公共卫生研究摘要 (2025-11-26)
共收录 57 篇研究文章
1. Cervical Myelopathy: Where Are We Now? Classification, Surgical Approaches, and Tips and Tricks to Stay Out of Trouble.
期刊: Instructional course lectures 发表日期: 2026 链接: PubMed
摘要
Degenerative cervical myelopathy continues to be an increasingly prevalent disease in the aging population. Early diagnosis and treatment can prevent major neurologic disability, including paralysis. Awareness of the clinical manifestations of cervical myelopathy, including gait disturbance and upper extremity dysfunction, is critically important. Recognition of the symptoms and signs of cervical myelopathy that are often noted in the spine clinic can prompt referral for appropriate evaluation and treatment, leading to the prevention of future disability. Surgical treatment of cervical myelopathy has been extensively reported to not only halt progression but also improve various clinical signs and symptoms. Indications for surgery and ideal surgical options continue to be topics of debate. Myelopathy classification systems and state-of-the-art surgical treatments, including avoidance and management of complications, are important topics.
2. China's post-zero-COVID Omicron wave: A Bayesian analysis.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-02 链接: PubMed
摘要
Following the late 2022 transition from its “dynamic zero-COVID” policy, China experienced a major nationwide severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron wave. To characterize the wave’s transmission dynamics, we used a Bayesian framework to fit a deterministic transmission model to two key data streams: reported COVID-19 daily case counts preceding the policy shift (up to November 11, 2022) and weekly virological and influenza-like illness (ILI) surveillance data afterward (through February 12, 2023). We estimated a nationwide cumulative infection attack rate reaching 87.8% (95% CrI: 75.9 to 93.3%) by mid-February 2023. Notably, 84.1% of the population became infected within just 1 mo following the full policy relaxation on December 7. The estimated time-varying effective reproduction number peaked at 5.69 (95% CrI: 4.56 to 6.85) on December 8, 2022. Although transmission intensity increased during the Spring Festival travel rush (Chunyun), widespread population immunity prevented a subsequent wave. Prior to the Chunyun period, distinct relationships emerged: Estimated transmission rates showed a significant positive correlation with long-term population behavioral response coefficient (reflecting cumulative infections; Pearson correlation: ρ = 0.92, P < 0.001), while mobility patterns correlated positively with short-term behavioral response coefficient (reflecting current infection prevalence; Pearson correlation: ρ = 0.87, P < 0.001). These dynamic behavioral associations, which we further validated against empirical data on keyword search and media coverage, then weakened during the Chunyun period. In summary, this analysis quantifies Omicron’s transmission potential and highlights the importance of incorporating time-varying behavioral factors into epidemic models to accurately describe transmission dynamics, especially during periods of abrupt policy change.
3. Tattoo ink induces inflammation in the draining lymph node and alters the immune response to vaccination.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-02 链接: PubMed
摘要
Despite safety concerns regarding the toxicity of tattoo ink, no studies have reported the consequences of tattooing on the immune response. In this work, we have characterized the transport and accumulation of different tattoo inks in the lymphatic system using a murine model. Upon quick lymphatic drainage, we observed that macrophages mainly capture the ink in the lymph node (LN). An initial inflammatory reaction at local and systemic levels follows ink capture. Notably, the inflammatory process is maintained over time, as we observed clear signs of inflammation in the draining LN 2 mo following tattooing. In addition, the capture of ink by macrophages was associated with the induction of apoptosis in both human and murine models. Furthermore, the ink accumulated in the LN altered the immune response against two different types of vaccines. On the one hand, we observed a reduced antibody response following vaccination with an messenger ribonucleic acid (mRNA)-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, which was associated with a decreased expression of the spike protein in macrophages in the draining LN. In contrast, we observed an enhanced response when vaccinated with influenza vaccine inactivated by ultraviolet (UV) radiation. Considering the unstoppable trend of tattooing in the population, our results are crucial in informing the toxicology programs, policymakers, and the general public regarding the potential risk of the tattooing practice associated with an altered immune response.
4. Redox regulation of memory formation by Rrp1 in Drosophila.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-02 链接: PubMed
摘要
Long-term memory (LTM) formation requires precise gene regulation, yet the role of redox activity in this process remains poorly understood. Here, we identify Drosophila recombination repair protein 1 (Rrp1), a homolog of human apurinic/apyrimidinic endonuclease 1 (APE1), as a key redox regulator of LTM. In paired dorsal-anterior-lateral neurons-critical for aversive olfactory memory-Rrp1 knockdown impairs memory formation, whereas its overexpression enhances retention. Pharmacological inhibition of Rrp1 redox activity with E3330 suppresses Period and CaMKII expression, disrupting LTM formation. Notably, human APE1 redox activity rescues memory deficits in Rrp1-deficient flies, promotes de novo Period synthesis, and facilitates LTM formation. Moreover, Rrp1 is required for CREBA-mediated LTM acceleration, revealing a redox-dependent link between transcriptional regulation and memory persistence. These findings establish Rrp1 as a critical modulator of LTM in Drosophila and highlight redox regulation as a conserved mechanism underlying memory formation.
5. Maternal Respiratory Syncytial Virus Vaccination and Preterm Birth: A Utah Statewide Retrospective Cohort Study.
期刊: Obstetrics and gynecology 发表日期: 2025-Nov-26 链接: PubMed
摘要
We conducted a statewide, retrospective cohort study to evaluate the association between maternal receipt of the respiratory syncytial virus (RSV) vaccine and preterm birth. All individuals who delivered a singleton neonate in Utah and were between 32 0/7 and 36 6/7 weeks of gestation from September 2023 to February 2024 were included and followed up until delivery. Overall, 2,733 of 24,213 individuals (11.3%) received the vaccine. Vaccine receipt was associated with lower odds of preterm birth (5.5% vaccinated group vs 6.8% unvaccinated group, adjusted odds ratio 0.80, 95% CI, 0.67-0.95). Receipt of the RSV vaccine was not associated with any adverse birth outcomes, including hypertensive disorders of pregnancy, low birth weight, or fetal or infant death. These findings support the safety of this vaccine in pregnancy, which is known to prevent neonatal severe lower respiratory tract disease.
6. In Response.
期刊: Anesthesia and analgesia 发表日期: 2025-Nov-25 链接: PubMed
摘要
7. Landfills as Hotspots of Multidrug Resistance Genes: Profiles, Drivers, and Hosts.
期刊: Environmental science & technology 发表日期: 2025-Nov-25 链接: PubMed
摘要
The United Nations has identified municipal solid waste (MSW) landfills as significant reservoirs of antibiotic resistance genes (ARGs). Although ARG profiles, their primary drivers, and associated hosts have been well characterized in landfill leachate, such information remains limited for MSW landfills, which are the original source of the resistome. This knowledge gap impedes effective ARG monitoring at the source and poses challenges for public health management. Herein, we investigated the profiles of ARGs, their potential drivers, and associated hosts in refuse samples collected from a large-scale landfill using metagenomic sequencing and quantitative polymerase chain reaction analysis. Our findings revealed that landfills harbor diverse ARGs, with multidrug resistance genes (MDRGs) emerging as the dominant class, accounting for 39.78% of all ARGs detected. Notably, MDRGs exhibited high mobility potential (associated with plasmids, phages, and mobile genetic elements (MGEs)) and were frequently colocated with virulence factors. Pseudomonas, Acinetobacter, and Brevundimonas were identified as key MDRG hosts. Partial least-squares path modeling analysis indicated that MDRG variation was driven by multiple factors (i.e., MGEs, metal resistance genes (MRGs), hosts, and environmental factors). Additionally, metagenome-assembled genomes were found to carry multiple MDRGs. Collectively, these results underscore the role of landfills as critical hotspots for MDRGs.
8. Receipt of Screening, Services, and Counseling During Perinatal Health Care Visits by Disability Status in the United States, 2018-2020.
期刊: Obstetrics and gynecology 发表日期: 2025-Nov-25 链接: PubMed
摘要
To examine the receipt of screening, services, and counseling during prepregnancy reproductive health, prenatal care, and postpartum care visits by disability status among people with recent live births in the United States. Cross-sectional data were from 24 states in PRAMS (Pregnancy Risk Assessment Monitoring System) that included the WGSS (Washington Group Short Set of Questions) on Disability (October 2018-December 2020). Participants reported receipt of screening, services, and counseling during prepregnancy reproductive health care visits, prenatal care visits, and a postpartum checkup at 4-6 weeks postdelivery. Associations between the extent of disability (some and a lot of difficulty vs none) and components of health care visits were estimated using modified Poisson regression, adjusted for sociodemographic characteristics (adjusted prevalence ratios [aPRs] and 95% CIs). A total of 41,027 participants were included in analyses; 33.7% (n=14,047) reported having some difficulty and 6.2% (n=2,714) reported having a lot of difficulty. Differences were observed for screening, services, and counseling received at health care visits by disability status. During prepregnancy reproductive health care visits, people with any difficulty reported similar receipt of care as those with no difficulty, with the exception of a lower prevalence of discussions about improving their health (aPR 0.92; 95% CI, 0.86-0.98) and sexually transmitted infections (aPR 0.89; 95% CI, 0.83-0.95). During prenatal and postpartum visits, people with any difficulty had a lower prevalence of discussions about lifestyle behaviors, pregnancy weight gain and weight loss, interpersonal violence, mental health, breastfeeding, and birth control, as well as being tested for diabetes (aPR ranged from 0.72-0.99). Perinatal health care visits provide opportunities to improve health and assist in the transition to parenthood. Our findings highlight the need for strategies to reduce barriers to care for people with disabilities and facilitate effective communication during visits.
9. Impact of Learner Autonomy on the Performance in Voluntary Online Cardiac Auscultation Courses: Prospective Self-Controlled Study.
期刊: JMIR medical education 发表日期: 2025-Nov-25 链接: PubMed
摘要
Learner autonomy-the ability to self-direct and regulate learning-is a key determinant of success in online education, yet its quantifiable impact in voluntary noncredit courses remains unclear. Understanding how autonomy translates into measurable behaviors and outcomes in clinical skills training may inform more effective online learning design and learning outcomes. This study aims to quantify the association between behavioral indicators of learner autonomy and performance in a voluntary noncredit online cardiac auscultation course. We conducted a prospective, self‑controlled, single‑center study. A total of 199 registrants (n=122 physicians and n=77 medical students) were recruited via WeChat and attended four weekly 2‑hour synchronous sessions using authentic patient heart sound recordings with imaging‑based explanations. The primary outcome was the final posttraining quiz score (0-100); training effectiveness was assessed by the pre‑ to posttraining score change. The autonomy indicators were full participation (attendance at all four sessions), in‑class engagement (number of responses to brief content‑aligned prompts posed approximately every 10-15 minutes; responses recorded for participation monitoring only), and postclass review (frequency/duration of reviewing recordings and materials). Analyses included Wilcoxon signed rank tests, χ2 tests, multivariable linear regression, and receiver operating characteristic profiling of “excellent learners” (top 10% improvement). Of the 199 registrants, 146 (73.4%) attended ≥1 session and 46 (23.1%) completed all sessions. Median test scores improved from 40 (IQR 20-50) to 70 (IQR 50-83; P<.001). Intrinsic motivation was associated with full participation (χ21=4.03; P=.045). In multivariable models, full participation (unstandardized B=41.55, 95% CI 24.43-58.67; standardized β=0.60; P<.001) and in‑class engagement (B=4.79 per additional response, 95% CI 3.05-6.45; β=0.70; P<.001) independently predicted higher final scores (adjusted R2=0.48). Receiver operating characteristic profiling indicated that greater postclass review (recordings/materials) led to learners achieving excellent performance. In this voluntary online clinical skills course, showing up consistently, engaging during class, and reviewing after class-practical expressions of learner autonomy-were key correlates of short-term performance. These behaviors may be encouraged through simple, feasible course designs such as clear expectation setting, periodic interactive prompts, and structured review opportunities, which warrant prospective evaluation in future studies.
