 0.20-0.37). Extremely high variability was observed between studies (Q=1293.13, df=29, P<.001, I²=98%), and moderating analysis showed that high heterogeneity in dropout rates was associated with 4 variables across three major characteristics: (1) participant demographic characteristics: single individuals; (2) participant clinical characteristics: baseline medication frequency; and (3) treatment characteristics: recruitment method and the degree of digitalization. Additionally, publication bias assessment and sensitivity analysis supported the robustness of the study results. This study explored the impact of digital psychosocial interventions on treatment adherence among adult illicit drug users, revealing complex factors affecting dropout rates through mediation analysis. These findings not only emphasize the necessity of further research but also provide important evidence for developing precision interventions, holding significant implications for both theory and clinical practice.
9. Comparing Sociodemographic, Health Status and Resources, Macroeconomic Status, and Environmental Factors on Infant Mortality Rates in Bahrain, Kuwait, and Oman: Longitudinal Time-Series Study.
期刊: JMIR pediatrics and parenting 发表日期: 2025-Oct-10 链接: PubMed
摘要
The United Nations considers children a crucial national asset and makes their welfare a top priority. However, infant mortality remains a persistent challenge, notably in Arab nations. Bahrain, Kuwait, and Oman, despite sharing similar income brackets and health care systems, differ in health policies, demographics, and maternal-child resource allocation. These countries also faced sharp fiscal deficits during the 2020 COVID-19 crisis. Compared to wealthier nearby nations like the United Arab Emirates, their lower gross domestic product further complicates efforts to reduce the Infant Mortality Rate (IMR) and sustain effective, equitable child health strategies. This study aimed to identify factors contributing to the IMR in Bahrain, Kuwait, and Oman by establishing an interpretative framework to examine the influence of sociodemographic, macroeconomic, health status and resource, and environmental factors. A longitudinal study collected annual time-series data (1990-2022) for Bahrain, Kuwait, and Oman from international open sources. To counterbalance the time-series effects on both IMR and explanatory factors, a generalized least squares model based on the Cochrane-Orcutt procedure with a first-order autoregressive model was used. Generalized least squares shows that the total fertility rate has a strong effect on IMR among the 3 countries (Oman: β=1.138, P<.001; Kuwait: β=.429, P=.006; Bahrain: β=.610, P=.03). Health status and resources, such as female life expectancy at birth, had an inconsistent impact on the IMR, with a positive effect (β=.103, P=.002) for Oman and a negative effect (β=-4.0697, P<.001) for Kuwait. Macroeconomic factors, such as female unemployment, were significant in decreasing the IMR only for Kuwait (β=-.076, P=.008). Gross domestic product per capita is significant only for Bahrain (β=-.398, P<.001). Environmental factors included CO2 emissions, which negatively impacted Oman’s IMR (β=-.077, P=.03), and N2O had a positive effect on Bahrain’s IMR (β=.420, P=.04). This study indicated the substantial effects of sociodemographics, health status and resources, macroeconomics, and environment on the IMR in 3 Arab countries. Sociodemographic and health-related factors like female life expectancy, fertility regulation, and female unemployment level were identified as key determinants of infant mortality.
10. High-Throughput Computing to Detect Harmful Drug-Drug Interactions in Older Adults: Protocol for a Population-Based Cohort Study.
期刊: JMIR research protocols 发表日期: 2025-Oct-10 链接: PubMed
摘要
Drug-drug interactions (DDIs) are a major concern, especially for older adults taking multiple medications. Although Health Canada and the US Food and Drug Administration (FDA) use population-based studies to identify adverse drug events, detecting harmful DDIs is challenging due to the millions of potential drug combinations. Traditional pharmacoepidemiologic studies are slow and inefficient, often missing important harmful DDIs. This protocol outlines a novel approach to efficiently identify harmful DDIs using administrative health care data. Using high-throughput computing, we will conduct multiple population-based, new-user cohort studies using Ontario’s linked administrative health care data. The cohorts will be selected from the population of Ontario residents aged 66 years and older who filled at least one oral outpatient drug prescription from 2002 to 2023. In each cohort, the exposed group will comprise individuals who are regular users of one drug (drug A) who start a new prescription for a second drug (drug B); the referent group will comprise regular users of drug A not taking drug B. We will evaluate 74 acute outcomes within 30 days of cohort entry, including hospitalizations, emergency department visits, and mortality. Propensity score methods will balance exposed and referent groups on more than 400 baseline health characteristics. Modified Poisson and binomial regression models will estimate risk ratios (RRs) and risk differences (RDs). To ensure findings are both statistically and clinically meaningful, we will apply prespecified thresholds for effect sizes (eg, lower bounds of 95% CIs≥1.33 for RRs and ≥0.1% for RDs) and control the false discovery rate at 5% using the Benjamini-Hochberg procedure to address multiplicity. Subgroup and sensitivity analyses, including negative control outcomes and E-values, will assess robustness. In a preliminary analysis, we identified approximately 3.8 million older adults who filled prescriptions for over 500 unique medications during the study period (2002-2023), and therefore, approximately 200,000 potential drug combinations will be available for study. The initial drug pair cohorts had a median of 583 new users per cohort (IQR 237-2130); the median overlap in drug pair prescriptions was 57 days (IQR 30-90). The protocol was finalized on August 30, 2025, and outlines the analysis of data from 2002 to 2023. The analysis is scheduled to be completed by fall 2026, with results interpreted in 2027. The final manuscript submission is planned for December 2028. This study aims to identify credible signals of harmful DDIs in older adults in routine care. This study will use an innovative approach that leverages data from provincial administrative health care databases and integrates high-throughput computing and rigorous pharmacoepidemiologic methods to generate robust real-world evidence that can inform safer prescribing practices and regulatory decision-making. DERR1-10.2196/77224.
11. Clinical Usefulness of a Smartphone-Based 6-Minute Walk Test in a Hospital Outpatient Clinic Within the Constraints of the COVID-19 Pandemic: Mixed Methods Study.
期刊: JMIR formative research 发表日期: 2025-Oct-10 链接: PubMed
摘要
The 6-minute walk test (6MWT) measures exercise capacity in cardiorespiratory, neurological, and musculoskeletal conditions. It consists of observing how far a patient can walk in 6 minutes and is usually performed in a corridor in a clinic. During the COVID-19 pandemic, as health care systems cancelled nonurgent outpatient appointments, many tests were conducted online. At Oxford University Hospitals National Health Service Foundation Trust, patients followed up on by cardiovascular outpatient clinics were asked to use the open-source Timed Walk app to perform the 6MWT in their community as a substitute for the regular tests in the clinic. This study aimed to assess the clinical usefulness of the app within the context of the pandemic. Consented patients were invited to perform a 6MWT outdoors using the app at least once a month and report the results through periodic telephone calls and visits. Clinical decisions made for the same cohort were registered, with a focus on the effect of the app in supporting decision-making. Data collected through the app during the study period were compared with 6MWTs performed in the prepandemic period. This study was conducted between October 2021 and December 2022. A total of 55 participants consented (n=25, 45% female; mean age 44.80, SD 17.49 y). In total, 741 events were logged. A total of 51 medical decisions were made for 25 patients; in 41% (21/51) of the decisions, the app played a role, affecting 44% (11/25) of the patients. Between 2018 and 2022, a cohort of 49 patients for whom data were available performed 63 6MWTs in the clinic (18 in 2021), whereas the same patients performed 605 tests using the app in 2022 (ie, October 2021 to December 2022). The use of the Timed Walk app for remote 6MWTs allowed clinicians to obtain frequent and objective indications of the status of the patients during the pandemic, compensating for the absence of regular clinic appointments and providing 33 times more tests than in the prepandemic period. These tests supported approximately half of the clinical decisions made regarding the consented patients, showing that the app is useful in clinical practice.
12. Optimizing Loop Diuretic Treatment for Mortality Reduction in Patients With Acute Dyspnea Using a Practical Offline Reinforcement Learning Pipeline for Health Care: Retrospective Single-Center Simulation Study.
期刊: JMIR medical informatics 发表日期: 2025-Oct-10 链接: PubMed
摘要
Offline reinforcement learning (RL) has been increasingly applied to clinical decision-making problems. However, due to the lack of a standardized pipeline, prior work often relied on strategies that may lead to overfitted policies and inaccurate evaluations. In this work, we present a practical pipeline-Pipeline for Learning Robust Policies in Reinforcement Learning (PROP-RL)-designed to improve robustness and minimize disruption to clinical workflow. We demonstrate its efficacy in the context of learning treatment policies for administering loop diuretics in hospitalized patients. Our cohort included adult inpatients admitted to the emergency department at Michigan Medicine between 2015 and 2019 who required supplemental oxygen. We modeled the management of loop diuretics as an offline RL problem using a discrete state space based on features extracted from electronic health records, a binary action space corresponding to the daily use of loop diuretics, and a reward function based on in-hospital mortality. The policy was trained on data from 2015 to 2018 and evaluated on a held-out set of hospitalizations from 2019, in terms of estimated reduction in mortality compared to clinician behavior. The final study cohort included 36,570 hospitalizations. The learned treatment policy was based on 60 states: the policy deferred to clinicians in 36 states, recommended the majority action in 22 states, and diverged significantly from clinician behavior in 2 of the states. Among the cases where the policy meaningfully diverged from the behavior policy, the learned policy was estimated to significantly reduce the mortality rate from 3.8% to 2.2% by 1.6% (95% CI 0.4-2.7; P=.006). We applied our pipeline to the clinical problem of loop diuretic treatment, highlighting the importance of robust state representation and thoughtful policy selection and evaluation. Our work reveals areas of potential improvement in current clinical care for loop diuretics and serves as a blueprint for using offline RL for sequential treatment selection in clinical settings.
13. Using SCORE2 with a risk chart or online calculator: Impact on model performance, treatment eligibility and cardiovascular disease prevention.
期刊: European heart journal. Quality of care & clinical outcomes 发表日期: 2025-Oct-10 链接: PubMed
摘要
Current European Cardiovascular Disease (CVD) prevention guidelines recommend 10-year risk assessment using the SCORE2 model to identify individuals eligible for preventive treatment. Risk can be estimated using conventional risk charts or online calculators, though these methods may differ in precision and treatment classification. Individuals without established CVD or diabetes mellitus were included from CPRD (United Kingdom, Europe’s low risk region, n=977,616) and HAPIEE (Czech Republic and Poland, high risk region and Lithuania, very high risk region, n=11,739). During median 8.4 years (IQR 5.0-10.4), 22,898 CVD events occurred. SCORE2 risk was estimated via two methods: an online calculator (unrounded SCORE2 algorithm) and risk charts from the 2021 ESC Prevention Guidelines. Predicted risks were higher with the risk charts than with the online calculator. In the low risk region, the median 10-year risk was 4.0% (IQR 2.0-6.0) with the risk charts versus 3.7% (IQR 2.3-5.8) with the calculator. In the high/very high-risk region, risk was 9.0% (IQR 5.0-15.0) and 8.4% (IQR 4.5-13.9), respectively. Chart-based risk assessment resulted in higher treatment eligibility (6.3% versus 4.0% in the low risk region; 51% versus 43% in high/very high risk region). Discrimination was higher with the online calculator: difference in C-statistic +0.010 (95%CI 0.008-0.012) in low risk region, +0.008 (95%CI 0.005-0.010) in high/very high risk region. Calibration was adequate for both approaches. Assuming a 50% relative risk reduction for preventive treatment, this corresponded to 53 vs. 46 events prevented per 1000 treated in the low-risk region and 80 vs. 74 in the high/very-high-risk region (calculator vs. risk charts). Risk assessment using SCORE2 risk charts yields too high predicted risks and too broad treatment eligibility. By avoiding rounding of risk factors, the online calculator shows better discrimination.
