公共卫生研究摘要 (2025-10-17)
共收录 58 篇研究文章
1. Financing and Prioritizing Diabetes and Other Non-Communicable Diseases in Ghana: A Qualitative Policy Analysis of the Barriers, Enablers and Opportunities.
期刊: Health systems and reform 发表日期: 2025-Dec-31 链接: PubMed
摘要
Diabetes and other chronic NCDs pose a major public health threat in Ghana, and where health systems are less developed and there are numerous competing societal priorities. This qualitative study examines the barriers hindering domestic financing and prioritization of diabetes and other NCDs in Ghana. The study applied Kingdon’s multiple stream framework using document reviews and face-to-face interviews with 29 key informants/stakeholders in the diabetes or NCD landscape in Ghana. Data from the document review and key informant interviews were thematically analyzed. The study revealed that at the problem stream level, diabetes and other NCDs are not yet sufficiently perceived by the general population and policy makers as major societal issues. Donors are also focusing on different health priorities. On the policy solution stream, many solutions are being initiated and developed by a rich array of policy entrepreneurs. The recent introduction of an excise tax bill on sugar-sweetened, alcoholic beverages and tobacco products suggests positive developments in the politics stream. The health financing system is advanced institutionally, and the country could rapidly convert a higher prioritization of diabetes into resource allocation if the macro-fiscal context permits it. The study concludes that applying Kingdon’s framework provides a nuanced understanding of the barriers, enablers, and opportunities for prioritizing NCDs in Ghana, and finds that policy prioritization will require political commitment from the upper echelon of government. Higher public awareness on the determinants and costs of NCDs would contribute to broad citizen support and the sustainability of the political commitment across successive governments.
2. Burden of Insomnia Disorder Among US Active-Duty Military Personnel.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Insomnia is highly prevalent among military personnel, with many gaps in knowledge. The purpose of this study was to quantify the medical, psychiatric, and utilization burden of insomnia among active-duty military personnel. We hypothesized that insomnia is associated with worsened health and economic outcomes. This was a retrospective case-control study. Data were derived from the Military Data Repository (2016-2021). Active-duty service members (ADSMs) younger than 65 years, with 12 months of continuous enrollment before and after first insomnia diagnosis and no evidence of previous insomnia or insomnia treatment, were matched 1:1 on demographic, clinical, and military characteristics to ADSMs without insomnia. Insomnia and psychiatric and medical comorbidities were defined using International Classification of Diseases, 10th Revision diagnostic codes. The impact of newly diagnosed insomnia on psychiatric and medical outcomes within 12 months was examined using time-to-event models. The impact of newly diagnosed insomnia on 12-month health care resource utilization (HCRU) was examined using generalized linear models. A total of 40,978 ADSMs met insomnia criteria and were matched to 40,978 ADSMs without insomnia. Participants were 78.6% male and 61.8% identified as White, with most younger than 44 years (90.3%). Insomnia was associated with increased risk of almost every studied physical and psychological health outcomes; relative to those without insomnia, ADSMs with insomnia demonstrated a 6-fold increased risk of post-traumatic stress disorder (hazard ratio [HR] 6.51, 95% CI 5.95-7.12, p < 0.001), as well as elevated risk of traumatic brain injury (HR 5.32, 95% CI 4.53-6.24, p < 0.001). ADSMs with insomnia demonstrated greater all-cause HCRU across all points of service (all p’s < 0.001). Among active-duty personnel, new-onset insomnia was associated with substantially increased risk of adverse medical and psychiatric burden, as well as increased utilization, over 12 months. Key limitations include our observational study design.
3. Plasma N-Glycan Profiling Enhances Diagnostic Precision in Multiple Sclerosis, AQP4-Ab NMOSD, and MOGAD.
期刊: Neurology(R) neuroimmunology & neuroinflammation 发表日期: 2025-Nov 链接: PubMed
摘要
Differentiating multiple sclerosis (MS) from antibody (Ab)-defined diseases, such as neuromyelitis optica spectrum disorders (NMOSDs), remains challenging, particularly as Ab levels decline. N-glycans play a key role in immunity, with changes in branching and fucosylation linked to T/B-cell function and MS onset while increased N-acetylglucosamine residues correlate with disease progression. Despite growing recognition of glycosylation in neuroinflammation, direct comparisons of the N-glycome between MS and Ab-defined diseases are lacking. This study aims to assess whether plasma N-glycome profiling can effectively differentiate these conditions and their subtypes. This cohort study included 120 participants: 30 with relapsing-remitting MS (RRMS), 30 with secondary progressive MS (SPMS), 30 with myelin oligodendrocyte glycoprotein Ab-associated disease (MOGAD), and 30 with aquaporin-4 (AQP4)-Ab NMOSD, recruited from the John Radcliffe Hospital, Oxford University Hospitals National Health System (NHS) Trust. Plasma N-glycans were analyzed using ultra-high-performance (UHPLC) hydrophilic interaction liquid chromatography (HILIC) coupled with high-resolution mass spectrometry. Orthogonal partial least-squares discriminant analysis was applied to identify disease-specific glycomic patterns. Distinct N-glycome profiles were identified across diseases and phenotypes. Plasma N-glycans differentiated MS from Ab-defined diseases with 80.5% accuracy (±1.5%), MOGAD from AQP4-Ab NMOSD with 77.8% accuracy (±3.1%), and RRMS from SPMS with 75.2% accuracy (±3.6%). Key discriminatory features included increased monosialylation (S1; odds ratio [OR] = 2.57, p < 0.0001), trigalactosylation (G3; OR = 2.70, p < 0.0001), highly branched N-glycans (OR = 2.32, p = 0.0002), and antennary fucosylation (OR = 2.89, p < 0.0001), effectively distinguishing Ab-defined diseases from MS, independent of Ab serostatus at the time of sampling. These findings underscore the potential of plasma N-glycomics as a diagnostic tool for neuroinflammatory diseases. While further research is needed to clarify the mechanistic links between glycomic alterations and disease pathology, our results suggest that plasma N-glycan profiling could improve disease classification. Given its noninvasive and cost-effective nature, this approach holds promise as a complementary diagnostic tool for CNS demyelinating diseases in clinical practice.
4. Heterogeneity of Ego Depletion and Its Relationship With Health Promotion Behavior Among Older Adults With Type 2 Diabetes Mellitus: Latent Profile Analysis.
期刊: Journal of gerontological nursing 发表日期: 2025-Oct-20 链接: PubMed
摘要
To identify latent profiles of ego depletion among older adults with type 2 diabetes mellitus (T2DM), and analyze how these profiles relate to health promotion behaviors. A cross-sectional study surveyed 220 older adults with T2DM on ego depletion and health promotion behaviors. Latent profile analysis identified distinct profiles of ego depletion, and multinomial logistic regression explored their links to health promotion behaviors. Latent profile analysis revealed three distinct profiles: high cognitive depletion, high behavioral depletion, and high emotional depletion. The high behavioral depletion profile was associated with fewer complications, more hypoglycemia, better stress management, greater enjoyment of life, and increased health responsibility. The high emotional depletion profile had lower levels of physical activity, reduced risk reduction behaviors, poorer stress management, and less adherence to a healthy diet. Tailored interventions addressing ego depletion are crucial for improving health promotion behaviors in this population.
5. Uncovering HIV Vulnerabilities Beyond the Usual Layers: Practices of Masculinity and HIV Risk Among Heterosexual Black Men in London, Ontario, Canada.
期刊: Community health equity research & policy 发表日期: 2025-Oct-16 链接: PubMed
摘要
In Canada, Black men are overburdened with HIV. Some studies have suggested that traditional masculinity practices are key drivers of new HIV infections as they endorse high-risk behaviors. However, critical scholars have also highlighted complex pathways through which Black men’s masculinity practices and their associated health impacts may be influenced by their structural circumstances in Canada. Informed by these, we draw on analyses of interviews (n = 13) and focus group discussions (n = 17) with self-identified heterosexual Black men resident in London, Ontario, to understand how they construct and practice masculinity in response to their HIV vulnerability. Using a mixed inductive-deductive thematic approach to data analysis, our findings suggest that in response to their HIV vulnerability and poor health outcomes, Black men practice progressive masculinities that empower them to engage with their health needs and help build resilience against HIV. Furthermore, race-based discrimination, stereotypes, societal expectations, and the ‘othering’ of Black men in Canada may engender the performance of traditional masculinity by some younger Black men, which may deplete their capacity to build resilience against HIV. We recommend that health policy stakeholders in Canada leverage these findings to engage Black men in addressing their structural vulnerabilities to HIV.
6. Rehabilitation in oncological palliative care, does it exist? A qualitative and multicentre study of healthcare professionals' perceptions.
期刊: Clinical rehabilitation 发表日期: 2025-Oct-16 链接: PubMed
摘要
ObjectiveTo investigate how health professionals working in palliative care services understand rehabilitation related to oncology palliative care in England and Brazil, according to different health system contexts.DesignQualitative study.SettingHospices, hospitals, community-based palliative care centre, palliative care units, nursing care homes in different areas of Brazil and England.ParticipantsThirty-six nurses and occupational therapists experienced in providing palliative care interventions from England and Brazil.InterventionsIndividual interviews with open-ended questions.Main MeasuresIndividual semi-structured, in-depth interviews, analysed using Braun and Clarke’s reflexive thematic analysis.ResultsProfessionals in England demonstrated a consolidated and integrated understanding of rehabilitation as part of palliative care, often supported by structured services such as hospices. In contrast, many Brazilian participants expressed uncertainty or perceived rehabilitation as incompatible with end-of-life care, reflecting conceptual misunderstandings, limited training and a lack of service infrastructure. The findings revealed divergence in how rehabilitation in palliative care is conceptualised and implemented in these countries. This divergence is reflected in structural, educational and cultural differences in how palliative care is organised and delivered. However, there is a growing recognition that rehabilitation and palliative care are not separate but complementary approaches.ConclusionsThe findings underscore the urgent need to clarify definitions, develop unified conceptual models and invest in policy and education to ensure that rehabilitation is no longer seen as contradictory to palliative goals, but as a complementary strategy to enhance quality of life in advanced cancer care.
7. Temporal Trends in Cervical Human Papillomavirus Prevalence Among Females in Xiamen, China (2016-2023): Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Oct-16 链接: PubMed
摘要
Human papillomavirus (HPV) is a primary causative agent of cervical cancer, accounting for more than 90% of cases worldwide. Epidemiological data on regional HPV prevalence and genotype distribution are critical for tailoring targeted cervical cancer prevention strategies, particularly in regions with limited population-based studies. This study aimed to investigate temporal trends in the prevalence of overall HPV infection and vaccine-targeted HPV genotypes among females in Xiamen between 2016 and 2023 using annual cross-sectional analyses. We analyzed retrospective deidentified data from 63,553 females who underwent HPV genotyping of cervical exfoliated cells at Zhongshan Hospital affiliated with Xiamen University from 2016 to 2023. Data on HPV genotyping, age, and detection time were collected from the hospital’s electronic information system. For each year, we conducted a cross-sectional assessment of HPV infection status to calculate annual HPV prevalence. Temporal trends of HPV prevalence were analyzed across 3 pandemic periods (prepandemic: 2016-2019, pandemic: 2020-2022, and postpandemic: 2023) and by age groups. The overall HPV prevalence was 25.24% (16,039/63,553), comprising high-risk human papillomavirus (HR-HPV) at 19.26% (12,242/63,553) and low-risk human papillomavirus (LR-HPV) at 10.08% (6409/63,553). Vaccine-targeted HPV prevalence rates were bivalent human papillomavirus at 3.56% (2264/63,553), quadrivalent human papillomavirus at 5.89% (3746/63,553), and nine-valent human papillomavirus at 13.64% (8666/63,553), respectively. Notably, the number of non-vaccine-targeted HPV genotypes accounted for 16.01% (10,177/63,553) of all tested females and 63.45% (10,177/16,039) of HPV-positive cases. The top 5 HR-HPV genotypes were HPV52 (3000/63,553, 4.72%), HPV58 (1895/63,553, 2.98%), HPV53 (1582/63,553, 2.49%), HPV16 (1461/63,553, 2.30%), and HPV39 (1116/63,553, 1.76%), while HPV81 (1407/63,553, 2.21%), HPV61 (1268/63,553, 2%), and HPV6 (1101/63,553, 1.73%) were the most prevalent LR-HPV genotypes. Temporal analysis revealed significant declines in the prevalence of overall HPV, HR-HPV, LR-HPV, bivalent human papillomavirus, quadrivalent human papillomavirus, nine-valent human papillomavirus, and specific genotypes (HPV52, HPV58, HPV16, HPV39, and HPV6) from 2016 to 2019 to 2023 (all P<.001). Conversely, HPV81 prevalence increased significantly in 2023 compared to 2020-2022 (2.44% vs 1.96%; P<.001). Age-stratified analysis of HPV prevalence showed a significant declining trend with increasing age (P<.001), with peak prevalence observed in the ≤20-year age group. Cervical HPV infection, particularly non-vaccine-targeted genotypes, remains a substantial public health burden in Xiamen, highlighting the urgency to develop broader spectrum vaccines, to enhance cervical cancer screening programs, and to implement age-specific interventions, specifically for females aged ≤20 years. Long-term surveillance of emerging HPV genotypes and vaccination coverage is recommended.