10. Scaling European Citizen Driven Transferable and Transformative Digital Health: Protocol for an Effectiveness-Implementation Hybrid Trial of a Digital Health Platform to Support Multimorbidity Self-Management.
期刊: JMIR research protocols 发表日期: 2025-Nov-25 链接: PubMed
摘要
Multimorbidity, the presence of 2 or more chronic conditions, is becoming increasingly prevalent worldwide, resulting in significant impacts on health care systems. For people with multimorbidity, self-management is challenging, requiring engagement in several tasks. Digital health platforms have been widely acknowledged as having the potential to enhance self-management practices for those with chronic conditions. However, limited longitudinal studies have explored the effectiveness of digital health platforms that support multimorbidity self-management or issues relating to their implementation and scalability in practice. The aim of this study is to determine the effectiveness and implementation of a digital health platform, ProACT, with support services including clinical triage and a care network (consisting of informal and formal caregivers and health care professionals) compared to the use of the platform alone and compared to standard care. An effectiveness-implementation type 1 hybrid study will be conducted across 3 European countries. A total of 720 older adults aged 65 years or older with multimorbidity (2 or more of the following: diabetes, a chronic respiratory disease, chronic heart failure, and chronic heart disease) will be recruited and randomized into 1 of 3 trial arms. Those in trial arm 1 will be invited to have up to 5 care network members participate with them, resulting in a maximum of 1500 care network participants. Effectiveness will be assessed through a 3-arm pragmatic randomized controlled trial, while implementation issues will be addressed via a process evaluation. Primary outcomes for participants with multimorbidity are quality of life and health care use, while secondary outcomes focus on the potential of the ProACT platform to support multimorbidity self-management (eg, self-efficacy, usability, engagement, and symptom stabilization). Primary outcomes for informal caregivers in the care network include caring burden, while secondary outcomes for all care network members include usability, engagement, satisfaction, and overall experiences with ProACT. Additional outcomes related to the process evaluation include the reach, uptake, and fidelity of implementation of ProACT and the way organizations implement and deliver ProACT; how they differ in this regard; and the factors underpinning these differences. A range of qualitative and quantitative data will be collected and analyzed to assess these outcomes. Enrollment in the trial began in September 2022, and the trial is anticipated to end by March 2026. Trial outcomes will be submitted for publication in 2026. The generation of evidence-based support for the routine use of the ProACT platform in applied settings would represent considerable impact. With health care services under increasing strain and traditionally designed to support those with single morbidities, it is more important than ever to develop actionable insights and resources to empower persons with multimorbidity to self-manage their complex care needs at home, with support from their caregivers. ISRCTN Registry ISRCTN34134007; https://www.isrctn.com/ISRCTN34134007. DERR1-10.2196/74989.
11. Costs and Cost-Effectiveness at 12 and 24 Months of an Enhanced Web-Based Physical Activity Intervention for Latina Adults: Secondary Analysis of a Randomized Controlled Trial.
期刊: Journal of medical Internet research 发表日期: 2025-Nov-25 链接: PubMed
摘要
We previously established the efficacy and cost-effectiveness of a web-based physical activity (PA) intervention for Latina adults, which increased PA, but few participants met PA guidelines, and long-term maintenance was not examined. A new version with enhanced intervention features was found to outperform the original intervention in long-term guideline adherence. This study aimed to determine the costs and cost-effectiveness of the enhanced multitechnology PA intervention compared to the original web-based intervention in increasing minutes of activity and adherence to guidelines. Latina adults (N=195) were randomly assigned to receive a Spanish-language, individually tailored web-based PA intervention (original) or the same intervention with additional phone calls and interactive SMS text messaging (enhanced). PA was measured at baseline, 12 months (end of active intervention), and 24 months (end of tapered maintenance) using self-report (7-day PA recall interview) and ActiGraph accelerometers. Costs were estimated from a payer perspective and included all features needed to deliver the intervention, including staff, materials, and technology. Cost-effectiveness was calculated as the cost per additional minute of PA added over the intervention and the incremental cost-effectiveness ratios of each additional person meeting guidelines. At 12 months, the costs of delivering the interventions were US $16 per person per month in the enhanced arm and US $13 per person per month in the original arm. These costs decreased to US $14 and US $8 at 24 months, respectively. At 12 months, each additional minute of self-reported activity in the enhanced group cost US $0.09 compared to US $0.11 in the original group (US $0.19 vs US $0.16 for ActiGraph), with incremental costs of US $0.05 per additional minute in the enhanced group beyond the original group. At the end of the maintenance period (24 mo), costs per additional minute decreased to US $0.06 and US $0.05 (US $0.12 vs US $0.10 for ActiGraph), with incremental costs of US $0.08 per additional minute in the enhanced group (US $0.20 for ActiGraph). Costs of meeting PA guidelines at 12 months were US $705 in the enhanced group compared to US $503 in the original group and increased to US $812 and US $601 at 24 months, respectively. The incremental cost-effectiveness ratio for meeting guidelines at 24 months was US $1837 (95% CI US $730.89-US $2673.89) per additional person in the enhanced group compared to the original group. The enhanced intervention was more expensive but yielded better long-term maintenance of activity, costing US $1837 per extra person meeting guidelines beyond those in the original group. Both conditions were low cost relative to other medical interventions. The enhanced intervention may be preferable in populations at high risk, where more investment in meeting guidelines could yield more cost savings. ClinicalTrials.gov NCT03491592; https://clinicaltrials.gov/study/NCT03491592. RR2-10.1186/s13063-022-06575-4.
12. Registry of Stroke in Korean Medicine Hospital (RoS-KoMH): Protocol for a Prospective, Multicenter, Observational Study.
期刊: JMIR research protocols 发表日期: 2025-Nov-25 链接: PubMed
摘要
Currently, conventional medicine for stroke treatment remains at a standstill. Korean medicine (KM), which is in high demand in Korea, has been shown to have a therapeutic effect on stroke; however, considering the absence of epidemiological and clinical characteristics of patients receiving KM for stroke in Korea and prospective, large-scale, long-term studies on the efficacy and safety of KM, the acquisition of data from KM treatments on stroke is essential. We aimed to collect and analyze data on the major clinical characteristics of patients with stroke receiving KM treatment and investigate the effectiveness and safety of KM in the Korean population. The Registry of Stroke in Korean Medicine Hospital (RoS-KoMH) is a prospective, multicenter, observational disease registry aimed at collecting data from 500 sets of patients at multiple timepoints. Eligible adult patients diagnosed with cerebral infarction, cerebral hemorrhage, or subarachnoid hemorrhage who visited 4 KM hospitals as outpatients or inpatients will be continuously registered using the electronic case report form. Baseline data at the first visit; KM treatment, rehabilitation therapy, and concomitant therapy during the visit; stroke evaluation every 4 weeks after the first visit; laboratory findings at discharge or the last visit; and safety evaluation information after each acupuncture or pharmacopuncture treatment will be collected. The study was funded on August 19, 2020, by the Ministry of Health and Welfare, Republic of Korea, and recruitment for the study started on November 3, 2021. As of September 25, 2024, a total of 410 participants have been recruited. The RoS-KoMH study is the first and largest multicenter, prospective registry to record comprehensive data on KM treatment of stroke. The results of this study will provide high-quality evidence on the current state of stroke treatment using KM in actual clinical practice, as well as treatment effectiveness and safety, and will consequently contribute to the promotion and standardization of therapeutic interventions for stroke in Korea. Clinical Research Information Service KCT0008494; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23999&search_page=L&search_lang=&class_yn=. DERR1-10.2196/67850.
13. Technology Activities and Cognitive Trajectories Among Community-Dwelling Older Adults: National Health and Aging Trends Study.
期刊: JMIR aging 发表日期: 2025-Nov-25 链接: PubMed
摘要
While the positive effects of digital technology on cognitive function are established, the specific impacts of different types of technology activities on distinct cognitive domains remain underexplored. This study aimed to examine the associations between transitions into and out of various technology activities and trajectories of cognitive domains among community-dwelling older adults without dementia. Data were drawn from 5566 community-dwelling older adults without dementia who participated in the National Health and Aging Trends Study from 2015 to 2022. Technology activities assessed included online shopping, banking, medication refills, social media use, and checking health conditions online. The cognitive domains measured were episodic memory, executive function, and orientation. Asymmetric effects models were used to analyze the associations between technology activity transitions and cognitive outcomes, adjusting for demographic, socioeconomic, and health-related covariates. Lagged models were applied for sensitivity analysis. In the asymmetric effects models, the onset of online shopping (β=.046, P=.02), medication refills (β=.073, P<.001), and social media use (β=.065, P=.01) was associated with improved episodic memory. The cessation of online shopping was associated with faster episodic memory decline (β=-.023, P=.047). In contrast, the cessation of online banking (β=-.078, P=.01) and social media use (β=-.066, P=.003) was associated with decreased episodic memory. The initiation of instrumental, social, and health-related technology activities was associated with slower cognitive decline in orientation. The lagged models further emphasized the effects of stopping online banking and starting online medication refills in relation to episodic memory, as well as the positive associations between online shopping and social media use and orientation. All significant effects were of small magnitude. Combining findings from the main and sensitivity analyses, results suggest that interventions designed to support episodic memory in older adults should emphasize promoting the use of online medication refill services and sustaining engagement with online banking, particularly among those who have already established these habits. To support orientation, strategies should focus on facilitating adoption of online shopping and social media use, helping older adults become comfortable navigating these platforms. Future trials are needed to assess the clinical relevance of targeted interventions for specific cognitive domains, to promote the initiation and maintenance of digital activities to help mitigate domain-specific cognitive decline in aging populations.
14. Development of a pre-discharge model for 1-year post-discharge all-cause mortality after endovascular treatment for aneurysmal subarachnoid haemorrhage using LASSO-Boruta feature selection.
期刊: Neurological research 发表日期: 2025-Nov-25 链接: PubMed
摘要
To develop a predischarge model for predicting 1-year post-discharge all-cause mortality in patients with aneurysmal subarachnoid haemorrhage (aSAH) following endovascular treatment (EVT). We retrospectively analysed 947 patients with aSAH who were discharged alive between April 2021 and April 2023 from four neurointerventional centres in China as the training cohort. Candidate variables were selected using the least absolute shrinkage and selection operator (LASSO) combined with the Boruta algorithm. Based on these features, six models - logistic regression (LR), XGBoost, random forest (RF), AdaBoost, decision tree, and gradient boosting decision tree (GBDT) - were developed and compared. The optimal model was selected by the area under the receiver operating characteristic curve (AUC). The external validation cohort comprised 692 aSAH patients discharged alive between April 2023 and April 2024 from two additional centres. Model performance was evaluated using AUC, calibration curves, and decision curve analysis (DCA). Given the imbalanced outcome distribution, we applied the Synthetic Minority Over-sampling Technique (SMOTE) to further assess model generalisability. Among 1,639 patients alive at discharge, 67 (4.1%) died within 1 year. LASSO and Boruta jointly identified five key predictors for model construction: age, modified World Federation of Neurosurgical Societies (mWFNS) grade, ICU length of stay (ICU-LOS), C-reactive protein (CRP), and monocyte-to-HDL ratio (MHR). The random forest achieved the best discrimination in training set and remained strong in external validation cohorts.Moreover, SMOTE training yielded further improvements in generalisability. Random forest model enables individualised pre-discharge risk stratification and may guide perioperative management.