14. Lactic acid produced by optimal vaginal Lactobacillus spp. potently and specifically inactivates HIV-1 in vitro by targeting the viral RNA genome and reverse transcriptase.
期刊: PLoS pathogens 发表日期: 2025-Oct-10 链接: PubMed
摘要
Vaginal microbiota modulates susceptibility to sexually transmitted infections and produces carboxylic acid metabolites that have antimicrobial activity; however, their activity against viral sexually transmitted infections is not well defined. We determined the HIV-1 virucidal activity of lactic acid (LA), short chain fatty acids (SCFAs), and succinic acid, representing conditions observed in women with an optimal Lactobacillus-dominated vaginal microbiota compared to women with bacterial vaginosis. Virucidal activity against enveloped HIV-1 and HSV-2, the non-enveloped HPV16, and the mechanism by which LA inactivates HIV-1 was further assessed. LA was > 10-fold more potent at inactivating an HIV-1 transmitted/founder strain than SCFAs and succinic acid when tested at an equivalent 20 mM of protonated acid (p≤0.05). While LA decreased HIV-1 infectivity by >103-fold, virions were intact, expressed a similar gp120:p24 ratio, and showed only a 2-fold decrease in CD4 binding compared to untreated HIV-1 (p≤0.05). Treatment of recombinant gp120 with LA revealed no major conformational changes by small angle X-ray scattering. LA treatment of HIV-1 resulted in an 80% decrease in virion-associated reverse transcriptase activity compared to untreated virus (p < 0.01), which was more potent than acetic acid or HCl-adjusted media at the same pH, with this effect observed in the presence of cervicovaginal fluid. LA decreased HIV-1 virion-associated RNA levels by ∼50% compared to untreated virus (p < 0.001), acetic acid or HCl acidified media. In contrast, HSV-2 virucidal activity of LA was similar to acetic acid and HCl-acidified media while HPV16 was acid-resistant. Our results demonstrate LA’s potent and specific HIV-1 virucidal activity compared to SCFAs and succinic acid found in the female reproductive tract, and its HIV-1 virucidal mechanism mediated by penetration of the viral membrane and core to target a key viral enzyme and nucleic acid. These findings have implications for the vaginal transmission of HIV to partners and neonates during birth.
15. Detection of dengue, malaria, and additional causes of acute febrile illness: The need for expanded testing, Bayelsa State, Nigeria.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Oct-10 链接: PubMed
摘要
Dengue virus (DENV) infection has not been previously reported from Bayelsa State, Nigeria. We aimed to determine the prevalence of dengue virus (DENV) infection, malaria, and coinfection, and other pathogens among febrile patients in the capital city, Yenagoa.We conducted a cross-sectional study among persons aged ≥1 year who presented with acute febrile illnesses (AFI) at four hospitals in Bayelsa State during 20 May - 15 June 2022. Blood samples from 443 participants were tested for DENV seromarkers (NS1, IgM, IgG), using serology and RT-PCR, and malaria was diagnosed by thick smear microscopy. Sociodemographic and risk factor data were collected using electronic questionnaires administered via smart phones/tablets and analyzed using univariate and multivariate methods. Metagenomic libraries were prepared and enriched by viral target capture and sequenced by NGS. The seroprevalence of acute DENV infection was 14.5% (n = 64) while the prevalence of malaria was 42.4% (n = 188); 6.5% (n = 29) of participants were coinfected with acute DENV infection and malaria. An additional 17.6% (n = 78) of participants had markers for past DENV infection. Rural/suburban residence and age ≥ 31 years were significantly correlated with having any dengue seromarker. Residence in a larger household (≥5 persons), and borehole water-use were predictors for malaria fever. RT-PCR results revealed multiple DENV serotypes, with serotype 3 dominant. Sequencing of unknown AFI cases revealed numerous viral causes such as adenovirus, EBV, and hepatitis A, as well as additional dengue and malarial infections missed by conventional testing. Of interest were Coxsackievirus A5 (hand, foot and mouth disease; HFMD) which has been diversifying locally for years in Nigeria and an mPox clade IIb (lineage A.2.3) strain that emerged in Nigeria during the 2022 global outbreak. The results of this study provide the first documentation of human DENV infection in Bayelsa State, Nigeria and suggests that dengue is an emerging and important cause of febrile illness in this area. Our findings support the need for routine testing to identify DENV among patients who present with acute febrile disease. Metagenomic NGS results highlight the benefits of unbiased surveillance to identify circulating and emerging pathogens.
16. Smartphone App-Based Survey Deployment Patterns and Longitudinal Response Rate: Randomized Controlled Trial.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-10 链接: PubMed
摘要
Survey fatigue is a common challenge in longitudinal studies, particularly when using smartphone apps to collect survey data. Evidence-based strategies are needed to maintain longitudinal response rates. This study aims to evaluate the effect of a more frequent smartphone-administered survey deployment strategy with smaller survey batches on participant response rates over an extended period. We conducted a randomized controlled trial (NCT04752657) embedded in the electronic Framingham Heart Study cohorts between June 2021 and December 2023. Participants were randomly allocated to receive a full set of surveys every 4 weeks (control group) or half of the survey set biweekly, such that the full set is completed every 4 weeks (experimental group). Randomization was stratified by age (≤75 y vs >75 y) and phone type (Android vs iPhone). Married couples were assigned to the same group using a blocked randomization approach. The primary outcome was the proportion of surveys returned per participant assessed longitudinally across four periods (baseline to wk 8, wk 8-16, wk 16-24, and wk 24-32), with 19, 17, 16, and 15 unique surveys deployed, respectively. We used mixed-effects regression models with random intercepts to compare the repeated outcome between groups. Stratified analyses by age and sex were performed. Among 492 participants (mean age 74, SD 6.3 y; 58%, n=284 women, 84%, n=413 non-Hispanic White), there was evidence that the experimental group had higher response rates over time compared to the control group (P=.003 for interaction between deployment pattern and time). Both groups showed similar proportions of surveys returned during the first period (75% vs 76%). The experimental group had higher response rates than the control group in subsequent periods (70% vs 67% in wk 8-16, 64% vs 59% in wk 16-24, and 58% vs 50% in wk 24-32). The proportion of participants not returning any surveys increased from 3% to 38% in the control group compared to 1% to 28% in the experimental group across the four time periods. Stratified analyses revealed that among younger participants (≤75 y), the experimental group showed 12% higher survey response rates compared to the control group in the final period, while the difference was minimal among older participants (>75 years). The effect of the deployment pattern was similar for men and women. Three-way interaction analyses revealed no significant differences in the deployment pattern effect over time by age group (P=.95) or sex (P=.65). Administering half of the surveys every 2 weeks, as compared to all surveys every 4 weeks, was associated with higher maintained longitudinal survey response rates. This strategy may help mitigate survey fatigue and improve data quality in digital health studies. ClinicalTrials.gov NCT04752657; https://clinicaltrials.gov/study/NCT04752657.
17. Just-in-Time Adaptive Intervention to Improve HIV Prevention and Substance Use in Youth Experiencing Homelessness (MY-RIDE): Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Oct-10 链接: PubMed
摘要
Youth who are experiencing homelessness face a higher risk of HIV infection compared to their housed peers, and suicide and overdose remain the leading causes of death among homeless youth. Just-in-Time Adaptive Interventions (JITAIs) are gaining momentum for HIV prevention and substance use research. Yet, most interventions for homeless youth have not addressed modifiable real-time factors. This paper describes the development and implementation of a randomized attention-controlled trial to assess the efficacy of motivating youth to reduce infections, disconnections, and emotional dysregulation (MY-RIDE), a JITAI to improve HIV prevention and substance use in homeless youth. This study will enroll 320 homeless youth aged 18-25 years. The intervention was co-designed with homeless youth using the Information-Motivation-Behavioral Skills Model and consists of an individual nurse-led session about HIV prevention and 3 months of a JITAI with personalized messaging delivered by phone in real time in response to one’s current level of risk. Participants also had access to an on-demand nurse helpline through the app. Institutional review board approval was obtained in the summer of 2024. Recruitment began in the fall of 2024 at shelters, drop-in centers, and other organizations that serve homeless youth. Participants complete a baseline survey and HIV/sexually transmitted infection (STI) testing and are provided with a smartphone with the intervention app. Follow-up surveys and HIV/STI testing are conducted at immediate, 3-, 6-, and 12-month time points post intervention to assess uptake of HIV prevention strategies and substance use reduction. A total of 192 are enrolled to date. The results of this study will determine whether MY-RIDE increases HIV prevention strategies and decreases substance use when compared to homeless youth in the attention control group. We will also evaluate if MY-RIDE impacts protective factors such as willingness to take pre-exposure prophylaxis medication and use of mental health and substance use services, and antecedents of risk such as stress, substance use urge, and substance use. Clinicaltrials.gov NCT06074354; https://clinicaltrials.gov/study/NCT06074354. DERR1-10.2196/78006.
18. Promoting Healthier Meal Selection and Intake Among Children in Restaurants: Protocol for a Cluster-Randomized Trial.
期刊: JMIR research protocols 发表日期: 2025-Oct-10 链接: PubMed
摘要
US children’s diets are high in calories and are of poor nutritional quality, and a likely contributing factor is the consumption of food from restaurants. While children readily accept the sweet and salty foods that characterize restaurant children’s menus, research shows that their taste preferences are malleable, and regular exposure to healthier foods can promote their acceptance. We describe a cluster-randomized controlled trial testing the effects of behavioral intervention strategies (choice architecture and repeated exposure) on ordering and dietary intake among children in restaurants and present baseline demographic data for the study cohort. Six locations of a regional quick-service restaurant chain were randomized to the intervention or control group in pairs based on income in surrounding census tracts. Families with children aged 4 to 8 years were recruited and asked to complete 8 visits to the study restaurant, including a baseline assessment completed at the time of enrollment, followed by 6 visits during a designated 2-month exposure period and a final posttest assessment. Intervention content provided to intervention group families after baseline assessments includes placemats promoting 2 healthier kids’ meals and the opportunity to redeem their kids’ meal “cone token” for a toy instead of a dessert (choice architecture strategies). In addition, participating families receive frequent diner cards, which can be used to earn a free kids’ meal after purchasing a promoted kids’ meal 6 times (repeated exposure strategy). Families in control restaurants receive generic versions of these materials (eg, frequent diner cards that can be redeemed for a free kids’ meal after purchasing any 6 kids’ meals). The primary outcome is the meal ordered for the child at a posttest restaurant visit following the exposure period (ie, whether or not a promoted meal was ordered). Additional order data will include calories, saturated fat, sodium, and sugar content of children’s orders at posttest. Other outcomes include children’s in-restaurant and daily consumption of calories, saturated fat, sodium, and sugar. This study was funded in 2019, with preregistration completed in 2020, data collection occurring from June 2021 to November 2024, and data processing, analysis, and primary outcome manuscript preparation in 2025-2026. A total of 236 families provided baseline data on children’s orders and comprise the study cohort; 234 of these families provided demographic data (n=184, 78.3% female parents; n=133, 56.8% female children; child mean age 6.5, SD 1.3 years). Given that restaurants are normative eating contexts for many children, this intervention has the potential to impact children’s dietary intake and health. If found to be successful, future directions could include scaling the current intervention approach and conducting further effectiveness, implementation, and dissemination research to understand its applicability and impact across different types of restaurants and sociodemographic contexts. ClinicalTrials.gov NCT04334525; https://clinicaltrials.gov/study/NCT04334525. DERR1-10.2196/73618.
19. Metabolic dysfunction-associated steatotic liver disease, insulin resistance and hepatocellular carcinoma: A deadly triad.
