公共卫生研究摘要 (2025-10-18)
共收录 53 篇研究文章
1. Longitudinal Associations of Multimodal Core 1 Alzheimer Disease Biomarkers With Cognition in Aging and Preclinical Alzheimer Disease.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Addressing the association between early-changing Alzheimer disease (AD) biomarkers and cognition is essential for characterizing preclinical AD. However, few studies have explored this relationship longitudinally, especially across multiple biomarker modalities. The aim of this study was to evaluate longitudinal associations of multimodal core 1 AD biomarkers with cognition in a cognitively unimpaired (CU) population at increased risk of AD dementia. This prospective observational study included CU individuals from the Alzheimer’s and Families+ cohort, based in Barcelona, Spain. Individuals had available baseline CSF biomarker measurements (normal or AD continuum profiles) and longitudinal neuropsychological assessments (2 time points, 3-year follow-up). The primary study outcome was the modified Preclinical Alzheimer’s Cognitive Composite (mPACC) score. Study measurements included plasma phosphorylated tau (p-tau) 217, CSF p-tau181/β-amyloid (Aβ) 42, and Aβ PET ([¹⁸F]flutemetamol). Mixed-effects models were used to evaluate the longitudinal associations between fluid biomarkers and mPACC score; voxel-wise models were used to evaluate the longitudinal association between neuroimaging and mPACC score. Sensitivity analyses evaluated these associations stratifying by Aβ status. In total, 350 individuals were included (mean age: 61 years; 60% female; mean education: 14 years). In the full sample, increases in plasma p-tau217 concentration (βSTD = -0.124, 95% CI -0.172 to -0.076; p < 0.001), CSF p-tau181/Aβ42 ratio (βSTD = -0.059, 95% CI -0.100 to -0.019; p = 0.005), and Aβ PET load in the prefrontal cortex, cingulate cortex, precuneus, and anterior temporal regions were associated with mPACC decline. In the Aβ-positive group (35%), increases in plasma p-tau217 concentration (βSTD = -0.121, 95% CI -0.194 to -0.049; p < 0.001) and Aβ PET load in anterior temporal regions were associated with mPACC decline. In the Aβ-negative group (65%), increases in plasma p-tau217 concentration (βSTD = -0.084, 95% CI -0.157 to -0.011; p = 0.024) and Aβ PET load in frontoparietal regions were associated with mPACC decline. This study demonstrated significant longitudinal associations between multimodal core 1 AD biomarkers and cognitive function over 3 years in CU individuals, including those at the Aβ-negative stage. Distinct biomarker modalities provided complementary insights, emphasizing the potential of blood-based biomarkers for tracking subtle cognitive decline and neuroimaging for delineating vulnerable brain regions in aging and preclinical AD. These findings are crucial for identifying and monitoring high-risk CU individuals, further informing preventive intervention strategies for AD.
2. Clinical Reasoning: A 56-Year-Old Woman With Right-Sided Weakness and Recurrent MRI Lesions.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Evaluating and managing patients with recurrent stroke presents a significant challenge, particularly in individuals with underlying autoimmune or rheumatologic conditions. We present a case of a 56-year-old woman with a long-standing history of medically controlled systemic lupus erythematosus (SLE) who has experienced multiple ischemic strokes and a subarachnoid hemorrhage. Despite an unremarkable standard stroke workup and adherence to secondary prevention medications, including antithrombotic and lipid-lowering therapies, the patient continued to experience recurrent strokes, warranting further investigation. Serial follow-up imaging including CT angiography, magnetic resonance angiography, and conventional angiography revealed progressive intracranial vascular narrowing, prompting a broad workup and differential diagnosis. This case highlights the importance of a stepwise and comprehensive diagnostic approach that integrates traditional vascular risk factors with those related to underlying autoimmune disease. It provides an insight into the diagnostic strategies and management of this high-risk population, ultimately supporting the need for personalized patient care to address the multifactorial causes of stroke.
3. Mapping the Association of Cerebral Small Vessel Disease, Gray Matter Integrity, and Cognitive Function.
期刊: Neurology 发表日期: 2025-Nov-11 链接: PubMed
摘要
Cerebral small vessel disease (CSVD) is associated with an increased risk of cognitive impairment and dementia. While its impact on white matter is well documented, CSVD-related gray matter alterations are less understood. In this work, we aimed to investigate the association between CSVD burden, regional gray matter integrity, and cognitive function in a large population-based cohort. We examined participants from the Hamburg City Health Study, who underwent multidomain neuropsychological testing and multimodal neuroimaging. A composite CSVD burden score was calculated by aggregating the white matter hyperintensity load, Fazekas score, perivascular space (PVS) count, and peak width of skeletonized mean diffusivity (PSMD). Advanced imaging techniques based on T1-weighted, fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted MRI were leveraged to assess the integrity of cortical and subcortical gray matter, including the hippocampus. General cognitive ability (g) was derived by a principal component analysis of cognitive test scores. Data from 2,603 participants (median age 65 years [interquartile range 14], 44.0% female) were analyzed. Higher CSVD burden was significantly associated with regionally specific gray matter abnormalities after family-wise error correction (family-wise error-corrected p value [pFWE] < 0.05): higher mean diffusivity and free water in cingulate, insular, and temporal cortices and basal ganglia; lower tissue fractional anisotropy in the anterior cingulate, insula, caudate, and hippocampus; lower T1/FLAIR ratio in the temporal cortex and hippocampus; lower thickness in the anterior cingulate, insula, and temporal cortex; and altered subcortical/hippocampal volumes. Aggregated indices reflecting these CSVD-related gray matter abnormalities were significantly associated with lower general cognitive ability (mean diffusivity: standardized β = 0.140, 95% CI 0.09-0.19, pFWE < 0.001; free water: standardized β = 0.183, 95% CI 0.13-0.23, pFWE < 0.001; tissue fractional anisotropy: standardized β = -0.097, 95% CI -0.13 to -0.06, pFWE < 0.001; T1/FLAIR: standardized β = -0.090, 95% CI -0.13 to -0.05, pFWE < 0.001; thickness/volume: standardized β = -0.051, 95% CI -0.09 to -0.01, pFWE = 0.026). Complementing previous research that focuses on CSVD and white matter changes, our study highlights abnormal gray matter integrity as a possible link between small vessel pathology and cognitive disorders.
4. Impact of the COVID-19 Pandemic on Routine Childhood Vaccination Coverage in Ecuador From 2019 to 2021: Comparative Analysis.
期刊: JMIRx med 发表日期: 2025-Oct-17 链接: PubMed
摘要
The COVID-19 pandemic disrupted essential health care services globally, including routine childhood immunization programs. Ecuador faced significant challenges in maintaining vaccination coverage during this period. The aim of this study is to analyze the impact of the COVID-19 pandemic on routine childhood vaccination coverage in Ecuador by comparing prepandemic (2019) and pandemic (2020-2021) data. This retrospective observational study analyzed vaccination coverage data from the Ministry of Public Health of Ecuador and demographic data from the National Institute of Statistics and Censuses. We examined routine childhood vaccination coverage for children under 24 months across all 24 provinces. Statistical analyses were performed using SPSS (version 28.0), including descriptive statistics and comparative analysis. Coverage rates were calculated as percentages of children in target age groups receiving recommended doses. A significant decline in routine childhood vaccination coverage was observed during the pandemic. BCG vaccine coverage decreased from 86.4% in 2019 (n=286,569) to 80.7% in 2020 (n=266,961) and 75.3% in 2021 (n=248,812). Pentavalent vaccine third dose coverage dropped from 85.0% to 68.0% across the same period. The most dramatic decline was seen in measles-mumps-rubella vaccine second dose coverage, falling from 75.7% in 2019 to 58.4% in 2021. Coastal and highland provinces experienced the most severe reductions, with approximately 137,000 fewer doses administered in 2020 compared to stable prepandemic levels. The COVID-19 pandemic significantly impacted routine childhood vaccination coverage in Ecuador, with sustained declines through 2021. Regional disparities were evident, with vulnerable populations facing greater challenges accessing immunization services. Urgent interventions, including catch-up campaigns and strengthened health systems, are needed to restore coverage levels and prevent outbreaks of vaccine-preventable diseases.
5. Comparison of Japanese Mpox (Monkeypox) Health Education Materials and Texts Created by Artificial Intelligence: Cross-Sectional Quantitative Content Analysis Study.
期刊: JMIR AI 发表日期: 2025-Oct-17 链接: PubMed
摘要
Mpox (monkeypox) outbreaks since 2022 have emphasized the importance of accessible health education materials. However, many Japanese online resources on mpox are difficult to understand, creating barriers for public health communication. Recent advances in artificial intelligence (AI) such as ChatGPT-4o show promise in generating more comprehensible and actionable health education content. The aim of this study was to evaluate the comprehensibility, actionability, and readability of Japanese health education materials on mpox compared with texts generated by ChatGPT-4o. A cross-sectional study was conducted using systematic quantitative content analysis. A total of 119 publicly available Japanese health education materials on mpox were compared with 30 texts generated by ChatGPT-4o. Websites containing videos, social media posts, academic papers, and non-Japanese language content were excluded. For generating ChatGPT-4o texts, we used 3 separate prompts with 3 different keywords. For each keyword, text generation was repeated 10 times, with prompt history deleted each time to prevent previous outputs from influencing subsequent generations and to account for output variability. The Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) was used to assess the understandability and actionability of the generated text, while the Japanese Readability Measurement System (jReadability) was used to evaluate readability. The Journal of the American Medical Association benchmark criteria were applied to evaluate the quality of the materials. A total of 119 Japanese mpox-related health education web pages and 30 ChatGPT-4o-generated texts were analyzed. AI-generated texts significantly outperformed web pages in understandability, with 80% (24/30) scoring ≥70% in PEMAT-P (P<.001). Readability scores for AI texts (mean 2.9, SD 0.4) were also higher than those for web pages (mean 2.4, SD 1.0; P=.009). However, web pages included more visual aids and actionable guidance such as practical instructions, which were largely absent in AI-generated content. Government agencies authored 90 (75.6%) out of 119 web pages, but only 31 (26.1%) included proper attribution. Most web pages (117/119, 98.3%) disclosed sponsorship and ownership. AI-generated texts were easier to understand and read than traditional web-based materials. However, web-based texts provided more visual aids and practical guidance. Combining AI-generated texts with traditional web-based materials may enhance the effectiveness of health education materials and improve accessibility to a broader audience. Further research is needed to explore the integration of AI-generated content into public health communication strategies and policies to optimize information delivery during health crises such as the mpox outbreak.
6. Non-Neoplastic Disorders Mimicking Posterior Segment Inflammation.
期刊: Ocular immunology and inflammation 发表日期: 2025-Oct-17 链接: PubMed
摘要
Masquerade syndromes encompass a heterogeneous group of ocular conditions that mimic intraocular inflammation but are caused by non-inflammatory processes. Accurate distinction from true uveitis is critical, as misdiagnosis can lead to inappropriate immunosuppression, delayed definitive therapy, and irreversible visual loss. This review focuses on non-neoplastic disorders presenting as posterior segment inflammation, highlighting their epidemiology, clinical hallmarks, multimodal imaging features, and diagnostic pitfalls. We discuss inherited retinal degenerations such as retinitis pigmentosa, chronic endophthalmitis, retinal detachment syndromes, intraocular foreign bodies, idiopathic uveal effusion, central serous chorioretinopathy, amyloidosis, and vascular anomalies including Coats disease. Developmental anomalies like persistent fetal vasculature and rare entities such as X-linked retinoschisis are also examined. For each disorder, we outline distinguishing characteristics from uveitis and propose a systematic diagnostic approach integrating history, examination, targeted laboratory testing, and imaging modalities including OCT, FAF, FA, ICGA, and ultrasonography. Early recognition of these mimickers is essential to guide appropriate management, prevent unnecessary exposure to corticosteroids or immunomodulators, and optimize visual prognosis.