15. The Critical Moderating Role of Cognitive Function in Digital Inclusion: Data Analysis Study on Depression Risk Among Older Adults.
期刊: JMIR aging 发表日期: 2025-Nov-25 链接: PubMed
摘要
Digital inclusion has become increasingly important in promoting healthy aging, yet its association with mental health among older adults appears complex and heterogeneous. The role of cognitive function as a moderator and the underlying mechanisms remain understudied. This study aims to examine cognitive function’s moderating role in the relationship between digital inclusion and depression risk among older adults, and to investigate multiple pathways of association. Using data from the 2020 wave of the China Health and Retirement Longitudinal Study, we analyzed 18,673 adults aged 60 years and above (mean age 68.4 y, SD 6.5; 50.8% male participants [n=9486], 49.2% female participants [n=9187]). We constructed interaction effect models to test the moderation hypothesis and employed path analysis with bootstrapped 95% confidence intervals (2000 iterations) to investigate multiple pathways through which digital inclusion is associated with depression. Cognitive function significantly moderated the digital inclusion-depression relationship (β=-.002, P=.03). The association was not statistically significant at low cognitive function (β=-.137, P=.33) but strongly protective at high cognitive function (β=-.517, P<.001), revealing a “cognitive threshold effect.” Path analysis identified 3 significant pathways: direct effects (66.7% of total effect), cognitive enhancement (8.3%), and social participation (8%). Importantly, higher digital inclusion was not found to be associated with increased depression risk at any cognitive function level. Our findings suggest that older adults require adequate cognitive resources to derive mental health benefits from digital participation, though no harmful effects were observed at lower cognitive levels. This asymmetric pattern has important implications for designing cognitive-informed digital inclusion programs that integrate digital skills training with cognitive enhancement strategies for promoting mental health in aging populations.
16. Effect of SMS Reminders, Telephone Calls, and Transport Incentives on Enhancing the Completion of Tuberculosis Diagnosis and Initiation of Treatment for Diagnosed Patients: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Nov-25 链接: PubMed
摘要
Globally, tuberculosis (TB) programs have enhanced efforts to improve case detection, treatment initiation, and monitoring of treatment outcomes. However, less attention has been given to reducing the number of persons with presumed TB who never get tested for TB or those with confirmed TB who never start treatment in endemic regions such as Uganda. Such losses hinder progress toward attaining the 2035 End TB goals. The World Health Organization recommends mobile health (mHealth) interventions such as SMS reminders, telephone calls, mobile apps, and digital monitoring devices to foster universal health coverage. To our knowledge, there is limited evidence on whether these mHealth interventions can increase linkage to care for persons with presumed TB, particularly in sub-Saharan Africa. We aim to conduct a randomized controlled trial (MILEAGE4TB) whose aim is to assess the effect of SMS reminders, telephone calls, and transport incentives on improving completion of TB diagnosis among persons with presumed TB and initiation of treatment for diagnosed patients in Uganda. This will be a 5-arm individual randomized controlled trial among persons with presumed TB aged 18 years or older who are referred for Xpert MTB/RIF testing. Participants will be randomly assigned (2:2:2:1:1) to (1) standard of care, (2) SMS reminders only, (3) telephone calls only, (4) SMS reminders and a transport incentive, and (5) telephone calls and a transport incentive. An estimated sample size of 2389 participants will be considered. The primary outcome will be completion of TB diagnosis, defined as submitting a sputum sample for Xpert MTB/RIF testing and receiving test results within 30 days of being identified as having presumptive TB. The secondary outcomes will include (1) TB treatment initiation, which will be defined as starting TB treatment within 30 days of being diagnosed; (2) median turnaround times for TB diagnosis and treatment initiation; and (3) acceptability and feasibility of the interventions. Participants will be followed for 30 days to check whether they have tested for TB and collected their results. Chi-square tests will be performed for categorical outcomes. Analysis will be by intention to treat. Modified Poisson regression models will be used to estimate the effects of the interventions on completion of TB diagnosis and treatment initiation. The study was funded in June 2020 and data collection for the trial started in August 2023. Results from this trial are not yet available. As of August 28, 2025, a total of 2355 participants had been recruited. Data from the preliminary analysis will be ready by December 2025 after all trial activities. This randomized controlled trial will provide insights on the use of mHealth interventions to improve the completion of TB diagnosis among persons with presumed TB and initiation of treatment for diagnosed patients.
17. Associations Between Both Smartphone Addiction and Objectively Measured Smartphone Use and Sleep Quality and Duration Among University Students: Cross-Sectional Study.
期刊: JMIR mental health 发表日期: 2025-Nov-25 链接: PubMed
摘要
The impact of smartphone use on sleep remains intensely debated. Most existing studies have used self-reported smartphone use data. Moreover, few studies have simultaneously examined associations between both smartphone addiction and objectively measured smartphone use and sleep, and the dose-response relationship between smartphone use and risk of poor sleep has been consistently overlooked, requiring systematic and further research on this topic. This study aimed to examine the associations between smartphone addiction and objectively measured smartphone use and sleep quality and duration. This cross-sectional study enrolled 17,713 participants from a university in China. We assessed objective smartphone screen time and unlocks by collecting screenshots of use records and measured smartphone addiction using a validated questionnaire. Sleep quality and duration were estimated via the Pittsburgh Sleep Quality Index. Binary logistic regression, linear regression, and restricted cubic spline regression models were used for the analyses. A total of 14.3% (2533/17,713) of the participants met the criterion for poor sleep, with a mean sleep duration of 507.1 (SD 103.2) minutes per night. Notably, university students with smartphone addiction exhibited 184% higher risk of poor sleep (odds ratio [OR] 2.84, 95% CI 2.59-3.11) and a 15.47-minute-shorter nighttime sleep duration (β=-15.47, 95% CI -18.53 to -12.42) compared to those without smartphone addiction. Regarding objectively measured smartphone use, participants with ≥63 hours per week of smartphone screen time had 22% higher odds of poor sleep (OR 1.22, 95% CI 1.08-1.37) and a 6.66-minute-shorter nighttime sleep duration (β=-6.66, 95% CI -10.19 to -3.13) compared to those with 0 to 21 hours of screen time per week, whereas those with approximately 21 to 42 hours per week of smartphone screen time had a 5.47-minute-longer nighttime sleep duration (β=5.47, 95% CI 1.28-9.65). Similarly, compared to those with 0 to 50 smartphone unlocks per week, participants with ≥400 smartphone unlocks per week showed 61% higher odds of poor sleep (OR 1.61, 95% CI 1.41-1.85) accompanied by a 4.09-minute-shorter nighttime sleep duration (β=-4.09, 95% CI -8.08 to -0.09), whereas those with approximately 50 to 150 smartphone unlocks per week had a 5.84-minute-longer sleep duration (β=5.84, 95% CI 2.32-9.36). An inverted U-shaped association between smartphone screen time and sleep duration was observed (P<.001 for nonlinearity). Smartphone addiction, excessive objectively measured smartphone screen time, and unlocks are positively associated with both sleep quality and duration. Restricted cubic spline analyses revealed different nuanced dose-response relationships, with an inverted U-shaped association observed between smartphone screen time and sleep duration.
18. Keeping In-the-Loop: Supporting Clinical Reasoning Skills for Nephrology Learners in the Age of Artificial Intelligence.
期刊: Clinical journal of the American Society of Nephrology : CJASN 发表日期: 2025-Nov-25 链接: PubMed
摘要
19. Immersive Virtual Reality Versus Instructor-Led Training for Adult Surgical Cricothyroidotomy Training: A Randomized Simulation Study.
期刊: Anesthesia and analgesia 发表日期: 2025-Nov-25 链接: PubMed
摘要
20. Evaluating R2Play, A Novel Multidomain Return-to-Play Assessment Tool for Concussion: Mixed Methods Feasibility and Face Validity Study.
期刊: JMIR rehabilitation and assistive technologies 发表日期: 2025-Nov-25 链接: PubMed
摘要
Return-to-play guidelines for concussion recommend a multimodal approach to assess recovery, symptoms, exertion tolerance, and cognition. However, existing assessments do not reflect the speed or complexity of multidomain skill integration in sport. We developed R2Play, a dynamic multidomain return-to-play assessment tool, and previously established proof of concept by demonstrating design objectives alignment. We aim to (1) assess the feasibility of R2Play according to usability, reliability, practicality, and safety; (2) examine physical exertion levels during R2Play as a preliminary marker of face validity; and (3) understand clinician and youth perspectives on the feasibility, face validity, potential value, and challenges associated with R2Play. A convergent parallel mixed methods design was used. Rehabilitation clinicians were paired with youth cleared to return-to-play postconcussion to complete R2Play together and provide feedback through semistructured interviews. Feasibility was assessed on predefined criteria for usability (clinician ratings on System Usability Scale), practicality (assessment duration), reliability (technical issues), and safety (adverse events). Face validity was evaluated with a target of youth achieving ≥80% of age-predicted maximal heart rate or rating of perceived exertion ≥7/10. Interviews explored perspectives on feasibility and face validity, analyzed using content analysis. Quantitative and qualitative results were merged via joint display to identify areas of convergence, divergence, and complementarity. Participants included 10 youth (ages 13-20 y) with a history of concussion and 5 clinicians (n=2 physiotherapists, n=2 occupational therapists, and n=1 kinesiologist). Success criteria were met or approached for all feasibility domains. Clinician-rated usability was good-to-excellent (System Usability Scale=84.00±6.02), and youth reported that instructions were easy to learn. There were no catastrophic technical or user errors interrupting assessments. Configuration was completed in 5.74 (SD 1.09) minutes, and assessments took 26.50±6.02 minutes. There were no safety or symptom exacerbation incidents requiring assessment modification. R2Play elicited vigorous intensity physical exertion (peak heart rate=90.10±5.78% age-predicted maximal heart rate, peak rating of perceived exertion=5.50±1.72), with target exertion criteria met for 9/10 youth. Clinician and youth feedback confirmed that R2Play reflects elements of sport across physical, cognitive, and perceptual domains, making it a valuable tool for assessing readiness to return-to-play and informing rehabilitation planning for unresolved issues. Mixed methods meta-inferences provided enhanced insights regarding how to improve the usability, practicality, safety, and face validity of R2Play. Findings support the potential feasibility and face validity of R2Play, a multidomain assessment tool for youth with concussion, demonstrating excellent usability, vigorous physical exertion demands, and promising feedback regarding its potential to fill gaps in the return-to-play process among this initial sample from a single site. Future work is underway to establish the cross-site feasibility of R2Play and evaluate its content validity by establishing the physical, cognitive, and perceptual loading of assessment levels.
21. From Passive to Active-Improving the Healthy Self-Help Behavior of Older Adults Through Community Health Association: Mixed Methods Study.