期刊: European journal of clinical investigation 发表日期: 2025-Oct-10 链接: PubMed
摘要
Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a leading cause of chronic liver disease worldwide, driven by the increasing prevalence of obesity and insulin resistance (IR). IR, a central feature of the metabolic syndrome, promotes hepatic lipid accumulation, inflammation and mitochondrial dysfunction, fostering the transition from steatosis to advanced liver injury and hepatocellular carcinoma (HCC). This review summarizes current evidence on the molecular mechanisms linking MASLD, IR and HCC, highlighting the role of insulin resistance in liver carcinogenesis and disease progression. A comprehensive literature search was conducted to identify experimental, clinical and epidemiological studies addressing the interplay between MASLD, IR and HCC. Key molecular pathways and risk profiles were synthesised and compared across etiologies. IR contributes to hepatic lipid deposition, oxidative stress and chronic inflammation through activation of PI3K/Akt and mTOR signalling. The coexistence of MASLD and IR enhances pro-inflammatory and pro-fibrotic pathways, accelerating the evolution to HCC. Patients with MASLD-associated HCC exhibit distinct metabolic and molecular characteristics compared with those with viral or alcohol-related HCC. Novel biomarkers and advanced imaging modalities show promise for identifying high-risk individuals at earlier disease stages. Although substantial progress has been made in understanding the MASLD-IR-HCC axis, critical gaps remain regarding genetic, environmental and metabolic determinants. A multidisciplinary approach integrating metabolic, molecular and oncologic research is essential for improving early detection, risk stratification and the development of targeted therapies against metabolic liver cancer.
20. Is Assisted Home Dialysis Feasible In the US? Addressing Legislative and Regulatory Levers.
期刊: Clinical journal of the American Society of Nephrology : CJASN 发表日期: 2025-Oct-10 链接: PubMed
摘要
21. Linking Order of RAX and OTX2 Following CRX in Polycistronic Vectors Can Partially Determine Efficacy of Direct Conversion to Photoreceptor-like Cells In Vitro.
期刊: Cell biochemistry and biophysics 发表日期: 2025-Oct-10 链接: PubMed
摘要
22. GSH1 plays a crucial role in melatonin-mediated cadmium tolerance in Arabidopsis.
期刊: Plant cell reports 发表日期: 2025-Oct-10 链接: PubMed
摘要
GSH1 functions the downstream of SNAT-mediated melatonin in Cd tolerance, increasing glutathione and total PCs contents. Melatonin is a multifunctional signaling molecule involved in mitigating the damage caused by cadmium (Cd) stress in plants. Previous studies suggested that the gene encoding serotonin N-acetyltransferase (SNAT) was the key gene in the melatonin biosynthetic pathway. Besides, glutathione (GSH) contributed to plant Cd tolerance, however, the specific role of SNAT-mediated melatonin biosynthesis in regulating GSH-dependent pathway, and whether GSH1 acts as an essential downstream effector, remain undefined. Here, we found that SNAT modulated the endogenous melatonin content and Cd stress response in Arabidopsis. Under Cd stress, SNAT-overexpressing roots accumulated higher melatonin levels and exhibited enhanced Cd tolerance with increased root elongation and fresh weight, whereas the atsnat mutant displayed reduced melatonin and hypersensitivity to Cd compared to wild-type. Furthermore, GSH levels were significantly higher in SNAT-overexpressing plants but not in the atsnat mutant upon Cd stress. Treatment with L-buthionine-(S,R)-sulfoximine (BSO, a GSH biosynthesis inhibitor), significantly decreased GSH levels across all genotypes. Exogenous melatonin failed to rescue Cd hypersensitivity in GSH1 mutant atcad2-1, which was defective in GSH biosynthesis. Genetic and transcriptional analyses further confirmed that GSH1 might be, at least partially, a downstream target of melatonin signaling to mediate Cd tolerance through GSH metabolism. Collectively, these findings highlight the critical role of the GSH1-mediated GSH accumulation in SNAT-dependent melatonin-enhanced plant tolerance to Cd stress. This advances current understanding by identifying GSH1 as a critical node integrating melatonin and heavy metal tolerance pathways.
23. Rinderine suppresses African swine fever virus replication in porcine alveolar macrophages by dual targeting of membrane-associated profilin 1 and phosphatidylethanolamine.
期刊: Emerging microbes & infections 发表日期: 2025-Oct-10 链接: PubMed
摘要
African swine fever (ASF) is a highly contagious disease caused by African swine fever virus (ASFV), posing a serious threat to the global pig industry. Natural small molecules have been reportd to exhibit anti-ASFV potential. This study utilized the previously established high-throughput platform for screening ASFV inhibitors to identify rinderine (RIN), a pyrrolizidine alkaloid that not only significantly inhibits ASFV replication but also maintains sustained anti-ASFV activity at 24, 48, and 72 hours postinfection. Moreover, RIN mainly suppresses the early stages of ASFV replication, particularly by inhibiting ASFV attachment to primary porcine alveolar macrophages (PAMs). Mechanistically, mass spectrometry based cellular thermal shift assay, further experimental validation and molecular docking analysis indicate that profilin 1 (PFN1) is a key target protein mediating the inhibitory effects of RIN on ASFV attachment to PAMs. Structural prediction analysis, co-immunoprecipitation assay, and confocal microscopy demonstrate that RIN disrupts the interaction between PFN1 and actin, thereby decreasing actin remodeling. Notably, untargeted metabolomics profiling and further experiments reveal that RIN reduces the phosphatidylethanolamine level derived from the glycerophospholipid metabolism pathway and decreases the membrane permeability of PAMs, contributing to its anti-ASFV activity. In conclusion, integrative proteomics and untargeted metabolomics analyses demonstrate that RIN exerts the antiviral effects against ASFV primarily by targeting proteins and metabolites associated with cell membrane formation and function, providing a novel insight into the prevention and control of ASF.
24. Primary and Secondary Stroke Prophylaxis in Children with Sickle Cell Anemia: A Meta-Analysis.
期刊: Blood advances 发表日期: 2025-Oct-10 链接: PubMed
摘要
We conducted a pooled analysis to evaluate the effectiveness of hydroxyurea (HU), chronic blood transfusions (CBT), myeloablative allogeneic hematopoietic stem cell transplants (HCT) with a matched related donor, and revascularization surgery (RVS) in children with sickle cell anemia (SCA). We compared the interventions with no therapy for primary and secondary stroke prevention. The Medline and EMBASE databases were searched for articles that included six or more patients published before January 2025. Four reviewers reviewed all studies to arrive at a consensus assessment. The stroke rates for primary stroke prevention in children with transcranial Doppler measurement > 200 cm/sec were per 100 person-years: no therapy, 10.7; after initial HU, 1.0; after initial CBT, 1.0. The stroke recurrence rates for secondary stroke prevention per 100 person-years were 19.6 after no therapy, 3.5 after initial HU, 2.7 after initial CBT, 1.0 after HCT, and 3.3 after RVS. Neither the HCT nor the RVS study adjusted for time-dependent stroke recurrence rate, resulting in an overestimation of their therapeutic benefit compared to the stroke recurrence rates before the intervention. In low-middle-income countries (LMICs), where approximately 99% of all children with SCA are born, the stroke recurrence rate in untreated children in the first year was 36.4 to 51.4 strokes per 100 person-years, in two studies; in the only randomized controlled trial of HU, 38% of children died within the first year. For children in LMICs where local hydroxyurea costs < $0.20 per day, HU is a practical, inexpensive option for primary and secondary stroke prevention.
25. The gut as a source of infection for fungal pathogens: increased fecal Candida albicans precedes onset of Candida late-onset sepsis in very preterm infants.
期刊: The Journal of infectious diseases 发表日期: 2025-Oct-10 链接: PubMed
摘要
The skin-to-blood route is traditionally considered the main pathway in Candida late-onset sepsis (LOS) development in preterm infants. However, emerging evidence suggests that the gut also serves as a source of infection. We aimed to characterize fecal mycobiota and microbiota profiles preceding onset of Candida LOS to assess the role of the preterm gut microbiome in disease development. In this multicenter, case-control study, very preterm infants (<30 weeks of gestation) with Candida LOS were included. Each case was matched to non-affected controls by gestational and postnatal age, hospital site, and/or cumulative antibiotic exposure prior to day of LOS onset (t=0). Fecal samples collected at t=0 and the five preceding days were analyzed using ITS1 and 16S RNA sequencing. Microbial amplicon yields, composition, and inter-kingdom correlations were assessed. Of 2,397 screened infants, fecal samples were available for 8/19 infants with Candida LOS. In these 8 cases, the ITS/16S amplicon yield ratio was increased (p<0.001) and the relative abundance of fecal Candida albicans correlated positively with fungal amplicon yield (ρ=0.71, padj=0.005), suggesting increased absolute abundance up to five days before onset. Additionally, bacterial yields were significantly lower (p=0.02) and α-diversity was significantly decreased (p=0.012), compared to the controls. Increased fecal C. albicans preceded Candida LOS onset, implicating the preterm gut as a potential source of infection. Reduced bacterial yields and diversity suggest ecological alterations that may facilitate Candida pathogenicity in the preterm gut. These findings support further research into gut-derived Candida LOS and potential for microbiota-targeted prevention strategies.
26. E-Commerce Growth Reduces Primary PM2.5 Emissions but Increases Secondary PM2.5 Precursors in China.
期刊: Environmental science & technology 发表日期: 2025-Oct-10 链接: PubMed
摘要
The rapid shift from traditional in-store to online shopping has raised critical questions about its environmental trade-offs, particularly regarding air pollution─a key contributor to public health risks and climate change. Despite growing concerns, incomplete assessments have hindered the development of effective emission mitigation strategies for the retail sector. In this study, we compiled a comprehensive air pollutant emission inventory for shopping activities in China from 1990 to 2023, comparing in-store and online shopping methods. Our analysis reveals that online shopping reduces PM2.5 emissions from the retail sector by 19% (0.013 g item-1 vs 0.031 g item-1), primarily due to the greater efficiency of courier deliveries compared to consumer travel to stores. However, emissions of secondary PM2.5 precursors (NOx, SO2, NMVOCs) increase substantially─by 49, 270, and 30%, respectively─driven by air freight use and overpackaging. Targeted strategies, such as shifting from consumer vehicles to walk and cycling, replacing air freight with high-speed railway freight, and adopting reusable packaging, could mitigate these impacts. Implementing these measures is essential for advancing sustainable retail practices amid the growth of E-commerce.
27. Feasibility of a ctDNA multigenic panel for non-small-cell lung cancer early detection and disease surveillance.
期刊: Molecular oncology 发表日期: 2025-Oct-10 链接: PubMed
摘要
The detection of actionable mutations in liquid biopsies is a crucial tool for precision oncology in patients with non-small-cell lung cancer (NSCLC). We evaluated actionable alterations using a multigene panel in circulating tumor DNA (ctDNA) from Brazilian NSCLC patients. We analyzed 32 samples from 30 patients with NSCLC, including four samples from a lung cancer screening program. ctDNA isolation and library preparation were performed using the Oncomine Lung cfDNA Assay, which covers 11 actionable genes, and sequenced on an Ion S5 Sequencer. The IonReporter 5.20 software was used for variant calling. Median read coverage reached 80 967, with a detection limit of 0.1%. TP53 (40.6%), KRAS (28.1%), and EGFR (12.5%) were the most frequently mutated genes, particularly in patients who had previously received treatment. BRAF, MAP2K1, PIK3CA, and ALK mutations were observed at lower frequencies (6.2%, 3.1%, 3.1%, and 3.1%, respectively). The EGFR p.T790M mutations related to resistance were identified in a patient who had been previously treated, and the TP53 p.R248Q mutation was discovered in an asymptomatic patient before diagnosis. No variants were observed in NRAS, ROS1, and MET genes. Our data showed that this commercial NGS panel could detect actionable mutations, enabling early detection, treatment monitoring, and disease surveillance.