8. Aggregating Patient Safety and Status Information in the Electronic Health Record to Support Time-Sensitive Mobility Interventions in the Intensive Care Unit: Protocol for the Design and Testing of a Clinical Decision Support Tool.
期刊: JMIR research protocols 发表日期: 2025-Oct-16 链接: PubMed
摘要
Patients who require intensive care unit (ICU) care frequently develop hospital-acquired functional decline, defined as a new or worsening loss of ability to perform self-care activities that is associated with prolonged immobility. This morbidity may persist for months to years after hospitalization but is potentially preventable through initiating mobility in the ICU using a multidisciplinary, evidence-based intervention to maintain functional status. While guidelines for ICU physical activity exist, timely identification of patients suitable for activity interventions is an ongoing challenge due to the dynamic nature of critical illness and the number of locations in the electronic health record (EHR) that clinicians need to click in and out of to synthesize patient data. Therefore, there is a critical need to develop an effective knowledge-based clinical decision support system (CDSS) interface in the EHR for efficient identification of patients appropriate for physical activity interventions and coordination of patient-specific activity plans within the ICU team. The objective of this 2-phase project is to develop a CDSS interface for consistent translation of patient-specific data to inform evidence-based physical activity interventions delivered by registered nurses and physical therapists in ICU settings and evaluate its usability, usefulness, cognitive workload, acceptability, feasibility, and effectiveness on decision-making outcomes. In phase 1, we will develop a usable, useful, and acceptable CDSS prototype by conducting 4 rounds of user-centered design interviews with registered nurses and physical therapists by using think-aloud and cognitive interview methods. In preparation for implementing CDSS in phase 2, we will conduct semistructured stakeholder interviews using the Consolidated Framework for Implementation Research to identify clinical workflow considerations, potential barriers, and implementation strategies. In phase 2, we will evaluate CDSS’s usability, cognitive workload, acceptability, and effectiveness for activity guideline adoption in two settings: (1) a simulated EHR environment and (2) two adult ICU units in a tertiary care hospital. This study received funding in April 2024. The CDSS development phase is expected to conclude by December 2025. Data collection and analysis of CDSS evaluation are expected to begin in April 2026 and conclude by December 2028. We expect the results of this multimethod process for designing, testing efficacy, and identifying barriers to real-world use to have an important positive impact on others who seek to develop safe and effective CDSSs that align with clinical workflow. Importantly, this work will complete the necessary pilot study for a subsequent multisite pragmatic clinical trial to scale the concurrent use of patient data with guideline recommendations at the point of care to deliver evidence-based interventions to reduce hospital-acquired functional decline and its negative, costly outcomes. DERR1-10.2196/75752.
9. Clinical Information Extraction From Notes of Veterans With Lymphoid Malignancies: Natural Language Processing Study.
期刊: JMIR medical informatics 发表日期: 2025-Oct-16 链接: PubMed
摘要
Clinical natural language processing (cNLP) techniques are commonly developed and used to extract information from clinical notes to facilitate clinical decision-making and research. However, they are less established for rare diseases such as lymphoid malignancies due to the lack of annotated data as well as the heterogeneity and complexity of how clinical information is documented. In addition, there is increasing evidence that cNLP techniques may be prone to biases embedded in clinical documentation or model development. These biases can result in disparities in performance when extracting clinical information or predicting patient outcomes. This study aims to report the development and validation of a cNLP pipeline that extracts clinical information such as performance status, staging, and diagnosis, as well as less common information such as substance use and military environmental exposures, from the clinical notes of veterans with lymphoid malignancies. We developed a rule-based cNLP pipeline that integrates domain expertise. We tested and compared the performance of the cNLP pipeline on notes from 2 veteran patient cohorts: one from non-Hispanic White veterans and the other from non-Hispanic Black veterans. Overall, our pipeline achieved promising performance on our study data, especially for extracting entities that have standard clinical documentation, such as performance status. We also found that while the pipeline has robust performance across the two patient groups, the false-positive and false-negative rates were significantly associated with race for detecting the primary diagnosis (P=.001 for both); the false-negative rate was significantly associated with race for identifying substance use (P=.02). The system exhibits satisfying and comparable performance for most clinical entities of interest except for (1) the primary diagnosis and (2) substance use. Future work will address the challenges encountered in developing and deploying the cNLP pipeline on the Department of Veterans Affairs data for rare cancers and enhance the performance of cNLP systems to avoid biases.
10. Toward Comprehensive Assessment of Beliefs and Attitudes Related to Physical Activity in Young Adults: Pilot Study.
期刊: JMIR formative research 发表日期: 2025-Oct-16 链接: PubMed
摘要
Studies show that despite the positive effects of physical activity (PA), most university students are not active enough. For interventions, it is necessary to understand the determinants of PA behavior. Theory of planned behavior (TPB) is one of the most widely used frameworks to describe the psychological determinants of health behavior. Research has shown that in addition to the determinants included in TPB (attitudes, subjective norms, perceived control, and intention), fear of negative outcomes (eg, discomfort or pain) is a major barrier to increasing one’s PA. It has been shown that accepting the possibility of unpleasant outcomes may help in reaching one’s PA goals. The purpose of this study was to create a questionnaire of PA determinants based on TPB and complemented by the topic of acceptance of unpleasant outcomes. The questionnaire is thus meant for evaluating the effectiveness of health psychological PA interventions in university students and young adults. This study was carried out using qualitative and quantitative methods and consisted of three phases: (1) an elicitation study for item generation, (2) pretesting for clarity and understanding, and (3) item selection using conceptual and psychometric criteria (based on a pretest with N=447) to maximize domain coverage and avoid redundancy. A questionnaire covering the core topics of TPB plus acceptance of negative outcomes was constructed, using a combination of qualitative and quantitative methods. The final shortened questionnaire consists of the following question blocks: positive and negative behavioral beliefs, acceptance of negative outcomes, subjective norms (injunctive and descriptive norms, and motivation to comply), and control beliefs. In terms of predicting self-reported PA, the shortened questionnaire was equal to the unabridged version. Notably, negative behavioral beliefs and acceptance of negative outcomes had opposite-signed correlations with self-reported PA (-0.22 and 0.32, P<.001). Despite the aim of avoiding redundancy, several item bundles (eg, positive and negative behavioral beliefs, and acceptance of negative outcomes) were highly homogenous in the final version, and are thus usable as psychometric scales. This questionnaire can assess a range of PA determinants and has good psychometric properties. The questionnaire can be used to assess the beliefs and attitudes (behavioral beliefs, perceived norms, control beliefs, and acceptance of negative consequences) related to PA in young adults when planning interventions, as well as evaluating the effects of health psychological interventions aiming to increase PA.
11. Association between dental floss use, dental visits, and a five-year Alzheimer's disease risk prediction score among United States adults aged 65 years and older.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Oct-16 链接: PubMed
摘要
BackgroundAlzheimer’s disease (AD) imposes substantial societal and healthcare burdens. Emerging evidence links poor oral hygiene to AD risk, but further research is still required to clarify this link.ObjectiveTo examine the associations between dental floss use, regular dental visits, and their combined effects on 5-year AD risk among United States (US) adults aged ≥65.MethodsA cross-sectional analysis included 3356 adults aged 65 + from NHANES (2013-2018). Predicted five-year AD risk scores (0-44) combined sociodemographic, psychological, behavioral, and medical factors, categorized as low (0-20) or high risk (21-44) groups. Dental floss use and past-year dental visits were assessed. Associations were evaluated using weighted logistic regression models to account for complex survey design and US representativeness.ResultsHigher rates of dental floss use and past-year dental visits were each associated with lower predicted 5-year AD risk scores. After adjustment, flossing reduced the odds of high predicted risk by 32% (OR = 0.68, 95% CI: 0.56-0.84) and dental visits by 28% (OR = 0.72, 95% CI: 0.58-0.90). Compared to those with neither behavior, participants who flossed alone (OR = 0.63, 95% CI: 0.48-0.83), had dental visits only (OR = 0.69, 95% CI: 0.52-0.92), or engaged in both behaviors (OR = 0.58, 95% CI: 0.45-0.74) showed progressively lower odds of being classified in the high predicted risk group.ConclusionsRegular dental flossing and visits were independently associated with reduced predicted 5-year AD risk, with partially additive effects when combined, supporting routine oral hygiene promotion as a potential preventive strategy in older adults.
12. Hospital resource use and in-hospital mortality before and during the COVID-19 pandemic: a nationwide cohort study.
期刊: Swiss medical weekly 发表日期: 2025-Oct-16 链接: PubMed
摘要
The COVID-19 pandemic has placed an enormous strain on the Swiss healthcare system. This study aims to assess the associations of the pandemic on Switzerland’s hospital resource use and in-hospital mortality among both COVID-19 and non-COVID-19 patients. In this national cohort study, we analysed administrative claims data for medical inpatients from 1 January 2018 to 31 December 2021, using mixed-effects segmented regression models. Hospitalisations were divided into a control and an exposure group before (January 2018 to December 2019) and during (January 2020 to December 2021) the pandemic. Before the pandemic, the division into the groups was performed by random split. We investigated trends in in-hospital mortality, hospital length of stay, 30-day hospital readmission and facility discharge rates before and during the COVID-19 pandemic, to assess the pandemic’s association with both COVID-19 (exposure) and non-COVID-19 (control) patients. Among 1,510,836 included cases, 763,533 were hospitalised before and 747,303 during the COVID-19 pandemic including 61,151 with a diagnosis of COVID-19. Before the pandemic, there were no relevant changes in population-averaged in-hospital mortality in the control group and the randomly defined exposure group (-0.0263% and 0.0201% per month, respectively). During the pandemic, however, mortality showed an increase among COVID-19 patients by 0.3553% per month (95% confidence interval [CI]: 0.3546-0.3560; change in slope p <0.001; difference in slopes p <0.001), while there was no relevant change in the pandemic control group (slope: -0.0277% per month). Similarly, COVID-19 patients showed an increase in hospital length of stay and discharge to a post-acute care facility, while the trend for 30-day hospital readmission was decreased. In this study, we observed an association between the COVID-19 pandemic and hospital resource use in COVID-19 patients only, resulting in higher in-hospital mortality, longer lengths of hospital stay and more frequent facility discharges. No relevant differences were seen in the control group during both time periods.