7. Challenges and Opportunities in Characterizing the Genetics of Stuttering: From Sample Acquisition to Functional Interpretation of the Genome.
期刊: Journal of speech, language, and hearing research : JSLHR 发表日期: 2025-Oct-17 链接: PubMed
摘要
Converging etiological evidence supports a genetic risk for developmental stuttering; however, major gaps detailing the genetic architecture remain. Technological advances in genetics have allowed us to explore novel approaches to analyzing this complex trait, but conducting robust and replicable genetic studies requires large, well-phenotyped cohorts of subjects. This article reviews previous research strategies employed to overcome these challenges in identifying genetic variants associated with stuttering and translating stuttering-associated variants into molecular and cellular mechanisms. We present an overview of data sources and strategies research teams have utilized for the genetic study of stuttering, highlighting the advantages and limitations of each approach. Primary data sources include (a) the International Stuttering Project, (b) the National Longitudinal Study of Adolescent to Adult Health, (c) BioVU, and (d) 23andMe, Inc. In addition to genome-wide association studies (GWASs), we review multiple post-GWAS follow-up analyses to probe the functional impact of stuttering-associated genetic variants and offer new transcriptome-wide analyses. To date, a diverse array of approaches has resulted in the identification of over 50 stuttering-associated genes. Many genetic associations were near or within genes previously linked to known neurological traits, highlighting a neurological role in stuttering. Additionally, validation studies using polygenic risk scores suggested a high level of genetic concordance between our samples. Functional follow-up studies suggest stuttering-associated variants may affect gene expression in tissues relevant to speech-related structures and neural correlates. While understanding how specific regions of the genome contribute to stuttering risk remains complex, research from our team and others has utilized a variety of data sources in an attempt to overcome previous limitations in the identification of genetic variation associated with stuttering. As the field of genetics evolves toward large-scale biobanks for research and discovery, prioritizing inclusion of traits such as stuttering will be key. https://doi.org/10.23641/asha.30299764.
8. The Association Between Presleep and Postwake Mobile Phone Use and Nonsuicidal Self-Injury Among University Students: Cross-Sectional Study.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-17 链接: PubMed
摘要
Nonsuicidal self-injury (NSSI) is a critical public health concern among university students, often considered a gateway behavior to suicide. With the widespread use of mobile phones, understanding the association between specific mobile phone use behaviors (eg, presleep and postwake mobile phone use) and NSSI has become increasingly important for targeted prevention. This study aimed to explore the association between presleep and postwake mobile phone use and NSSI among Chinese university students, examining potential dose-response relationships and sex differences. A multistage random cluster sampling survey was conducted across 6 universities in Shaanxi province (northwest China) from October 2022 to November 2022. A total of 18,585 undergraduates were included in the final analysis. Binary logistic regression models were used to examine the association between presleep and postwake mobile phone use duration and past-month NSSI, whereas restricted cubic spline regression was applied to assess dose-response relationships. The prevalence of past-month NSSI among participants was 3.81% (709/18,585). Compared with individuals who reported lower presleep mobile phone use (0-30 minutes per day), those with higher presleep mobile phone use had substantially increased odds of NSSI, with odds ratios of 1.34 (95% CI 1.07-1.66) for the group with 61 to 120 minutes per day of use and 1.93 (95% CI 1.53-2.42) for the group with ≥120 minutes per day of use. For postwake mobile phone use, compared with the group with 0 to 1 minute per day of use, the participants in the group with >30 minutes per day of use showed a significant association with NSSI (odds ratio 1.27, 95% CI 1.02-1.58) in the fully adjusted model. Continuous variable analyses revealed that each 10-minute increase in presleep and postwake use was associated with a 3% and 2% higher NSSI risk, respectively. Restricted cubic spline analysis confirmed linear dose-response relationships for both presleep and postwake use (P>.05 for nonlinearity). No significant sex differences were observed in these associations. Prolonged presleep and postwake mobile phone use exhibited linear associations with NSSI among Chinese university students, with no significant sex disparities. These findings underscore the necessity of longitudinal studies to establish causality, elucidate underlying mechanisms, and inform targeted interventions.
9. Correction: Changes in Sarcopenia Status and Subsequent Cardiovascular Outcomes: Prospective Cohort Study.
期刊: JMIR aging 发表日期: 2025-Oct-17 链接: PubMed
摘要
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10. Developing a Quick Isolation Bed Inquiry System During the COVID-19 Outbreak: User-Centered Design Approach Based on the Toyota Production System.
期刊: JMIR formative research 发表日期: 2025-Oct-17 链接: PubMed
摘要
During the COVID-19 outbreak in May 2021, our hospital-designated as a specialized facility for severely infected patients-faced critical staff and resource shortages. The urgent need for efficient bed management to ensure timely admissions underscored the inefficiencies of the manual, phone-based allocation process, which averaged 454 seconds per query. Traditional IT solutions were not feasible due to time and cost constraints. This study aims to design and implement a rapid, zero-cost Quick Isolation Bed Inquiry System that provides real-time bed information and enables timely admissions without requiring additional workforce or expense. We conducted a 3-cycle pre-post quality improvement study guided by the Toyota business practice (TBP), an 8-step problem-solving framework. After clarifying the problem and constructing a value stream map, we identified bottlenecks. A user-centered solution was developed by leveraging an underutilized data export function in the hospital’s bed inquiry platform. Using Microsoft Excel Visual Basic for Applications, we automated the filtering and display of relevant bed information. The primary outcomes were process time and number of steps; secondary outcomes included staff time savings and system accuracy. The baseline manual process required 25 steps and 454 seconds to complete a query. The new system reduced this to 3 steps and 12 seconds, representing a 97.4% gain in efficiency. Single-click execution generated 3 outputs (administrative PDF, large-screen display, and mobile version) in 4 seconds, with distribution to the hospital LINE group completed in 7 seconds. Reliability reached 100%, with continuous availability through virtual private network access. Development and debugging were completed within 3 days using only existing resources. Postpandemic, the system was adapted for general ward management with minimal modifications. Applying TBP enabled the rapid development of a user-centered, zero-cost bed management tool by repurposing existing digital assets. The intervention markedly improved efficiency, reliability, and usability without additional staffing or expenditure, providing a scalable model for agile health care systems operating under resource constraints. Future work will focus on deeper automation, such as application programming interface-based real-time updates, and on evaluating downstream impacts on patient flow and bed turnover.
11. Associations Between Online Casual Sexual Behavior and HIV-Related Risk Behaviors Among Men Who Have Sex With Men in Southeast China: Cross-Sectional Study.
期刊: JMIR formative research 发表日期: 2025-Oct-17 链接: PubMed
摘要
With the growing popularity and convenience of the internet, an increasing number of men who have sex with men (MSM) are seeking casual sexual partners online. However, the effect of online casual sexual behavior on other HIV-related risk behaviors remains unclear. This study aims to explore the characteristics of internet-based casual sexual behavior and its relationship with HIV-related risk behaviors among MSM. This cross-sectional study was conducted between June and December 2018 in 4 cities in Zhejiang Province, China. Peer-driven sampling was used for recruitment. Announcements were disseminated by 4 community-based organizations and 10 voluntary counseling and testing clinics online and offline. After informed consent, participants completed an electronic questionnaire covering demographic characteristics, casual sexual behaviors, HIV-related risk behaviors, and HIV prevention. SPSS (version 19.0; IBM Corp) was used to conduct chi-square tests, univariate and multivariate logistic regression analyses using a backward stepwise method based on the likelihood ratio test, and Poisson regression with robust variance to identify associations between finding casual sexual partners online and other risk behaviors. P values of <.05 were considered statistically significant. In the past 6 months, 40.2% (302/751) of participants reported finding casual sexual partners online; 18.9% (142/751) reported finding casual sexual partners offline; 7.6% (57/751) reported having sexual intercourse with MSM without condoms after drinking alcohol; and 6.9% (52/751) reported condomless sex after using stimulants. Among those who found partners online, 62.5% (188/301) did so more than once per month and 39.5% (113/286) had more than one online sexual partner. In total, 39.3% (114/290) had sex with online partners at home and 10.1% (30/297) sought partners in other cities. Compared with participants who engaged in receptive anal intercourse (or both roles), those who engaged only in insertive intercourse reported a higher proportion of finding partners online more than once per month (72.7% vs 57.4%, P=.01), having more than 2 online sexual partners (52.1% vs 33.3%, P=.002), and conducting inconsistent condom use with online sexual partners (40.0% vs 25.8%, P=.01). Regression analysis showed that, compared with MSM who did not find partners online, those who did were more likely to report finding casual sexual partners offline (adjusted odds ratio [aOR] 9.398; 95% CI 5.956-14.829), having sex without condoms after drinking alcohol (adjusted prevalence ratio [aPR] 1.788; 95% CI 1.062-3.011), and having sexual intercourse without condoms after using stimulants (aPR 2.064; 95% CI 1.178-3.617). Internet-based casual sexual behavior is increasingly common among MSM. Finding partners online was associated with offline partner-seeking and condomless use after alcohol or stimulant use. Future HIV prevention efforts should emphasize behavioral interventions tailored to MSM who use dating apps.
12. Developing and Testing an Online Portal for Virtual Navigation for Asian American Patients With Cancer: Pilot Feasibility Study.
期刊: JMIR cancer 发表日期: 2025-Oct-17 链接: PubMed
摘要
Asian American patients have reported unique needs and barriers related to cancer care. While patient navigation can facilitate care coordination and help address barriers to care, in-person navigation is time and resource intensive. Virtual patient navigation can extend the benefits of patient navigation to more patients, especially those with non-English language needs. This study aimed to develop, implement, and test an online portal providing virtual navigation, including access to resources in English, Chinese, and Vietnamese, for Asian American patients with newly diagnosed colorectal, lung, or liver cancer. The online portal was built on a secure, cloud-based platform. We recruited adults aged 21 years or older with a recent diagnosis of stage I-IV colorectal, lung, or liver cancer; who identified as Asian American; spoke English, Cantonese, Mandarin, or Vietnamese; and resided in the Greater San Francisco Bay Area, California. Participants were assigned a language-concordant navigator who assessed their needs and provided tailored resources and support over 6 months through the online portal. Participants completed baseline, 3-month, 6-month, and user experience surveys. We report descriptive statistics on sociodemographic characteristics, quality of life (Functional Assessment of Cancer Therapy-General [FACT-G]), and user experiences. We used generalized estimating equations (GEE) to analyze repeated measures of quality of life. The online portal included (1) a public-facing landing page, (2) a navigator interface, and (3) a participant interface, which were all available in English, Chinese, and Vietnamese. Among 51 participants, 47 (92%) and 49 (96%) completed the 3- and 6-month surveys, respectively. The mean age was 58 (SD 13) years, with 37 (73%) men, 33 (65%) speaking English, and 20 (39%) having less than a college education. Twenty-six participants (51%) had colorectal cancer, 21 (41%) had lung cancer, and 4 (8%) had liver cancer. The average total FACT-G score was 73.0 (SD 17) at baseline, 73.2 (SD 17) at 3 months, and 75.1 (SD 19) at 6 months. In GEE models, participants reported an increase in emotional well-being at 6 months compared to baseline (coefficient 0.99, 95% CI 0.01-1.97). Among the 47 participants who completed the user experience survey, some reported issues with registering and logging into the portal, but 44 (94%) reported that the program was culturally appropriate, 35 (74%) found calls from the navigators helpful, and 35 (74%) would recommend the program to others. This multilingual virtual patient navigation program for Asian American patients with cancer was deemed culturally appropriate and helpful in our pilot study. Emotional well-being improved among users of the portal. Some participants reported technical challenges, but most were satisfied with the program. Language-concordant virtual patient navigation and online supportive care tools can extend the reach and benefits of patient navigation.