28. The Mediation Role of the Placental IGF1 Signaling Pathway on Associations between Prenatal PFAS Exposure and Adverse Birth Outcomes: Evidence from Serial Mediation Models.
期刊: Environmental science & technology 发表日期: 2025-Oct-10 链接: PubMed
摘要
Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) is associated with adverse birth outcomes, yet mechanistic pathways remain unclear. We measured 32 maternal serum PFAS (including their alternatives and isomers) and quantified placental mRNA levels of insulin-like growth factor 1 (IGF1), the IGF1 receptor (IGF1R), and the insulin receptor (INSR), alongside serum IGF1 and insulin levels, in 285 mother-infant pairs from the Maoming birth cohort. We applied simple, serial, and moderated mediation models to investigate placental IGF1 signaling as a mediator of PFAS-related preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA). Simple mediation showed placental IGF1R mediated 15.08%-41.18% of associations between perfluorooctanesulfonate (PFOS) isomers and PTB (odds ratios [ORs-total effect]: 1.06-1.10), LBW (ORs: 1.05-1.10), or SGA (ORs: 1.05-1.10). Serial mediation identified a sequential pathway: PFOS exposure correlated with altered IGF1 expression, followed by IGF1R changes, and subsequent associations with PTB (ORs: 1.01-1.02), LBW (ORs: 1.01-1.02), and SGA (ORs: 1.01-1.02). Moderated mediation highlighted serum IGF1 and insulin as modifiers of these relationships. Molecular docking demonstrated preferential binding of branched PFOS to IGF1R’s ligand-binding domains. This study integrates advanced mediation frameworks and molecular evidence to demonstrate that placental IGF1 signaling mediates PFAS-related adverse birth outcomes, elucidating mechanisms of developmental toxicity.
29. Evaluation of an Autonomous Robotic System for Reducing Radiation Risk in a Real-World Cardiac Imaging Laboratory.
期刊: Journal of medical systems 发表日期: 2025-Oct-10 链接: PubMed
摘要
Nuclear imaging is the cornerstone of clinical practice across many disciplines. Few innovations in imaging have addressed occupational health of radiographers exposed to radiation in their daily work. In this proof-of-concept study, we hypothesized that the use of autonomous robots in a high-volume Myocardial Perfusion Imaging (MPI) clinic to help reduce radiation risk for radiographers. After initial assessment of the radiographer’s workflow, an autonomous robot was set up to navigate and deliver radiotracer doses between the radio pharmacy and the injection room. 8 radiographers were briefed on robot usage and allowed to use the robot for their daily operations. Radiation exposure was measured as part of the regular bi-monthly Thermoluminescent Dosimeter (TLD) dose tracking. Radiation exposure before and after robot implementation were compared to assess whether the implementation of the autonomous robot significantly reduced radiation exposure for the radiographers. We observed a significant reduction in mean bi-monthly radiation exposure following the implementation of the autonomous robot. The mean radiation dose decreased from 0.67 mSv (95% CI: 0.60-0.74) pre-implementation to 0.49 mSv 95% (CI: 0.44-0.54) post-implementation, corresponding to a relative reduction of approximately 27%. A Bayesian independent t-test revealed strong evidence for this reduction, with Bayes Factors (BF10) of 17.04 for skin dose and 17.76 for whole-body dose, supporting the hypothesis that the autonomous robot effectively reduced radiation exposure among radiographers. In this study, we provided a proof-of-concept on the use of autonomous robots in a MPI clinic as an additional tool to help radiographers manage radiation risk in their work. The innovations in technologies could expand the strategies available for managing occupational radiation risks in alignment with as low as reasonably achievable (ALARA) principles. Future work on scalability across diverse clinical and operational contexts would be next steps.
30. Silica nanoparticles trigger striatal oxidative stress, apoptosis, and histopathological alterations: in vivo and in silico molecular docking insights.
期刊: Histochemistry and cell biology 发表日期: 2025-Oct-10 链接: PubMed
摘要
Humans are increasingly exposed to silica nanoparticles (SiNPs) from environmental and occupational sources, raising significant concerns about their safety. Despite growing applications, data on their neurotoxic effects, particularly those involving oxidative/nitrosative imbalance and striatal damage, remain limited. This study aimed to elucidate the mechanisms of SiNP-induced neurotoxicity in the striatum, a brain region crucial for motor control and learning, using a rat model. Subacute intraperitoneal administration of SiNPs (25 and 100 mg/kg bw/day for 28 days) resulted in a marked increase in lipid peroxidation (LPO), reactive oxygen species (ROS), nitrite (NO), and protein carbonyl content, alongside a significant reduction in the activity of antioxidant enzymes, viz. superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), as well as glutathione (GSH). Additionally, cholinergic [acetylcholinesterase (AChE) and b1utyrylcholinesterase (BChE)] and membrane-bound adenosine triphosphate (ATP)ase (Na+/K+, Mg2+, and Ca2+ ATPase) activities were significantly reduced in the striatum. Immunofluorescence and immunohistochemistry revealed elevated expression of antioxidant markers, particularly nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1). Quantitative reverse-transcriptase real-time polymerase chain reaction (qRT-PCR) analysis demonstrated upregulation of pro-apoptotic genes (Bax, p53, caspase-9/3) and downregulation of the anti-apoptotic gene Bcl-2, leading to an increased Bax/Bcl-2 ratio. Complementary in silico molecular docking studies showed that SiNPs exhibit notable binding affinities toward Nrf2, HO-1, AChE, and BChE. Collectively, these findings indicate that SiNPs induce striatal neurotoxicity via oxidative/nitrosative stress-mediated apoptosis, involving activation of Nrf2/HO-1, cholinergic disruption, and apoptotic signaling pathways.
31. Environmental Noise Exposure and Risk of Cancer: A Systematic Review and Meta-Analysis.
期刊: Current environmental health reports 发表日期: 2025-Oct-10 链接: PubMed
摘要
Environmental noise has been identified as a risk factor for cardiovascular and metabolic outcomes. Its association with cancer risk remains poorly understood. This systematic review (on evidence up to February 2025) is to synthesize and meta-analyze the epidemiological evidence. The studies involved over ten million participants, predominantly from Europe. The most reported outcomes were breast and colorectal cancers, with road traffic noise exposure being the most frequently assessed exposure. The pooled random-effects estimates indicated null association between road traffic noise and breast cancer incidence (RR 1.01; 95% CI 0.99-1.03) or mortality (RR 0.98; 95% CI 0.86-1.10), nor with colon cancer subtypes. Studies risk of bias was high to probably high, particularly in exposure assessment and confounding control. Overall, the available evidence does not support an association between traffic noise and cancer incidence or mortality. However, the certainty of evidence is very low due to methodological heterogeneity, high risk of bias, and the limited number of studies for most cancer sites.
32. Suicide deaths among dentists in the United States.
期刊: Journal of the American Dental Association (1939) 发表日期: 2025-Oct-10 链接: PubMed
摘要
Dentists experience myriad occupational stressors and are known to have an elevated risk of suicide. Previous US studies focused on suicide among White male dentists, and all studies were published before 2000. This study aimed to assess suicide mortality among male and female US dentists, to evaluate methods of suicide, and to examine trends over time. Data on US dentists who died from 1979 through 2018 were provided by the American Dental Association and matched to the National Death Index. Decedents who died by intentional self-harm were identified, and proportionate mortality ratios (PMRs) indirectly standardized for age, sex, race, and 5-year calendar period with 95% CIs were calculated using the Life Table Analysis System (National Institute for Occupational Safety and Health). Suicide methods and trends over time were also analyzed. Of 21,928 eligible decedent records, 475 (2.2%) deaths were caused by suicide, with PMRs of 2.01 (95% CI, 1.83 to 2.21; P < .001) for male dentists and 2.15 (95% CI, 1.23 to 3.49; P = .009) for female dentists. Firearms were the predominant suicide method for male dentists (61.4%), but female dentists were split between firearms (31.3%) and hangings (31.3%). PMRs for suicide increased steadily for male and female dentists since 1995. From 1979 through 2018, US male and female dentists exhibited higher suicide mortality than the general population, with a steady increase since 1995. Dentist suicide prevention resources may be beneficial, particularly addressing occupational stressors. Reducing stigma and enhancing access to mental health services could lessen the risk of suicide for dental care professionals.
33. Perceptions of a mindfulness-based cognitive therapy intervention: Focus group findings examining acceptability for African Americans with epilepsy.
期刊: Epilepsy & behavior : E&B 发表日期: 2025-Oct-09 链接: PubMed
摘要
Depression commonly co-occurs in people with epilepsy (PWE). Reducing depression in PWE may contribute to improved quality of life and outcomes. Project UPLIFT, a distance-delivered, mindfulness-based cognitive therapy program has reduced depressive symptoms among PWE. Little is known about the acceptability of the program among African Americans with epilepsy. Thus, we conducted a formative evaluation to assess African Americans’ cultural adaptation needs and to identify any associated required changes. Focus groups of African Americans with epilepsy and support persons to African Americans with epilepsy were conducted to elicit suggestions for program adaptation. Participants received the intervention materials prior to the focus group. Using a semi-structured guide, we asked about their perceptions of Project UPLIFT. The focus groups were recorded and transcribed. We used thematic analysis to explore acceptability of Project UPLIFT for African Americans with epilepsy. There were 6 focus groups with 4 of PWE (n = 22) and 2 of support persons (n = 13). Participants affirmed the acceptability and perceived effectiveness of Project UPLIFT. With affirming acceptability, they liked aspects of the program and suggested minimal changes. Participants were willing to try the activities and identified the content as true to their experience. With perceived effectiveness, they described variations in experiences and highlighted the value of group-based delivery. Project UPLIFT, as presented in previous trials, appears acceptable, and of interest, to African Americans with epilepsy. These results support testing the efficacy of this intervention in reducing depression among African Americans with epilepsy.
34. Psychometric Testing of the Brief Illness Perception Questionnaire in the Context of Chronic Illness Self-care Among Thais With Chronic Illnesses.
期刊: The Journal of cardiovascular nursing 发表日期: 2025-Oct-09 链接: PubMed
摘要
Illness perception plays a crucial role in chronic illness self-care; however, its assessment among Thais with chronic conditions remains limited. The Brief Illness Perception Questionnaire (BIPQ) is a concise measure, but its psychometric properties require validation in this population. The aim of this study was to evaluate the psychometric properties of the BIPQ and its relationship to self-care measures. This methodological, and cross-sectional study analyzed data from 407 Thais with chronic conditions recruited across multiple primary healthcare centers. The BIPQ was translated and cross-culturally adapted following the ISPOR Task Force for Translation and Cultural Adaptation guideline. Structural validity was assessed using exploratory and confirmatory factor analyses. Hypothesis testing was conducted to examine the associations between self-care measures, along with known-group comparisons. Reliability was evaluated using internal consistency, test-retest reliability, and measurement error analysis. Both exploratory and confirmatory factor analyses supported a 2-dimensional structure comprising pessimistic and optimistic dimensions. Significant correlations between BIPQ scores and the Self-Care of Chronic Illness Inventory version 4.c and the Self-Care Self-Efficacy Scale version 3.0 supported construct validity. Known-group analysis demonstrated significant differences in BIPQ scores across demographic and clinical subgroups. The BIPQ demonstrated good internal consistency (McDonald ω = 0.80), test-retest reliability (intraclass correlation coefficient, 0.85), and acceptable measurement error. The BIPQ is a valid and reliable instrument for assessing illness perceptions among Thais with chronic illnesses. Its application may help guide targeted self-care interventions in both clinical and research. Authors of future studies should explore its utility in diverse chronic conditions and cultural contexts.