13. Gestational and Pregestational Diabetes Screening Changes in Early Pregnancy and Perinatal Outcomes.
期刊: Obstetrics and gynecology 发表日期: 2025-Oct-16 链接: PubMed
摘要
To evaluate an initiative to decrease gestational diabetes (GDM) screening rates before 24 weeks of gestation and to increase early-pregnancy hemoglobin A1C (Hb A1C) testing for undiagnosed pregestational diabetes and the association of this change with perinatal complications. All patients with live births and without overt diabetes who delivered between 2018 and 2022 were included. We performed an interrupted time series analysis to examine perinatal outcomes associated with the recommended changes. To reflect the level of exposure to recommended changes that started April 2020, delivery dates were categorized into three time periods: T1, unexposed (January 1, 2018-March 31, 2020); T2, partially exposed (April 1-December 31, 2020); and T3, fully exposed (January 1, 2021-December 31, 2022). The primary outcome was a composite including large-for-gestational-age birth weight, cesarean delivery, preeclampsia, severe maternal morbidity, preterm birth, shoulder dystocia, neonatal hypoglycemia, and neonatal intensive care unit admission. Among 221,068 delivering individuals, early GDM screening rates decreased from 31.1% in T1 to 20.6% in T2 and 4.3% in T3 (standardized mean difference [SMD] T3 vs T1, -0.75), and Hb A1C testing increased from 12.3% to 23-35.2% (SMD T3 vs T1, 0.56). There was no change in the prevalence of the composite primary outcome: 43.1% in T1, 44.2% in T2, and 45.2% in T3 (SMD T3 vs T1, 0.04). Interrupted time series analysis adjusted for covariates showed no change in risk of the composite outcome during T1 (percent change/4 weeks, 0.06 [95% CI, -0.01 to 0.13]), T2 (0.02 [95% CI, -0.21 to 0.25]), or T3 (-0.02 [95% CI, -0.26 to 0.23]). A decrease in early GDM screening accompanied by increased early Hb A1C testing did not influence perinatal outcomes.
14. Can vigorous physical activity mitigate the effect of systemic inflammation on cognitive performance? Results from a large older community dwelling population in The Netherlands.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Oct-16 链接: PubMed
摘要
BackgroundElevated systemic inflammation is associated with poorer cognitive function, while vigorous physical activity enhances cognition.ObjectiveThis study examines whether physical activity moderates the relationship between systemic inflammation and cognitive performance.MethodsWe analyzed 24,661 adults (50+) from the Dutch Lifelines cohort across two waves. Cognitive performance was assessed via a validated composite score from the Cogstate Brief Battery, with higher scores indicating lower cognitive performance. Leukocyte count (3-11 × 109 cells/liter) served as a systemic inflammation biomarker, categorized as low (<6.5 × 109 cells/liter) or high (≥6.5 × 109 cells/liter). We used the Short Questionnaire to Assess Health-Enhancing Physical Activity to define moderate (0, 1-149, 150+ minutes) and vigorous (0, 1-74, 75+ minutes) physical activity. We performed linear regression models to examine the effect of inflammation and vigorous physical activity on cognition, adjusting for moderate physical activity and covariates. An interaction effect analyzed the potential moderation of vigorous physical activity.ResultsIndividuals with high systemic inflammation (SI) levels in both waves exhibited significantly longer reaction times (b = 0.062 [95% confidence interval: 0.002; 0.122]) compared to those with low SI levels in both waves. Individuals who engaged in 1-74 min or 75+ minutes of vigorous physical activity had significantly faster reaction times (1-74: b = -0.114 [-0.193; -0.034], 75+: b = -0.160 [-0.210; -0.111]) than those who did not. The interaction term was insignificant.ConclusionsAlthough vigorous physical activity is protective, it cannot mitigate the negative association between systemic inflammation and cognition. Nevertheless, promoting vigorous physical activity in an ageing population can be an effective strategy for preventing or delaying cognitive decline.
15. Accelerating innovation: implementation science as a cornerstone of high-performance Swiss research infrastructures.
期刊: Swiss medical weekly 发表日期: 2025-Oct-16 链接: PubMed
摘要
Switzerland invests substantially in research, yet many innovations fail to reach routine healthcare. This paper argues that embedding implementation science into national research infrastructures is key to closing this gap, reducing research waste and accelerating translation into practice. By strengthening initiatives such as IMPACT and national funding programmes, Switzerland can ensure its innovations deliver timely, sustainable benefits for patients and society.
16. Clinic Adaptations and Changes in Abortion Use After Dobbs in Illinois, July 2021-June 2023.
期刊: American journal of public health 发表日期: 2025-Oct-16 链接: PubMed
摘要
Objectives. To assess changes in abortion service delivery in Illinois after the Dobbs v Jackson Women’s Health Organization decision. Methods. We used data from a monthly survey of 2 Illinois abortion providers that provide half of Illinois’s abortions. We collected data from 2021 to 2023 on abortion counts, overall and stratified by method, gestation duration, and patient state. We compared pre- and post-Dobbs findings. Results. A total of 24 071 abortions took place from July 2021 to June 2022 and 32 579 from July 2022 to June 2023. This 35% increase was driven by a 191% increase in out-of-state patients. Medication abortions increased by 22%, procedural abortions by 53%, and abortions occurring at 12 weeks or later by 75%. Conclusions. After Dobbs, 2 large Illinois abortion providers increasingly offered care to out-of-state patients and patients presenting at later gestations while maintaining in-state abortion rates. Public Health Implications. Policymakers in states where abortion remains legal can anticipate increased demand for care when other states restrict abortion. By passing legislation to protect access to medication and procedural abortions and abortions later in pregnancy, they can support facilities in meeting patient needs. (Am J Public Health. Published online ahead of print October 16, 2025:e1-e9. https://doi.org/10.2105/AJPH.2025.308273).
17. Congenital Syphilis: From Near-Elimination to Crisis.
期刊: American journal of public health 发表日期: 2025-Oct-16 链接: PubMed
摘要
This analytic essay examines the transformation of congenital syphilis (CS) in the United States from near-elimination to crisis. Drawing from the January 2025 Congenital Syphilis Summit in Atlanta, Georgia-convening public health leaders, Tribal health departments, the National Coalition of STD Directors, and Centers for Disease Control and Prevention experts-we contrast prevention systems during near-elimination (1998-2005) with the current crisis (2018-2025). Evidence revealed how dismantling public health infrastructure produced dramatically different outcomes, with CS cases increasing 937% over the past decade and racial/ethnic disparities worsening. American Indian/Alaska Native communities face rates up to 100 times higher than White populations in some regions, illustrating the multiplicative effects of system failures on vulnerable communities. We identify 5 critical system failures: cyclical boom-and-bust funding, workforce deterioration, fragmented surveillance, disconnected health care systems, and health equity failures. We present policy proposals for rebuilding prevention infrastructure through a deliberate phased approach transitioning from crisis response to sustained maintenance, ensuring prevention systems receive continuous support rather than episodic investments that have characterized past approaches. (Am J Public Health. Published online ahead of print October 16, 2025:e1-e10. https://doi.org/10.2105/AJPH.2025.308266).
18. Chemotherapy and Supportive Care Practice Patterns Among Older Adults With Metastatic Pancreatic Cancer.
期刊: JCO oncology practice 发表日期: 2025-Oct-16 链接: PubMed
摘要
Metastatic pancreatic ductal adenocarcinoma (mPDAC) is a leading cause of cancer mortality in the United States. Although fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) and gemcitabine with NAB-paclitaxel (GnP) represent first-line chemotherapy options for mPDAC, practice patterns in older adults remain understudied. We describe national treatment trends, factors associated with treatment selection, and receipt of second-line treatment in older adults with mPDAC. Using the SEER-Medicare linked database (2010-2019), we identified a cohort of individuals age 66 years and older diagnosed with mPDAC who initiated infusion chemotherapy within 90 days of diagnosis. Temporal trends in first-line treatment selection were quantified for the overall population and stratified by levels of a claims-based frailty index (robust, prefrail, and frail). We used multinomial logistic regression to describe associations between patient factors and first-line agent received adjusted for year of diagnosis. We characterized median time on first-line therapy, use of supportive care interventions, and receipt of second-line therapy. Among 7,473 adults with mPDAC (median age = 74 years, 50.7% female), gemcitabine monotherapy was the predominant treatment in 2010 at 69.3%, but in 2019 it fell to the third most-used regimen (16.6%) behind GnP (45.2%) and FOLFIRINOX (20.9%). In the most recent data (2019), 29.8%, 19.8%, and 6.8% of robust, prefrail, and frail individuals received FOLFIRINOX, respectively. Factors associated with regimen selection included age, sex, race/ethnicity, comorbidity, and frailty. Approximately one third of FOLFIRINOX initiators received second-line GnP (36.3%) and vice versa (31.1%). Chemotherapy use has evolved for older adults with mPDAC and varies across levels of baseline frailty. The heterogeneity in chemotherapy selection and practice patterns in older adults merits ongoing investigation to help ensure patients receive treatment tailored to their unique geriatric needs.
19. Sex and body size disparities under MELD 3.0: Evaluation of persisting gaps in liver transplant access.
期刊: Hepatology (Baltimore, Md.) 发表日期: 2025-Oct-16 链接: PubMed
摘要
The July 2023 implementation of MELD3.0 aimed to address longstanding sex disparities in liver transplant (LT) access. However, its impact has been understudied. We analyzed US transplant registry data (2/4/2020-9/30/2024) among adult LT candidates. Using a difference-in-differences (DiD) design, we assessed the impact of MELD3.0 during immediate and 3-month post-implementation (“burn-in”) periods on receipt of: 1) a top 5 organ offer or 2) transplant. Poisson and logistic models estimated offer and transplant probabilities. Mediation and subgroup analyses by height were also conducted. We analyzed 9,952,473 person-day observations from 60,159 LT candidates. Following MELD3.0, women had greater relative increases in top 5 organ offer rates (rate ratio [RR] 1.141.251.37 at implementation; RR 1.111.161.22 at three months). Pre-MELD3.0, transplant rates were lower for women than men (odds ratio [OR] 0.840.860.89). Post-policy, women had greater relative improvements in transplant access than men (OR 1.161.361.60 at implementation; 1.091.181.29 at three months), but this advantage diminished over time, with the model-estimated improvement for women relative to men declining to OR 0.81 by the study end. In mediation analysis, adjustment for height eliminated the difference in transplant rates by sex (OR 0.981.011.05). Among taller (≥166 cm) candidates, baseline differences by sex persisted (OR 0.890.920.96), but not in the shorter (<166 cm) group (OR 0.920.971.03). Post-policy, the benefit for women was more pronounced in shorter candidates (OR 1.191.471.83). MELD3.0 led to early gains in transplant access for women, though this effect diminished over time and differences by sex mediated by body size persisted.
20. Bridging the Infodemic Equity Gap: North-South Digital Health Disparities and a Framework for Action.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-16 链接: PubMed
摘要
Rapidly propagating false and misleading health claims do not strike all societies evenly. Structural digital inequalities, uneven platform governance leverage, gaps in multilingual health literacy, and divergent political information climates have combined to produce what is argued here as an infodemic equity gap: a patterned disparity in exposure to, resilience against, and recoverability from health misinformation between and within countries. This viewpoint advances a pragmatic equity-centered framework that dissects that gap into layered capacities (structural infrastructure, ecosystem governance, sociocultural trust and literacy, and adaptive intervention capability) and shows how their interaction generates differential outcomes. Using a purposive comparative lens across 5 archetypal settings (Finland, Taiwan, the United States, Brazil, and India), it shows distinct causal pathways linking technological architectures, governance choices, and social context to measurable process metrics (detection latency, rumor half-life, and multilingual coverage) and outcome indicators (trust trajectories, vaccination differentials, and equity-sensitive gaps). Rather than revisiting broad definitional terrain already synthesized elsewhere, the focus is on isolating disparities that are specifically actionable through digital health policy, measurement standardization, and investment strategies. A forward agenda is outlined for harmonized indicators, evaluation methods, and ethical safeguards needed to reduce inequities in future health emergency information ecologies. The intended audiences are digital health researchers, platform governance teams, public health decision-makers, and funding bodies shaping cross-border preparedness.