期刊: Journal of medical Internet research 发表日期: 2025-Nov-25 链接: PubMed
摘要
While China’s aging population and strained health care resources heighten the need for effective health promotion, traditional community health education faces barriers such as passive participation among older adults, short-term behavioral changes, and limited sustainability. This study aims to develop and examine the impact of an innovative community healthy self-help education model for older adults on healthy behavior and active health awareness among older people. A mixed methods study was conducted to enroll older participants, including a 12-month pre-post self-controlled trial in 5 communities in Shanghai, China. Health behaviors, autonomy, and eHealth literacy were assessed at baseline, 6 months, and 12 months using standardized scales (measuring health-promoting lifestyle, self-rated abilities for health practices, healthy self-management behaviors, participation/autonomy, and eHealth literacy). Comparisons of scale scores at each time point were analyzed using repeated measures ANOVA. Semistructured interviews were conducted after the intervention, focusing on the dimensions of willingness to manage health, behavioral transformation, social role change, and attend experiences. The themes were extracted through thematic analysis. Qualitative data served to interpret and enrich quantitative findings. A total of 80 community-based older people were included in our study, with a mean age of 68.9 (SD 2.2) years. Intervention participants significantly improved in healthy self-help behavior (F3,237=25.43, P<.001). The total mean score improved from 85.90 (SD 22.74) baseline to 107.46 (SD 16.09) 12 months post intervention. Sustained enhancements occurred in health promotion lifestyle (F3,237=76.41, P<.001), health practices ability (F3,237=31.82, P<.001), participation and autonomy (F3,237=5.11, P=.004), and eHealth literacy (F3,237=26.75, P=.002). At the end of the intervention, 11 participants attended semistructured interviews. After the intervention, older people demonstrated stronger willingness and proactive behavior in health management, with increased health knowledge and social engagement. Compared to self-directed activities, health care professional-led education was perceived as more authoritative, whereas peer-organized activities were more interactive and flexible. The community health association education model based on a community healthy self-help education model for older adults significantly enhanced older adults’ healthy self-management behavior, active health awareness, and eHealth literacy. Integrating professional support with peer empowerment addressed core limitations of traditional models: low engagement and unsustainable behavioral change. This community-embedded approach provides a scalable solution for sustainable health promotion, with significant policy implications for alleviating health care system pressures and advancing active aging.
22. Waiting periods for the initiation of cancer treatment and the factors associated with delays in the Hokushin region of Japan.
期刊: Japanese journal of clinical oncology 发表日期: 2025-Nov-25 链接: PubMed
摘要
Extended waiting periods between cancer diagnosis and treatment initiation may impact patients’ quality of life and prognosis. However, few studies have examined the current situation in Japan and the factors influencing these waiting periods. This study included individuals with gastric cancer (n = 1956), colorectal cancer (n = 2843), lung cancer (n = 3309), and female breast cancer (n = 3172) diagnosed in 2016-17 at 19 facilities in the Hokushin region of Japan. The proportion of patients who waited over 30 days for each cancer type was calculated. Multilevel logistic regression analysis was used to examine the association between waiting over 30 days and patient and facility characteristics. The proportions of patients who waited over 30 days were 53.7% for gastric cancer, 42.8% for colorectal cancer, 50.5% for lung cancer, and 75.7% for female breast cancer. Among lung cancer patients, elderly patients showed a higher proportion of waiting over 30 days compared to younger patients. Patients at medical institutions with a large number of hospital beds showed higher proportions of waiting over 30 days across multiple cancer types. In the Hokushin region, patients who waited over 30 days are prevalent among female patients with breast cancer compared to other cancer types, and among older adults with lung cancer compared to younger lung cancer patients, as well as in medical institutions with a large number of hospital beds across cancer types. Hence, efforts to reduce this number are needed.
23. Workplace health promotion for healthy aging: a randomized controlled trial within the Semmelweis-EUniWell Workplace Health Promotion Model Program comparing email-based and face-to-face motivational interviewing to increase step count.
期刊: GeroScience 发表日期: 2025-Nov-25 链接: PubMed
摘要
With the aging population in Europe, particularly Hungary, unhealthy aging is emerging as a growing public health challenge. Physical inactivity is a modifiable risk factor for age-related diseases and remains highly prevalent. Increasing daily physical activity is a key strategy for extending health span. Step-count-based interventions, including motivational interviewing and email-based feedback, have been shown to promote physical activity, but direct comparisons of these approaches in workplace settings are limited. Conducted within the framework of the Semmelweis-EUniWell Workplace Health Promotion Model Program, this study aimed to evaluate the effect of two scalable workplace interventions compared with a control group on increasing daily step count and total weekly physical activity, and to examine the sustainability of intervention effects over six months. In this three-armed randomized controlled trial, Semmelweis university employees were assigned to one of three groups: combined program of face-to-face motivational interviewing and email-based motivation, email-based motivation program alone or a control group with no intervention. Daily step counts were self-reported using participants’ personal smart devices and recorded at baseline, every two weeks during an eight-week intervention, and at 1-, 3-, and 6-month follow-up. Total weekly physical activity was assessed using the International Physical Activity Questionnaire. Changes were modeled and compared with mixed model regression. A total of 155 employees participated (49 in the face-to-face motivational interviewing group, 53 in the email-based motivation group, and 53 controls). Both interventions were associated with increased step counts during the intervention period compared with control, with an average increase of 1,624 steps per day. Initial improvements were comparable between the two intervention groups, but the decline in step count during follow-up was slower in the face-to-face group. Additionally, at one-month post-intervention, the face-to-face group also showed a significantly higher total MET-minutes per week (997 MET/week) compared with controls. Both face-to-face and email-based interventions were effective in increasing physical activity during the intervention period. The slower decline in the face-to-face group suggests differences in sustainability between approaches. The results suggest a potential short-term benefit of workplace health promotion programs on physical activity, and that motivational interviewing may support longer-term maintenance of gains. Embedding such hybrid interventions into broader healthy aging strategies, such as those promoted by the Semmelweis-EUniWell Workplace Health Promotion Model Program, offers a promising pathway to address the aging challenge in Hungary and across Europe. Looking ahead, artificial intelligence-driven tools could enhance these programs by delivering personalized feedback, adaptive goal setting, and real-time engagement at scale, complementing human-delivered motivational support and further extending their reach and impact.
24. An evaluation of stage-based survival and renal prognosis in the general super-older population of Japan.
期刊: Clinical and experimental nephrology 发表日期: 2025-Nov-25 链接: PubMed
摘要
The risk of mortality and cardiovascular disease (CVD) may be higher among some super-older adults with chronic kidney disease (CKD). We assessed outcomes across CKD stages in an aging Japanese population. This retrospective cohort study using nationwide health examination and insurance claims database enrolled individuals aged 75-90 years whose renal function was measured > 2 times during the observation period. CKD stages were classified using eGFR and urinary protein levels. We used a Cox proportional hazards model to evaluate all-cause mortality and CVD events by CKD stage and a logistic regression model to assess dialysis initiation by renal function and proteinuria among patients with advanced CKD. Of 365,664 individuals aged 75-90 years, > 30% met the CKD diagnosis criteria, mostly the CKD G3aA1 category. During follow-up, 18,238 deaths and 48,937 CVD events occurred. Mortality and CVD incidence increased with advancing CKD stages. Mortality risk was elevated only among G3a patients with urinary protein (A2/3: HR 1.64 [95% CI 1.53-1.76]), but not without (A1: HR 1.01 [0.97-1.05]). CVD risk increased significantly across all A2/3 stages, but not in A1. Dialysis was initiated in 9.5% of patients with CKD G4/5, with an earlier risk observed in the A2/3 group. In older adults, CKD prognosis varies according to stage and proteinuria. Most individuals with early-stage, proteinuria-negative CKD do not experience adverse outcomes, whereas trace or greater proteinuria indicates higher risk. Outcome-based CKD management in a super-older population is essential to avoid overtreatment and ensure appropriate care.
25. Feasibility of endoscopic response evaluation after induction chemotherapy for determining treatment strategies in esophageal cancer: a post hoc analysis of the CROC trial.
期刊: Esophagus : official journal of the Japan Esophageal Society 发表日期: 2025-Nov-25 链接: PubMed
摘要
The CROC trial assessed a response-guided approach using endoscopic criteria to identify candidates for definitive chemoradiotherapy (dCRT) as an alternative to surgery for resectable thoracic esophageal squamous cell carcinoma (ESCC). Precise evaluation of treatment response following induction chemotherapy is essential for determining curative strategies. This post hoc analysis of the CROC trial investigated the interobserver concordance of endoscopic response evaluation and its clinical implications. Eighty-seven patients with resectable thoracic ESCC underwent three cycles of induction chemotherapy with docetaxel, cisplatin, and 5-fluorouracil. Endoscopic responses were centrally reviewed by three expert oncologists and categorized as remarkable response (RR), limited partial response, or poor response. Patients were classified as having definitive RR, definitive non-RR, or uncertain response based on reviewer agreement. A comprehensive consensus was achieved, with 51.7% (45/87) and 31.0% (27/87) of patients categorized as definitive RR and definitive non-RR, respectively, whereas 17.2% (15/87) were classified as uncertain response. Patients with definitive RR and uncertain response exhibited high complete response (CR) rates to dCRT at 89.7% (35/39) and 90.9% (10/11), respectively, whereas those with definitive non-RR demonstrated a lower CR rate of 25.0% (1/4). 18F-fluorodeoxyglucose positron emission tomography revealed a progressive decrease in maximum standardized uptake value in the RR and uncertain response groups compared with the non-RR group. Among the surgical cases with definitive RR, the positive predictive value for pathological findings was 83.3% (5/6). High interobserver concordance supports standardizing endoscopic evaluation criteria. Furthermore, an uncertain response may indicate the suitability of dCRT because of favorable outcomes.
26. A Note on Quantifying the Contributions of Incidence Functions in Spatio-Temporal Epidemic Models.
期刊: Acta biotheoretica 发表日期: 2025-Nov-25 链接: PubMed
摘要
Reaction-diffusion epidemic models play a central role in understanding how infectious diseases propagate through space and time, offering valuable insight for public health analysis. A key element of such models is the incidence function, which governs the nonlinear interaction between susceptible and infected populations. Despite extensive studies on various incidence formulations, the systematic identification of a suitable one for a given setting remains an open question. This work introduces a theoretical framework that interprets the selection of an incidence function as quantifying the contribution of several plausible formulations to the overall transmission dynamics, inferred from observational data. The resulting problem takes the form of a PDE-constrained optimization, where the objective is to determine the optimal weights in a convex combination of incidence functions that best fit the observed epidemic patterns. The analysis establishes the Fréchet differentiability of the parameter-to-state operator and derives first-order optimality conditions via an adjoint system. A numerical illustration, based on the Landweber iteration method, highlights the framework’s potential as a mathematical tool to enhance modeling accuracy and support strategies aimed at disease prevention.
27. Cardiovascular adverse events associated with denosumab versus zoledronic acid in patients with breast cancer: a propensity score overlap weighted analysis.
期刊: Breast cancer research and treatment 发表日期: 2025-Nov-25 链接: PubMed
摘要
To compare the risks of cardiovascular events, fractures, and all-cause mortality between denosumab and zoledronic acid in patients with breast cancer bone metastases. We identified female patients with breast cancer and bone metastases who received denosumab or zoledronic acid between April 2014 and August 2023 from a nationwide database of routinely collected administrative claims data in Japan. After adjusting for potential confounders using propensity score overlap weighting, we estimated the incidence of outcomes (per 10,000 person-years) and hazard ratios (HRs) using Cox proportional hazards models. Among the eligible 4350 patients, 2953 received denosumab and 1397 received zoledronic acid. The participants’ median age was 76 years (interquartile range, 68 to 81). The adjusted incidence of composite cardiovascular disease was 118 in the denosumab group and 152 in the zoledronic acid group (HR 0.80, 95% confidence interval, 0.67 to 0.95). Heart failure was less frequent in patients administered denosumab [65 vs. 92; HR, 0.69 (0.55 to 0.87)] than in those administered zoledronic acid, whereas the rates of stroke and myocardial infarction were similar between the two groups. Denosumab was also associated with lower risks of any fracture [237 vs. 298; HR 0.80 (0.71 to 0.90)], hip (31 vs. 43), vertebral (135 vs. 168), and non-vertebral (114 vs. 142) fractures. Overall, 471 all-cause mortality events occurred in the denosumab group and 610 in the zoledronic acid group [HR 0.75 (0.69 to 0.82)]. In patients with breast cancer bone metastases, denosumab was associated with lower risks of cardiovascular events, fractures, and mortality than those with zoledronic acid.