13. Changes to Family Life, Youth COVID-19 Pandemic-Related Traumatic Stress, and the Youth Mental Health Crisis.
期刊: Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53 发表日期: 2025-Oct-17 链接: PubMed
摘要
Traumatic stress symptoms increase the risk for mental health problems. We examine patterns of COVID-19-related changes in youth and family experiences (material hardships, behavior change, coping strategies), how these patterns vary with sociodemographic factors, and how COVID-19-related experiences associate with youth pandemic-related traumatic stress (PTS) symptoms. K-means clustering examined patterns of pandemic-related experiences in Environmental influences on Child Health Outcomes data (April 2020-August 2021; N = 9,139; 48% female), a demographically and regionally diverse sample. Clusters were characterized by sociodemographic factors measured pre-pandemic. Sparse partial least squares regression evaluated associations between cluster parameters and youth PTS symptoms in two samples (children [<13 years-old, n = 1,293]; adolescents [≥13 years-old], n = 1,272). Clustering replicated in the child and adolescent samples. One cluster reported more (HiChange) and one reported less (LoChange) pandemic-related change. The LoChange (versus HiChange) group included more Black individuals, single-parent households, and had lower income and education. PTS Scale scores were more associated with the youth’s own versus the parent/caregiver’s experiences. Nonetheless, across all youth, a report of “no change” in parent/caregiver behavior was associated with lower youth PTS Scale scores. For all children, lower PTS Scale scores are associated with the parent/caregiver being able to isolate. Use of coping strategies was not associated with lowered scores. Higher scores are associated with changes in youth health behaviors (e.g. eating, exercise, time outside), health care access, and increased media use. Results provide information for public health guidance, which can minimize youth PTS symptoms now and in future health disasters: stability in health behaviors, access to healthcare, and ability to isolate are paramount.
14. Changes in Medicaid Enrollment Among Adult Survivors of Childhood Cancer After Medicaid Expansion: A Report From the Childhood Cancer Survivor Study.
期刊: JCO oncology practice 发表日期: 2025-Oct-17 链接: PubMed
摘要
Little is known about whether Medicaid expansion under the Affordable Care Act affects insurance coverage among adult survivors of childhood cancer, a high-risk population requiring lifetime follow-up care. We examined the association of Medicaid expansion with Medicaid enrollment among participants in the Childhood Cancer Survivor Study. We identified 13,355 adult survivors (age 18-64 years) diagnosed with cancer at age <21 years between 1970 and 1999 and linked these survivors to Medicaid administrative data from 2010 to 2019. Outcomes included the percentage of survivors with any Medicaid enrollment and Medicaid-covered days (total number of days when a survivor was enrolled in Medicaid) each year. Multivariable difference-in-differences (DD) models were used to examine outcome changes (post- v pre-expansion) in expansion versus nonexpansion states. Medicaid enrollment rates among survivors increased in expansion states (17.1% pre-expansion to 22.8% postexpansion) but decreased in nonexpansion states (16.6%-15.7%), leading to a net increase of 7.1 percentage points (ppts; 95% CI, 6.1 to 8.1). The DD model also showed a net mean increase of 18.7 days/year (95% CI, 15.0 to 22.4) in Medicaid-covered days in expansion relative to nonexpansion states. The expansion-associated increase in enrollment was greatest among survivors who were age 18-29 years (11.2 ppts; 95% CI, 8.3 to 14.1), non-Hispanic Black (13.6 ppts, 95% CI, 8.8 to 18.4) or Hispanic (13.4 ppts, 95% CI, 7.0 to 19.8), with <$20K in US dollars (USD) self-reported household income (13.5 ppts, 95% CI, 10.7 to 16.3), and noncollege graduates (9.3 ppts, 95% CI, 7.7 to 10.9). Similar patterns were observed when examining Medicaid-covered days. To our knowledge, we provide the first evidence of increased Medicaid enrollment and longer coverage duration among adult survivors of childhood cancer after Medicaid expansion. Greater increases were seen among survivors from underrepresented racial/ethnic backgrounds, young adult survivors, and those with lower socioeconomic status, providing a mechanism to reduce disparities and ensure long-term medical care for childhood cancer survivors.
15. Designing Patient-Friendly Messages: Tutorial on Applying Human-Centered, Self-Determination Theory With AI Considerations.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-17 链接: PubMed
摘要
Patient messaging technologies offer treatment information and recommendations through web-based platforms, patient portals, mobile apps, and SMS text messaging. Many of these technologies have started to incorporate messages that are crafted by artificial intelligence (AI). Such tools are most effective when constructed with theoretical grounding and iterative input from end users. Thus, we outline a human-centered design approach for developing patient messaging content that aligns with self-determination theory (SDT), a widely used framework that has shown positive impacts on health behavior change. We illustrate our approach step-by-step for the development of messages that promote evidence-based treatment opportunities for patients with chronic pain. Messages were initially developed by subject matter experts and refined using SDT constructs (autonomy, competence, and relatedness) and motivation and behavior change techniques. Using a rapid prototyping approach, we sequentially met with 3 patient engagement boards to elicit feedback on message prototypes and enhance their content. We synthesized and aligned disparate feedback across boards with SDT and motivation and behavior change techniques. Drawing upon the input from the engagement boards, existing co-design approaches, and the field of human-centered AI, we recommend strategies to collaborate with patient partners to enhance the readability and clarity of messaging content. Recommended strategies include (1) involve engagement boards early in messaging framing and modality selection, (2) represent diverse perspectives when refining messages, (3) acknowledge and set expectations to integrate unique experiences and views, (4) prioritize message tailoring for the population of interest, (5) incorporate continual feedback mechanisms, and (6) keep the human interaction in patient-facing messages. By illuminating the process of developing message content that aligns with SDT constructs and providing guidance for iterative patient engagement and practical prototyping, we hope this tutorial can be used to enhance patient messaging content and improve uptake of evidence-based treatments. Our approach and recommendations can also guide multidisciplinary research and design teams to build patient-centered health messages. This tutorial has special consideration for future AI-guided messaging interventions, as patients are typically not involved in message content development or framing, but early engagement can potentially mitigate known AI concerns related to privacy, transparency, and fairness. As technologies and patient populations change over time, linking continual end user input with theoretical grounding plays a key role in simplifying complex medical information and promoting understanding of treatment opportunities that can ultimately improve health outcomes.
16. Community-Engaged Approach to Increase Physical Activity Among Black Individuals With Colorectal Cancer: Protocol for a Feasibility Randomized Controlled Trial of the Physical Activity Centers Empowerment Study.
期刊: JMIR research protocols 发表日期: 2025-Oct-17 链接: PubMed
摘要
Black individuals are more likely to die from colorectal cancer (CRC) and experience more treatment-related side effects compared to White individuals. Physical activity (PA) has been associated with decreased side effects, improved CRC treatment completion rates and responses, and survival. However, Black survivors of CRC are 60% less likely to engage in PA than White survivors. The Physical Activity Centers Empowerment (PACE) study is testing an intervention specifically designed to increase PA among Black individuals diagnosed with CRC. This study outlines the protocol for a randomized controlled trial. The study aims to test the feasibility of PACE and will use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. The PACE study was developed in partnership with a community advisory board consisting of Black cancer advocates and survivors of cancer. The study aims to recruit 72 participants aged >18 years from North Carolina who have been diagnosed with CRC. These participants will be randomized in a 1:1 ratio to an intervention or control group. During the 12-week intervention, all participants will receive a wearable activity tracker and informational materials from the American College of Sports Medicine’s “Moving through Cancer” program. The intervention group will also receive additional PACE theory-guided intervention components, including personalized daily adaptive step goals, access to the PACE video library, and optional video chat meetings for PA support. Data will be collected at 3 time points: baseline, after the intervention (3 months), and 6 months after the intervention (9 months). Using the RE-AIM framework, the study aims to evaluate the intervention’s reach, effectiveness, acceptability, implementation, and maintenance. The National Institute on Minority Health and Health Disparities funded this study in 2021. Study enrollment began in August 2024 and is anticipated to conclude in December 2024. This study will advance our understanding of effective behavioral strategies to increase PA and help advance the use of PA as a form of complementary cancer treatment, with the aim of improving health outcomes for Black survivors of CRC. ClinicalTrials.gov NCT06411756; https://clinicaltrials.gov/study/NCT06411756. DERR1-10.2196/65804.
17. Enduring Power of Print: How Health Information Pamphlets Promote Equity and Trust in Patient Education.
期刊: JCO oncology practice 发表日期: 2025-Oct-17 链接: PubMed
摘要
18. How Social Environment Shapes Pre-Death Grief Experiences in Dementia Caregiving: A Qualitative Study.
期刊: Qualitative health research 发表日期: 2025-Oct-17 链接: PubMed
摘要
Caregivers of persons living with dementia experience significant losses as they witness the progressive cognitive decline and personality changes of their loved ones while managing substantial caregiving responsibilities. This results in pre-death grief, which is a multifaceted response to the losses experienced. Although pre-death grief is traditionally conceptualized as an intrapersonal and dyadic phenomenon, this study examines how social environments shape caregivers’ grief experiences. Through semi-structured interviews with 33 dementia caregivers in Singapore, we identified 11 distinct domains that influence grief experiences: self, persons with dementia, family, domestic workers, friends, workplaces, fellow caregivers, health and social care services, public, policy, and social-cultural contexts. Our findings reveal that pre-death grief emerges through multifaceted interactions across these domains rather than solely through individual psychological processes. Caregivers navigate personal sacrifices and other losses while experiencing validation and invalidation of the losses across different social contexts. Particularly notable is the previously unexplored role of domestic workers, who significantly influence the caregivers’ grief experiences by redistributing the caregiving burden and providing emotional sustenance. The findings supplement dominant theoretical frameworks that primarily focus on intrapersonal or dyadic processes, suggesting instead that pre-death grief in dementia caregiving is fundamentally a social process. This perspective has significant implications for developing more comprehensive support systems that address the socially embedded nature of grief rather than focusing exclusively on individual coping strategies. By understanding pre-death grief as socially situated, we can better support caregivers throughout their dementia caregiving journey.
19. Oncology pharmacy practice in Nepal: Integration, challenges, and policy directions.
期刊: Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners 发表日期: 2025-Oct-17 链接: PubMed
摘要
N/A.
20. Burnout Among U.S. School Nurses After the COVID-19 Pandemic: Integrating Insights on Symptoms and Workplace Factors.
期刊: The Journal of school nursing : the official publication of the National Association of School Nurses 发表日期: 2025-Oct-17 链接: PubMed
摘要
BackgroundBurnout among school nurses is a growing concern as it may influence mental health and job performance.PurposeThis qualitative study investigates burnout-related factors among school nurses in the United States.MethodsA 2022 large multi-state survey of school nurses was conducted with 1,259 responses to an open-ended question regarding burnout. These were analyzed using content analysis to identify themes. The difference between those with and without burnout was examined on the identified themes.ResultsSymptoms of burnout reported were anxiety, stress, irritability and anger, loss of personal and social connectedness, sleep disturbances, depressive symptoms, and physical symptoms. The nurses reporting burnout also reported high workloads, job dissatisfaction, and intention to leave their current position.ConclusionsFindings suggest the potential importance of workload in reducing burnout, which would require structural reform and sustained administrative support.