35. Frequency and Predictors of Adolescent Worry for School Gun Violence in the United States: Findings From a Nationally Representative Study.
期刊: The Journal of adolescent health : official publication of the Society for Adolescent Medicine 发表日期: 2025-Oct-09 链接: PubMed
摘要
While adolescent exposure to school gun violence (SGV) incidents in the United States (U.S.) has risen sharply over the past decade, limited research has examined adolescent worries about SGV. We examined the frequency and correlates of SGV worry in a U.S. nationally representative sample of adolescents. Data were from adolescent participants (14-17 years; N = 1,017) in the 2022 National Survey of Sexual Health and Behavior, a nationally representative study of sexual health experiences of people in the U.S. SGV worry was a single five-point item (not at all worried - extremely worried). We used both weighted descriptive statistics to examine SGV frequency and random intercept mixed effects ordinal regression to examine demographic and background impact on SGV worry. Nearly 75% of adolescents reported some degree of SGV worry; of these, one in five was very or extremely worried. SGV worry was significantly higher for adolescents in younger grades and among racial/ethnic minority youth, as well as for cisgender female and gender minority teens. Adolescents in higher income homes were less worried about SGV. Both teens living in metropolitan locations and teens who reported higher anxiety in the past 2 weeks noted higher SGV worry. The U.S. adolescents have a significant level of worry about SGV. Because there are detrimental long-term impacts of prolonged worry, targeted interventions are important for reaching those who are at greatest worry risk, including lower income, race/ethnic minority, and gender minority teens.
36. Rest-activity rhythms in individuals who separately or concomitantly use cannabis and cigarettes.
期刊: Drug and alcohol dependence 发表日期: 2025-Oct-02 链接: PubMed
摘要
Cannabis use and cigarette smoking, a primary source of nicotine exposure, are prevalent behaviors that frequently co-occur. The independent or interactive effects of cigarette-derived nicotine and cannabis on rest-activity rhythms (RAR) are not well understood. Using data from the 2011-2012 and 2013-2014 cycles of the National Health and Nutrition Examination Survey (NHANES), we tested whether self-reported cigarette and/or cannabis use was associated with RAR-assessed from actigraphy data-in U.S. adults ages 18-59 years old. 5129 participants with valid RAR, as well as cigarette and cannabis use information were included in the analysis. A vast majority of participants reported no use of cannabis or cigarettes (71 %), while 15.7 % consumed only cigarettes, 6.3 % consumed only cannabis, and 6.7 % endorsed dual consumption. Our multiple linear regression models, which were adjusted for (model 1) age, sex, race/ethnicity; (model 2) income, education; (model 3) BMI, alcohol use, and number of prescription medications showed that cigarette use, with or without cannabis co-use, was associated with a decrease in Interdaily Stability (IS) scores. Decreased relative amplitude (RA) scores were associated with respondents who used cigarettes, with or without cannabis use. All exposure categories, including co-use, were associated with decreased Intradaily Variability (IV) scores. Cigarette and cannabis use have varying effects on RAR, with the effects of co-use largely reflecting the influence of cigarettes. Research involving greater specificity regarding substance use exposures is necessary to elucidate the dose related effects of cannabis and cigarette use on RAR.
37. Premalignant Colorectal Adenoma Detection in Individuals with Inherited CDH1 Genetic Mutations: A Single-Institution Experience.
期刊: Southern medical journal 发表日期: 2025-Oct 链接: PubMed
摘要
Pathogenic germline CDH1 variants result in increased risk of gastric (GC) and invasive lobular (ILC) carcinomas with high penetrance. Limited data suggest a higher incidence of colorectal neoplasia in carriers of CDH1 mutations, but data remain limited on the risk of colorectal adenoma formation and the role of colonoscopy in this population. Adult patients who underwent germline testing revealing a pathogenic mutation (PM) or variant of uncertain significance (VUS) in CDH1 were identified and seen in consultation were identified. Clinical and treatment characteristics were analyzed. Thirty-eight patients with CDH1 PM or VUS were identified at a single high-volume cancer center. Median age of CDH1 mutational analysis was 42 years (interquartile range 35-58). The majority of patients had deletion (N = 15, 39.5%) or nonsense (N = 6, 15.8%) mutations or VUS (N = 7, 18.4%). Twenty-six (68%), 20 (53%), and 11 (29%) had a family history of ILC, GC, and colon cancer, respectively. Eighteen (47%) patients underwent screening colonoscopy in addition to screening for GC and ILC; the median age at screening colonoscopy was 51.5 years (interquartile range 46-58) and 4 patients (22%) patients were younger than 45 years of age at the time of colonoscopy. Among patients younger than 45 years of age, the rate of adenoma detection was 50% (n = 2/4). Adenomas were identified in 8 (44.4%) patients, and of these patients, 6 (75%) had right-sided, 4 (50%) had left-sided, and 2 (25%) had both right- and left-sided adenomas. No patients were identified on colonoscopy to have colorectal cancers. When examining only patients with CDH1 PM (N = 31), 16 (51.6%) patients underwent screening colonoscopy, and 8 (50%) patients had adenomas detected. Conversely, of the two of the seven CDH1 VUS patients who underwent screening colonoscopy, neither patient had adenomas detected. The association between inherited CDH1 variants and colorectal neoplasia remains undefined, but the rate of colorectal adenoma detection in this population of patients is significantly higher than that of the general population. Since these individuals already undergo upper endoscopy for their care, consideration of earlier colonoscopy and insurance approval may be warranted.
38. Identifying Axillary Metastases in Patients with T3 Invasive Lobular Carcinoma.
期刊: Southern medical journal 发表日期: 2025-Oct 链接: PubMed
摘要
Axillary lymph node (ALN) metastases are difficult to diagnose in invasive lobular carcinoma (ILC). This study evaluated the use of axillary ultrasound (AUS) and magnetic resonance imaging (MRI) in predicting ALN metastases in patients with ILC tumors >5 cm, who are at high risk of axillary metastases. This is a single-institution, institutional review board-approved, retrospective review of patients with pT3 ILC between 2014 and 2023. Clinicopathologic features, preoperative axillary imaging, surgical pathology, and locoregional or distant recurrence were collected. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. The Kruskal-Wallis (numerical covariables) and χ2 or Fisher exact (categorical covariates) tests were used with significance set at P < 0.05. In total, 139 patients with a mean age of 61 years (range 36-89) were included; all patients underwent AUS and 110 (79.1%) received preoperative MRI. After either AUS or MRI, 93 (66.9%) were classified as having clinical N0 (cN0) disease and 43 (30.9%) as cN1 disease. In total, 49.5% (46/93) cN0 patients converted to pathologic N1-3 (pN1-3) disease after surgery. A total of 43 patients had ALN fine-needle aspiration. Nine patients with negative fine-needle aspiration converted to pN1-3 disease (false negative rate of 25.7%). Despite preoperative AUS and/or MRI, nearly half of the patients with T3 ILC diagnosed as having cN0 disease converted to pN1-3. Both AUS and MRI had low sensitivity and negative predictive value. Our data suggest that current imaging has poor accuracy for axillary metastases in ILC. Surgeons should have a high index of suspicion for axillary disease, despite a negative preoperative evaluation.
39. Molecular Subtypes and Radiotherapy as Determinants of Survival in Invasive Breast Cancer: Insights from a Single-Center Study.
期刊: Southern medical journal 发表日期: 2025-Oct 链接: PubMed
摘要
Invasive breast cancer (IBC) is a heterogeneous disease, with molecular subtypes guiding treatment and prognosis. Radiotherapy, a key component of breast cancer therapy, may vary in efficacy across subtypes. This study assessed the distribution of molecular subtypes and the use of radiotherapy, as well as their associations with clinicopathological features, overall survival (OS), and disease-free survival (DFS) in a single-center cohort. We retrospectively analyzed 178 IBC patients diagnosed between 2018 and 2021. Associations between molecular subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 enriched, triple-negative breast cancer [TNBC]) and clinical features were assessed via χ2 tests. Kaplan-Meier and Cox regression analyses were performed on 158 patients with follow-up, after propensity score matching. Tumor size (P = 0.012), American Joint Committee on Cancer stage (P = 0.004), histological grade (P < 0.001), and chemotherapy (P = 0.016) differed significantly among the four molecular subtypes. OS and DFS varied by subtype (P = 0.024 and P = 0.042), with TNBC showing poorer outcomes than luminal B (OS P = 0.006, DFS P = 0.007) and luminal A (OS P = 0.035). Radiotherapy was associated with improved OS and DFS (P = 0.04 and P = 0.03). Multivariate Cox analysis confirmed radiotherapy as an independent factor for improved OS (hazard ratio 0.112; 95% confidence interval 0.022-0.566) and DFS (hazard ratio 0.129; 95% confidence interval 0.026-0.632). IBC displays molecular subtype-specific differences in tumor behavior and prognosis, with TNBC linked to the worst clinical outcomes. Radiotherapy independently improved OS and DFS across all subtypes, supporting its continued role regardless of molecular profile.
40. Prevalence of Germline Mutations among Young Women with Breast Cancer in Louisiana by Cancer Subtype and Race.
期刊: Southern medical journal 发表日期: 2025-Oct 链接: PubMed
摘要
Black women in Louisiana have an increased breast cancer incidence. In addition, mortality and incidence of breast cancer in younger patients are on the rise, regardless of race or germline mutations. Most available germline mutation data in breast cancer are based primarily on White patient populations. We sought to evaluate the relationship between race, pathogenic germline mutations, and breast cancer subtypes among young women (younger than 40 years old) diagnosed as having breast cancer in Louisiana. We collected and reviewed a 10-year retrospective database from 2012 to 2022 of 773 women younger than age 40 years diagnosed as having breast cancer in a Louisiana-based regional health system. Associations between subtypes and germline mutations were assessed using the χ2 test. In total, 632 patients had available genetics data: 38% of patients with pathogenic germline mutations were Black or African American and 62% were White, 53% of Black or African American patients had a variant of uncertain significance (VUS) vs 47% of White patients. The association between pathogenic germline mutations and triple-negative breast cancer (estrogen receptor [ER]-/human epidermal growth factor receptor 2 [HER2]-) was noted with P = 0.0122. The presence of VUS was not statistically significant when compared with no mutation in the triple-negative cohort (odds ratio [OR] 1.13; 95% confidence interval [CI] 0.70-1.83; P = 0.6224). No statistically significant difference was noted in the prevalence of germline mutations among ER+/HER2- and ER-/HER2+ cancers. Evaluation of the germline mutations demonstrated an association between germline mutation and race (P = 0.0045). VUS was twofold in Black or African American patients compared with no mutation (OR 2.12; 95% CI 1.35-3.34; P = 0.0012). The presence of a pathogenic germline mutation was 1.19 times as common in Black or African American patients compared with no mutation (OR 1.19; 95% CI 0.79-1.79; P = 0.4018]. These data demonstrate that triple-negative breast cancer continues to have a significant association with germline mutations in a young patient population. Pathogenic germline mutations and VUS may be more common in younger Black or African American patients as demonstrated by our research, however.
41. A Silver Lining for Massive Weight Loss Patients with Breast Cancer: A Propensity-Matched Analysis Comparing Abdominal Outcomes after DIEP and Abdominoplasty.