21. Variations in liver allocation systems across continents with a focus on MELD exceptions.
期刊: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 发表日期: 2025-Oct-16 链接: PubMed
摘要
Variations in liver allocation systems world-wide are presented, with a specific focus on regional differences and their potential impact on outcomes, with the goal to serve as a reference for future policy development. Summaries of liver allocation across multiple European, Scandinavian, Asian systems as well as the combined allocation system of Australia plus Canada, the United States, and the systems in Central America, South American, and the Caribbean are reviewed. A comprehensive comparison of how different regions address MELD exceptions, primarily focusing on hepatocellular carcinoma, along with the most common etiologies of liver disease requiring transplantation. Additionally, the adoption of living donation and donation after circulatory death (DCD) is discussed. The study involves contributions from a diverse group of world experts in liver transplantation and may serve as an essential resource to foster international dialogue as countries strive to optimize organ allocation policy, including MELD exceptions.
22. Predicting Maltreatment in Foster Homes: The Role of Child Welfare Agency Policies.
期刊: Child maltreatment 发表日期: 2025-Oct-16 链接: PubMed
摘要
Although maltreatment of children living in substitute care has significant negative consequences for both the children who experience it and for child welfare agencies, research examining this outcome is underdeveloped and has focused on a limited number of risk factors. Using administrative data from one Midwestern state and a social ecological framework, the current study examined the impact of multiple child, caseworker, case, and agency-level factors on the occurrence of maltreatment among children placed in foster homes. The results highlighted the importance of several agency-level factors. Foster home licensing was a significant predictor of substantiated maltreatment in substitute care, with children in unlicensed kinship and unlicensed fictive kinship foster homes at elevated risk of maltreatment compared to those in licensed placements. A majority of kinship and fictive kinship homes were unlicensed, which suggests that increasing licensure may improve child safety in substitute care. Other factors that increased the risk of maltreatment included larger caseworker caseloads, larger number of unrelated children in the foster home, and child mental health needs.
23. Daily Household Electricity Consumption in Community-Dwelling Older Individuals With Cognitive Impairment: Prospective Cohort Study.
期刊: JMIR formative research 发表日期: 2025-Oct-16 链接: PubMed
摘要
Various digital biomarkers have been explored to detect cognitive impairment in community-dwelling older individuals, among which electricity consumption (EC) data obtained from smart meters are novel and promising because they pose no burden to the individuals. The study aimed to explore the potential of EC as a digital biomarker to screen older individuals with cognitive impairment living alone. We recruited 40 older individuals living alone and recorded their 1-year daily household EC data. We used the Japanese version of the Montreal Cognitive Assessment to categorize participants into 2 groups: those with and without cognitive impairment. As the pattern of daily household EC is different between lower and higher temperature ranges because of the use of heating and cooling equipment, we divided the daily household EC into 3 temperature ranges. Using a linear mixed model, we evaluated the association between daily household EC, daily outside temperature, and the groups. After excluding 12 participants, they were categorized into 2 groups: those with (10/28, 36%) and without cognitive impairment (18/28, 64%). The daily household EC data consisting of 9391 points showed two characteristics: (1) daily household EC was significantly lower in the group with cognitive impairment than in the group without cognitive impairment in the high temperature range (2.158 kWh at 25 °C, P=.02; 3.712 kWh at 30 °C, P<.001). The increase in EC with rising temperature from 25 °C to 30 °C was less in the group with cognitive impairment (2.387 kWh, P<.001) than in the group without cognitive impairment (3.940 kWh, P<.001); and (2) a tendency for lower daily household EC in the group with cognitive impairment was observed in the moderate temperature range (1.795 kWh at 15 °C, P=.06; 1.582 kWh at 20 °C, P=.08). The group with cognitive impairment may use less cooling equipment in the high temperature range and fewer home appliances in the moderate temperature range. Daily household EC might be useful in screening cognitive impairment in older individuals living alone.
24. Exploring the mediating role of active coping in reducing perceived stress among men with advanced prostate cancer: a randomized controlled trial of cognitive behavioral stress management.
期刊: Journal of behavioral medicine 发表日期: 2025-Oct-16 链接: PubMed
摘要
Cognitive-behavioral stress management (CBSM), which integrates active coping strategies, has been shown to enhance psychological adaptation in cancer survivors, resulting in reduced emotional distress and better quality of life. However, research on the impact of active coping in advanced cancer survivorship remains underexplored. This study examined whether active coping mediated the effects of CBSM on perceived stress among men with advanced prostate cancer (APC). APC survivors (N = 189) who had received androgen deprivation therapy (ADT) were randomized to a 10-week CBSM or a health promotion (HP) intervention and followed for one year. Structural equation modeling was used to test whether active coping mediated the effect of CBSM on perceived stress adjusting for relevant sociodemographic and clinical covariates, and to determine whether this mediating role was specific to the CBSM condition. CBSM predicted a decrease in perceived stress from baseline to 12 months post-baseline through active coping. As expected, this full mediating effect was observed only in patients who received CBSM. While active coping declined over time, CBSM appeared to have a buffer effect, helping to sustain coping compared to the control group. This may be particularly relevant for advanced cancer survivors, who often experience a general shift towards less coping over time, potentially due to psychological adaptation and increasing physical burdens. Findings suggest that sustaining active coping mechanisms through CBSM can contribute to reducing psychological stress and improving health-related quality of life in APC survivors. Future research should focus on optimizing interventions by tailoring coping strategies to the evolving needs of this population.
25. Selective α-glucosidase inhibitory activity of (+)-eupenoxide and 3-ketone derivatives produced by the endophytic fungus of Aspergillus sp.
期刊: Journal of natural medicines 发表日期: 2025-Oct-16 链接: PubMed
摘要
α-Glucosidase and α-amylase are two important glycosidases involved in carbohydrate metabolism. Inhibitors of these enzymes are considered crucial therapeutic agents for carbohydrate absorption disorders such as diabetes and obesity. However, the inhibition of salivary amylase can result in undigested starch reaching the stomach, causing indigestion and potentially leading to gastric and duodenal ulcers as well as gastritis. Selective inhibitors that possess α-glucosidase inhibitory activity without affecting α-amylase are needed to address this issue. It has been revealed that (+)-eupenoxide and its 3-ketone derivative, produced by the endophytic fungus of Aspergillus sp. C-1-1 strain associated with Catharanthus roseus, selectively inhibits α-glucosidase. Additionally, from the α-glucosidase inhibitory activity of related compounds, we have successfully deduced the chemical structure feature necessary for α-glucosidase inhibition.
26. Overview of rehabilitation interventions for ESPEN/EASO-defined sarcopenic obesity: a scoping review.
期刊: European geriatric medicine 发表日期: 2025-Oct-16 链接: PubMed
摘要
Sarcopenic obesity (SO) is a global concern characterized by the co-existence of sarcopenia and obesity. Although various interventions are recommended for SO, inconsistent definitions represent a barrier to clinical practice. This scoping review aimed to provide an overview of rehabilitation interventions for SO based on the definitions provided by the European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity. A systematic search was conducted across nine databases, with a final search conducted on February 27, 2024. The eligible studies included randomized controlled trials, prospective and retrospective cohort studies, and case-control studies without restrictions on language, country, sex, or publication date. The risk-of-bias assessment focused on muscle strength, physical function, and body composition. The risk of bias was assessed using the Risk of Bias 2 tool for randomized trials and the Newcastle-Ottawa scale for non-randomized studies. Four randomized controlled trials involving 246 participants were included, all of which were conducted in communities. In addition, three studies comprised exclusively female participants, and all four studies employed resistance exercises. One study used a combination of resistance exercises and nutritional interventions. The overall risk of bias was high for all outcomes. The reported studies emphasized the limited number of studies covering diverse populations and settings. Further studies with improved methodological rigor are essential to identify effective rehabilitation strategies for SO. The study protocol was registered in the Open Science Framework ( https://osf.io/wak9n/ ) on January 31, 2024.
27. Secondary Prevention after Carotid Stenting in Patients With Atrial Fibrillation.
期刊: Vascular and endovascular surgery 发表日期: 2025-Oct-16 链接: PubMed
摘要
IntroductionThere is no consensus on the optimal secondary stroke prevention regimen for patients with atrial fibrillation undergoing carotid artery stenting (CAS). Our objective is to compare the long-term efficacy and safety of different medical regimens after CAS.MethodsThis retrospective observational study included patients with pre-existing atrial fibrillation who underwent CAS from 2011 to 2024. Patients were divided into three treatment groups: dual antiplatelet therapy (DAPT), single antiplatelet therapy plus oral anticoagulation (AA), and triple therapy (dual antiplatelet therapy plus oral anticoagulation, TT). The primary outcome was the incidence of major bleeding. Secondary outcomes included the incidence of clinically relevant minor bleeding, recurrent stroke, and stent thrombosis.ResultsOf the 1047 patients who underwent CAS, 129 met the inclusion criteria: 31 in the DAPT group, 46 in the AA group, and 52 in the TT group. At 3 months, major bleeding events occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 7.7% (4/52) in the TT group (P = 0.71). Ischemic stroke after stent placement occurred in 6.4% (2/31) of cases in the DAPT group, compared to 4.3% (2/46) in the AA group and 1.9% (1/52) in the TT group (P = 0.57). Stent thrombosis occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 1.9% (1/52) in the TT group (P = 0.32).ConclusionOur findings suggest no significant differences in bleeding events or ischemic outcomes among the different antiplatelet and anticoagulation regimens in patients with atrial fibrillation who underwent CAS.
28. Recurrence of High-Grade Vulvar Intraepithelial Neoplasia After Treatment With Excision Compared With Imiquimod.
期刊: Obstetrics and gynecology 发表日期: 2025-Oct-16 链接: PubMed
摘要
To evaluate long-term recurrence rates and time to first recurrence for human papillomavirus (HPV)-associated high-grade vulvar intraepithelial neoplasia (VIN) by initial treatment. This was a retrospective cohort study of patients treated with excision, imiquimod, or laser for HPV-associated VIN grade 2-3 at a high-risk colposcopy center. We collected demographic, clinical, and longitudinal pathology data. Given the small number (n=15), the cohort of patients treated with laser were excluded from analyses. We performed χ2 and Wilcoxon rank-sum tests to compare the rates of recurrence and median time to first recurrence by treatment modality. Univariate and multivariate analyses were conducted to compare predictors of recurrence and time to recurrence. Multivariate models were adjusted for side effects or barriers to imiquimod use, lesion focality, and initial histology based on significant findings in the univariate models. Three hundred fifteen patients met the criteria for inclusion, 231 treated with excision and 84 with imiquimod. Median follow-up time from initial diagnosis was 36 months. Recurrence rates and median time to recurrence with imiquimod (40.5% and 7.4 months) and excision (34.6% and 11.3 months, P=.34, P=.38) did not differ significantly. In univariate analysis, positive margins (odds ratio [OR] 4.68, 95% CI, 2.53-8.62), multifocal disease (OR 2.27, 95% CI, 1.19-4.33), and presence of carcinoma in situ on initial diagnosis (OR 6.21, 95% CI, 1.45-26.6) were predictors of recurrence after excision. Only the presence of side effects or barriers to imiquimod use (OR 2.46, 95% CI, 1.01-6.02) was significant in the univariate model for recurrence after imiquimod. No significant difference remained for the odds of recurrence after treatment with imiquimod compared with excision in the multivariate model (OR 1.28, 95% CI, 0.77-2.14); there was similarly no significant difference in the multivariate model of time to recurrence (hazard ratio 1.41, 95% CI, 0.86-2.30). In appropriately selected patients, imiquimod appears to have outcomes similar to those of excision for the prevention of recurrent HPV-associated VIN.
29. A positive allosteric modulator of the β1AR with antagonist activity for catecholaminergic polymorphic ventricular tachycardia.