21. Multiscale networks in Alzheimer's disease identify brain hypometabolism as central across biological scales.
期刊: PLoS computational biology 发表日期: 2025-Oct-17 链接: PubMed
摘要
Alzheimer’s disease encompasses multiple biological scales, spanning molecular factors, cells, tissues, and behavioral manifestations. The interplay among these scales in shaping the clinical phenotype is not yet fully comprehended. In particular, there is great interest in understanding the heterogeneity of the clinical aspects of AD in order to improve treatment and prevention, by targeting those aspects most susceptible to the disease. Here we employed a systems biology approach to address this issue, utilizing multilayer network analysis and deep phenotyping. This integrative analysis incorporated genomics, cerebrospinal fluid biomarkers, tau and amyloid beta (Aβ) PET imaging, brain MRI data, risk factors, and clinical information (cognitive tests scores, Clinical Dementia Rating and clinical diagnosis) obtained through the ADNI collaboration. Multilayer networks were built based on mutual information between the elements of each layer and between layers. Boolean simulations allowed us to identify paths that transmit dynamic information across layers. The most prominent path for predicting variables in the cognitive phenotype layer included the PET radiotracer fluorodeoxyglucose (FDG) in the posterior cingulate. Combinations of different symptomatic variables, mainly related to mental health (depression, mood swings, drowsiness) and vascular features (hypertension, cardiovascular history), were also part of the paths explaining the average phenotype. Our results show that integrating the flow of information across biological scales reveals relevant paths for AD, which can be subsequently explored as potential biomarkers or therapeutic targets. In particular, our results point for paths related with brain hypometabolism as a key feature in AD.
22. Level of physical activity among nurses and its associated factors: A cross-sectional study.
期刊: Work (Reading, Mass.) 发表日期: 2025-Oct-17 链接: PubMed
摘要
BackgroundPhysical activity is essential for preventing chronic disease and maintaining overall health. However, hospital nurses may face challenges maintaining adequate physical activity due to demanding work schedules and occupational stressors.ObjectiveTo examine the levels of physical activity among hospital nurses in Jordan and to identify demographic, occupational, and health-related factors associated with physical activity.MethodA cross-sectional survey was conducted among 750 nurses across Jordanian hospitals, with 597 respondents (80% response rate). Validated self-administered questionnaires were used to assess demographic, work characteristics, psychological well-being, sleep quality, musculoskeletal pain, and physical activity. Descriptive statistics summarized participant characteristics, and multiple linear regression was performed to identify independent associations with physical activity levels.ResultsThe mean age of participants was 32.1 years, and average work hours were 43.4 h per week. Approximately 31% of nurses report moderate physical activity levels, while 40% reported high physical activity levels. Higher physical activity levels were independently associated with longer work hours (β = 46.1; 95% CI: 1.9 to 90.2), more frequent night shifts (β = 163.8; 95% CI: 11.8 to 315.7), and more musculoskeletal pain sites (β = 254.9; 95% CI: 171.3 to 338.7). Having a chronic disease was significantly associated with lower physical activity (β = -1384.1; 95% CI: -2443.5 to -324.1).ConclusionMost nurses met recommended physical activity levels, and their engagement in physical activity was influenced by work demands and health status. Workplace health promotion initiatives should consider these factors to effectively support and sustain physical activity among hospital nurses.
23. Self-Reported Exposure to Community Violence and Perceived Stress as Barriers to Healthy Eating Intention Among Black Adults.
期刊: American journal of health promotion : AJHP 发表日期: 2025-Oct-17 链接: PubMed
摘要
PurposeThis study examined how community violence and perceived stress relate to healthy eating intention.DesignCross-sectional analysis of online survey data.SettingUnited States.Subjects501 Black adults (age 18+).MeasuresRespondents self-reported information on their demographics, exposure to community violence [measured by the Self-Reported Exposure to Community Violence screener (SECV)], perceived stress (measured by the Perceived Stress Scale), and intention to eat healthfully in the next 2 months (measured by the Healthful Eating Belief scale).AnalysisMultivariate logistic regression models were used to analyze associations between SECV, perceived stress, and intention to eat healthfully while controlling for demographics. An interaction term assessed the multiplicative effect of SECV and perceived stress.ResultsIndividuals in the highest quartile of SECV score had lower odds of intending to eat healthy than those in the lowest quartile (aOR:0.54; CI:0.30-0.96). Individuals in the highest perceived stress score tertile had lower odds of intending to eat healthy compared to those in the lowest tertile (aOR:0.53; CI:0.30-0.92). Individuals in the highest quartile of SECV score and highest tertile for perceived stress score had the lowest odds of intending to eat healthy (aOR:0.21; CI:0.08-0.55).ConclusionHigh SECV and perceived stress are associated with reduced odds of intending to eat healthy among Black adults. More research is needed to describe whether these factors influence dietary behavior.
24. Perceptions of HIV risk amongst heterosexually identifying migrants from Southeast Asia, Northeast Asia, and sub-Saharan Africa living in Australia: implications for virtual elimination of HIV.
期刊: AIDS care 发表日期: 2025-Oct-17 链接: PubMed
摘要
Heterosexually identifying migrants in Australia are among populations experiencing increasing HIV notifications, highlighting concerns about low rates of sexual health testing and awareness of Pre-Exposure Prophylaxis (PrEP). Utilising in-depth interviews, we explored perceptions of HIV risk among 16 heterosexually identifying migrants from Southeast Asia, Northeast Asia, and sub-Saharan Africa. Domains of inquiry were HIV risk assessment and management, knowledge and attitudes. Participants were majority female, aged 35 years and above, living in Australia for at least three years. Constructed themes were stigma and personal responsibility, access and awareness, proximity and distance, and differing socio-cultural attitudes. Cultural or community-based stigma influenced participants’ perceptions of HIV or their reluctance to use PrEP, linked to morality and safety concerns. Limited uptake of PrEP was contrasted by generally high knowledge of HIV transmission, prevention, and treatment. Attitudes and perceptions were commonly influenced by access to sexual health education, exposure to and visibility of HIV information, social proximity to people living with HIV, and sociocultural norms. Participant insights highlight the need for culturally responsive public health education outside dedicated sexual health spaces, particularly regarding PrEP, and reinforce the need for targeted, peer and community-led health promotion responses to support virtual elimination of HIV.
25. Innovating the Buccal Micronucleus cytome assay to improve its utility as a biomarker of in vivo genotoxicity.
期刊: Mutagenesis 发表日期: 2025-Oct-17 链接: PubMed
摘要
The Buccal Micronucleus Cytome (B-MNcyt) assay is used world-wide to study chromosomal abnormalities and environmental genotoxicity and cytotoxicity in humans. The aim of this paper is to discuss the strengths and limitations of the B-MNcyt assay and to identify emerging opportunities to further improve and validate its use. This can be achieved by innovating and evolving the B-MNcyt assay by identifying and solving important knowledge and technological gaps that hinder its utility. The cells examined in the B-MNcyt assay are squamous epithelial cells that can be easily collected from the inside of the mouth. These cells are post-mitotic cells generated from the proliferative basal layer and may contain micronuclei (MN). MN can be generated during mitosis of the basal cells prior to their differentiation into squamous cells. The B-MNcyt assay is increasingly being used to measure DNA damage induced in vivo by environmental genotoxins. Results with this assay have been shown to correlate positively with MN frequency measured using the well-validated lymphocyte cytokinesis-block micronucleus cytome (L-CBMNcyt) assay. However, the B-MNcyt assay has some important limitations that need to be addressed to achieve a similar level of validation and applicability as the L-CBMNcyt assay. These include: (i) lack of evidence that the buccal MN frequency predicts disease risk in prospective studies; (ii) no automated scoring system to score MN in buccal cells which is essential to achieve statistically robust results and to improve the feasibility of the assay in population studies; (iii) kinetics of MN expression in buccal cells needs more research to define optimal time frames to score MN after acute exposure or during chronic genotoxin exposure; (iv) studies are also required to test the suitability of using the B-MNcyt assay for radiation exposure bio-dosimetry. This paper discusses these issues and provides some suggestions how to address them.
26. Work alienation and unsafe behavior in new-generation miners: Dual mediation effects and the protective buffer of psychological capital.
期刊: Work (Reading, Mass.) 发表日期: 2025-Oct-17 链接: PubMed
摘要
BackgroundWith the acceleration of coal mine intelligence transformation, new generation miners (NGM) are gradually becoming the main force of production. The correlation between their work alienation (WA) and unsafe behavior (UB) has become a core challenge of safety management.ObjectiveThis study aims to explore the influence mechanism of WA on NGM’ UB and test the mediating function of organizational identification (OI) and work engagement (WE) as well as the moderating effect of psychological capital (PC).MethodsThis study takes 355 NGM from Shanxi Datuhe Coking Co., Ltd in China as a sample, adopts the structural equation model and Bootstrap method to conduct data analysis, and examines the relationship between variables and their function mechanism.ResultsWA is significantly positively correlated with UB; OI and WE independently mediate this relationship, with empirical evidence of chain mediation under generational characteristics in high-risk industrial settings. PC significantly moderates the negative impact of WA on OI and WE, and individuals with high PC can effectively buffer the negative impact of alienation.ConclusionsThe study innovatively integrates PC theory with JD-R model, revealing WA affects NGM’ UB through OI and WE sequentially. PC buffers WA’s negative influence on these mediators particularly in high-risk industries. Strengthening OI, enhancing WE, and cultivating miners’ PC can mitigate alienation’s adverse outcomes, providing strategic insights for coal mine safety management.
27. Pediatric Sarcopenia: What do We Know?
期刊: Acta medica portuguesa 发表日期: 2025-Oct-17 链接: PubMed
摘要
Pediatric sarcopenia is an emerging health issue that affects muscle development, strength, and overall well-being in children and adolescents. While it was initially linked to aging, recent studies highlight its presence in younger populations, particularly among those with chronic conditions. This condition affects growth and neurodevelopment in the short term and is associated with an increased risk of long-term complications, namely metabolic and cardiovascular diseases. Several factors contribute to pediatric sarcopenia, including inadequate prenatal nutrition, low birth weight, genetic susceptibility, insufficient dietary protein intake, sedentary behaviors, obesity, metabolic imbalances, and chronic illnesses. Reduced muscle mass impairs bone health, delays growth spurts, and affects physical performance, which may result in a lower quality of life. In children with chronic diseases, sarcopenia exacerbates clinical outcomes, prolongs hospital stays, and increases the likelihood of complications. Diagnosing sarcopenia in children is complex due to differing growth patterns. Existing assessment methods, such as imaging techniques and body composition analysis, lack standardized reference values tailored to pediatric populations, which makes early detection challenging. Preventive strategies emphasize physical activity, especially resistance exercises (muscle strengthening), reduced screen time, improved dietary habits, and sleep hygiene. Innovative treatments are being explored, including targeted drug delivery to the muscle to minimize side effects, regenerative approaches utilizing nanoparticles, and myostatin inhibitors for stimulating muscle growth. Stem cell therapy and biomaterial-based muscle reconstruction are also under investigation; however, pediatric-specific therapeutic guidelines remain undefined. Early intervention is crucial for reducing its negative effects and fostering healthier developmental paths.
28. Metallosalphen-Covalent Organic Framework-Based Semiconducting Artificial Enzymes with Radio-Activable Antitumor Immunity for Suppressing Tumor Metastasis and Recurrence.