28. Coronary Artery Calcification in Type 1 Diabetes After 10-Year Ketogenic Diet.
期刊: Journal of applied physiology (Bethesda, Md. : 1985) 发表日期: 2025-Nov-25 链接: PubMed
摘要
Adults with type 1 diabetes (T1D) are at a higher risk for cardiovascular disease (CVD) compared with the general population. HbA1c is the primary modifiable risk factor for CVD in T1D. However, fewer than 1% of patients achieve euglycemia (<5.7% HbA1c). Ketogenic diets (KD; ≤50g carbohydrate/day) could improve glycemia and reduce CVD risk in T1D by reducing HbA1c and insulin load. One gold-standard cardiovascular assessment - coronary artery calcification - has not yet been reported among individuals with T1D undergoing a KD. In T1D, 30-70% of males between the ages of 30-39 years old have CAC >1, which rapidly progresses to 70-90% between the ages of 40-49 years old, with male sex and elevated low-density lipoprotein (LDL-C) as predictors of CAC progression. Therefore, this case report aims to provide CAC scores from an individual who followed a KD for over 10 years for the first time. We collected this medical history information from the 33-year-old male case study participant with T1D following the KD for over 10 years without use of lipid-lowering medication. The participant achieved euglycemia with an HbA1c of 5.5%. High-resolution computed tomography (CT) imaging of the chest was performed, focusing on the coronary arteries. Scans were obtained using a 64-slice CT scanner equipped with coronary calcium quantification software. Analysis revealed a total Agatston calcium score of 0 across all coronary artery territories. These findings indicate an absence of detectable coronary artery calcification, suggesting the absence of atherosclerotic plaque formation despite concern about the long-term cardiovascular consequences of a KD.
29. Comprehensive transcriptomic analysis identifies Lrg1 as a potential therapeutic target for preventing muscle atrophy in cancer cachexia.
期刊: American journal of physiology. Cell physiology 发表日期: 2025-Nov-25 链接: PubMed
摘要
Cancer cachexia is a debilitating syndrome characterized by progressive skeletal muscle wasting and systemic inflammation, primarily observed in patients with advanced-stage cancer. Cachexia severely impacts patients’ quality of life and even increases mortality rates; however, effective therapeutic interventions remain elusive. To identify key mediators of muscle atrophy, we integrated more than one hundred bulk and single-cell transcriptomic datasets from diverse murine cachexia models, including colorectal, lung, and pancreatic cancer. This analysis identified leucine-rich alpha-2-glycoprotein 1 (Lrg1), as consistently upregulated in skeletal muscle endothelial cells across cachexia models and progressively increased during disease progression. Functional studies demonstrated that recombinant Lrg1 induced myotube atrophy in vitro, accompanied by reduced fusion index, shortened myotube length, and increased expression of the atrogenes MAFbx and MuRF1. Neutralization of Lrg1 or pharmacological inhibition of Stat3 prevented these effects. Our findings nominate Lrg1 as a candidate biomarker and potential therapeutic target for preventing skeletal muscle wasting in cancer cachexia.
30. Cocreation of Integrated Interventions Addressing Noncommunicable Diseases and Environmental Degradation: Protocol for a Participatory Qualitative Study.
期刊: JMIR research protocols 发表日期: 2025-Nov-25 链接: PubMed
摘要
Addressing the adverse impacts of climate change on human health requires a global effort across multiple sectors. People living in low- and middle-income countries are particularly vulnerable to the health crises induced by climate change. Therefore, context specific solutions to tackle such challenges are essential to ensure preventive measures are in place for mitigating such risks. This protocol aims to outline an integrated, participatory approach to cocreate multisectoral interventions tailored to specific environmental and health challenges in Bangladesh, India, and Indonesia. This work is done as part of the Global Health Research Centre for Non-Communicable Diseases and Environmental Change, funded by the National Institute for Health and Care Research. The overall aim is to collaboratively design and assess interventions that deliver dual benefits for planetary and human health. To address the multisectoral nature of the challenges, this study will adopt a cocreation methodology that blends co-design and coproduction approaches. While the problem areas are specific to each context-tackling air pollution due to plastic burning in Indonesia, improving dietary diversity of public food procurement systems and managing extreme heat in India, and mitigating drinking water salinity in Bangladesh-the underlying cocreation framework is consistent and can be adapted to the needs of each study setting. The workflow consists of 4 key stages guided by an existing cocreation framework: planning, developing, evaluation, and reporting, with the 6 core elements of the Medical Research Council’s complex intervention development framework embedded throughout the process. Drawing on the Double Diamond design process, the cocreation stage involves the following phases: codevelopment of a theory of change to explore potential context-specific interventions, short-listing of intervention components through gap analysis and prioritization, co-designing and coproducing selected intervention components, and assessing appropriateness and feasibility of intervention implementation. The cocreation process will be evaluated using the Research Quality Plus for Co‑Production framework to ensure methodological rigor and quality. Cocreation will take place over 6 months. Sampling and recruitment of cocreators (key stakeholders across sectors) have been completed in all 3 countries, with each cocreator group consisting of 20-30 members. We have developed the tools for the cocreation phase, informed by the findings from formative research, and received the necessary ethics approval to conduct these activities. We will generate a series of academic and nonacademic outputs on the cocreation process to disseminate the findings, as well as training materials for implementers to facilitate future adoption in similar settings. The cocreation of multisectoral interventions to tackle both environmental change and health is a comparatively new domain of implementation research. This protocol addresses the complex, multidimensional, and unique nature of such interventions by developing a structured and scientifically sound approach to be implemented in real-life settings. DERR1-10.2196/80368.
31. AI-Assisted Cardiovascular Risk Assessment by General Practitioners in Resource-Constrained Indonesian Settings Using a Conceptual Prototype: Randomized Controlled Study.
期刊: Journal of medical Internet research 发表日期: 2025-Nov-25 链接: PubMed
摘要
Preventive strategies integrated with digital health and artificial intelligence (AI) have significant potential to mitigate the global burden of atherosclerotic cardiovascular disease (ASCVD). AI-enabled clinical decision support (CDS) systems increasingly provide patient-specific insights beyond traditional risk factors. Despite these advances, their capacity to enhance clinical decision-making in resource-constrained settings remains largely unexplored. We conducted a randomized controlled study to assess the effect of AI-based CDS on 10-year ASCVD risk assessment and management in primary prevention. In a 3-way, within-subject randomized design, doctors completed 9 clinical vignettes representative of primary care presentations in a resource-constrained outpatient setting. For each vignette, participants assessed 10-year ASCVD risk and made management decisions using a conceptual prototype of AI-based CDS, automated CDS, or no decision support. The conceptual prototype represented contemporary risk calculators based on traditional machine learning models (eg, random forest, neural networks, logistic regression) that incorporate additional predictors alongside traditional risk factors. Primary outcomes were correct risk assessment and patient management (prescription of aspirin, statins, and antihypertensives; referral for advanced examinations). Decision-making time and perceptions about AI utility were also measured. In total, 102 doctors from all 7 geographical regions of Indonesia participated. Most (n=85, 83%) participants were 26-35 years of age, and 57 (56%) were male, with a median of 6 (IQR 4.75) years of clinical experience. AI-based CDS improved risk assessment by 27% (χ22 (n=102)=48.875, P<.001) when compared to unassisted risk assessment, equating to 1 additional correct risk classification for every 3.7 patients where doctors used AI (number needed to treat=3.7, 95% CI 2.9-5.2). The prescription of statins also improved by 29% (χ22 (n=102)=36.608, P<.001). In pairwise comparisons, doctors who were assisted by the AI-based CDS correctly assessed significantly more cases (z=-5.602, n=102, adjusted P<.001) and prescribed the appropriate statin more often (z=-4.936, adjusted P<.001, medium effect size r=0.35) when compared with the control. AI-assisted cases required less time (estimated marginal means 63.6 s vs 72.8 s, F2, 772.8=5.710, P=.003). However, improvements in the prescription of aspirin and antihypertensives did not reach statistical significance (P=.08 and P=.30, respectively). No improvement was observed in referral decisions. Participants generally viewed AI-based CDS positively, with 81 (79%) agreeing or strongly agreeing that they would follow its recommendations and 82 (82%) indicating they would use it if given access. They believed CDS could enhance the efficiency of risk assessment, particularly in high-volume primary care settings, while noting the need to verify AI recommendations against clinical guidelines for each patient. Improvements in risk assessment and statin prescription, coupled with reduced decision-making time, highlight the potential utility of AI in ASCVD risk assessment, particularly in resource-constrained settings where efficient use of health care resources and doctors’ time is crucial. Further research is needed to ascertain whether improvements observed in this online study translate to real-world low-resource settings.
32. eHealth and the Digital Divide Among Older Canadians: Insights from a National Cross-Sectional Study.
期刊: Journal of medical Internet research 发表日期: 2025-Nov-25 链接: PubMed
摘要
The multidisciplinary life course theory emphasizes the relation between a person’s choices and their socioeconomic context, and their capacity to make decisions within existing opportunities or constraints. Older age is particularly characterized by social and environmental conditions that may impact people’s use of technology and eHealth applications. This research aims to present an overview of eHealth application use among older Canadian adults and examine the relationship between eHealth use and social and health system interaction determinants. We conducted a national cross-sectional survey of older adults (n=2000) in Canada, assessing their technology (eg, tablets, computers) and eHealth application (eg, fall detection and telemonitoring technologies, internet) use, social determinants (eg, sociodemographic characteristics, environmental living conditions), and health system interactions (eg, health status, access to care, services utilization). There is technological readiness (owned a computer: 1703/2000, 85.2%; used the internet daily or a few times per week: 1652/2000, 82.6%) among older Canadian adults, although it does not translate into eHealth application use. Internet use to connect with health care professionals, access results or patient portals, or book medical appointments was limited. The use of telemonitoring and fall detection technologies was low (189/2000, 9.4%, and 84/2000, 4.2%, respectively). There were significant variations in eHealth use, highlighting the importance of accounting for social determinants and interactions with the health care system. Of the variance in online access to laboratory results, 12.7% was explained by the province of residence (higher in Ontario and British Columbia), living environment (lower in rural settings), and access or need variables (higher for those with private insurance and willingness to pay for quicker access; higher for those hospitalized). Women reported more internet use for self-diagnosis and looking for online information. Individuals with excellent perceived health and those with no recent emergency visits or home care services reported greater use of mobile health apps and fall detection technologies (odds ratio [OR]=2.16, 95% CI 1.23-3.80; OR=3.427, 95% CI 1.55-7.60), respectively. A digital divide exists within the older adult population, which raises concerns about whether those with higher needs and limited resources have access to and can benefit from eHealth applications. Addressing the digital health gap among older adults is not simply a matter of technological access but also a matter of health equity and system sustainability. Without deliberate policies, digital health risks reinforcing existing disparities by disproportionately excluding those with the greatest health needs and the fewest resources. Our findings identify the groups most at risk of digital exclusion, such as rural residents, institutionalized older adults, and those with limited financial or insurance coverage, and point to where interventions can yield the greatest benefit.