期刊: Southern medical journal 发表日期: 2025-Oct 链接: PubMed
摘要
Patients with a history of massive weight loss (MWL) frequently undergo body-contouring surgery such as abdominoplasty, and the safety profile of this procedure is well accepted. The deep inferior epigastric artery perforator (DIEP) flap is a procedure where excess abdominal tissue is used to reconstruct the breast. The abdominal muscles are preserved by isolating the flap on vascular perforators to the abdominal skin and adipose tissue, whereas in abdominoplasty, the same tissue is removed and discarded. In this study, the abdominal-contouring outcomes of patients who underwent DIEP breast reconstruction following MWL were compared with the abdominal contouring outcomes of those who received abdominoplasty following MWL. A propensity-matched retrospective cohort study was performed comparing MWL patients who underwent either DIEP flap breast reconstruction after breast cancer treatments with mastectomy or abdominoplasty. Patients were matched for multiple preoperative variables. Statistical analysis included an independent-samples t test and the Fisher exact test for univariate analysis and multivariate analysis for predictive variables of postoperative complications. Eighteen patients with a history of MWL who underwent DIEP flaps were matched to 18 patients who underwent abdominoplasty. Patient data for the DIEP cohort were obtained from a database of 314 patients and a total of 484 flaps performed at our institution. Patient data for the abdominoplasty cohort were obtained from a database of 155 patients who underwent abdominoplasty at our institution. Groups differed on body mass index and total body weight loss (P = 0.008 and P = 0.002, respectively), but they did not differ in excess body weight loss (P = 0.094). All abdominoplasty patients and 50% of the DIEP patients had undergone bariatric surgery. Complication rates at the abdominal site were similar between the two groups (DIEP 33% vs body-contouring surgery 39%, P = 0.73). Patients with DIEP procedures were found to have abdominal complication rates similar to those who received standard abdominoplasty. This information can be used by plastic surgeons to counsel MWL patients considering DIEP that their chance of a postoperative abdominal complication is similar to abdominal body-contouring procedures.
42. Procrastination Within the Nursing Context: A Concept Analysis.
期刊: Nursing open 发表日期: 2025-Oct 链接: PubMed
摘要
This study employs Walker and Avant’s concept analysis methodology to systematically define and operationalise procrastination within nursing practice. While ‘procrastination’ is widely cited in behavioural science literature, its definition remains ambiguous in the nursing context. This conceptual uncertainty hampers comparative research and the development of targeted interventions, underscoring the need for conceptual clarification. A literature review guided by Walker and Avant’s eight-step framework. English-language articles published between 2003 and 2025 were retrieved from 11 major databases, including CINAHL Complete, Cochrane, MEDLINE Complete, PubMed, Science Direct, Health Source: Nursing/Academic Edition, Academic Search Complete and PsycARTICLES. Concept analysis was conducted following Walker and Avant’s method. Article screening and data extraction were independently performed by two reviewers, with inter-rater agreement (κ = 0.86). Three defining attributes of procrastination in nursing were identified: (1) a breakdown in self-regulation, (2) awareness of negative consequences and (3) the postponement of planned tasks. In nursing practice, its antecedents include heightened work stress, diminished self-efficacy and compromised personal health and fatigue. The consequences ranged from reduced quality of care and professional burnout to decreased motivation, poor performance and potential harm to patients. This analysis positions procrastination as a multidimensional construct in nursing, characterised by intentional task avoidance that carries significant systemic implications. The clarified conceptual framework offers a foundation for future research and strategies in nursing education, management and policy. These efforts may help mitigate procrastination’s adverse effects on care quality and provider well-being.
43. Why psychiatric bed capacity varies widely: Strategic questions on global mental health.
期刊: PLoS medicine 发表日期: 2025-Oct 链接: PubMed
摘要
A recent PLOS Medicine study reveals the wide variation in psychiatric bed numbers across the US. Globally, capacity differs 80-fold among OECD countries, reflecting history, policy, and care models. Without global standards and access, the efficiency and quality of psychiatric care remain uneven.
44. What influences engagement with a bipolar disorder self-management app? A qualitative investigation of use of the PolarUs app.
期刊: PLOS digital health 发表日期: 2025-Oct 链接: PubMed
摘要
Interventions delivered via smartphone apps may support individuals with bipolar disorder (BD) to learn about and implement evidence-based self-management strategies in the context of their daily lives. However, app usage rates are often suboptimal. The subjective experience of users may provide insights into factors influencing engagement (and disengagement) with an mHealth intervention. The present study describes a qualitative investigation of the experiences of people with BD who participated in the evaluation of a novel app-based intervention for BD self-management, the PolarUs app. Twenty-five individuals with BD were provided with access to an app-based self-management intervention over a three-month study period, and were later interviewed about personal experiences of engagement with the intervention, including attempts to enact self-management strategies. Thematic analysis was used to identify important aspects of the experience of engaging with a self-management app. Three themes describing drivers of engagement with the PolarUs app and associated features were generated: 1) Motivations, 2) Salience, and 3) Perceived effort. Drivers of engagement were shaped by contextual influences, summarised in four themes: 1) The smartphone ecosystem, 2) Daily life, 3) Mood symptoms, and 4) Involvement in a research study. The findings of this research generate insights into how individuals with BD engage with app-based interventions. Lived experience perspectives can inform the design of engaging app-based interventions for BD. Further, these findings emphasise the importance of considering the context in which people use self-management apps for BD for both research studies and implementation.
45. A Pilot Study: Adaptation Phase of the PROMIS Women Education Program-Promoting Cervical Cancer Prevention Methods Among Muslim Women in Virginia.
期刊: Cancer medicine 发表日期: 2025-Oct 链接: PubMed
摘要
The purpose of this comprehensive research project is to address the notable disparities in cervical cancer prevention experienced by Muslim women in Virginia, compared with non-Muslim women. Low participation in prevention and control activities, such as cervical cancer screening and HPV vaccination, often leads to their diagnosis with late-stage cervical cancer. The long-term research goal is to develop a culturally appropriate and religiously adapted intervention program to promote cervical cancer screening and prevention among Muslim women. Driven by an integrative conceptual model, the primary aim is to adapt existing evidence-based educational materials to create a religiously adapted and culturally appropriate intervention program to improve cancer screening rates among Muslim women in the U.S. The study adapted existing evidence-based educational materials to fit religious and cultural contexts, facilitated through focus group sessions with 10 Muslim women aged 18 and older. Additionally, interviews with five Muslim religious leaders provided feedback on the materials. The PEN-3 model was employed to categorize and analyze cultural factors influencing health behaviors. Preliminary findings from the thematic analysis, structured around the three domains of cultural identity, relationships, and expectations, and cultural empowerment, indicated a strong positive reception and increased awareness among participants. Key themes identified include the importance of culturally sensitive health messages, the influential role of community leaders, and the need for educational materials that consider cultural and gender dynamics. Data saturation was reached after the second focus group session, as no new themes emerged in participating discussions. Additionally, the Community Advisory Board (CAB) actively participated in the refinement process by reviewing the educational materials alongside the research team, ensuring that the content was culturally appropriate and aligned with community needs. Participants demonstrated a heightened readiness to engage in preventive behaviors, highlighting the effectiveness of a culturally tailored educational approach.
46. Evaluating the efficacy of the praziquantel dose pole for schistosomiasis treatment: A multi-country systematic review.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Oct 链接: PubMed
摘要
Schistosomiasis is a neglected tropical disease targeted for elimination as a public health problem by 2030 under the WHO’s roadmap. Praziquantel, administered via the dose pole, which estimates the number of tablets needed for treatment according to an individual’s height, has been used as preventive chemotherapy (PC) for 25 years, particularly for school-aged children (SAC). In 2022, PC was required for schistosomiasis in 50 countries, affecting a total of 264.3 million people, including 129.4 million adults. This systematic review evaluates the accuracy of the praziquantel dose pole across 64,212 individuals from 21 countries, focusing on its efficacy in delivering optimal, acceptable, insufficient, and excessive doses during school-based and community-wide treatment campaigns for schistosomiasis. The search strategy included the terms “dose pole” OR “tablet pole” AND “praziquantel” AND “schistosomiasis” in four databases (PubMed, Scopus, LILACS, and Embase), ranging from 1999 to September 2024. The dose pole demonstrated 96% accuracy in providing optimal/acceptable doses (30-60mg/Kg) to SAC. However, its effectiveness markedly declined for adults (15-95 years), with a pooled proportion of 19% receiving insufficient doses (<30mg/Kg), ranging from 10% to 34%. These discrepancies arise from misalignments between adult body metrics and the dose pole’s height-based dosing, primarily due to overweight and obesity, leading to underdosing. While the dose pole remains effective for SAC, its limitations for adults necessitate urgent adaptation or alternative dosing strategies to ensure equitable and effective treatment across all age groups.
47. Socioeconomic and ecological drivers of snakebite incidence in Mexico: A spatial analysis of risk factors.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Oct 链接: PubMed
摘要
Snakebite envenoming constitutes a significant public health challenge in tropical and subtropical regions, with Mexico reporting substantial incidence rates in the Americas. While previous investigations have documented the socioeconomic burden of snakebites, particularly in economically marginalized regions, a comprehensive understanding of the relative contributions of biological and socioeconomic determinants to spatial heterogeneity in snakebite incidence remains poorly understood. This study aimed to identify and quantify the main determinants of snakebite spatial heterogeneity across Mexico while accounting for potential reporting biases in surveillance data. We implemented a rigorous Bayesian analytical framework utilizing a conditional autoregressive zero-inflated Poisson model to examine snakebite incidence across 2,463 Mexican municipalities. Our methodological approach integrated three critical components: environmental suitability indices for venomous snake species derived from refined species distribution models, socioeconomic vulnerability metrics, and healthcare accessibility parameters. Social lag index (β = 0.308, 95% CI: 0.106-0.522), road network density (β = 0.376, 95% CI: 0.215-0.539), and environmental suitability for Bothrops asper (β = 0.268, 95% CI: 0.047-0.504) emerged as the primary factors explaining spatial variation in snakebite incidence. Healthcare facility distribution (β = 0.225, 95% CI: 0.126-0.326) was identified as a significant source of reporting bias. After controlling for this bias, our model revealed substantially different spatial pattern of risk, with elevated predicted incidence in urban centers and specific coastal regions not previously identified as high-risk areas. Our findings demonstrate that snakebite risk in Mexico is driven by a complex interaction between social vulnerability, infrastructure development, and the distribution of key venomous snake species. The identification of systematic reporting biases offers critical insights for optimizing surveillance protocols and implementing targeted interventions in high-risk municipalities.
48. Cross-Cultural Validation of the Occupational Coping Self-Efficacy Scale for Nurses: A Cross-Sectional Study.
期刊: Nursing open 发表日期: 2025-Oct 链接: PubMed
摘要
To translate the Occupational Coping Self-Efficacy Scale for Nurses (OCSE-N) into a simplified Chinese version and test its reliability and validity among the Chinese nursing population. Coping self-efficacy beliefs are important self-appraisals of one’s capability to cope with challenging situations. Using a reliable and valid instrument to assess nurses’ coping self-efficacy is essential. However, in previous studies in China, a specific scale to assess nurses’ occupational coping self-efficacy was not available. Cross-sectional study. In total, 1172 of 1200 nursing staff selected by convenience sampling from 5 public hospitals in Shenzhen completed the investigation. The OCSE-N was translated and adapted using the Brislin translation-back translation method. Then, the internal consistency of the OCSE-N-CHI was measured by Cronbach’s alpha. The construct validity of the OCSE-N-CHI was analysed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach’s alpha of the OCSE-N-CHI was 0.882, and the test-retest reliability was 0.991 (95% CI: 0.985-0.993, p < 0.01). The correlation coefficients of each item and the total score were 0.482-0.683 (p < 0.01). After exploratory factor analysis, the scale extracted 2 common factors with a cumulative variance contribution of 67.508% and a commonality of 0.524-0.860 for each entry. The empirical factor analysis of each fit index met the recommended criteria. Statistical differences existed in the occupational coping self-efficacy scores of nurses with different marital statuses, different levels of satisfaction with their jobs, as well as their income, and different average numbers of night shifts per week. The reliability and validity of the OCSE-N-CHI are good, and it can be used as an assessment tool to evaluate the occupational coping self-efficacy of nursing staff in China. The OCSE-N-CHI can be completed by participants in less than 2 min and is considered a convenient and reliable measure of occupational coping self-efficacy for nurses. After participants signed an informed consent form, questionnaires were completed in a conference room. The questionnaires were collected and entered in pairs in the office, and the data were analysed. Finally, the articles were written and revised.