期刊: ACS nano 发表日期: 2025-Oct-17 链接: PubMed
摘要
Reactive oxygen species (ROS)-catalytic therapies have gained increasing popularity in preventing tumor metastasis and recurrence, yet their efficiency is often compromised by limited systemic immune activation. Herein, we report the de novo design of Ru-coordinated bis-Schiff base salphen-covalent organic frameworks (SCOF-Ru) to serve as semiconducting artificial enzymes with radio-activable ROS-catalytic efficiency and antitumor immunity for suppressing tumor metastasis and recurrence. Experimental and theoretical results demonstrate that the semiconducting SCOF-Ru displays large π-conjugation, efficient electron transfer, strong electron-hole separation, and unique Ru2-N4O2 catalytic centers, enabling the most superior ROS production capability under low-dose X-ray irradiation. Rather than relying on high-Z elements, semiconducting SCOF-Ru with optimized band structures endows Ru sites with high radiosensitization effects. Our findings have disclosed that the SCOF-Ru can not only effectively inhibit DNA repair but also trigger robust apoptosis through the downregulation of calcium signaling pathways. Correspondingly, the therapeutic superiority and recurrence inhibition efficacies of SCOF-Ru have been validated in different tumor models, especially radiotherapy-resistant patient-derived xenograft models. Combined with immune checkpoint blockade, radio-activable SCOF-Ru shows great potential to robustly inhibit the growth of distant tumors. We believe the innovative design of ROS-catalytic and radio-activable artificial enzymes will enable a promising avenue for treating malignant tumors.
29. Simultaneous priming of HIV broadly neutralizing antibody precursors to multiple epitopes by germline-targeting mRNA-LNP immunogens in mouse models.
期刊: Science immunology 发表日期: 2025-Oct-17 链接: PubMed
摘要
Germline-targeting is a promising approach to HIV vaccine development that begins with the elicitation of precursors to broadly neutralizing antibodies (bnAbs), but it remains unclear whether simultaneous elicitation of precursors to multiple epitopes on the HIV envelope (Env) would be inhibited by competition. This study used preclinical mouse models with physiologically relevant frequencies of bnAb precursor-bearing B cells to compare precursor elicitation by coadministration of multiple protein or mRNA lipid nanoparticle (mRNA-LNP) germline-targeting immunogens. These immunogens activate multiple bnAb precursor classes targeting distinct epitopes on Env but with evidence of potential competition. Simultaneous delivery of immunogens encoded by mRNA-LNPs, however, drove maturation across different precursor frequencies and immunogen doses. Furthermore, administration of a cocktail of mRNA-LNP immunogens (N332-GT5 gp151, ApexGT5 gp151, eOD-GT8 60mer, and 10E8-GT12 24mer) led to balanced activation of four distinct bnAb precursor classes, indicating that multiepitope HIV bnAb precursor priming might be successfully implemented in humans but might be immunogen dependent.
30. Temperature Dependence of Halogen Radical Reactivity with Dissolved Organic Matter.
期刊: Environmental science & technology 发表日期: 2025-Oct-17 链接: PubMed
摘要
Reactions with dissolved organic matter (DOM) govern the sinks and concentrations of halogen radicals in aquatic environments, yet the impact of seasonal and regional temperature variations remains unclear. Here, second-order rate constants (k) for four halogen radicals (Cl•, Br•, Cl2•-, and Br2•-) reacting with six DOM isolates were determined from 9 to 39 °C. At 25 °C, k values (MC-1 s-1) were approximately 105-106 for Br2•-, 106-107 for Cl2•-, and 108 for Cl•/Br•. Their temperature dependence followed the Arrhenius equation, yielding apparent activation energies (Ea) of 5.8-34.1 kJ mol-1. DOM reactions with Cl• and Br• were nearly barrierless, with average Ea of 9.7 (Cl•) and 13.2 kJ mol-1 (Br•), while Cl2•- and Br2•- displayed stronger temperature dependence, with average Ea of >20 kJ mol-1. Empirical models were developed to predict both Ea and the pre-exponential factor (A) from bulk DOM properties. Thermodynamic analysis reveals entropy-driven control of Cl•/Br• reactions with DOM, whereas both enthalpy and entropy shaped Cl2•-/Br2•- reactivity. Incorporating temperature dependence into kinetic modeling quantitatively explained the micropollutant degradation during advanced oxidation. This study establishes a quantitative framework linking water temperature and DOM properties with halogen radical fate in aquatic systems.
31. Predicting Risk of Heat-Related Injuries for Individuals Wearing Personal Protective Equipment Using Smartwatches: Feasibility Observational Study.
期刊: JMIR formative research 发表日期: 2025-Oct-17 链接: PubMed
摘要
The risk of developing heat-related illness increases when personal protective equipment (PPE) is worn, especially in hot and humid environments. While cooling strategies are effective, they must be applied preemptively or delivered promptly, which can be difficult if individuals are working in dangerous environments or wearing contaminated PPE. Wearable sensors can be leveraged to continuously monitor health including heart rate, respiration rate, blood oxygen levels, and physical activity. This study aims to (1) evaluate the use of wearable sensors for monitoring the real-time health of individuals wearing PPE to mitigate the risk of developing a heat-related illness and enable timely intervention, (2) understand how PPE may affect smartwatch data quality and comfort, and (3) identify circumstances in which people wearing PPE may not be able to wear a smartwatch. Individuals participating in planned field trainings or exercises where PPE was being worn were asked to wear Garmin Fenix 6 smartwatch (Garmin Ltd) before, during, and after the event to monitor health and recovery. These convenience cohorts were selected to understand the feasibility of using smartwatches with different types of PPE (ie, level C PPE and firefighter gear) for different types of training (ie, a simulated environmental cleanup exercise and skill and tactical maneuver training for new firefighter recruits). Two data collections were conducted using the Garmin Fenix 6 smartwatch to assess wearability, data quality, and data accuracy. For the first effort, participants wore the watch for 3.9-5.1 days, and wear compliance ranged from 83.8% to 99.9%. For the second effort, participants wore the watch for the exercise only, which was 3.5 hours. Participants were able to wear the watches for the entire time that they were wearing PPE and did not report any adverse events. Changes in heart rate corresponded with changes in physical activity, providing evidence that physiology can be acceptably monitored during physical activity. Heart rate data artifact ranged between 5.8% and 9.3% and was highest for the control participant (second data collection) who was not wearing PPE. Based on the results obtained from the 8 pilot users, the Garmin Fenix 6 smartwatch is an appropriate choice for continuously monitoring the health of individuals wearing PPE. The watch can be tolerated for extended wear periods and data quality is sufficient for monitoring heart rate and predicting core body temperature.
32. SHIFT-48: Schedule and Health Improvements for Firefighters Transitioning to 48/96.
期刊: Journal of occupational and environmental medicine 发表日期: 2025-Oct-17 链接: PubMed
摘要
Examine the effects of transitioning from a 24/48 to a 48/96 shift schedule on health and performance in firefighters assigned to a single, suburban station. A longitudinal analysis was conducted over three time points in 11 male firefighters. Measures included VO2peak, peak power, blood pressure, resting heart rate, lipid profiles, and psychological assessments. Linear mixed-effects models analyzed changes across timepoints. Transitioning to the 48/96 schedule was associated with improvements in peak power (+27.1 W, p = 0.042), resting blood pressure (SBP -5.5 mmHg, p = 0.05, DBP -5.8 mmHg, p = 0.04), heart rate (-13.2 bpm. p = 0.03), sleep quality (ISI -2.6, p = 0.03), and alcohol use (AUDIT -1.8, p = 0.02); VO2peak did not reveal a significant time effect (p > 0.05). Extended inter-shift recovery in a 48/96 schedule may promote cardiovascular recovery and readiness without negative health effects in similar departments.
33. Managing fatigue in Parkinson's disease: Preparing for a randomized controlled trial.
期刊: Journal of Parkinson’s disease 发表日期: 2025-Oct-17 链接: PubMed
摘要
BackgroundFatigue in Parkinson’s disease (PD) is a common, debilitating symptom often overlooked in research and clinical practice. Effective interventions are needed to mitigate its impact on people with PD.ObjectiveThis pilot study evaluated the feasibility of the individual videoconference version of the Packer Managing Fatigue program for people with PD and explored its preliminary effectiveness versus usual care to inform the design of a definitive trial. Here we report on the second objective.MethodsA two-arm, assessor-masked, randomized controlled pilot study recruited participants with PD who experience severe fatigue, have English proficiency, and internet access. Outcome measures included occupational performance, satisfaction with performance, occupational balance, fatigue impact, quality of life, and sleep. Mixed repeated-measures ANOVA and non-parametric tests were used for analysis.ResultsMixed-design ANOVA (N = 25) showed an exploratory trend toward significant for the Time × Group interaction effect differences in satisfaction with performance between groups over time (p = 0.09). Paired t-tests within the intervention group indicated significant improvement in satisfaction with performance (p = 0.04). The effect size for this outcome was moderate. Small to moderate effect sizes were observed for occupational balance, occupational performance, and subscales of the Multidimensional Fatigue Inventory. Other measures showed negligible effects.ConclusionsThe results provide preliminary evidence of the program’s benefits for people with PD. Larger, more rigorous studies are needed to confirm its effectiveness. Despite the small sample size and challenges posed by COVID-19, this study offers valuable insights into recruitment strategies and effect sizes to inform future trial designs. People living with Parkinson’s disease (PD) often feel extremely fatigued. It can make daily activities difficult and reduce quality of life. Our study tested a program called “Packer Managing Fatigue” which helps people manage their energy better. This program teaches strategies like planning rest breaks, simplifying tasks, and improving sleep habits. There is proof that the program helps people with multiple sclerosis. This is the first time testing it for people with PD. We worked with 25 people from Nova Scotia and Ontario, Canada. They were divided into two groups: one group used the Packer Managing Fatigue program, and the other group continued with their usual care. We measured their level of performance and satisfaction doing meaningful daily life activities, whether they felt they led a balanced life, the impact of fatigue on their life, quality of life, sleep quality, and other factors before and after the program. We compared the two groups to see if there was a difference. The program helped improve peoples’ satisfaction with their daily activities. However, we did not find significant changes in other areas. This first, small study suggests that the program has potential to help people with PD. A new study with a larger group of participants is recommended to confirm its effectiveness. This study is an important first step in understanding how to better support people with PD in managing fatigue. Future research will help refine the program and determine the best ways to deliver it to those who need it.
34. Guidelines for IAQ monitoring with low-cost air sensors in homes with asthmatic patients.
期刊: Journal of the Air & Waste Management Association (1995) 发表日期: 2025-Oct-17 链接: PubMed
摘要
Indoor air quality (IAQ) is a crucial determinant of health, which is of particular concern for low-income black children, who are disproportionately exposed to asthma triggers in their indoor housing environment and have higher rates of asthma and poorer outcomes from the disease, indicating an environmental justice issue. However, guidelines for IAQ data collection vary between organizations, making assessments and comparisons difficult. This study consolidates recommended practices into one cohesive set of guidelines for monitoring IAQ. It outlines a structured approach for defining IAQ sampling objectives, identifying the most appropriate low-cost air sensors, determining optimal sensor placement in homes, developing data collection and analysis, and presenting and interpreting results. With indoor PM2.5 as a case study, the guidelines were used to determine sampling duration, analysis, and quality assurance in five households with pediatric asthma patients. The metrics illustrate PM2.5 concentration by the 90th percentile (with average concentration level from 4 - 109 μg/m3), daily average minutes of PM2.5 concentration exceeding recommended exposure limits of 0 - 134 mins, daily average PM2.5 concentration of 1.8 - 82 μg/m3, and significant temporal variation across households. This study highlights the significance of employing low-cost air sensors to provide real-time notifications of IAQ, along with simplified monitoring guidelines for researchers, healthcare providers, and parents working to improve IAQ for households with asthmatic children, potentially reducing the frequency and severity of asthma attacks. The low-cost sensors and resulting metrics can direct interventions effectively and provide a basis for determining the efficacy of environment-based air quality interventions.Implications: Given the substantial time spent indoors, particularly in homes, precise and timely indoor air quality (IAQ) monitoring is essential to inform occupants about mitigation actions to reduce asthma exacerbations. As a specific group, low-income black children are at higher risk for asthma and have more exposure to environmental pollutants in the home environment. Low-cost air sensors are increasingly adopted for immediate IAQ monitoring, but many organizational guidelines, primarily designed for occupational rather than residential environments, complicate evaluations. This study integrates best practices into a single set of guidelines for deploying low-cost sensors to deliver real-time IAQ alerts in residential settings, aiming to decrease asthma attack frequency and severity while improving quality of life. A case study utilizing the developed guideline in this study was applied to demonstrate the ability to collect and evaluate PM2.5 concentration levels in some low-income residential homes in Southeastern Louisiana.