33. Surfactant-Based Drug Delivery Strategies for HIV/AIDS Therapy: Advances in Formulation and Clinical Translation.
期刊: Pharmaceutical development and technology 发表日期: 2025-Nov-25 链接: PubMed
摘要
The Human Immunodeficiency Virus (HIV) is a major global health concern, demanding the ongoing development of novel therapy techniques. Antiretroviral therapy (ART) has considerably increased the life expectancy of HIV patients; yet, obstacles such as drug resistance, low bioavailability, systemic toxicity, and viral persistence continue to prevent complete viral eradication. Surfactants, which are amphiphilic molecules with customizable physicochemical properties, have emerged as attractive options for HIV treatment due to their ability to increase drug solubility, stability, and targeted administration. The present paper provides a detailed overview of surfactants’ function in HIV/AIDS therapy, with a focus on medication administration, direct antiviral mechanisms, and microbicide formulations. The use of surfactant-based nanotechnology into antiretroviral therapy has resulted in the development of liposomes, polymeric micelles, nanoemulsions, and surfactant-modified biomaterials that provide controlled release and increased bioavailability of antiretrovirals. Furthermore, many surfactants have inherent antiviral activity, which disrupts the viral lipid envelope, inhibits viral replication, and prevents HIV from entering host cells. The paper also explores the potential of surfactant-based biosensors for HIV diagnostics, emphasizing their role in improving sensitivity and selectivity and recent progress in formulation design using surfactants such as sodium lauryl sulfate, poloxamers, and biosurfactants, emphasizing their safety, biocompatibility, and clinical potential. Key challenges including scalability, environmental impact, and user acceptability are discussed alongside emerging AI-driven approaches for personalized nanomedicine. Despite their potential, surfactant-induced cytotoxicity, inflammation, and poor long-term biocompatibility remain major hurdles. Developing safe, biocompatible surfactants with optimal pharmacokinetics is essential for advancing HIV/AIDS therapy. This study explores emerging trends, key challenges, and future prospects in surfactant-based approaches, aiming to bridge fundamental research with clinical application. This research discusses how surfactants molecules commonly found in daily products can play a crucial role in HIV treatment. They can improve the effectiveness of medications by allowing them to dissolve more quickly, remain longer in the body, and reach the proper areas. Surfactants may also directly weaken the virus and improve HIV testing, although safety and long-term effects remain uncertain.
34. The efficiency of rotavirus A spread to extraintestinal tissues is not determined by the levels of its replication in the gut.
期刊: PLoS pathogens 发表日期: 2025-Nov-25 链接: PubMed
摘要
Rotavirus A (RVA) spreads to multiple extraintestinal organs; however, it is not well understood what viral or host characteristics regulate the efficiency of this spread. We conducted this study to determine whether more efficient intestinal RVA replication leads to a higher rate of its extraintestinal spread. We also examined the distribution of known RVA glycan receptors in different tissues to better understand their potential role in facilitating viral dissemination to extraintestinal sites. We inoculated germ-free pigs with porcine OSU G5P[7] characterized by remarkably robust in vitro/in vivo replication, and G9P[13] which replicates to low-to-moderate titers and several other strains. Significantly higher RVA titers were observed in intestinal tissue/contents/feces of pigs infected with G5P[7], whereas G9P[13] was associated with a relatively modest intestinal replication but the most efficient extraintestinal spread. As expected, and coinciding with the increased sialic acid/glycan abundance and diversity, all RVA strains replicated to highest titers in the gut. Further, among the examined extraintestinal tissues, the lungs: a) had the highest frequency of RVA RNA detection; b) exhibited the highest host glycan diversity/abundance; and c) represented the only extraintestinal tissue in which both gross and microscopic lesions were observed. This further underscores the association between the RVA receptor diversity and respiratory lesions. This is the first experimental evidence that RVA extraintestinal spread does not depend on its replication efficiency in the gut. Additionally, these findings may provide an explanation for the current global dominance of G9P[13] and related RVA strains, which could be capable of airborne spread.
35. Improving Work-Related Challenges in Psychiatric-Psychosomatic Clinics: Study Protocol for an Internet-Based Needs Assessment and Co-Design of a Training.
期刊: JMIR research protocols 发表日期: 2025-Nov-25 链接: PubMed
摘要
Medical, psychiatric-psychosomatic facilities are confronted with a variety of daily challenges that affect working conditions, the mental health of employees, and the quality of patient care. This project focuses on the work-related challenges faced by health care professionals in psychiatric-psychosomatic clinics in Germany. The aim of the current research is to investigate the interactions between individuals and their social environment, identify psychological and organizational challenges and job demands, and use these findings to inform the development of a participatory, evidence-based intervention. This 2-phase research is grounded in the job demands-resources model (JD-R). Study phase (needs assessment) uses a cross-sectional online survey with health care professionals in German psychiatric-psychosomatic clinics to assess job demands, resources, and outcomes in a target sample of N=600 participants (power analysis). Study phase 2 (co-design of a training) involves co-creatively designing an intervention based on survey findings through participatory workshops with at least N=20 participants. Analyses include regression and moderation tests (SPSS; IBM Corporation) and qualitative data analysis to co-design training. The recruitment of participants is planned to be finished by December 2025. The co-designing of workshops (phase 2) will be started in February 2026. As this is a study protocol, results are not available yet. This current research examines the work-related challenges faced by health care professionals in psychiatric-psychosomatic clinics. It is expected that burnout, engagement, and psychological safety will likely emerge as central mediating and moderating variables. As the findings of phase 1 serve as a basis for the development of an intervention, this research seeks to improve the well-being of health care professionals in psychiatric-psychosomatic institutions sustainably.
36. Examining the Relationships Between Occupational Exposures and Health Outcomes Among Informal Wood Furniture Workers in Thailand.
期刊: New solutions : a journal of environmental and occupational health policy : NS 发表日期: 2025-Nov-25 链接: PubMed
摘要
This study examined occupational exposures and their associations with health outcomes among informal wood furniture workers in Thailand. A cross-sectional survey of 167 workers was conducted using the Healthy i-Work web application. The most common exposures were wood dust (69.46 percent), awkward postures and heavy lifting (64.07 percent), and noise (48.50 percent). Musculoskeletal disorders were the most prevalent health issue (58.68 percent), followed by fatigue, numbness, and hearing and visual problems. Logistic regression analyses revealed that twisting, bending, and/or heavy lifting were strongly associated with musculoskeletal pain (AOR = 9.607, p < .001), exposures to energy and motion with injuries (AOR = 6.967, p = .044), chemical exposures with eye or skin irritation (AOR = 8.484, p = .003), and heat exposure with fatigue (AOR = 3.394, p = .008). Noise and psychosocial exposures were also significant predictors of hearing and stress-related symptoms. These findings highlight the urgent need for occupational safety interventions, ergonomic improvements, and expanded healthcare access for informal workers in Thailand.
37. Mind the Gap: A systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers.
期刊: The Gerontologist 发表日期: 2025-Nov-25 链接: PubMed
摘要
Care transitions for people living with dementia are critical periods requiring coordinated, person-centered support. Effective transitions can reduce caregiver burden, prevent adverse outcomes, and improve care quality. However, the barriers, facilitators, and lived experiences during transitions remain poorly understood. This systematic review synthesizes evidence on these factors from the perspectives of people with dementia and their informal caregivers. A comprehensive search across MEDLINE, CINAHL, PsycINFO, ProQuest, and Web of Science identified 67 eligible English-language studies published from 2018 to 2023. Quality appraisal used Joanna Briggs Institute tools. The protocol was registered on PROSPERO: CRD42023452669. Four themes captured the barriers, facilitators, and experiences shaping care transitions for people with dementia and their caregivers. Systemic influences included fragmented governance, funding and policy inconsistencies, and structural challenges in care coordination and delivery, mitigated by proactive planning and integrated care. Health and social care workforce factors highlighted gaps in dementia training, staffing, and communication, with empathetic, informed staff improving transitions. Emotions and decision-making reflected caregiver burden, uncertainty, and advocacy, eased by early guidance and peer support. Cultural, social and situational influences showed how values, socioeconomic status, and rurality affected transition choices, underscoring the need for culturally sensitive, person-centered support. Care transitions remain complex, shaped by systemic, workforce, emotional, and cultural factors. Addressing inequities and coordination gaps is critical for more integrated transitional care. Strengthening dementia-specific training, home-based care models, and culturally responsive communication may improve continuity, person-centeredness, and caregiver support.
38. Author Correction: Quantification of Pesticides and In Vitro Effects of Water-Soluble Fractions of Agricultural Soils in South Africa.
期刊: Archives of environmental contamination and toxicology 发表日期: 2025-Nov-25 链接: PubMed
摘要
39. The Intensive Stroke Cycling for Optimal Recovery and Economic Value Trial (I-SCORE): Protocol for a Randomized Clinical Trial.
期刊: Physical therapy 发表日期: 2025-Nov-25 链接: PubMed
摘要
Current rehabilitative approaches for the recovery of upper (UE) and lower extremity (LE) function following stroke involve costly time- and personnel-intensive 1-on-1 motor learning-based training. Preliminary data in chronic stroke indicate facilitated aerobic exercise (FE), where volitional LE movements are mechanically supplemented, enhances UE motor recovery associated with task-based practice. The goals of the Intensive Stroke Cycling for Optimal Recovery and Economic Value trial are to determine effects of FE in facilitating UE and LE motor recovery post-subacute stroke, to elucidate neural and biochemical substrates of FE-induced motor recovery, and to evaluate cost-effectiveness of a FE-centered intervention. A prospective, single-center, parallel group, rater-blind, pragmatic randomized clinical trial will be conducted. The setting will be a large academic medical institution. Individuals with hemiparesis due to subacute stroke (N = 66) will be enrolled. Participants will be randomized into (1) FE followed by abbreviated sessions of physical and occupational therapy (FE+rehab) or (2) usual care consisting of consecutive sessions of physical and occupational therapy (rehab). All participants will receive a comparable dose of contact time: 90 minutes, 2 times per week for 12 weeks. Motor outcomes will be collected at baseline, end of treatment (EOT) and EOT+6 months. Electroencephalograms and blood biomarkers will be collected at baseline and EOT. Cost-effectiveness will be modeled over immediate and long-term horizons. The global effect of FE has the potential to enhance recovery in a growing population of stroke survivors in a cost-effective manner, thus accelerating its clinical acceptance. The mechanistic aim will explore the effects of each approach on substrates underlying neuroplasticity.
40. Thrombosis, bleeding, and mortality in patients with sepsis-induced coagulopathy: Analysis of a prospective cohort.
期刊: Thrombosis research 发表日期: 2025-Nov-24 链接: PubMed
摘要
Sepsis-induced coagulopathy (SIC) is an early phase of disseminated intravascular coagulation and a candidate marker for risk stratification. Although SIC is linked to higher mortality, its value for predicting thrombotic and hemorrhagic events remains uncertain. We assessed the prevalence of SIC and its association with hemostatic complications and mortality in sepsis. In a prospective cohort of 389 adults with sepsis admitted to an intermediate care unit, SIC was defined by International Society of Thrombosis and Haemostasis criteria (score ≥ 4). Primary outcomes were 30-day venous thromboembolism, arterial thrombosis, and bleeding; all-cause 30-day mortality was secondary. Predictive performance of the SIC score was evaluated with receiver operating characteristic analysis, bootstrap resampling, and Monte Carlo simulation. SIC was present in 33.4 % of patients. Thirty-day mortality was 27.1 % in SIC-positive patients versus 13.1 % in SIC-negative patients (p = 0.001), and SIC remained independently associated with death (adjusted OR 1.43; 95 % CI 1.13-1.80; p = 0.003). SIC positivity was not associated with overall thrombotic events: 42.9 % (12/28) of patients with thrombosis and 32.7 % (118/361) without thrombosis had SIC (p = 0.301). Discrimination for thrombotic and hemorrhagic events was poor (AUROC 0.573 and 0.576, respectively), with further decline after resampling; simulation analyses confirmed limited predictive capacity for either complication. In this cohort, SIC was associated with higher mortality but not with thrombotic or hemorrhagic events. This association likely reflects overall severity of illness rather than clinically overt vascular complications. These findings do not support using SIC alone to guide anticoagulation or transfusion decisions and support the development of outcome-specific risk models, potentially integrating dynamic clinical variables and serial laboratory trajectories.