期刊: The Journal of clinical investigation 发表日期: 2025-Oct-16 链接: PubMed
摘要
Orthosteric β-blockers represent the leading pharmacological intervention for managing heart diseases owing to their ability to competitively antagonize β-adrenergic receptors (βARs). However, their use is often limited by the development of adverse effects such as fatigue, hypotension, and reduced exercise capacity, due in part to the nonselective inhibition of multiple βAR subtypes. These challenges are particularly problematic in treating catecholaminergic polymorphic ventricular tachycardia (CPVT), a disease characterized by lethal tachyarrhythmias directly triggered by cardiac β1AR activation. To identify small molecule allosteric modulators of the β1AR that could offer enhanced subtype specificity and robust functional antagonism of β1AR-mediated signaling, we conducted a DNA-encoded small molecule library screen and discovered Compound 11 (C11). C11 selectively potentiates the binding affinity of orthosteric agonists to the β1AR while potently inhibiting downstream signaling following β1AR activation. Moreover, C11 prevents agonist-induced spontaneous contractile activity, Ca2+ release events, and exercise-induced ventricular tachycardia in the CSQ2-/- murine model of CPVT. Collectively, our studies demonstrate that C11 belongs to an emerging class of allosteric modulators termed PAM-antagonists that positively modulate agonist binding but block downstream function. With unique pharmacological properties and selective functional antagonism of β1AR-mediated signaling, C11 represents a promising therapeutic candidate for the treatment of CPVT and other forms of cardiac disease associated with excessive β1AR activation.
30. The global prevalence of mental disorders among adolescents: Focus on sex, regional and socio-demographic differences.
期刊: International review of psychiatry (Abingdon, England) 发表日期: 2025-Oct-16 链接: PubMed
摘要
Adolescence is a critical developmental period during which many mental and substance use disorders first emerge, yet global estimates remain limited. Using data from the Institute for Health Metrics and Evaluation for the Global Burden of Disease Study 2021, we examined prevalence among adolescents aged 10-19 years across 204 countries. In 2021, 15.2% had at least one mental disorder. Anxiety disorders were most prevalent (4.9%), followed by conduct disorder (2.7%), ADHD (2.6%), and depressive disorders (2.4%), with major depressive disorder affecting 2.0%. Autism spectrum disorders accounted for 0.9%, intellectual disability 1.7%, bipolar disorder 0.3%, and eating disorders 0.3% (anorexia 0.1%, bulimia 0.2%). Schizophrenia (0.04%) and other disorders (0.2%) contributed smaller fractions. Substance use disorders affected 0.8%, mainly drug use (0.5%) and alcohol (0.3%), with cannabis use disorders at 0.4%. Prevalence varied by sex, region, and socio-demographic development: females showed higher internalizing conditions, males higher externalizing disorders. High-SDI regions had highest prevalence (20.7%) versus low-SDI (13.4%); High-Income North America recorded 22.8%, South Asia 9.7%, and Sub-Saharan Africa 11.6%, likely reflecting under-recognition, stigma, and limited diagnostic capacity. These findings highlight the global significance of adolescent mental health, disparities across sexes and regions, and the need for context-specific prevention and treatment strategies.
31. Trends in Persons Prescribed HIV Postexposure Prophylaxis in the United States, 2015-2023.
期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 发表日期: 2025-Oct-16 链接: PubMed
摘要
HIV postexposure prophylaxis (PEP) is the only intervention for reducing HIV acquisition risk after exposure. Our objective was to describe PEP user characteristics and analyze national trends in PEP regimens recommended by the Centers for Disease Control and Prevention (CDC) in 2016 and of off-label bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) for PEP. We analyzed the IQVIA Real World Data-Longitudinal Prescriptions database to identify persons aged ≥16 years prescribed antiretroviral (ARV) PEP regimens recommended by CDC or BIC/FTC/TAF from 2015-2023. We excluded persons with an HIV diagnosis or prescribed ARVs for HIV or hepatitis B virus treatment. Two clinicians reviewed regimens to confirm probable PEP prescriptions. We reported an annual number of PEP users, stratified by demographic characteristics, regimen type, and days of supply. The number of persons prescribed PEP increased from 20,618 in 2015 to 44,934 in 2023. The number of persons prescribed a bictegravir-based PEP regimen increased from 1,377 (4.1% of total PEP users) in 2018 to 7,536 (16.8%) in 2023. Among 44,934 PEP users in 2023, 53.8% were men, and 39.8% were aged 25-34 years. Most (88.4%) PEP users were prescribed a full course of PEP (28-30-day supply). Our analysis found an increasing trend in PEP use annually, possibly reflecting greater PEP awareness and broader HIV prevention efforts. Increased use of a bictegravir-based PEP regimen in 2023 suggests a shift in PEP prescribing practices, likely due to its once-daily dosing and high tolerability. Our findings can guide future recommendations for PEP medications.
32. Drought intensity and duration interact to magnify losses in primary productivity.
期刊: Science (New York, N.Y.) 发表日期: 2025-Oct-16 链接: PubMed
摘要
As droughts become longer and more intense, impacts on terrestrial primary productivity are expected to increase progressively. Yet, some ecosystems appear to acclimate to multiyear drought, with constant or diminishing reductions in productivity as drought duration increases. We quantified the combined effects of drought duration and intensity on aboveground productivity in 74 grasslands and shrublands distributed globally. Ecosystem acclimation with multiyear drought was observed overall, except when droughts were extreme (i.e., ≤1-in-100-year likelihood of occurrence). Productivity losses after four consecutive years of extreme drought increased by ~2.5-fold compared with those of the first year. These results portend a foundational shift in ecosystem behavior if drought duration and intensity increase, from maintenance of reduced functioning over time to progressive and profound losses of productivity when droughts are extreme.
33. Revolutionizing Dialysis: The Dual Impact of Incremental Peritoneal Dialysis on Patient Care and Sustainability.
期刊: Blood purification 发表日期: 2025-Oct-16 链接: PubMed
摘要
Chronic kidney disease (CKD) significantly impacts global health, with dialysis patients often experiencing reduced quality of life. Incremental start peritoneal dialysis has emerged as a promising individualized treatment strategy, offering potential benefits for both patient outcomes and environmental sustainability compared to standard peritoneal dialysis. This study aimed to evaluate the impact of incremental start continuous ambulatory peritoneal dialysis (CAPD) on quality of life, clinical outcomes, and environmental metrics, such as plastic waste generation, compared to conventional CAPD. A multicenter study involving two groups (incremental start CAPD-INPD and standard dose conventional CAPD-STPD groups) was conducted. Baseline and six-month follow-up data were collected, including laboratory parameters, treatment-related plastic waste, glucose load, residual renal function, and quality of life assessed using the Kidney disease quality of life short form (KDQOL-SF). There was no statistically significant difference in median age and gender between the two groups (p>0.05). In the third month of the study, a significant difference was observed in PET ultrafiltration volume, with higher values in the STPD group (p=0.020). There were no statistically significant differences between study groups according to permeability groups (p=0.714) or KtV (p=0.743). In the sixth month of the study, the INPD group demonstrated significantly better residual renal function (p<0.001) and reduced weekly polyprolene and polyvinile chloride plastic waste ( p<0.001) and glucose load (p<0.001) in both the baseline and sixth months of the study. KDQOL-SF scores were significantly higher in the INPD group (p<0.001). INPDD demonstrated superior outcomes in maintaining residual renal function, reducing treatment burden, and improving quality of life while significantly lowering environmental impact compared to STPD. These findings support the adoption of INPD as an individualized and sustainable strategy in CKD management. Further research is needed to validate these findings in larger cohorts and explore long-term outcomes.
34. A review of ergonomics and technological advancements in safety boots for the construction industry.
期刊: Work (Reading, Mass.) 发表日期: 2025-Oct-16 链接: PubMed
摘要
BackgroundOne of the riskiest industries in the world is the construction industry, where employees are subjected to accidents. To reduce these risks, personal protective equipment (PPE) is introduced. Many technical advancements are happening around the globe. However, such advancements are lacking in the construction industry and PPE kits.ObjectiveThis study reviews how product design affects the design of safety boots used in the construction sector.MethodsA systematic literature review was conducted using SCOPUS, Google Scholar, PubMed, and ScienceDirect databases, focusing on peer-reviewed journal articles published in English over the last ten years (2014-2024). Articles were selected based on a detailed screening process, including evaluations of titles, abstracts, and full texts, to ensure relevance to the study. Following the PRISMA approach, 30 papers were identified using keywords such as “safety boots,” “construction industry,” “ergonomics,” “IoT,” and “AI.” These selected studies were analyzed to identify key research questions, findings, and gaps within the field.ResultsResearch has indicated that factors that influence the boot wear design in the construction industry are materials, pressure point, shaft height, shaft weight, boot weight, sole height, foot arch, toe box, ergonomics, foot morphology, technological advancement, etc, all these factors can, directly and indirectly, affect the function, durability, and comfort of the boots. An ergonomically advanced boot can decrease pain, musculoskeletal disorders, and wounds. Artificial intelligence can be directly used in the design process for refinement, prototyping, and analysis. Data analysis, communications, and coordination can be increased by using advanced smart boots. In short, incorporating ergonomics, technologies, and AI can improve the user experience and worker safety.ConclusionBy better understanding the relationship between product design, material, ergonomics, technology and AI, the design of safety boots can promise more comfort and safety. Many factors like toe box, sole height, foot arch, shaft height, weight can directly affect the function of a boot. New materials like cordura, sympatex can be used for making membranes of the boots. Temperature, biometric, chemical sensors, and AI can increase the safety and data analysis. But further research has to be done on many factors like shaft height, weight, sensors, and usage of AI in design process and manufacture. Designing a smart safety boot for construction workers has good scope. The manufacturers can create boots that exceed workers’ expectations, thereby providing a safer and more productive work environment.
35. Evaluation of DNA damage in long-term paint exposed workers by non-invasive buccal micronucleus assay.
期刊: Toxicology and industrial health 发表日期: 2025-Oct-16 链接: PubMed
摘要
Workers involved in paint production or application are extensively exposed to various hazardous substances like organic solvents, lead-based pigments, adhesives, and residual plastic monomers. Therefore, workers in the paint industry are at high risk of suffering adverse health effects. Studies of the lymphocytes of paint workers have demonstrated that industrial paint induces DNA damage and cellular changes. The aim of the present study was to assess DNA damage in 54 paint workers from paint production and application areas and 54 age-gender matched control subjects using a non-invasive buccal micronucleus (MN) assay. Buccal MN frequencies were significantly increased in workers compared to controls. MN frequencies significantly increased among workers from paint production areas compared with workers from paint application areas. MN frequencies in long-term workers (>10 years) were found to be significantly higher than those of short-term workers (≤10 years), which indicates that the duration of exposure to paints causes cytogenetic damage. MN frequencies increased with increasing age, while smoking status and the use of protective masks had no additional effect on MN frequencies within groups. In conclusion, it appears that long-term exposure to complex chemical mixtures during paint production may increase DNA damage in the workers. Understanding the possible causes of occupational exposure-induced genotoxicity in paint industry workers is of great importance for the protection of public health. Monitoring variables related to genotoxic damage in the paint workers using non-invasive methods will facilitate and improve risk assessment in the paint production sector.
36. Causal mediation analysis with two mediators: A comprehensive guide to estimating total and natural effects across various multiple mediators setups.
期刊: Psychological methods 发表日期: 2025-Oct-16 链接: PubMed
摘要
Mediation analysis is widely used in psychology to assess how an independent variable transmits its causal effect on an outcome both directly and indirectly through intermediary variables known as mediators. Causal mediation analysis addresses numerous criticisms of product-of-coefficients approach, often regarded as the primary method for estimating indirect effects in psychological research. However, navigating causal mediation analysis, especially in settings with multiple mediators, can be challenging for those unfamiliar with its concepts, assumptions, and estimation strategies. In this tutorial, we therefore offer a comprehensive guide to conducting causal mediation analysis with two mediators across three data-generating mechanisms: setups with causally dependent mediators, independent mediators, and noncausally dependent mediators. For each of these mechanisms, we provide formal mathematical definitions and assumptions for the natural direct and indirect effects, along with less technical explanations of these concepts. We also provide R and Stata codes for estimating the natural direct effect, the joint natural indirect effect, and the path-specific natural indirect effects using four different estimators: the imputation approach, the extended imputation approach, the inverse probability weighted approach, and the extended quasi-Bayesian Monte Carlo approach. Additionally, we illustrate each of these methods with examples from the International Dating Violence Study. This tutorial aims to equip applied researchers in psychology with all the necessary tools to conduct causal mediation analysis involving two mediators across various multiple mediators setups. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
37. Compassionate Understanding.
期刊: The Journal of medicine and philosophy 发表日期: 2025-Oct-16 链接: PubMed
摘要
The trauma and anguish professional people encounter in their work over time can lead to losses in competence and occupational burnout. However, the practice of detachment designed to avoid these outcomes can tip over into losses in the ability to connect with clients, and even to alienation from the professional role itself. Some have thought that the proper regulation of levels of empathic concern ensures a balance between these two poles. I argue against this and instead advocate for a stance I call compassionate understanding. I contend that this best achieves sustained professionalism while remaining morally attuned to the norms of one’s occupation. I focus on health care to illustrate what is at stake in compassionate understanding, though the position I defend has applications across a significant range of professions.