35. Testosterone and pre-androgens by age and menopausal stage at midlife: findings from a cross-sectional study.
期刊: EBioMedicine 发表日期: 2025-Oct-16 链接: PubMed
摘要
Whether testosterone and the pre-androgens, androstenedione and dehydroepiandrosterone (DHEA) change at menopause remains uncertain. The Australian Women’s Midlife Years Study recruited a nationally representative sample of 8096 women aged 40-69 years, between 27th October 2023 and 19th March 2024. Participants were excluded from providing a blood sample if pregnant, breastfeeding, using medications that affect sex hormone concentrations, or living over 100 km from a collection centre. Sex steroids were measured by liquid chromatography-tandem mass spectrometry and menopausal status was determined by the Stages of Reproductive Ageing Workshop (STRAW) + 10 criteria. Blood samples were provided by 1435 of the 5031 invited participants. After excluding participants with no menopause stage classification, abnormal thyroid function, hyperprolactinemia, bilateral oophorectomy, and an unreported pregnancy, 1104 participants, mean (SD) age 56.5 (8.5) years, were included in the main analysis. Median testosterone concentrations declined between the ages of 40-44 and 55-59 years (median (interdecile range) 0.56 (0.29-1.01) nmol/L vs 0.42 (0.21-0.79) nmol/L, p = 0.001 adjusted for BMI and smoking), reached a nadir at the age of 58-59 years, followed by a modest increase, and did not differ between the youngest group and participants aged 60-64 or 65-69 years. Median androstenedione and DHEA concentrations declined from the age of 40-44 years to 65-69 years, by 51% and 33%, respectively. Testosterone and DHEA concentrations did not vary by menopausal stage in participants aged 48-53 years, whereas androstenedione concentrations were significantly higher in premenopausal, compared with postmenopausal individuals (median (IQR) 1.94 (1.42-2.54) nmol/L vs 1.63 (1.01-2.02) nmol/L, p = 0.001). Testosterone concentrations declined from the age of 40 years, reaching a nadir at approximately 58-59 years followed by a modest increase, with no impact of natural menopause. These data do not support menopause per se as an indication for testosterone supplementation. This research was supported by a National Health and Medical Research Council (NHMRC) Leadership 3 Investigator Grant award SRD (2016627).
36. A Delphi study on valuing DNA sequencing in oncology: a European stakeholder developed framework for assessing next generation sequencing and comprehensive genomic profiling diagnostics.
期刊: EBioMedicine 发表日期: 2025-Oct-16 链接: PubMed
摘要
Advanced genomic technologies like Next Generation Sequencing and Comprehensive Genomic Profiling are pivotal for the prevention, management and treatment of cancer by identifying crucial genetic markers. However, their adoption in Europe is inconsistent, partly due to the lack of a validated approach to assessing their value. A multi-phase mixed-methods approach was implemented, integrating a systematic review and multi-stakeholder consensus-generating Delphi exercise to derive a comprehensive set of value criteria and arrive at a value assessment framework. This value assessment framework adapted an existing Latin American-focused diagnostic framework to the European context. The Delphi included representatives from the broader stakeholder community (patient advocacy, industry, decision-makers, health technology assessment, regulators, academia, and physicians). Over four rounds, participants refined and rated the significance of these criteria in the context of the assessment of the specified technologies in oncology, particularly for reimbursement decisions. Responses were analysed in terms of stability and level of consensus in order to generate a final value assessment framework. 34 individuals participated in all rounds of the Delphi exercise. The final value assessment framework includes 8 distinct value criteria, including: clinical impact; test performance and quality; quality of scientific evidence; non-clinical impact; impact on health system integration, organisation and delivery of care; economic aspects; ethical and governance concerns; and health system priorities. Within these criteria, a total of 27 distinct sub-criteria were identified, 23 of which had consensus as ‘important’ or ‘very important’ in assessing value. The resultant value assessment framework is validated by a wide range of key European stakeholders and enables systematic assessment of Next Generation Sequencing and Comprehensive Genomic Profiling technologies used in oncology diagnostics within the European setting. The framework includes aspects that are not adequately considered in current health technology assessment and goes beyond existing value assessment frameworks through the inclusion of newer criteria such as data governance concerns. Funding was provided by the Precision Cancer Consortium with an unrestricted educational grant.
37. Pre-admission fine particulate matter exposure is associated with invasive pulmonary aspergillosis in patients with severe pneumonia, results from two multicenter cohort studies.
期刊: EBioMedicine 发表日期: 2025-Oct-16 链接: PubMed
摘要
Aspergillus, the causative pathogen of invasive pulmonary aspergillosis (IPA)-a highly lethal infectious disease-produces spores with diameters that fall within the fine particulate matter (PM2.5) range and are frequently detected in ambient PM2.5 samples. In this study, we investigated whether pre-admission exposure to PM2.5 is associated with an increased risk of IPA in patients with severe pneumonia. Daily PM2.5 levels for the six months before admission were obtained from a multicenter retrospective cohort and a multicenter prospective cohort. Multivariable logistic regression was used to assess whether pre-admission PM2.5 exposure is an independent risk factor of IPA in both cohorts. Pooled concentration-response curves determined the dose-response relationship. Mediation analysis was used to assess whether the presence of Aspergillus acts as a mediator between PM2.5 exposure and 28-day mortality. Among 2287 patients, higher average daily PM2.5 exposure over six-month before admission was independently associated with an increased risk of IPA. For every 10 μg/m3 increase in average daily PM2.5 exposure during the six months before admission, the risk of IPA increased by 21% (95% CI: 10%-32%). The dose-response relationship was linear, and results remained robust across subgroups and sensitivity analyses. Mediation analysis showed that Aspergillus positivity was found to mediate 21.26% (95% CI: 4.5%-48%; P = 0.008) of the relationship between daily PM2.5 exposure in the 90 days preceding admission and 28-day mortality. In this study, we evaluate the association between pre-admission PM2.5 exposure and IPA. Our findings demonstrate that higher concentrations of PM2.5 prior to admission are associated with an increased risk of IPA among ICU-admitted patients with severe pneumonia. In addition, our findings suggest that Aspergillus mediate the association between PM2.5 exposure and mortality in this population. This work was supported by National Science and Technology Major Project of China (2025ZD0549000), National Natural Science Foundation of China (grant no. 82202356, 82341109, and 82173645), the Zhejiang Provincial Natural Science Fund (grant no. LTGY24H190001), “Pioneer” and “Leading Goose” R&D Program of Zhejiang (grant no. 2025C02090).
38. Evaluating environmental health communication: The readability of factsheets about per- and polyfluoroalkyl substances (PFAS).
期刊: International journal of hygiene and environmental health 发表日期: 2025-Oct-16 链接: PubMed
摘要
It is important for environmental health professionals to inform the public about potential chemical risks. Factsheets are a common way to disseminate information to the public, however, there has been little evaluation of whether these materials are fit for purpose. This study evaluated the readability of factsheets about per- and polyfluoroalkyl substances (PFAS), contaminants of emerging concern that have impacted communities worldwide. Using grey literature searches, we identified 36 PFAS fact sheets published by government agencies in countries where PFAS contamination events had occurred. Factsheets were evaluated using the Simple Measure of Gobbledygook (SMOG) readability formula, language complexity, and the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P). The factsheets had an average reading grade level of 15.1 with no factsheets meeting the recommended reading grade range of 5-8. On average, almost one quarter of the words used in the factsheets were complex or uncommon words. Only 8 of the factsheets scored above 70% on PEMAT-P, which is the threshold at which factsheets are categorised as understandable. This study demonstrates that PFAS factsheets are typically not written at an appropriate reading level. We identify several areas for improvement such as using health literacy tools to reduce the complexity of language, incorporating infographics and pop out boxes, and providing concise summaries of information. To increase environmental health literacy, environmental health communicators should draw on the learnings of health communication and utilise existing tools to improve readability.
39. Super Users' Reported Best Practices for Coordinating Proactive Integrated Use of Virtual Healthcare Resources: A Prospective Concurrent Mixed Methods Human Centered Design Study.
期刊: Journal of medical Internet research 发表日期: 2025-Oct-16 链接: PubMed
摘要
Proactive integrated virtual healthcare resource (VHR) use is the self-initiated coordinated use of applicable virtual systems as a team or an individual for coordinating timely delivery of high-quality healthcare. Based on literature and the purpose of this project, super users are defined as clinical team members who are identified by their clinical colleagues as proactive users of VHRs (i.e. early adopters) to coordinate care delivery and champion resource use. Super users’ proactive integrated VHR use improves workflow and workload efficiency, and supports provider uptake and promotion, which increases patient adoption and sustained use, to improve care outcomes. Previous studies have not examined super users’ integrated use of available VHRs across the healthcare continuum or within service-specific clinical workflows. The objective of this project was to describe VHR super users’ activities and outcomes to document their practices, and inform identification and dissemination of current and best practices. A prospective, concurrent, mixed-methods design leveraging qualitative interviewing and human centered design was used to accomplish the study objective. Purposive sampling was used to recruit and conduct interviews with super users across 5 specialty services (i.e., cardiology, whole health, spinal cord injury, education, and rehabilitation) at a large Department of Veterans Affairs (VA) hospital in the Southeastern United States. Tailored scripts and surveys were used to conduct data collection. Rapid iterative content analysis and data triangulation were used to inform data distillation. Super user (N=15) data, from specialty services (n=5) revealed n=57 best practices (48 data-derived and 9 established) using 60 VHR within 11 major categories of tasks (e.g., appointment management, patient care delivery, medication management), with 43 sub-categories (e.g., scheduling, appointment reminder, pre-appointment huddles). Computerized patient record system and joint legacy viewer, Secure Messaging, Telephone, VA Video Connect, and Microsoft Teams (Microsoft Corp), were reported as 5 most commonly used VHRs. Across the care continuum, best practices around PGHD (n=15), and appointment management and patient and staff technology resource access (n=13) were most commonly reported. Results identify super users’ practices through case scenarios that illustrate the integration of VHRs within and across service-specific clinical workflows. This project informs “best practices” through integrated use of VHRs across the care continuum. While the findings were specific to 5 specialty services, practices can be applied across services throughout workflows. Recommendations were also made for consideration for de-implementation of select practices. Findings can be used for training, education, and establishing best and de-implementation of practices. Future research should aim to evaluate outcomes associated with the use of best practices. These data-driven products lay foundational work in identifying and disseminating best practices in VHR use, to inform the transformation of the Veterans Health Administration’s (VHA) learning healthcare system into a culture of VHR super users.
40. Airborne free DNA in chicken farms: The overlooked traits in microbial diversity, viral composition, and antimicrobial resistance risk.