49. The association between irregular working hours and cardiovascular diseases in a multi-ethnic population: the HELIUS study.
期刊: Occupational medicine (Oxford, England) 发表日期: 2025-Oct-01 链接: PubMed
摘要
Irregular working hours are a risk factor for cardiovascular diseases (CVD). We studied ethnic disparities in the association between irregular working hours and CVD, as well as the mediating stress-related pathways. Logistic regression was used to study the cross-sectional association between (a history of) irregular working hours and prevalent CVD (self-reported myocardial infarction, dotter/bypass operation or stroke) in 18 284 participants (18-71 years) in a population of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin from the HELIUS study. We considered three mediator models adjusting for behavioural, physiological and psychosocial stress. We tested for interaction between irregular working hours and ethnicity and stratified the analysis by ethnicity. The prevalence of CVD was 18% (717 out of 4041) and 14% (1963 out of 14 243) in individuals with versus without irregular working hours. Working irregular hours was associated with prevalent CVD (OR 1.27, 95% CI 1.15-1.40) after adjusting for sociodemographic confounders. There was a significant interaction between ethnicity and irregular working hours on CVD. Strongest associations with prevalent CVD were found for South-Asian Surinamese (OR 1.47, 95% CI 1.18-1.82), African Surinamese (OR 1.29, 95% CI 1.06-1.57) and Moroccans (OR 1.43, 95% CI 1.11-1.84). There were considerable ethnic differences in the mediating stress-related pathways that associate irregular working hours with prevalent CVD. Working irregular hours is associated with an increased prevalence of CVD in a multi-ethnic population. We show ethnic disparities in the associations between irregular working hours and CVD, as well as in the stress-related pathways that mediate these associations.
50. Screen Time and Standardized Academic Achievement Tests in Elementary School.
期刊: JAMA network open 发表日期: 2025-Oct-01 链接: PubMed
摘要
Few studies have investigated the longitudinal associations between different types of screen time in young children and academic achievement in elementary school. To examine whether there is an association between screen time in young children and standardized academic achievement tests in grades 3 and 6. This prospective cohort study was conducted among children participating in the TARGet Kids! primary care cohort in Ontario, Canada, between July 2008 and June 2023. Participant data were linked to annual grades 3 and 6 provincial standardized academic achievement test results. Parent-reported child total screen time, TV and digital media time, and video gaming time. The screen time measurement closest before the outcome was used. Academic achievement levels on standardized tests in reading, writing, and math for grades 3 and 6 were classified as below, at, or above the Ontario provincial standard. This study included 3322 grade 3 children (mean [SD] age at test, 8.86 [0.28] years; 1714 [51.6%] male students) and 2084 grade 6 children (mean [SD] age at test, 11.86 [0.28] years; 1070 [51.3%] male students). Screen time was measured at mean (SD) age of 5.54 (2.36) years for grade 3 children and 7.54 (2.90) years for grade 6 children. From adjusted proportional odds models, each additional hour of total screen time was associated with 9% to 10% lower odds of achieving a higher academic level in grade 3 reading (odds ratio [OR], 0.91; 95% CI, 0.86-0.96; P = .001), grade 3 math (OR, 0.91; 95% CI, 0.86-0.96; P < .001), and grade 6 math (OR, 0.90; 95% CI, 0.84-0.96; P = .002). Similarly, higher TV and digital media time was associated with lower achievement levels in grade 3 reading and math and grade 6 math. Video game use was associated with lower achievement level in grade 3 reading (OR, 0.77; 95% CI, 0.62-0.94; P = .01). In the sex-stratified analysis, video game use among female students was associated with lower grade 3 reading and math achievement. In this prospective cohort study of Canadian children recruited from primary care settings, high levels of total screen time and TV and digital media in young children were associated with lower achievement levels in reading and math on standardized tests in elementary school. Early interventions to reduce screen time exposure should be developed and tested to enhance academic achievement in elementary school.
51. Contextual barriers to PrEP uptake and continuation among young Black gay and bisexual men who have sex with men living in the South.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Young, Black Gay, and Bisexual men who have sex with men (YBGBM) are disproportionately impacted by HIV, especially in Southern United States. We conducted a cross-sectional survey (Feb19-Mar20). Eligibility criteria were self-reported age 16-29 years, HIV-negative, Black race, and cis-gender male. We assessed associations between demographics, religiosity, intersectional stigma, and pre-exposure prophylaxis (PrEP) use (never, previous or current) among YBGBM in Alabama. Univariate and multivariable multinomial logistic regression models were fit with factors selected a priori, guided by a conceptual framework including individual-, interpersonal- and structural-level barriers to PrEP. 305 participants completed surveys (median age 24, 75% employed, 32% lacked personal transportation, and 41% reported annual incomes < $15,000). Compared to never PrEP use (n = 219), factors associated with current PrEP use (n = 51) included: ≥ college degree [AOR (95% CI): 5.48 (2.05, 14.62)], friends’ social support [AOR (95% CI): 1.33 (1.00, 1.52)], perceived HIV risk [AOR (95% CI): 1.27 (1.14, 1.42)], and PrEP knowledge [AOR (95% CI): 1.42 (1.23, 1.65)] AND factors associated with previous PrEP use (n = 35) included: depression [AOR (95% CI): 3.08 (1.34, 7.09)], condom use less than all the time [AOR (95% CI): 11.98 (1.52, 94.41)], intrinsic religiosity [AOR (95% CI): 0.77 (0.68, 0.88)], stable housing [AOR (95% CI): 0.30 (0.11, 0.81)], perceived sexual stigma [AOR (95% CI): 0.84 (0.75, 0.94)], and perceived HIV risk [AOR (95% CI): 1.18 (1.05, 1.33)]. YBGBM face distinct challenges with engagement in HIV prevention services and further investigation is needed to understand individual, interpersonal as well as structural-level factors that may mediate the ability to utilize PrEP services. Tailored multilevel strategies are urgently needed to improve PrEP uptake and persistence in YBGBM.
52. Test-retest reliability and minimal detectable change of Dutch-Flemish Patient Reported Outcomes Measurement Information System (PROMIS®) Computerized Adaptive Tests for musculoskeletal disorders.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
To examine the test-retest reliability and minimal detectable change (MDC) of the Dutch-Flemish Patient Reported Outcomes Measurement Information System (DF-PROMIS) Pain Interference (PI) v1.1, Physical Function (PF) v1.2, and Upper Extremity (UE) v2.0 computerized adaptive tests (CATs) in patients with musculoskeletal conditions receiving physical therapy in primary care. Observational cohort study. Patients with musculoskeletal conditions of the spine or upper extremity were recruited from fourteen physical therapy practices. Participants completed DF-PROMIS CATs at baseline and again three to fourteen days later. Test-retest reliability was evaluated using the intraclass correlation coefficient (ICC) (two-way random effects, absolute agreement) and minimal detectable change (MDC). Reliability at the participant-level was visually represented by plotting test-retest scores with corresponding 95% confidence intervals (CIs). Data from 225 patients were analyzed. The DF-PROMIS CATs demonstrated sufficient test-retest reliability, with ICC values ranging from 0.79 to 0.91. MDC values ranged from 4.80 to 6.08 across all measurements. Participant-level reliability was high (0.9-0.95) for most measurements but lower for scores further from the mean. The 95% CIs for test-retest measurements overlapped in 95.3% of measurement pairs. The DF-PROMIS PF, UE, and PI domain CATs demonstrated sufficient reliability and precision in patients with musculoskeletal conditions receiving physical therapy in primary care practices. Future research should focus on implementing DF-PROMIS CATs in clinical practice, examining their responsiveness, and evaluating their feasibility. Adoption of DF-PROMIS domains as outcomes in intervention studies and clinical practice will enhance interpretability and comparability of results across different patient groups.
53. Individual and facility level factors influencing timely antenatal care initiation in Ethiopia: A multilevel analysis of the 2021/2022 ESPA data.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Antenatal care (ANC) is a package of healthcare services for pregnant women that improves the health of both the women and their unborn babies, with a minimum of eight times and most effective when initiated within the first 12 weeks. This study aimed to assess the magnitude and factors associated with timely ANC initiation among pregnant women attending their first ANC visit during their most recent pregnancy in Ethiopia. We analysed weighted data from 2,037 pregnant women who attended their first ANC visit during their most recent pregnancy, extracted from the 2021/2022 Ethiopian Service Provision Assessment. We fitted a multilevel mixed-effects logistic regression model to examine individual and facility level factors influencing timely ANC initiation, which was calculated in weeks. We reported descriptive statistics using frequencies and percentages, and regression results using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). We conducted all analyses using STATA version 16 software. The magnitude of timely ANC initiation in Ethiopia was 14.9%, with a mean gestational age at initiation of 22 weeks. Primary education (AOR = 1.74, 95% CI: 1.08, 2.82), partner involvement (AOR = 1.42, 95% CI: 1.03, 1.96), and attending non-public facilities (AOR = 2.49, 95% CI: 1.45, 4.28) were associated with higher odds of timely ANC initiation. Conversely, bypassing nearby facilities (AOR = 0.44, 95% CI: 0.30, 0.64) and attending facilities in large central regions (AOR = 0.24, 95% CI: 0.15, 0.40) or small peripheral regions (AOR = 0.27, 95% CI: 0.13, 0.52) were associated with lower odds of timely ANC initiation. One in seven pregnant women in Ethiopia initiated ANC within the first 12 weeks of pregnancy, far below the World Health Organization recommendation that all pregnant women should begin ANC within this period. Timely ANC initiation could be explained by factors related to women, their partners, and healthcare facilities. Policy interventions should prioritise women’s education, partner involvement, utilisation of nearby available healthcare facilities, community awareness to improve timely ANC initiation in Ethiopia.
54. Subcutaneous injections of penicillin (SCIP): Convenient and effective treatment for Māori, Pacific Peoples and their families in preventing rheumatic heart disease.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant health issues for Māori and Pacific communities in Aotearoa New Zealand (NZ). Subcutaneous injection of penicillin (SCIP) enables injections to be given 10-weekly as an alternative to the standard four-weekly intramuscular (IM) injections. As part of a clinical trial involving participants with ARF who have been on SCIP for at least one year, we aim to explore treatment adherence, pain management, and quality of life for Māori and Pacific participants and their families (whānau). A community centred approach aligned with Kaupapa Māori, and Pacific-centred research values was used. Semi-structured interviews were conducted with 10 families, including nine participants on SCIP. Data collection occurred between March and August 2024. Thematic analysis was used to identify key themes from participants’ experiences. Six themes emerged: Reduced burden of treatment; emotional impact from reduced injection frequency; family-centered care by healthcare providers; relationship building (whakawhanaungatanga); health literacy; and pain management. Participants valued SCIP’s 10-week dosing interval, which contributed to improvements in quality of life. The extended dosing interval also alleviated emotional barriers, including the stress associated with more frequent injections. Participants valued that nurses offered them the choice of which location to receive their injections, at home, in a clinic, at work, or at school. Strong relationships with healthcare providers, especially research nurses, were essential for adherence. This study highlights that the extended dosing interval provided by SCIP reduced the physical and emotional burdens participants experienced with their monthly IM BPG injections, thereby enhancing quality of life. The findings emphasise the importance of culturally responsive, family-centered models of care. SCIP offers an opportunity to improve adherence to secondary prophylaxis and if implemented as a standard treatment option, improve health outcomes both in NZ and internationally.