38. Suicide thoughts and behaviors among police officers: A systematic review with meta-analysis.
期刊: Death studies 发表日期: 2025-Oct-16 链接: PubMed
摘要
Police officers face chronic occupational stress, yet reliable estimates of their suicidal behaviors remain scarce. This meta-analysis assessed the pooled prevalence of suicidal ideation, plans, and attempts among police officers across various time frames. A systematic search of five databases (2000-2025) identified 36 eligible studies from 16 countries, encompassing 62,663 officers. Random-effects meta-analysis estimated lifetime prevalence rates of 21% for suicidal ideation (95% CI: 15.2%-28.9%), 6% for suicide planning (95% CI: 4.1%-7.2%), and 3% for suicide attempts (95% CI: 1.1%-7.8%). These rates often exceeded those in the general population. Findings also revealed an 11% decrease in lifetime ideation over the past two decades and a 23% reduction in risk between ages 33 and 50. Results underscore the urgent need for targeted mental health research and increased institutional support from political and law enforcement entities.
39. Exposure, Environment, and Well Being. A Cross-Sectional Study of the Health Hazards, the Working Environment and the Quality of Life Among Cashew Workers in South Kerala, India.
期刊: Journal of community health 发表日期: 2025-Oct-16 链接: PubMed
摘要
Cashew processing is a labor-intensive work, which requires physical demand exposing workers to various occupational health problems. This study aims to identify the occupational health issues faced by cashew workers, evaluate their working environment and assess their quality of life. A cross-sectional study was conducted among 280 cashew factory workers in South Kerala. Data was collected using a semi structured questionnaire which includes sociodemographic characteristics, working environment, and system related health issues. The WHOQOL-BREF questionnaire was used to assess Quality of life among workers. The collected data was entered and coded into Microsoft Excel (Version 2016) and analyzed via SPSS Version16.0. Prevalence of musculoskeletal pain (96.8%) was high, followed by central nervous system-related symptoms (68.2%) and dermatological issues (58.5%).Of the ten factories surveyed, one-third (33.3%) did not have a proper system for fumes and dust extraction, provision of personal protective equipment, appointment of welfare officers and accessible washing facilities. Participants above 45 yrs of age were found to have 1.7 times higher odds of experiencing occupational health issues compared to those aged less than 45 years, as per multivariate analysis(p < 0.05). With respect to Quality of life, workers had higher social health mean score of 65.11 ± 15.02 and lower psychological health mean score of 46.93 ± 10.61. Musculoskeletal pain was the most prevalent health issue among cashew workers. The working environment among cashew workers is generally poor, which, along with occupational hazards, contributes to compromised quality of life in multiple domains.
40. Safety and effectiveness of left atrial appendage occlusion in patients with atrial fibrillation and high bleeding risk: a cardinality-matched comparison with direct oral anticoagulation on long-term stroke and bleeding rates.
期刊: Swiss medical weekly 发表日期: 2025-Oct-15 链接: PubMed
摘要
Left atrial appendage occlusion (LAAO) is an accepted alternative stroke prevention strategy for patients with atrial fibrillation (AF) and contraindications to oral anticoagulation despite the lack of randomised data in this population. This study aims to compare the outcomes of LAAO and direct oral anticoagulation (DOAC) therapy in patients with high bleeding risk. This cardinality-matched analysis comprised data from the Beat-AF and Swiss-AF cohorts (n = 3960; enrolment from 2010 to 2014 and from 2014 to 2017, respectively), along with the Zurich LAAO Registry (n = 535; patients included between 2010 and 2023). The primary endpoint was a composite of stroke, cardiovascular death or major bleeding. The individual components constituted the secondary endpoints. Time-dependent cumulative incidence curves were constructed and a competing risk analysis was included. After matching, 478 patients with a DOAC score ≥8 and 159 patients with previous major bleeding were compared in a 1:1 and 1:2 ratio, respectively, regarding their stroke prevention strategy (DOAC versus LAAO). After a median follow-up time of 4.9 years (interquartile range [IQR]: 2.2-6.1) in all patients with a DOAC score ≥8 and 4.4 years (IQR: 2.0-6.0) in all patients with previous major bleeding, there were no significant differences in the primary endpoint (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.67-1.14, p = 0.33 and HR: 0.79, 95% CI: 0.50-1.27, p = 0.33) and in the rates of stroke (HR: 0.74, 95% CI: 0.39-1.42, p = 0.36 and HR: 1.09, 95% CI: 0.33-3.62, p = 0.89) and cardiovascular death (HR: 0.97, 95% CI: 0.68-1.38, p = 0.85 and HR: 0.91, 95% CI: 0.50-1.64, p = 0.74). The rate of major bleedings was significantly lower in the LAAO group of both cohorts (HR: 0.55, 95% CI: 0.32-0.94, p = 0.029 and HR: 0.32, 95% CI: 0.13-0.79, p = 0.013). In this high bleeding risk population, LAAO was associated with similar effectiveness in preventing atrial fibrillation-related stroke and cardiovascular death and significantly lower rates of major bleeding compared to DOAC therapy. This strengthens the value of LAAO as an alternative stroke prevention strategy for patients at high risk of bleeding.
41. Interstitial lung disease in targeted therapies: A Society of Gynecologic Oncology clinical practice statement.
期刊: Gynecologic oncology 发表日期: 2025-Oct-15 链接: PubMed
摘要
Interstitial lung disease (ILD) is a potentially serious and sometimes fatal complication of targeted therapies, including antibody-drug conjugates and immunotherapies, in gynecologic oncology. Risk factors include pre-existing lung disease, advanced age and prior thoracic radiation. Early detection, patient and clinician education, and prompt multidisciplinary collaboration are critical to mitigate ILD morbidity and mortality. This Society of Gynecologic Oncology clinical practice statement provides evidence-based recommendations for the diagnosis, grading and management of ILD associated with gynecologic cancer therapies, emphasizing the importance of baseline risk assessment, ongoing monitoring and standardized intervention protocols to optimize patient outcomes.
42. Effects of nocturnal light environments on urban bird diversity: birds adapted to and inhabiting cities.
期刊: Journal of environmental management 发表日期: 2025-Oct-15 链接: PubMed
摘要
As urbanisation accelerates, artificial lighting at night (ALAN) has reshaped the nocturnal living environment of urban life. The mutual influence between light environmental variables and their interaction with environmental and climatic variables have not been studied sufficiently. We choose birds as indicator species, which can reflect ecosystem health, and acoustic indices as indicator variables. In our research, we explore the following questions: (1) The extent of the influence of natural light on bird diversity in the urban nocturnal. (2) How urban bird diversity changes under the influence of ALAN ? (3) Investigate the different patterns of bird diversity in urban parks with different environmental characteristics. To achieve such goals, we conducted a field survey of the soundscape and lighting environment, using reliable environmental data sources to assist the analysis. Ultimately, we captured linear and nonlinear relationships between variables by establishing models such as GLMs and GAMMs. Following conclusion are derived: (1) Nocturnal natural light in urban environments has some mild effects on bird diversity, which is amplified by climatic factors and ALAN. (2) ALAN has a more significant effect on bird diversity. The peak positive effect of ALAN on bird diversity at a value of 0.002 W/(m2·sr·μm). (3)Urban birds demonstrate a degree of behavioral and ecological adaptation to nocturnal light conditions. Interactions between ALAN and urban habitat features collectively shape diversity outcomes.
43. Soil ecological index as an approach to assess soil health across diverse land use types.
期刊: Journal of environmental management 发表日期: 2025-Oct-15 链接: PubMed
摘要
Land degradation is a global challenge driven by increasing demands for food, fodder, and fiber. It is often associated with rapid urbanization and poor land resource utilization, including overlooked areas such as urban marginal lands (UML). However, these lands can address degradation if monitored and restored sustainably. Therefore, the present study developed and validated a Soil Ecological Index (SEI) focusing on UML types. The SEI was developed through soil physicochemical and biological properties across bareland (Sites 2,4,5), grassland (Sites 1,3), scrubland (Site 6), and forest area (control) of UML using principal component analysis (PCA). Results depicted that the physicochemical properties for available nitrogen, total nitrogen, available phosphorus (AP), total phosphorus, and soil organic carbon (SOC) ranged from 123 to 531 kg ha-1, 151-656 kg ha-1, 35-48 kg ha-1, 44-51 kg ha-1, and 1.53-1.78 %, respectively. Moreover, biological parameters such as microbial biomass carbon (MBC) ranged from 57.47 to 117.88 μg g-1. PCA trends suggested that MBC, AP, and SOC were the most prominent variables for SEI across all seasons. A vegetation survey was also done to gather baseline data, highlighting leguminous trees, such as Leucaena and Albizia, which could enhance soil quality. Based on the SEI profile, bareland had poorer soil quality than other land-use types. Therefore, this study emphasizes the significance of building a comprehensive SEI, suggesting apposite trees across UML types to enhance soil quality, and providing directions for multipurpose benefits in achieving the Land Degradation Neutrality and UN-SDG targets.
44. Effects of vitamin K2 and D3 supplementation on epicardial adipose tissue and systemic inflammation: A substudy of the AVADEC trial.
期刊: Atherosclerosis 发表日期: 2025-Oct-12 链接: PubMed
摘要
Vitamins K2 and D3 may improve cardiovascular health by modulating inflammation and vascular calcification. Inflammation contributes to atherosclerosis and can be assessed through imaging and systemic biomarkers. This study investigated whether vitamin K2 and D3 supplementation reduces inflammation in epicardial adipose tissue (EAT), including pericoronary adipose tissue (PCAT), and systemic inflammation in elderly men at cardiovascular risk. In the Aortic Valve DECalcification (AVADEC) trial, 388 men aged 65-74 received daily vitamin K2 (720 μg) and D3 (25 μg) or placebo for 24 months. EAT inflammation was assessed using non-contrast CT [EAT volume and attenuation] and contrast-enhanced CT [PCAT attenuation]. Systemic inflammation was evaluated via hs-CRP, IL-6, TNF-α, Fetuin-A, and osteopontin (OPN). Dephosphorylated uncarboxylated matrix Gla protein (dp-ucMGP), the inactive form of MGP, served as a proxy for vitamin K2 status. After 24 months, EAT volume increased in the placebo group (Δ5.66 cm3,95% CI 1.35; 9.98) and non-significantly in the vitamin group (Δ3.44 cm3, 95% CI -0.44; 7.33), with an intergroup difference of -2.22 cm3 (95% CI -8.01; 3.57). EAT attenuation declined similarly (intergroup difference: 0.32 HU, 95% CI -0.23; 0.87). PCAT attenuation remained unchanged. No significant changes were seen in systemic markers, though OPN increased modestly in the vitamin group (Δ25.72 pg/mL, 95% CI 2.40; 49.05). dp-ucMGP decreased significantly with supplementation (intergroup difference: 255.31 pmol/L, 95% CI -289.56; -221.05). Despite reduction in dp-ucMGP, high-dose vitamin K2 and D3 supplementation did not affect EAT, PCAT or systemic inflammation over 24 months. Alternative strategies may be needed to target inflammatory pathways in cardiovascular disease prevention.