期刊: Journal of hazardous materials 发表日期: 2025-Oct-14 链接: PubMed
摘要
The enrichment of DNA from total suspended particulates (TSP) onto 0.22 µm pore size filters (intracellular DNA, iDNA) is a critical step in characterizing the airborne microbiome. However, free DNA (< 0.22 µm, fDNA) may harbor unrecognized microbial and genetic components. In this study, metagenomic analysis was employed to compare airborne fDNA and iDNA from eight chicken houses. Overall, the average concentration of fDNA was 5.6-fold higher than that of iDNA. A total of 587 genera spanning 28 phyla were identified in fDNA, including 162 genera absent from iDNA. Notably, 39.7 % of open reading frames were unique to fDNA, involving key metabolic and regulatory pathways. A total of 50.2 % viral contigs were only detected in fDNA, carrying mobile genetic elements, virulence factor genes, and resistance genes against antibiotics, biocides, and metals. The total absolute abundance of the antibiotic resistome was higher in fDNA, with 79.2 % of significantly varied genes enriched therein, including 16 high-risk genes. Metagenomic binning further supported that fDNA harbors broader microbial diversity and functional traits. These findings underscore airborne fDNA as an underexplored reservoir of microbial and genetic diversity, meriting further investigation for its ecological and public health implications.
41. Cobalt exposure increases fasting plasma glucose by inhibiting hepatic glycogen synthesis and enhancing gluconeogenesis.
期刊: Journal of hazardous materials 发表日期: 2025-Oct-13 链接: PubMed
摘要
Cobalt (Co) is an important transition metal and widely distributed in the natural environment. Co exposure is associated with an increased risk of diabetes. Epidemiological studies have identified the associations between Co exposure and fasting plasma glucose (FPG) levels. However, the mechanism of cobalt associated with FPG increase is still unclear. In this study, we investigated the relationship between urinary Co and FPG through population surveys and explored the mechanism of Co-induced glucose metabolic disorders in mice and MIHA human normal liver cell line. We found a positive correlation between urinary Co concentrations and FPG levels in investigated population, and the PI3K/Akt signaling pathway was screened out by metabolomics and network toxicology analyses, which might be associated with Co-induced the elevation of FPG. Mechanistically, Co inhibited hepatic glucose uptake and glycogen synthesis and enhanced gluconeogenesis by suppressing PI3K/Akt signaling pathway activation that acted on glucose metabolism by FOXO1, GSK-3β and glucose transporter protein GLUT2. Furthermore, Co upregulated the expression of PTEN, an inhibitory protein of PI3K/Akt signaling, via reduced the miR-148b-3p, leading to the suppression of PI3K/Akt signaling, ultimately induced glucose metabolic disorders in liver. However, Co has no effects on the glucose metabolism of skeletal muscle in mice. Our research results provide a new discovery for Co disrupting glucose metabolic and increasing FPG levels through inhibiting glycogen synthesis and increasing gluconeogenesis, not affecting the glycolytic capacity in liver.
42. Coupled syngas fermentation to multiple oxidized contaminants reduction in a membrane biofilm reactor.
期刊: Water research 发表日期: 2025-Oct-13 链接: PubMed
摘要
Multiple oxidized contaminants (MOC) frequently coexist in water sources, posing significant human health risks. Major challenges in the biological reduction of MOC include the lack of effective carbon sources and competition for a sole electron donor. This study demonstrates the feasibility of using syngas fermentation in a lab-scale membrane biofilm reactor (MBfR) to provide dual electron donors, volatile fatty acids (VFAs) and H2, to support simultaneous removal of nitrate, selenate, bromate, and perchlorate. MBfR was employed for efficient gas delivery, achieving complete MOC removal with non-toxic end products (N2, Se0, Br-, and Cl-) generated over 200 days of operation. In situ batch tests revealed that MOC reduction was synergistically driven by H2 and VFAs generated via gas fermentation. H2 primarily facilitated bromate reduction, VFAs enhanced perchlorate reduction, while nitrate and selenate were reduced by both electron donors. Maximal removal rates reached 108.1 mg N/L/d, 6.9 mg Br/L/d, 5.5 mg Cl/L/d, and 5.4 mg Se/L/d when both H2 and VFAs were utilized. High-throughput 16S rRNA gene amplicon sequencing suggested gas fermenters (Acetobacterium and Clostridium), autotrophic MOC-reducing taxa (e.g., Shewanella), and heterotrophic MOC-reducing taxa (e.g., Clostridium, Desulfovibrio) as the dominant community members, underscoring their roles in syngas conversion and contaminant reduction. These findings highlight the potential of integrating syngas fermentation in MBfRs as an efficient strategy for simultaneous MOC removal, providing a promising approach for water remediation.
43. Prenatal BPB exposure at environmentally relevant dose induces male-specific neuropsychiatric disorders: Impaired neuropeptide-mediated synaptic transmission via lncRNA-dependent ceRNA networks.
期刊: Journal of hazardous materials 发表日期: 2025-Oct-13 链接: PubMed
摘要
Adolescent neuropsychiatric disorders impose a major global health burden. Bisphenol B (BPB), a prevalent endocrine disruptor in maternal biospecimens, remains an unexamined risk factor. Whether environmentally relevant exposures elicit sex-specific effects or involve long non-coding RNA (lncRNA)-mediated mechanisms is still largely unknown. Using animal models and behavioral assessments, we demonstrated that prenatal BPB exposure at environmentally relevant doses induced male offspring-specific depression- and anxiety-like behaviors, accompanied by alterations in synaptophysin and glutamatergic postsynaptic densities in the cortex. Cortical transcriptomics identified that differentially expressed genes were primarily enriched in neuropeptide signaling, G protein-coupled receptor pathways, and synaptic transmission. Key neuropeptide genes (Gal, Galr1, Oxt, Cartpt) and their corresponding neurotransmitter receptors were downregulated postnatally. Mechanistically, through integrated molecular docking, transcription factor prediction, and competitive endogenous RNA (ceRNA) network construction, we found that BPB may bind to Tcf4/Neurog2/Sp9 and thereby suppressed the expression of lncRNA NONMMUT096884.1, which in turn reduced the expression of neuropeptide-related genes (Galr1 and Oxt) via the ceRNA mechanism, ultimately impairing synaptic transmission and contributing to anxiety/depression-like behaviors in male offspring. This study uncovers previously unrecognized lncRNA-mediated epigenetic pathways underlying sex-biased susceptibility to environmental BPB exposure, providing novel biomarkers and therapeutic targets for neuropsychiatric disorders.
44. E-Cigarettes in Historical Context-Innovation, Risk, and Regulation.
期刊: JAMA health forum 发表日期: 2025-Oct-03 链接: PubMed
摘要
This Viewpoint discusses the potential for e-cigarettes to displace smoking, restrictive regulations, and public misperceptions amid enduring nicotine demand and persistent smoking-related disease.
45. The microbiome and gut-lung axis in nontuberculous mycobacterial pulmonary disease.
期刊: PLoS pathogens 发表日期: 2025-Oct 链接: PubMed
摘要
Nontuberculous mycobacterial pulmonary disease (NTM-PD) is increasingly recognised as a significant global health concern. It is characterised by a highly heterogenous clinical course and remains poorly understood, from host susceptibility to disease pathophysiology, and is notoriously difficult to treat. Recent advances highlight the microbiome as a critical modulator of host physiology, with site-specific ‘microbiota’ influencing the delicate balance between health, infection and disease. While microbial populations vary across discrete anatomical sites, there is a growing recognition that they are interconnected. For example, gut microbes can influence immune cell functions in the lung via the gut-lung axis (GLA). Drawing parallels with other related chronic respiratory diseases, it is hypothesised that microbiota-host-interactions shape susceptibility and manifestation of NTM-PD. This review synthesises current knowledge of some key host susceptibility factors in NTM-PD, and their potential interactions with host microbiota. With only recently emerging studies, we explore the potential role of the GLA in NTM-PD, given its promising links to microbial communities and immunological and metabolic pathways. We assess the limited, but growing body of research on the lung microbiota in NTM-PD and evaluate the small number of studies on faecal microbiota in NTM-PD. By considering insights across anatomical sites, this review aims to contextualise the microbiome within multiple dimensions of NTM-PD, including host susceptibility, disease progression, treatment responsiveness, and the effects of antibiotic therapy. A better understanding of the microbiome in NTM-PD could hold promise in uncovering the complex and multifactorial mechanisms that contribute to the heterogenous clinical course and challenging management of NTM-PD.
46. Tasks Contributing to Job Satisfaction Among Health Professionals: A Qualitative Descriptive Study.
期刊: Nursing open 发表日期: 2025-Oct 链接: PubMed
摘要
This study described healthcare professionals’ experiences of tasks that contribute to job satisfaction. A qualitative descriptive study was conducted. Data were collected through a survey questionnaire with an open-ended question on job satisfaction. 5464 healthcare professionals responded to the questionnaire. Data were analysed through manifest qualitative content analysis. The theme ‘Enhancing healthcare professionals’ job satisfaction through coherence, manageability, and meaningfulness’ emerged with the following five categories: Enhancing person-centred care, Enhancing education, mentorship, and patient communication, Enhancing active participation in organisational development and transformation, Enhancing multi-professional teamwork and collaborative care, and Enhancing rewards and support. This study emphasises that job satisfaction among healthcare professionals depends on meaningful caring activities, a supportive work environment, and workplace resources. These factors boost resilience, reduce stress, and improve retention and patient care. A resource-based, salutogenic approach promotes both professional and personal well-being, fostering healthier, more effective healthcare environments. No patient or public contribution.
47. Electromagnetic Stimulation to Reduce Disability After Ischemic Stroke: The EMAGINE Randomized Clinical Trial.
期刊: JAMA network open 发表日期: 2025-Oct-01 链接: PubMed
摘要
Ischemic stroke remains a leading cause of disability worldwide. Preliminary studies have suggested that noninvasive, frequency-tuned, low-intensity electromagnetic network targeting field (ENTF) stimulation may have recovery benefit for patients with stroke. To evaluate the safety and effectiveness of ENTF therapy in reducing global disability among patients in the subacute ischemic stroke phase with moderate to severe disability and upper-extremity impairment. This multicenter, double-blind, sham-controlled, randomized clinical trial was conducted at 15 US-based acute care and inpatient rehabilitation facilities from December 2021 to November 2023. Participants were enrolled 4 to 21 days after a stroke and had a baseline modified Rankin Scale (mRS) score of 3 or 4 (moderate or moderately severe global disability) and Fugl-Meyer Assessment for Upper Extremity score of 10 to 45 (higher scores indicating better arm function). Target sample size was 150 participants. Participants were randomly allocated to receive either active or sham ENTF stimulation. Modified intention-to-treat approach was used in primary efficacy and safety analyses. Participants allocated to the active or sham ENTF stimulation were treated with a proprietary brain-computer interface-based stimulation device paired with an evidence-based, functional, repetitive, home-based physical and occupational exercise regimen for 45 one-hour sessions, 5 times per week within the first 90 days after a stroke. The primary end point was change in global disability, assessed with the mRS (score range: 0 [indicating normal or no symptoms] to 6 [indicating death]), from baseline to day 90. Secondary end points were change from baseline to day 90 in upper-limb impairment, arm motor function, gait speed, hand function, and physical and functional limitations as well as day-90 health-related quality of life, each of which was assessed with a specific metric. The trial was stopped early after enrollment of 100 participants (50 in active group, 50 in sham group) when a promising zone threshold was not attained at planned interim analysis of the first 78 evaluable participants. Participants had a mean age of 59.0 (12.5) years and included 66 males (67.3%). The median (IQR) time from stroke to first ENTF treatment was 14 (12-19) days. Study groups were similar in age, sex, and baseline mRS scores, but imbalances were noted with participants in the active, compared with the sham, group having more right-hemisphere strokes (31 of 49 [63.3%] vs 22 of 49 [44.9%]), more severe upper-extremity impairment (Shoulder Abduction Finger Extension score <5; 31 of 49 [63.3%] vs 24 of 49 [49.0%]), and fewer small-vessel infarcts (14 of 49 [28.6%] vs 21 of 49 [42.9%]). For the primary outcome, the mean (SD) disability reduction on mRS at day 90 was not statistically significantly higher in the active group than in the sham group (-1.96 [0.12] vs -1.72 [0.12]), including mRS score of 0 to 1 attained in 12 participants (26.0%) vs 5 participants (10.0%) (odds ratio, 2.99; 95% CI, 0.96-9.30; P = .05). Point estimates for secondary outcomes favored the active group, although the differences were not statistically significant, in the prespecified analysis. No ENTF device-related serious adverse events were noted. This trial found that ENTF therapy is safe. Although the difference between groups was not statistically significant, ENTF therapy may reduce global disability in patients with severe baseline disability after ischemic stroke. These results warrant confirmation in a higher powered pivotal trial of ENTF therapy. ClinicalTrials.gov Identifier NCT05044507.