41. "Who are they? What does that mean for care?": An exploratory descriptive study of clinicians' experiences of caring for patients and family members from culturally diverse backgrounds.
期刊: Intensive & critical care nursing 发表日期: 2025-Nov-24 链接: PubMed
摘要
Cultural diversity is a broad term used to encompass ethnic and racial diversity, multiculturalism, diverse languages, religions, practices, beliefs and identities of people. In ICU, people who are culturally diverse are at increased risk of marginalisation, sub-optimal care, higher morbidity and mortality. Ethnocultural biases and stereotypical assumptions can negatively influence ICU care. To explore the experiences of nurses, physicians and allied health professionals (clinicians) in caring for patients and their family members from culturally diverse backgrounds. Ethical approval was granted for an exploratory descriptive study. Convenience sampling was used to recruit clinicians involved in patient care, from two ICUs in Australia. Semi-structured individual interviews were undertaken to gather data, with interviews audio recorded and auto-transcribed. Data were analysed using inductive content analysis. Twenty clinicians participated, with interviews lasting 26 min (mean). Analysis revealed four main themes: (i) Cultural sensitivity and responsiveness, which describes the importance of cultural sensitivity and responsiveness in care; (ii) Complexities of communication, which includes descriptions of strategies to overcome communication barriers; (iii) At the end of life, which describes end-of-life care challenges, particularly in the context of brain death and organ donation; and (iv) The way forward, offering suggestions for optimising care for patients and family members who were culturally diverse. Cultural diversity complicates patient and family care and communication in the ICU. These findings emphasise the importance of clinicians’ sensitivity and openness to difference, and that it is clinicians’ responsibility to overcome cultural and linguistic differences, not the critically ill patient or their family. Achieving greater openness and awareness requires ICU and healthcare leaders to promote the use of professional interpreters to their full scope of expertise, development of culturally-specific resources and creation of a wider community network of cultural representatives to bridge cultural gaps.
42. Retention and morale in the ICU: interprofessional team members' perspectives on interprofessional staffing in adult ICUs.
期刊: Intensive & critical care nursing 发表日期: 2025-Nov-24 链接: PubMed
摘要
To explore how interprofessional team staffing-comprised of registered nurses, physicians, and respiratory therapists-is perceived to impact team members and patient care in the ICU. Using previously collected interview data from a study focused on optimal interprofessional teams in adult ICUs from a single academic medical center, we used thematic analysis to examine how team staffing influenced team members and patient care; we paid particular attention to perspectives on patient safety, team member well-being, and retention. Using data from 14 interviews (7 registered nurses, 4 physicians, 3 respiratory therapists) we identified five themes: (1) patient assignments were linked to patient safety: “sometimes it can get a little dicey”; (2) continuity of care helps, “but let’s get real… you need breaks”; (3) when staffing is inadequate - “you can’t provide the type of care you want” - interprofessional team members feel demoralized; (4) retention was both a cause and a result of inadequate interprofessional staffing; and (5) team support is critical: “we are like a unified front…we band together”. Staffing was described as cyclical, dynamic, and interconnected. Interprofessional team members described ICU staffing as complex and may influence patient safety, continuity of care, team member well-being, and retention. Focusing on how to improve ICU interprofessional team staffing may have the potential to improve both team and patient outcomes. Given current workforce dynamics for ICU nurses and their colleagues, the ICU interprofessional team might benefit from understanding how interprofessional team staffing aids in well-being, retention, and patient safety. These study findings can inform future research and quality improvement programs to explore opportunities to enhance interprofessional team collaboration to promote excellence ofcareofcritically illpatients.
43. Beds we make, futures we shape: A life cycle and cost analysis of reusable and disposable linen in the ICU.
期刊: Intensive & critical care nursing 发表日期: 2025-Nov-24 链接: PubMed
摘要
The aim of this study was to quantify and compare the environmental impact and cost associated with transitioning from disposable under pads (blueys) and bed protectors (pinkies) to reusable linen products in the intensive care unit (ICU). A process-based life cycle assessment (LCA) was employed to evaluate carbon emissions and cost across the manufacturing, transportation, laundering, landfill, and disposal stages of disposable versus reusable linen. The analysis compared data from the pre (April 2022 - March 2023) and post-implementation (April 2023 - March 2024) phases of adopting reusable linen in a single centre metropolitan ICU in Melbourne, Australia. The introduction of reusable linens to replace single use products resulted in a 50 % reduction in total carbon emissions, decreasing from 7,206 kg CO2 equivalent (CO2e) to 3,605 kg CO2e. The intervention avoided approximately 3.6 tonnes of CO2e emissions and 2.2 tonnes of landfill waste, despite a 3 % ($1,005) increase in overall costs driven mainly by reusable pinkies. Reusable blueys required more frequent use to achieve CO2e emissions parity with single use variants due to their higher initial carbon footprint, while pinkies reached parity earlier in their lifecycle. These data underscore the environmental advantages of adopting reusable medical products in healthcare settings, and highlights both environmental impact and financial considerations. The findings support wider implementation of reusable products in healthcare to advance sustainability goals while maintaining patient care standards. Exploration is required of long-term trends when reusables are introduced, and studies in other socioeconomic settings, on the overall financial and environmental outcomes.
44. Development and validation of an LC-MS/MS method for the simultaneous detection of urinary inflammatory biomarkers in a Flemish birth cohort.
期刊: Journal of chromatography. B, Analytical technologies in the biomedical and life sciences 发表日期: 2025-Nov-21 链接: PubMed
摘要
Chronic inflammation is a significant contributor to various diseases but its assessment via blood sampling presents challenges, particularly in children. The evaluation of urinary biomarkers, including 3-bromotyrosine (Bty), 3-chlorotyrosine (Cty) and leukotriene E4 (LTE4), offers a non-invasive alternative. This study presents the optimization and validation of a sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for the simultaneous quantification of Bty, Cty and LTE4 in urine. Under optimized conditions, sample preparation was based on SPE using Oasis MAX cartridges, followed by LC-MS/MS analysis. Method performance was validated using the ICH 10 guidelines, resulting in satisfactory results for all analytes in terms of recovery, linearity, limits of quantification, precision and accuracy. Recovery rates ranged from 82 % to 97 %, while matrix effects were observed within the range of -11 % to 26 %. Linear range spanned from 0.08 to 20 ng/mL for the three analytes. Application to 332 urine samples from the ENVIRONAGE birth cohort (Belgium), comprising of children aged 4-11 years, revealed detection frequencies of 18 % for LTE4, 19 % for Cty and 50 % for Bty. Notably, creatinine-corrected Cty and LTE4 exhibited statistically significant Spearman correlations with established systemic inflammation markers. Specifically, Cty was positively correlated with absolute monocyte count (ρ = 0.53, p < 0.05), while LTE4 showed a positive correlation with relative eosinophil levels (ρ = 0.46, p < 0.05) and a negative correlation with the relative neutrophil levels (ρ = -0.56, p < 0.01). These results highlight the validated method as a valuable tool for investigating distinct inflammatory pathways in epidemiological settings and clinical research.
45. In utero and early life exposures to smoking are associated with systemic autoimmune rheumatic diseases.
期刊: Seminars in arthritis and rheumatism 发表日期: 2025-Nov-11 链接: PubMed
摘要
Systemic autoimmune rheumatic diseases (SARDs) are influenced by genetic and environmental factors. We examined pregnancy complications, early life events (birth season, birth order, feeding), and exposures to tobacco smoking in relation to SARD diagnosis. In a case-control study, probands with SARDs were compared to same-sex close-in-age unaffected siblings (US), and demographically-matched unrelated controls (UC); 329 children (probands=124, US=115, UC=90) and 184 adults (probands=76, US=63, UC=45) were included. Conditional and unconditional logistic regression were used to examine proband-US and proband-UC comparisons. We examined associations between SARDs and exposures to smoking while adjusting for HLA-DRB103:01 in White probands and UC. No specific pregnancy complication was associated with SARDs; however, the total number of pregnancy complications was greater in juvenile probands. A higher proportion of juvenile-onset probands than UC were exposed to tobacco smoking, both in utero and after birth (prenatal, 20 % vs 4 %, OR=4.04, 95 %CI=1.20-17.7; household smoking before age 3, 14 % vs 3 %, OR=4.83, 95 %CI=1.31-26.1). Among adult-onset probands and US, household smoking exposure before age 10 was associated with SARDs (60 % vs 42 %, OR=10.06, 95 %CI=1.23-82.0). Among White subjects, HLA-DRB103:01 was associated with SARDs (juvenile-onset OR=2.03, 95 %CI=1.04-4.10; adult-onset OR=7.67, 95 %CI=2.72-26.4). After adjusting for HLA-DRB1*03:01, household smoking exposure was associated with juvenile- and adult-onset SARDs (OR=5.49, 95 %CI=1.22-39.7, and OR=4.01, 95 %CI=1.11-17.2). Early life exposure to tobacco smoking is associated with SARDs; the effect remained after adjusting for the genetic risk of HLA. These findings support a role for early environmental exposures in autoimmune diseases.
46. Toronto's Supervised Consumption Sites and Local Crime.
期刊: JAMA network open 发表日期: 2025-Nov-03 链接: PubMed
摘要
Beginning in August 2017, 9 overdose prevention sites and supervised consumption sites (OPS/SCS) began operating in Toronto, Canada. Following years of community pushback stating that these sites increased local crime and disorder, they were closed in March 2025. To examine the association between OPS/SCS and local crime and disorder. This ecological cohort study used Toronto Police Service data to compare crime incidence before and after OPS/SCS implementation using an interrupted time series study design. Analysis was restricted to crimes that occurred within city boundaries between January 1, 2014, and June 30, 2025. The study used monthly event counts of all assaults, auto thefts, break and enters, robberies, thefts over $5000, bicycle thefts, and thefts from motor vehicles as the 7 outcomes. Incidence within 400 m of the geolocation of each OPS/SCS before and after implementation were compared and results were pooled for population-level estimates. Within 400 m (approximately a quarter mile), OPS/SCS implementation was associated with increases in break and enters (49.88%; 95% CI, 27.03% to 76.84%), and to a lesser extent, thefts from motor vehicles (20.03%; 95% CI, -0.63% to 44.99%). However, monthly trends for break and enters (-1.19%; 95% CI, -1.71% to -0.68%), robberies (-1.32%; 95% CI, -1.93% to -0.70%), thefts over $5000 (-1.48%; 95% CI, -2.45% to -0.50%), bicycle thefts (-1.82%; 95% CI, -2.93% to -0.68%), and thefts from motor vehicles (-1.30%; 95% CI, -2.18% to -0.42%) declined. Site-specific results revealed some OPS/SCS were associated with increases in crime while most were not. This ecological cohort study found that the association between Toronto’s OPS/SCS and crime was generally neutral to beneficial. OPS/SCS were associated with increases in break and enters, and to a lesser extent thefts from motor vehicles, immediately postimplementation. Incidents of crimes declined with time.