45. Cardiac amyloidosis in a Swiss autopsy cohort - distribution and clinical relevance.
期刊: Swiss medical weekly 发表日期: 2025-Oct-01 链接: PubMed
摘要
Cardiac amyloidosis (CA) characterised by myocardial amyloid accumulation is likely underdiagnosed. The distribution and extent of myocardial amyloid deposits remain unclear. With the emergence of disease-modifying drugs for ATTR and AL amyloidoses, early detection has become increasingly important. We aim to determine the frequency, clinical relevance and distribution of amyloid subtypes in cardiac amyloidosis in an autopsy cohort. We retrospectively analysed consecutive unselected adult autopsies with cardiac amyloidosis over 10 years (January 2014 - December 2023). Two pathologists applied a biventricular semi-quantitative scoring system for interstitial and vascular amyloid deposits. Histopathological findings were correlated with ante mortem clinical data. Cardiac amyloidosis was found in 104 of 1972 autopsies (5%) with 91% neither diagnosed nor suspected ante mortem based on documentation in digital medical records. Ninety-eight patients (94%) had amyloid transthyretin-cardiac amyloidosis (ATTR-CA) and six (6%) amyloid light chain-cardiac amyloidosis (AL-CA). AL-CA patients were younger than ATTR-CA patients (mean ± SD: 73.2 ± 15.3 vs 84.2 ± 8.1, p = 0.006) and systemic amyloidosis was more frequent (100% vs 38%, p = 0.003). Female patients (40.4%) were significantly older (mean ± SD: 85.8 ± 8.1 years) than males (82.0 ± 9.2 years, p = 0.23), and male sex was associated with clinical suspicion and diagnosis (88.9% in males vs 11.1% in females, p = 0.06). A high vascular amyloid score correlated with systemic amyloidosis (left ventricle, p = 0.003; right ventricle, p = 0.013). Right ventricular amyloid burden was strongly linked to clinical suspicion and detection (p = 0.001). Our autopsy analysis found that most cardiac amyloidosis cases were undiagnosed ante mortem, especially ATTR-CA in older patients with less systemic involvement. Underdiagnosis was more pronounced in females. Our findings suggest that high vascular amyloid burden contributes to systemic amyloidosis and links right ventricular amyloid to clinical suspicion and detection.
46. Frailty and the Fall: Unveiling the Burden of Falls among the Elderly in the Urban Slums of Siliguri.
期刊: The Journal of the Association of Physicians of India 发表日期: 2025-Oct 链接: PubMed
摘要
Falls among the elderly are a significant public health concern, particularly in socioeconomically disadvantaged urban settings. Beyond physical injuries, falls contribute to psychological effects such as fear of falling, which may limit mobility and increase dependency. The concept of fall efficacy, or the confidence in performing daily activities without falling, has emerged as a key psychological indicator in understanding fall risk. However, limited data exist on these aspects among older adults living in urban slums in India. To determine the prevalence of falls among older adults residing in urban slums of Siliguri, West Bengal, and to explore the association between fall efficacy and the occurrence of falls. A descriptive cross-sectional study was conducted among 207 adults aged ≥60 years selected via two-stage cluster sampling from 30 urban slum clusters in Siliguri. Data were collected via a pretested, semi-structured questionnaire capturing sociodemographic information, medical history, fall episodes, and fall efficacy, assessed using the Fall Efficacy Scale (FES). Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0 with multivariable logistic regression to identify predictors of falls. The prevalence of falls in the past 6 months was 41.1%, and the distribution of falls was nearly equal between indoor and outdoor settings. Significant predictors of falls included advanced age [≥80 years; adjusted odds ratio (AOR) = 4.25], presence of comorbidities (AOR = 8.16), physical disabilities (AOR = 2.50), and residence in pucca houses (AOR = 3.38). Although higher concern about falling (as indicated by higher FES scores) was associated with increased fall risk (AOR = 1.88), the association was not statistically significant. Falls among the elderly in urban slums are prevalent and influenced by a complex interplay of age, health status, and living conditions. Integrating physical, environmental, and psychological interventions is critical for fall prevention among older adults, especially in underserved urban slums.
47. 'They build roads, not cycle paths': a qualitative study of Pacific children's physical activity barriers.
期刊: Health promotion international 发表日期: 2025-Sep-03 链接: PubMed
摘要
The Pacific Islands have high rates of non-communicable diseases (NCDs), which are preventable by ensuring healthy levels of physical activity (PA) and sedentary behaviour in childhood. This study explored barriers and facilitators to children meeting PA and sedentary behaviour guidelines through the lens of stakeholders involved in the care and education of children in four Pacific Islands. Qualitative interviews were conducted English or French in Fiji (n = 10), French Polynesia (n = 6), New Caledonia (n = 7), and Wallis and Futuna (n = 4) between 2019 and 2022. French recordings were transcribed using HappyScribe.com and translated. Deductive and inductive qualitative analysis was conducted and presented based on Bronfenbrenner’s ecological theory and classified into the five categories of the Social Ecological Model (SEM). At the intrapersonal level, concerns were expressed about the lack of awareness of PA and sedentary behaviour guidelines from children and caregivers. At the intrapersonal level, negative caregiver attitudes towards PA perceived inability to control screen time rules were highlighted, alongside challenges within school settings. At the organizational level, the importance of sports organizations to provide opportunities for children to be active was highlighted. At the environmental level, the lack of urban planning, green space, and safe outdoor areas emerged as key barriers. At the policy level, the need for policy changes to support PA promotion in schools, particularly regarding prescriptive curricula, was stressed. Future interventions need to be culturally responsive, while including strategies that consider the urban-rural divide in the Pacific Islands. Schools and religious institutions can play a key role in promoting active lifestyles for children.
48. Video-Observed Therapy as an alternative to Directly-Observed Therapy for active tuberculosis: a prospective study of feasibility and acceptability by patients and nurses in a low-incidence high-income area.
期刊: Swiss medical weekly 发表日期: 2025-Sep-01 链接: PubMed
摘要
Tuberculosis remains a public health issue in Switzerland. Adherence to treatment is a challenge. To promote adherence, Video-Observed Therapy (VOT) has been proposed as an alternative to Directly Observed Therapy (DOT) that is less stigmatising, respects patients’ privacy and uses less resources. This study aimed to assess (1) the feasibility and (2) the acceptability of VOT for tuberculosis by patients and specialised nurses in our area. All subjects aged above 16 years with a newly diagnosed active tuberculosis, irrespective of site of infection, and followed by our centre could be included. Patients were provided with a pictogram-based smartphone app and trained by specialised nurses to send daily videos of their treatment to a secure platform. Acceptability by patients and by specialised nurses, ratio of number of videos sent to those expected and technical issues were prospectively recorded. Over 18 months, 55 patients were invited to participate. Four (7.2%) declined (92.7% acceptance rate). Of the remaining 51, 5 (9.8%) failed to start VOT, thus leaving 46 patients followed by VOT (their median age was 40.3 years with interquartile range [IQR] 33-45; 27 [53%] were female). Three cases (6.5%) dropped out. No cases of multidrug-resistant tuberculosis were documented. The ratio of total number of videos received/ expected (5744/6392) was 89.9%; the median individual ratio of videos sent/received was 96% (IQR: 73-100); the number of videos sent remained stable over 6 months. Of the 5744 videos sent, 312 (5.4%) showed minor technical problems. Results of an 18-item questionnaire showed that VOT was well accepted by our specialised nurses. VOT showed a high rate of acceptance by patients and specialised nurses in our area and appears to be a feasible alternative to DOT.
49. Pitstop approach: diabetologist referral and quality of care in patients with type 2 diabetes - a Swiss longitudinal study.
期刊: Swiss medical weekly 发表日期: 2025-Aug-25 链接: PubMed
摘要
Patients with type 2 diabetes mellitus are typically managed in primary care settings, but management has become more complex in recent years due to modern therapeutic options. There is a paucity of data on the role of a one-off referral to an outpatient diabetes centre (a “pitstop” approach) in improving the quality of diabetes care. This was a retrospective study of patients with type 2 diabetes mellitus who were referred to an outpatient diabetes centre at a regional hospital in Switzerland between 1 January 2019 and 31 December 2020. The primary outcome was the change in glycated haemoglobin (HbA1c) between the first and last consultation. Secondary endpoints included changes in body weight, blood pressure, low-density lipoprotein cholesterol and use of antidiabetic medications. At a median follow-up of 5.1 months (interquartile range [IQR] 3.0-9.1) after referral to an outpatient diabetes centre, haemoglobin A1c improved from 8.6% / 70.5 mmol/mol to 7.3% / 56.3 mmol/l (difference -1.28% / -14.2 mmol/l; 95% confidence interval [CI] -1.50 to -1.05), body weight decreased from 91.0 kg to 88.0 kg (difference -3.93; 95% CI -4.9 to -3.0) and systolic blood pressure values decreased by 1.6 mm Hg (95% CI -2.7 to -0.5), while low-density lipoprotein cholesterol levels remained unchanged. Compared to baseline, the pitstop approach resulted in decreased prescriptions for sulfonylureas (11.0% vs 2.8%) and dipeptidyl peptidase-4 inhibitors (31.4% vs 20.0%), but increased prescriptions for sodium-glucose cotransporter 2 (SGLT2) inhibitors (15.3% vs 27.5%) and glucagon-like peptide-1 (GLP1) receptor agonists (13.7% vs 46.3%). A short-term intervention by an outpatient diabetes clinic was associated with significant improvements in glycaemic control and body weight in patient with type 2 diabetes. It promoted a shift towards modern antidiabetic medications with proven cardiorenal protective effects.
50. Role of health professions academia in initiating, promoting and facilitating health-related initiatives of the sustainable developmental goals of the United Nations, 2023.
期刊: The National medical journal of India 发表日期: 2025 链接: PubMed
摘要
During the year of India’s presidency of the G-20 group from 2022 to 2023, the United Nations released in September 2023, a declaration, consisting of 17 sustainable developmental goals for the world that need to be achieved by 2030. Three of these goals are also relevant for the healthcare profession since they pertain to the health of the community. This document should be a stimulus and motivator for the health professions academia, to visualise new roles for themselves, inside and outside the classroom and to reflect on their roles in achieving the health-related goals of this movement. The 3 goals pertinent to health relate to (i) health and well-being, (ii) education and (iii) innovations. This paper focuses on the role teachers of the health profession play in initiating, facilitating and stimulating the process towards these goals both by their actions within the classroom to improve quality of the outgoing graduate and outside the classroom in facilitating access to good health and health-related innovations which can take healthcare to the doorsteps of the community. In addition, their role lies in influencing policy towards this goal so that the target as specified by the declaration can be achieved by 2047, if not, by 2030.
51. Therapeutic Strategies for Patient Safety.
期刊: American journal of therapeutics 发表日期: 链接: PubMed
摘要
Therapeutic Strategies for Patient Safety represents, regardless of the medical field in which it is developed, a way of approaching that can lead to reducing the risks of applying therapies, developing patient-oriented therapeutic plans, based on the promotion of positive results, but also on the development of personalized medicine, applicable and adaptable to each patient. The literature is typically focused on therapeutic strategies or patient safety, but fewer approaches focus on promoting patient safety and implementing a plan to prevent harm. The development of therapeutic strategies that prioritize patient safety requires the advancement of specific research and the creation of reliable therapeutic tools and measures, which are essential for the strategy to be effective, grounded in moral principles, and in accordance with established ethical standards. The understanding of the phenomenon of the development of Therapeutic Strategies for Patient Safety was achieved both based on 5 literature searches in PubMed, MEDLINE, Plus, Scopus, and Web of Science (2015-2023) and through the development of articles (review or original), from different medical fields, by doctoral students (first author) and their teams, and which are part of a special issue of the American Journal of Therapeutics, entitled “Therapeutic strategies for patient safety.” Patient safety and therapeutic strategies are regulated by laws and regulations at the EU level and are a concern for those developing research in the field of clinical medicine. The articles that are part of the special issue of the AJT each represent a model for the development of research in the field of patient safety, regardless of the field of medical (polypharmacy, vancomycin therapy) or surgical (urolithiasis, rectal cancer) therapy, of the use of conventional or nonconventional instruments (remote monitoring devices, telemedicine, transcranial direct current stimulation), through care organized within medical institutions or through self-care (effective self-care among newly diagnosed patients), regardless of the stage or severity of the condition (end-of-life care, management of organophosphate poisoning). The development of a health system based on moral and ethical values and oriented toward increasing the quality of life through therapeutic strategies and measures to ensure patient safety, a holistic approach to the patient and the disease, and the development of personalized therapies contribute to increasing the efficiency of medical activity and improving clinical outcomes in conditions of reduced risks and errors in health systems.