48. Exploring Treatments for Hepatic Epithelioid Hemangioendothelioma: A Subsegmental Bland Embolization Case Series With Review.
期刊: Cancer control : journal of the Moffitt Cancer Center 发表日期: 2025 链接: PubMed
摘要
IntroductionEpithelioid Hemangioendothelioma is a rare vascular neoplasm unresponsive to chemotherapy, radiotherapy, or immunotherapy. Surgical options are considered; however, recurrence rates reach up to 30%. Irreversible electroporation is difficult with large or numerous lesions. This paper reviews treatment options, exploring long-term response after subsegmental bland embolization of hepatic epithelioid hemangioendothelioma (HEHE).Case SeriesThis IRB approved retrospective study involved 3 patients after subsegmental bland embolization of 8 total HEHE lesions. Preoperative and postoperative contrast enhanced CT scans were compared up to 4 years post-operatively. Patient 1, a 28-year-old male whose single lesion involved segments 4, 5, and 8, with a mean volume of 458.1 mL that progressed despite treatment with Axitinib and Pembrolizumab. One-month postembolization volume was 439.6 mL and 4-year follow-up volume was 128.9 mL, representing a 72% volume reduction. The second patient, a 54-year-old female could not finish her IRE treatments. Four of the lesions, 2 right-sided and 2 left-sided, were treated with subsegmental bland embolization (mean volume 108.8 mL, SD 86.1 mL). The 1-month postembolization mean volume was 78.1 mL (SD 48.3 mL), and 4-years mean volume was 9.8 mL (SD 8.4 mL), representing a 91% tumor reduction volume. The third patient, a 61-year-old female presented with numerous, bilobar lesions not amenable to IRE. Three lesions were treated with subsegmental bland embolization (mean volume 52.4 mL, SD 55.9 mL). One-month postembolization, the mean volume was 49.9 (SD 49.5 mL). One-and-a-half-year follow-up demonstrated a mean volume of 38.8 mL (SD 48.9 mL), representing a 22% reduction in mean tumor volume. No grade 3 or greater complications after any procedure occurred.ConclusionsSubsegmental bland embolization is safe and effective, having the potential to stabilize HEHE not otherwise suitable for surgery or IRE. All patients achieved sustained disease control with most lesions demonstrating a partial response. Possible future directions include starting a prospective patient registry to obtain additional long-term data regarding subsegmental bland embolization outcomes.
49. Variations in Ovarian Cancer Survival Rates: Investigating Equity and Prognostic Factors Throughout Nova Scotia.
期刊: Cancer control : journal of the Moffitt Cancer Center 发表日期: 2025 链接: PubMed
摘要
IntroductionThere is large inter- and intra-country variability in ovarian cancer outcomes. Individuals diagnosed with advanced stage cancer in Nova Scotia have a 3-year net survival of 31.9%, the lowest in the country. This study aimed to identify factors impacting survival, and to investigate evidence of inequities in survival from the point of diagnosis moving forward.MethodsThis population-based retrospective study included all women diagnosed with ovarian cancer in Nova Scotia from Jan 1, 2007, to Dec 31, 2016. Administrative health data were linked to gather individual, tumor, and health system characteristics. Both prognostic and equity factors potentially contributing to variations and inequities in survival were assessed using descriptive and time to event techniques.ResultsThis study found no regional differences in survival across Nova Scotia. It revealed that disparities in equity factors do not appear to be significantly associated with survival at the time of diagnosis moving forward. Instead, survival variations were attributed to legitimate prognostic factors, such as cancer stage, subtype, comorbidities, and frailty. However, notable inequities were identified between socioeconomic status and prognostic factors that may contribute to poor survival upstream, rather than at the time of diagnosis.ConclusionThough inequities do not appear to directly contribute to differences in ovarian cancer survival at the time of diagnosis, they may influence outcomes by increasing the development of prognostic factors that lead to poorer survival. Future research should capture equity factors not found in administrative data and begin making comparisons between other jurisdictions to determine why survival rates vary worldwide. Survival rates for ovarian cancer have been found to vary between and within countries, as identified by past research efforts. However, it is unclear what causes these differences in survival or whether issues of fairness (ie, inequities) and access to care might play a role. As such, this study explored why ovarian cancer survival is lower in Nova Scotia, which is the province with the lowest 3-year survival rate for advanced ovarian cancer in Canada. We found that inequities may indeed impact survival, but in relation to the development of factors that affect people’s health and circumstances before they are diagnosed (ie, having other health issues). These findings highlight the need to address broader social and economic inequities that can lead to worse cancer outcomes. They also show that future research should go beyond routinely collected health data to understand what is driving survival differences.
50. Occupational exposure to polycyclic aromatic hydrocarbons and cognitive impairment: Protocol of a systematic review.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Occupational exposure to polycyclic aromatic hydrocarbons (PAHs) has been associated with adverse health effects, yet evidence on the cognitive consequences of such exposure remains fragmented and has not been systematically synthesized across occupational groups. This protocol outlines a systematic review that will examine the relationship between occupational PAH exposure and cognitive impairment across eight predefined occupational categories. Relevant studies will be identified through electronic searches of major databases, including PubMed, Web of Science, Scopus, Embase, ProQuest, PsycINFO, CINAHL, the Cochrane Library, and Google Scholar. Eligible studies must assess PAH exposure in occupational settings and evaluate cognitive outcomes using validated instruments, with domain-specific neuropsychological tests prioritized as primary outcomes and global screening tools (e.g., MoCA, MMSE) included as supportive outcomes. Both observational and comparative study designs will be considered. Titles and abstracts will be screened by two independent reviewers, and full texts of potentially eligible articles will be assessed using predefined criteria. Data will be synthesized narratively, with contingency meta-analysis conducted where sufficient comparable data are available and heterogeneity is acceptable. Prespecified subgroup analyses will be undertaken by occupational category, biomarker, cognitive domain, and exposure context, with meta-regression considered if an adequate number of studies are identified. Risk of bias will be assessed using JBI tools at the study level and ROBIS at the review level, with planned sensitivity analyses. The review will consolidate current evidence on PAH-related cognitive outcomes across occupational groups, including under-studied populations such as wildland firefighters, and will inform occupational health policy, workplace screening initiatives, and future research aimed at safeguarding cognitive health in exposed populations.
51. Household perceptions, practices, and experiences with real-world alternating dual-pit latrines treated with storage and lime in rural Cambodia.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Achieving universal safely managed sanitation (SMS) is an ambitious long-term goal in resource-limited rural areas. The non-governmental organization, iDE, introduced the alternating dual-pit latrine (ADP), which treats fecal sludge (FS) on-site using storage and lime to increase SMS in rural Cambodia. However, SMS via ADPs requires adherence to recommended practices (e.g., how and when to switch between pits). We surveyed 765 rural households with ADPs across five of 25 Cambodian provinces to understand how real-world household sanitation practices and knowledge affect and are related to adherence to recommended practices at scale. We calculated summary statistics of household survey responses and used regression models of composite indices to describe how households’ practices and attitudes related to ADPs affect adherence to recommended ADP practices. By 24 months after training, three in five households did not recall how long treatment must proceed until emptying can be performed safely. No household waited the recommended two years to empty their pits. While households appreciated the advantages of owning an ADP (e.g., reduced costs and required land area compared to single-pit latrines over time), no household followed recommended treatment practices. This lack of adherence could have health and environmental implications for households using ADPs. Household practices also varied by province, flood proneness, and education level, adding complexity to how to improve adherence; for example, having at least one household member that completed formal education surprisingly reduced compliance with recommended ADP practices. Household behaviors impact the use and maintenance of on-site sanitation systems in rural areas, with proper adherence is necessary to achieve sustained SMS. Increased access to affordable and safe emptying service providers could enable households to manage the pits of their ADPs and dispose of FS in-situ according to treatment duration, while also ensuring that household practices in operating on-site sanitation systems are integrated into the design, installation, and SMS monitoring of such systems.
52. Children's preferences for features and designs of KN95-style respirators: A comparative study between Indonesia and Nepal.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Air pollution is a global crisis, posing significant health risks to humans. Children are particularly vulnerable to the effects of particulate air pollution, and the use of respiratory protection could reduce their exposure. Certified, well-fitting respirators have been shown to effectively filter airborne particles and are increasingly available for children in non-occupational settings. However, their effectiveness relies on proper fit and consistent use. Understanding children’s perspectives on wearing respiratory protection, specifically their preferences for different types and styles of respirators, is crucial. To explore these issues, 12 focus group discussions were conducted in January 2023 with 116 children aged 6-12 years living in Kathmandu, Nepal (N = 67) and Bandung, Indonesia (N = 49). Participants were recruited from public and private schools in each city using purposive sampling to ensure diversity in age, gender and socio-economic background. Focus groups were held in school settings and facilitated by local researchers in the children’s native languages. Children were shown seven different respirators and asked questions about their preferred styles and features. Statistical analyses using Wilcoxon one-sample tests and ordinal regression showed the most popular types of respirators had ear-loops rather than head-straps and some features (e.g., patterned rather than plain masks) were more popular with certain groups (e.g., younger children). These results suggest that respirator manufacturers should ideally offer a variety of styles or designs.
53. Variable-based probabilistic calibration with binary outcome.
期刊: Biostatistics (Oxford, England) 发表日期: 2024-Dec-31 链接: PubMed
摘要
In developing risk prediction models for specific diseases, it is essential to evaluate the calibration performance of the prediction model. Various methods have been proposed to assess the calibration of prediction models, but it has been pointed out that conventional methods based on the predicted probability of the model are insufficient to detect miscalibration. Another problem is that a method for evaluating calibration for continuous variables of interest has not yet been established. We therefore propose two methods to evaluate the calibration of the variable of interest: the variable-based probabilistic calibration plot (VPC-Plot), which is a visual assessment, and the variable-based probabilistic calibration error (VPCE), which is a corresponding evaluation metric. We conducted theoretical and simulation studies to investigate the properties and effectiveness of the proposed method. Theoretical and simulation studies demonstrated that the proposed methods can detect miscalibration by evaluating the calibration based on the variable of interest, even when conventional methods fail to detect miscalibration. To show the usefulness in the real-world data analysis, we evaluated diabetes prediction models developed using the national health insurance database for Osaka, Japan. We show that the proposed method can identify miscalibration of key covariate in a diabetes prediction model.