55. Incidence and predictors of chronic kidney disease among hypertensive patients in Ethiopia: A Bayesian multivariate joint model.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Hypertension (HTN) is a major contributor to chronic kidney disease (CKD), a leading cause of global morbidity and mortality. In low-resource settings such as Ethiopia, where CKD risk factors remain understudied, identifying predictors and longitudinal blood pressure (BP) patterns associated with CKD incidence is crucial for early intervention. Therefore, this study aimed to determine the incidence and predictors of CKD, as well as its association with longitudinal BP changes, among hypertensive patients in Ethiopia. An institution-based retrospective follow-up study was conducted at the University of Gondar Comprehensive Specialized Referral Hospital. Using a Bayesian joint modeling approach, we integrated Cox proportional hazard and linear mixed effects models to evaluate the effects of time-dependent BP trajectories on CKD risk. The data were entered into the Kobo toolbox and analyzed with R software (version 4.3.1). A total of 408 hypertensive patients were followed for 2322.83 person-years. At the end of the follow-up, 58/408 (14.22%) developed CKD, with an incidence density of 2.5 cases per 100 person-years (95% CI: 1.89-3.14). Both the current values and longitudinal the quarterly rate of change in BP were significantly associated with increased CKD risk. For systolic BP, the adjusted hazard ratio (AHR) was 6.25 (95% CrI: 2.85-9.85) for the current values and 3.75 (95% CrI: 3.16-7.95) for the quarterly rate of change. Similarly, the diastolic BP had an AHR of 4.32 (95% CrI: 2.35-8.27) for the current values and 5.64 (95% CrI: 4.24-10.82) for the quarterly rate of change. Additionally, age ≥ 65 years (AHR = 4.62; 95% CrI: 1.83-12.21), HDL-C < 40 mg/dL (AHR = 3.32; 95% CrI: 1.73-7.86), diabetes mellitus (AHR = 3.08; 95% CrI: 2.01-9.54), and proteinuria positivity (AHR = 2.85; 95% CrI: 1.48-5.55) were significant predictors of the incidence of CKD. These findings highlight the importance of close BP monitoring in Ethiopian hypertension clinics. The incidence of CKD in this study was relatively high compared with that reported in previous similar studies conducted in Ethiopia. Our findings confirm that time-dependent systolic BP and diastolic BP trajectories are strongly associated with an increased risk of CKD. Additionally, age, low HDL-C levels (<40 mg/dl), the presence of diabetes mellitus, and proteinuria were identified as significant predictors of CKD. Therefore, effective CKD prevention among hypertensive patients in Ethiopia hinges on regularly checking both their current blood pressure levels and how those levels change over time. We also need to keep a close eye on older patients (65 + years), low HDL-C, diabetes, and proteinuria to catch those at highest risk early and step in with care.
56. Exploring barriers to accessing healthy diets among pregnant women living with HIV in the Njombe region, Tanzania: A qualitative study.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Proper nutrition is essential for women with HIV during pregnancy; however, information on how to access nutritious diets is scarce. This study, informed by the socio-ecological perspectives, examines the barriers to obtaining a healthy diet among pregnant women living with HIV in the Njombe region of Tanzania. A qualitative study employing the ethnography method using semi-structured and narrative interviews to gather information from key informant interviews, indepth interviews and focus group discussions engaged a diverse range of stakeholders. The analysis was done by MAXQDA software employing qualitative content analysis. Further, the thematic analysis was carried out by assigning data into relevant codes to generate categories based on study objectives. The study found inadequate nutritional knowledge among individuals and some healthcare providers in the Njombe region. Poor emotional and physical support from spouses and family members caused pregnant women living with HIV to shoulder an excessive household workload, leading to exhaustion and stress, which hindered their ability to practice healthy dietary behaviors. The level of alcohol consumption was high, posing a risk to their health and well-being. The study identified significant barriers at the individual, community, environmental, and organizational levels that prevent pregnant women living with HIV in the Njombe region of Tanzania from accessing healthy diets. Elevating nutritional awareness within these communities is essential for improving the knowledge, skills, and motivation of pregnant women, their partners, and the wider community to embrace healthy and nutritious dietary practices. While various obstacles to healthy diets may exist, motivation and intentionality in pursuing those dietary choices are equally important. Even in the face of challenges, individuals with a strong understanding of nutrition are more likely to discover alternative strategies to maintain healthy diets.
57. Prefrontal cortex activity during virtual obstacle avoidance and distracted walking: A methodological proof of concept using augmented reality and functional near-infrared spectroscopy.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
There is an established interplay between gait and attention allocation. Attention during walking is important to reduce instability, process environmental stimuli, and perform simultaneous tasks. It is of critical importance to consider how attention modulation during dual-tasking influences prefrontal cortex (PFC) activity and gait characteristics. However, paradigms probing this relationship are often limited in realism and must balance mobility challenges with practicality. This protocol introduces a novel methodology combining functional near-infrared spectroscopy (fNIRS) and augmented reality (AR) in a complex gait dual-task to validate the use of virtual obstacles to probe for a cortical indicator of altered attention during distracted walking. This methodological development study investigated 11 healthy adults (mean age 50.9 ± 5.8 years, 5 female) in an obstacle navigation cognitive-motor dual-task combining fNIRS and AR during navigation of realistic AR-projected 3D virtual obstacles and physical obstacles. The distraction task involved a 5-word recall from a mimicked phone call. Participants performed six experimental tasks: walking; walking + distraction; walking + obstacles (both physical and virtual); and walking + obstacles (both physical and virtual) + distraction. Intraclass correlations ranged from 0.563 to 0.886 for oxyhemoglobin (O2Hb) ratios and gait velocity between virtual and physical obstacles, demonstrating moderate-to-good consistency between methods. Proportional bias in the Bland-Altman plots was observed for O2Hb. Participants also demonstrated task-dependent modulation of gait and PFC activity in response to dual task conditions in both tasks. This combination of technologies elicited task-dependent modulation in PFC activity and gait behaviours in healthy adults, confirming the efficacy of AR-projected obstacles in a cognitive-motor dual-task paradigm. Based on these outcomes, it is likely that this experimental approach will be useful in probing cortical activity changes associated with dual-tasking to inform the relationship between mobility and cognition and characterize behavioural and neural markers of functional mobility.
58. Green synthesis of Fe2O3-MnO2 nano-hybrids on pumice for complete degradation of pharmaceutical pollutants.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Pharmaceutical contaminants in wastewater pose critical environmental and public health risks due to their persistent nature and resistance to conventional treatment. To address this challenge, we developed an innovative, green-synthesized Fe2O3-MnO2 nano-hybrid catalyst supported on acid-activated Syrian pumice. The catalyst was prepared via an eco-friendly hydrothermal method using Laurus nobilis leaf extract as a bio-reducing agent, emphasizing sustainability. Structural characterization revealed significant enhancement in surface properties, with the modified catalyst exhibiting a high surface area (214.7 ± 3.5 m2/g) and optimized pore architecture (0.36 cm3/g volume, 6.7 nm average diameter) featuring 80% mesopores and 20% micropores. Under mild conditions (pH 7, 25°C, 0.5 g/L catalyst dose, 10 mM peroxymonosulfate), the system achieved 92.3% COD and 93.5% BOD5 removal within 3 hours for wastewater laden with the beta-lactam antibiotic amoxicillin (50 mg/L). LC-MS/MS analysis confirmed the complete degradation of the target pollutants, with no toxic intermediate byproducts detected. The catalyst exhibited exceptional stability, retaining >86% efficiency after five reuse cycles, with minimal metal leaching (Fe/Mn < 0.3 mg/L, within WHO limits). In continuous-flow mode, it maintained 89.6% COD and 90.4% BOD5 removal, demonstrating scalability. This study bridges nanotechnology and circular economy principles by valorizing locally abundant volcanic pumice (a natural waste) through an eco-friendly synthesis route, presenting a scalable and industrially viable solution for pharmaceutical wastewater treatment.
59. Factors influencing medical students' knowledge and attitudes toward climate change: A cross-sectional study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Climate change is one of the biggest environmental challenges of the 21st century. Physicians are at the forefront of recognizing, preventing, and treating climate-induced health issues. This study aims to assess attitudes, education, and knowledge of recent medical graduates regarding climate change and its health impacts, and to identify factors influencing these domains. A cross-sectional web-based survey of recently graduated medical students was conducted at two large academic medical centers in the United Arab Emirates (UAE). Mean composite Likert scales were calculated. Linear regression models were utilized to study predictors of knowledge and attitude. Of 458 applicants to residency programs, 311 completed the survey (67.9% response rate). Most participants were female (n=206, 66.2%), aged 25 to 30 years (n=183, 58.8%), and attended medical schools in the Middle East and North Africa (MENA) region (n=209, 67.2%). The median knowledge score was 9 out of 14 (64.3%), with an IQR of 7 to 10. The mean attitude score was 50 out of 70 (71.4%), with an IQR of 44 to 54. These results suggest moderate levels of knowledge and generally positive attitudes. Most respondents (n=197, 63.3%) did not receive climate change education in medical school. Students who completed their education in the MENA region were the least likely to have received climate change education (16.75% vs. 46.94%; p <.001). Survey respondents who received education demonstrated significantly improved knowledge (β=1.23, p <.001). Having a higher knowledge composite score was positively associated with a higher composite attitude score (β=.71, p=.002). Effects of climate change are particularly pronounced in the MENA region due to heat extremes, water scarcity, and air pollution. Recent medical graduates applying to residency programs in the UAE have had limited education in climate change. Medical schools around the world should prepare students to address the escalating health risks of climate change. This will require investing in faculty development, supporting student-led advocacy, adopting curriculum mapping tools, and most importantly, integrating clinical experience, such as project-based learning, simulations, and participatory action.
60. Genetic diversity and population structure analysis of soybean [Glycine max (L.) Merrill] genotypes based on agro-morphological traits and SNP markers.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Soybean (Glycine max) is one of the world’s most important oilseed crops and has adapted to various environmental conditions. Yields of soybeans in Nigeria are notably low due to different production constraints, including the limited availability of improved varieties and the slow replacement rate of old varieties with new and high-yielding ones. Ensuring high genetic diversity in the working germplasm is among the primary factors for the success of breeding programs in identifying high-yielding and well-adapted improved varieties. This study aimed to assess the genetic diversity and population structure of 45 soybean breeding lines of the International Institute of Tropical Agriculture soybean breeding program at the advanced evaluation stage based on phenotypic traits and SNP markers to support breeding strategies. Field trials were conducted in 2022 across three International Institute of Tropical Agriculture stations in Nigeria using a 5 × 9 alpha-lattice design with three replications. The collected yield and yield component data were subjected to analysis of variance, mean comparison, principal component analyses, and cluster analyses using R software. The genotypes were further assessed using 10,630 SNP markers obtained from DArTseq genotyping. The combined analysis of variance revealed a significant genotype × location interaction for grain yield and a highly significant difference in days to 50% flowering and days to 95% maturity. The genotypes G02, G10, G11, G01, and G24 were significantly superior in grain yield. Principal component analysis showed that the first three components explained 64.8% of total variation, with major contributions from traits such as lodging score, hundred seed weight, plant height, nodulation, and days to 50% flowering. Hierarchical clustering grouped the genotypes into five clusters, highlighting desirable traits such as high yield, early maturity, and lodging tolerance. SNP-based population structure grouped the genotypes into three distinct subpopulations. The SNP markers showed average observed heterozygosity, expected heterozygosity, minor allele frequency, and polymorphic information content of 0.08, 0.27, 0.20, and 0.22, respectively, which showed the existence of considerable genetic variation among the studied genotypes.