52. Arsenic and heavy metal contamination in drinking water from an industrial zone in Dhaka District, Bangladesh.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Heavy metals (HMs), even in trace concentrations, can pose serious health risks when consumed over time. In Bangladesh, the widespread use of tube wells for drinking water, coupled with industrial activity, has contributed to the contamination of groundwater with HMs. This study investigated heavy metal contamination in drinking water samples from Gazipur, an industrial hub, using Inductively Coupled Plasma-mass Spectrometry (ICP-MS). The results revealed that the mean concentrations of HMs in mg/L followed the order: Fe (5.479 ± 3.740)> Mn (0.203 ± 0.233)> Pb (0.133 ± 0.370)> Zn (0.068 ± 0.070)> Cu (0.016 ± 0.034)> As (0.003 ± 0.004)> Ni (0.002 ± 0.001)> Cr (0.002 ± 0.001). Concentrations of Pb, Fe, and Mn exceeded safe limits while As, Cd, Cr, Ni, Cu, and Zn were within acceptable ranges. The scatter plot analysis revealed weak and non-significant correlations between As concentrations and other heavy metals with low R² values. A strong difference in metal contamination levels between shallow (20-80 meters) and deep wells (>80 meters), with shallow wells exhibiting significantly higher contamination percentages, often approaching 100%, while deep wells consistently remained below 30%. Ecological risk assessments showed low to moderate contamination at most sampling sites. Health risk evaluations (HQ and HI) indicated that all metals remained below harmful levels, though arsenic posed a heightened cancer risk, particularly for children. Principal Component Analysis (PCA) and Cluster Analysis suggested that As, Pb, Fe, Zn, and Mn were linked to industrial activities, while the other metals were likely of geological origin. The study emphasized the need for ongoing surveillance and intervention to protect public health in areas impacted by industrial pollution.
53. Unveiling hidden threats: Polycyclic aromatic hydrocarbons pollution in the glacial waters of the Meili Snow Mountains in the southeastern Tibetan Plateau.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Polycyclic aromatic hydrocarbons (PAHs) have posed considerable threats to both ecosystems and human health. To explore their characteristics and risks in temperate glacial watersheds, water samples from the Meili Snow Mountains in the southeastern Tibetan Plateau were collected and analyzed. The results revealed that the concentrations of total PAHs (∑PAHs) ranged from 406.5 to 820.9 ng‧L-1, and the mean ∑PAH level was relatively high compared to other global studies. PAHs were characterized by low-molecular-weight congeners, mainly including fluorene, and phenanthrene. Fluorene, phenanthrene, pyrene, and benzo[a]pyrene, were prevalent throughout the Meili Snow Mountains, with concentrations ranging from 164 to 425 ng‧L-1, 23.6 to 201 ng‧L-1, 17.9 to 90.1 ng‧L-1, and 50-117 ng‧L-1, respectively. PAHs originated from heterogeneous combustion sources, such as coal combustion, vehicular emissions, and biomass burning. These variations were attributed to various factors, including altitude effects, long-range atmospheric transport, and local environmental driving patterns. Specifically, ∑PAHs in runoff rivers decreased with increasing altitude, reflecting differences in local anthropogenic activities. The risk assessment indicated that PAHs posed moderate to high ecological risks and potential carcinogenic threats. This study provides valuable insights into the safety of drinking surface water resources and the structural and functional stability of ecosystem in the Meili Snow Mountains, which is significant for improving regional ecological safety and human health.
54. Prevalence and associated factors of unhealthy food consumption among 6-23-month-old children in South Ethiopia; A community-based cross-sectional study.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Unhealthy food consumption in children is an emerging public health problem and has various health effects on children. Overweight/obesity in children is increasing at an alarming rate due to an unhealthy diet and other associated factors. Hence, determining the unhealthy food consumption and responsible factors among 6-23-month-old children is vital to conducting a targeted intervention. A community-based cross-sectional study was conducted among 392 randomly selected children whose ages were between 6-23 months at Arba Minch City, Gamo Zone, from March 12, 2024, to April 30, 2024. Data were collected by face-to-face interviews using a pretested structured questionnaire. A binary logistic regression model was fitted to identify factors associated with unhealthy food consumption. In bi-variable analysis, variables with a p-value <0.25 were candidate variables for multivariable logistic regression analysis. An adjusted odds ratio with corresponding confidence interval was used to determine the strength of the association. A p-value <0.05 was used to declare statistical significance. The prevalence of unhealthy food consumption among children aged 6-23 months was 52.8% (95% CI: 47.7, 57.9). Age 12-17 months [AOR = 1.77; 95% CI = 1.77; 1.05, 2.97], bottle feeding [AOR = 2.36, 95%CI = 1.48, 3.75], sub-optimal dietary diversity score [AOR = 2.08; 95% CI = 2.08; 1.24, 3.49], no postnatal care visit [AOR = 2.39, 95% CI = 1.07, 5.33], and insufficient maternal knowledge of child-feeding[AOR = 1.65; 95% CI = 1.01, 2.70] were significantly associated with unhealthy food consumption. Over half of children aged 6-23 months consume unhealthy food in the city. Unhealthy food consumption was influenced by being at a younger age, bottle feeding history, sub-optimal dietary diversity, no postnatal care visit, and low maternal child feeding knowledge among these young children. Designing interventions aimed at boosting maternal understanding of child feeding practices and improving health care services with a focus on children’s healthy diet status in the city is highly encouraged.
55. Evaluation of disparities in the incidence, presentation, and treatment of pediatric differentiated thyroid cancer in the United States (2000-2022).
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Rates of pediatric differentiated thyroid cancer (DTC) have been increasing, yet disparities in incidence, diagnosis, and treatment across race and ethnicity have not been fully explored. We assessed temporal trends in the incidence of pediatric DTC using data from 2000-2022 (excluding 2020 due to COVID-19) from the National Childhood Cancer Registry. Annual percent changes (APC) were calculated using joinpoint regression analysis overall and by race, ethnicity, age, and clinical factors. Differences in cancer presentation and treatment by race and ethnicity were evaluated using data from Surveillance, Epidemiology, and End Results (SEER) for 18 registries for 2006-2018, while accounting for socioeconomic status (SES). Overall pediatric DTC incidence increased 4.5% annually from 2000-2018 (95%CI: 3.8%-5.8%), then declined (-6.9%) through 2022 (95%CI: -14.5%, -1.2%). Rates of decline appeared sharpest among Non-Hispanic White patients. Incidence rates continued increasing among Non-Hispanic Asian/Pacific Islanders and patients diagnosed with tumors >4 cm. Compared to non-Hispanic White patients, non-Hispanic Black, non-Hispanic Asian/Pacific Islander, and Hispanic children were more likely to be diagnosed with a tumor >4 cm. Declines in reported pediatric thyroid cancer incidence, particularly among the smallest tumor sizes, after 2018 may be attributable to application of thyroid cancer management guidelines. However, the continued increase among those presenting with larger tumor sizes may support a true continued increase in incidence among some groups. The greater proportion of non-White children being diagnosed with larger tumors could be due to inequities related to timely access to care, differential application of thyroid management guidelines, differences in cancer subtypes, or other factors. These findings warrant further exploration when additional years of data are available.
56. Work-life balance, job satisfaction, and burnout among nurses in Jordan: A cross-sectional study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
This study aims to investigate work life balance (WLB), job satisfaction, and occupational burnout among nursing professionals in Jordan. identifying key factors that influence their well-being and professional engagement. This cross-sectional study (January-April 2023) surveyed Jordanian nurses using the Netemeyer Work-Life Balance Scale, Job Satisfaction Scale, and Copenhagen Burnout Inventory. Stratified sampling ensured diverse representation. Multiple logistic regression analyzed WLB determinants, adjusting for demographics and work-related factors. Ethical approval was obtained from JUST-IRB, with informed consent and confidentiality assured. A total of 500 nurses participated, 67.8% female. Key findings include nurses with a master’s or PhD degree reported significantly higher WLB than those with a bachelor’s degree (aOR = 3.081, p = 0.003). Work interference with personal life was evident, with 40.7% (165 respondents) reporting that their job demands negatively impacted their family life. In contrast, those working more than 50 hours per week had higher WLB (aOR = 2.652, p = 0.029). The study highlights the demographic and occupational factors influencing WLB, job satisfaction, and burnout among Jordanian nurses. Nurses working over 50 hours per week reported significantly higher WLB, yet job satisfaction remained moderate, and burnout, especially work-related, was a prevalent issue. Understanding these factors is crucial for enhancing the well-being and performance of nurses in Jordan.
57. The effects of RYSEN-induced supportive, propelling and impeding forces on step parameters and muscular control in walking after stroke.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Body weight support (BWS) devices are increasingly used for gait training after stroke. The RYSEN not only allows for vertical BWS but also for the addition of mediolateral and anteroposterior forces. To assess to what extent the RYSEN could be used for targeted gait training, this study aimed to investigate the effect of BWS with and without the addition of mediolateral and anteroposterior forces on step parameters and muscular control in individuals after stroke and able-bodied individuals. In this cross-sectional study, fifteen individuals after stroke and fifteen able-bodied individuals completed several overground walking conditions: unsupported and BWS with(out) mediolateral and anteroposterior forces. Step length, step width (variability), single stance time and walking speed were determined using motion capture data. Muscular control was assessed using electromyography. Linear mixed-effect models were used to analyze the (interaction) effects of condition and group on step parameters. Statistical parametric mapping was used to analyze muscular control. Providing BWS led to increased speed and balance confidence in individuals after stroke, and caused decreased speed, step width variability and m. Gluteus Medius activity in able-bodied individuals. Adding mediolateral forces did not lead to additional changes. Adding anterior forces increased speed in individuals after stroke. Adding posterior forces slightly increased plantar flexor activity during push-off in able-bodied individuals. RYSEN BWS facilitates gait training at increased speed and balance confidence. Adding mediolateral or anteroposterior forces did not provide strong additional effects. Further research may determine how these forces can be better utilized during training.
58. Healthcare employees' perspectives on organizational communication about preventive mental health interventions: A focus group study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The COVID-19 pandemic exposed healthcare employees to stressful situations with possible long-term mental health consequences, stressing the need for supportive interventions. However, in practice healthcare employees’ use of preventive mental health interventions seems limited. Persuasive communication strategies may help to bridge this gap. The aim of this study was to further refine our understanding of healthcare employees’ perspectives on organizational communication about preventive mental health interventions. A qualitative approach was used, consisting of 5 focus groups with hospital workers, either with (K = 3) or without (K = 2) direct patient contact. We used vignettes as a method to discuss three different scenarios to reflect the different levels of prevention (primary, secondary, tertiary). Focus group sessions were audio-taped and transcribed verbatim. Two researchers independently analyzed the data applying thematic analysis within each prevention level. This qualitative study on the employee perspective on communication about preventive mental health interventions demonstrated an overarching funnel movement in which the source and content/channel become increasingly targeted towards the individual employee as mental health symptoms increase. The primary prevention level revealed the theme ‘Multilevel sources of communication and various channels’, the secondary prevention level revealed the theme ‘Specific sources of communication and specific channels’, and the tertiary prevention level revealed the theme ‘A central role for supervisors’. A safe culture in the workplace appeared an important prerequisite for timely discussion of employee mental health. These insights contribute to the development of more tailored organizational communication about mental health of healthcare employees.