47. A review of occupational noise-induced hearing loss: focus on mechanisms and preventive measures.
期刊: British medical bulletin 发表日期: 2025-Sep-22 链接: PubMed
摘要
This research investigates the epidemiology, underlying mechanisms, and prevention strategies associated with occupational noise-induced hearing loss (ONIHL), while also presenting effective control measures. Relevant literature was sourced from databases such as MEDLINE, PubMed, Embase, Web of Science, and Google Scholar, encompassing articles until February 2025. ONIHL is widely recognized as a common occupational health issue among workers. Additionally, noise can lead to psychological and physiological complications beyond direct auditory damage. The effects of noise differ across individuals, and the precise causes behind ONIHL remain poorly understood, although several pathways have been proposed. New treatment options focused on oxidative stress, inflammation, and neuropathy are being developed through innovative drug delivery systems. There is a pressing need for molecular approaches to explore the mechanisms of ONIHL, particularly in the care of individuals with hearing disabilities.
48. Silent Harm: How Ambient Air Pollution Threatens Prenatal and Neonatal Health. A Systematic Review.
期刊: Investigacion y educacion en enfermeria 发表日期: 2025-Sep 链接: PubMed
摘要
To examine the link between ambient air pollution and poor pregnancy and neonatal outcomes. This systematic study searched numerous databases, including PubMed, Scopus, Web of Science, and Cochrane Library, revealed 26 papers that met established criteria. This research looked at how pollutants such as Particulate matter smaller than 2.5 microns, Particulate Matter ≤10 micrometers, Nitrogen Dioxide, Sulfur Dioxide, Ozone, and black carbon affected maternal and new-born health, including miscarriage, preeclampsia, preterm delivery, low birth weight, and neonatal respiratory and neurological abnormalities. Findings repeatedly revealed that enhanced the danger of gestational problems and poor neonatal consequences, with pollutants including Particulate matter smaller than 2.5 microns and Nitrogen Dioxide substantially related to hypertensive disorders, before the expected time of delivery, low birth weight, and reduced new-born immune and respiratory function. The paper also discusses how pollution impacts health via biological processes such as oxidative stress and epigenetic alterations. Variability in research designs, exposure assessment methodologies, and regional pollution levels were observed. This review underscores the link between ambient air pollution, particularly Particulate matter smaller than 2.5 microns and Nitrogen Dioxide, and poor pregnancy and neonatal outcomes. Recognizing these risks is crucial for nursing care, allowing nurses to educate, identify early risks, and advocate for policies that protect mothers and newborns. Strengthening interventions will improve health outcomes for both.
49. Factors Associated with the Development of Skin Lesions in Hospitalized Patients Admitted to a Nursing Preventive Care Program in Colombia.
期刊: Investigacion y educacion en enfermeria 发表日期: 2025-Sep 链接: PubMed
摘要
This work sought to determine the factors associated with the development of skin lesions among patients hospitalized and admitted to a preventive skin care program carried out by nursing. Analytical observational study of cases and controls, which included a sample of 150 cases and 300 controls hospitalized in a clinic with tier IV level of complexity in Bogotá (Colombia). A classification and regression tree was developed to explore the complex interactions that define cases and controls. According to the decision tree, the factors that represent greater probability for the development of skin lesions in the study population were the preventive use of hydrocolloid dressings, hospital stay > 12 days, BMI > 23, incontinence, diagnosis upon admission related with cardiovascular problems and peripheral vascular disease, cancer, surgery, or respiratory failure. Development of skin lesions was related with the interaction of different clinical conditions presented by the patients. Integration of this knowledge is essential for structuring preventive care programs in high-complexity hospitals and in formulating individualized care plans.
50. Health promotion for young Brazilian and Portuguese university students in terms of self-perception and self-image: Instagram profile.
期刊: Investigacion y educacion en enfermeria 发表日期: 2025-Sep 链接: PubMed
摘要
To build a scientific content profile with validity evidence on the Instagram social network, focusing on health promotion for Brazilian and Portuguese university students regarding self-perception and self-image. . A multi-method study based on Design Thinking in four stages: Knowledge Building (1st Review with 26 studies and Documentary Study with 962 forms); Product Definition (2nd Review with 50 studies and Focus Group with 13 participants); Development (Profile Prototyping); and Evaluation and Delivery (with evidence of usefulness, ease, and acceptability assessed by seven users). It was evidenced in 42.3% of the studies that young people have difficulties with the use of alcohol and drugs; among technologies for intervention, multimedia campaigns and social networks were highlighted. The majority (53.8%) of the records expressed the young people’s desire to change something about their bodies. The focus group understood the need to intervene in the self-perception and self-image of young people through Instagram. The profile @multi.brasilportugal was created with content about the promotion of self-care, links for theoretical depth, and professional referrals. Regarding usefulness, ease, and acceptability, users considered it extremely likely to be useful for achieving the objective, extremely easy to operate the profile, and quite likely in terms of the clarity and understanding of the interaction with the technology. Design Thinking encouraged the creation of an Instagram profile with interaction and the possibility of using scientific content for education and health promotion, especially to improve body positivity and self-esteem.
51. Improving training on hepatitis B research in Nigeria: Findings from an innovation bootcamp to strengthen capacity.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
We organized an Innovation Bootcamp for young people in Nigeria to develop strategies promoting the uptake of the hepatitis B birth dose vaccine among newborns, which remains low, with an estimated coverage of 52%. This event was a collaborative, cross-disciplinary capacity-building platform to generate creative solutions addressing barriers to Hepatitis B vaccine uptake. The purpose of this study was to describe the bootcamp activities that address this gap and evaluate the impact of an Innovation Bootcamp designed to build research capacity among young Nigerians. The bootcamp was informed by Participatory Action Research focused at engaging young people as co-researchers to investigate and address issues affecting their respective communities using the PEN-3 cultural model. Qualitative data from the community needs assessment were analyzed using a thematic analysis framework to identify and synthesize emerging themes. Socio-demographic characteristics of the participants were collected, and a pre- and post-survey was administered. The participants’ knowledge of hepatitis B and research skills were compared using the Wilcoxon test. Our results included five teams composed of fifteen participants with a mean age of 25.5 years, originating from the Southern regions of Nigeria. The post-survey showed significant improvements in participants’ knowledge and research skills, with knowledge increasing by 21.6% (mean score: 39.7 to 48.3, p = 0.010) and research skills by 36.4% (mean score: 56.1 to 76.5, p < 0.001). Each team co-designed implementation strategies, including referral pathways from traditional birth attendants to formal health centers, comprehensive training workshops, and trusted community leaders as vaccination ambassadors. In conclusion, the bootcamp demonstrated its effectiveness in strengthening capacity and increasing knowledge (although in a small sample size), which contributed to informing the development of implementation strategies. Findings from the pilot studies will ultimately inform future research focused on promoting and sustaining youth-derived vaccination service delivery strategies in Nigeria.
52. Trends in nulliparous singleton alive births by cesarean section in India: Empirical patterns across public and private hospitals for 720 districts, 2016-2021.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Unnecessary cesarean surgeries pose significant short and long-term risks, affecting fertility, future pregnancies, and child health outcomes. Timely monitoring and precise targeting are crucial to mitigate additional health and economic burdens. This study examines trends and patterns in cesarean deliveries among nulliparous singleton births across all 36 states and 720 districts in India, comparing public and private hospitals between 2016 and 2021. Using a repeated cross-sectional analysis of two waves of India’s National Family Health Survey, we assess the prevalence of cesarean births and explore how the relative contribution of different geographical levels (villages/blocks, districts, states) to the total variation has evolved over time. At the national level, cesarean rates in public facilities declined by 1.2 percentage points, while private facilities saw an increase of 2.1 percentage points. Regional disparities were evident, with Telangana and Jammu & Kashmir consistently reporting the highest cesarean rates in both sectors. Variation across states was more pronounced than at other geographical levels. In private hospitals, the state-level variance partitioning coefficient increased from 69.2% in 2016 to 78.2% in 2021, whereas in public hospitals, it rose from 44.7% to 48.6% over the same period. Notably, states such as Tamil Nadu, Telangana, and Kerala had nearly all districts falling into the high-prevalence category. It is important to consider burden and variation among smaller geographical units (like districts) to monitor the burden. Increased inter-state inequalities with high prevalence among private facilities in southern states imply the absence of uniform protocols for cesarean births. This calls for urgent policy action to regulate the healthcare sector about the issue, and more awareness is required to avoid the additional health and economic burden.
53. Women's experiences with the use of traditional medicine during childbirth in selected areas of Zambia.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
While motherhood is often a positive and fulfilling experience, for many women, it is associated with suffering, pain, ill-health, and even death. Like in many African countries, some Zambian communities rely on traditional medicines to mitigate birth related challenges and make motherhood a more positive experience. Most researchers emphasise that the safety of traditional medicines is particularly important for pregnant women. This qualitative study was conducted to better understand women’s experiences and perceptions of traditional medicine in maternal care, particularly how they navigate its use alongside modern medical practices in selected areas of Zambia. The study explored women’s perceptions and experiences towards the use of traditional medicines during childbirth in Zambia. This was an explanatory study, with sixteen focused group discussions conducted with women that used traditional medicine during childbirth (n = 192) and eight with women who supply traditional medicine to pregnant women (n = 96). The sample was purposively recruited until data saturation was reached. The study was conducted in Lusaka, Solwezi and Kaoma districts of Zambia. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. While some women reported faster labour progression and less pain, others experienced complications. Cultural beliefs, fear of caesarean births, and hospital mistreatment reinforced the reliance on traditional medicine. Traditional medicine was commonly administered through oral ingestion, vaginal insertion, and medicinal tattooing to, restore fertility, for vaginal tightness, prevent complications and aid postpartum recovery. Many women perceive herbal remedies safer alternatives to conventional medical treatments, especially in settings where access to formal healthcare was a challenge. Women’s experiences with herbal medicine during childbirth are shaped by a combination of personal beliefs, cultural traditions, and the socio-economic context in which they live. These findings highlight the need for safe and culturally sensitive maternal healthcare interventions.
54. Interventions to improve racial and ethnic equity in critical care: A scoping review.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Racial and ethnic disparities in the delivery and outcomes of critical care are well documented. However, interventions to mitigate these disparities are less well understood. We sought to review the current state of evidence for interventions to promote equity in critical care processes and patient outcomes. Four bibliographic databases (MEDLINE/PubMed, Web of Science Core Collection, CINAHL, and Embase) and a list of core journals, conference abstracts, and clinical trial registries were queried with a pre-specified search strategy. We analyzed the content of interventions by categorizing each as single- or multi-component, extracting each intervention component during review, and grouping intervention components according to strategy to identify common approaches. The search strategy yielded 11,509 studies. Seven-thousand seventeen duplicate studies were removed, leaving 4,491 studies for title and abstract screening. After screening, 93 studies were included for full-text review. After full-text review by two independent reviewers, eleven studies met eligibility criteria. We identified ten distinct intervention components under five broad categories: education, communication, standardization, restructuring, and outreach. Most examined effectiveness using pre-post or other non-randomized designs. Despite widespread recognition of disparities in critical care outcomes, few interventions have been evaluated to address disparities in the ICU. Many studies did not describe the rationale or targeted disparity mechanism for their intervention design. There is a need for randomized, controlled evaluations of interventions that target demonstrated mechanisms for disparities to promote equity in critical care.
55. Acceptability and perceived barriers to adoption of the core outcome set for maternal and neonatal health research and surveillance during emerging and ongoing epidemic threats (MNH-EPI-COS): An online survey.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
The Maternal and Newborn Health Core Outcome Set during Epidemics (MNH-EPI-COS) is a standardized set of outcomes developed to harmonize outcome selection in maternal and neonatal health research conducted during outbreaks and epidemics. It was developed through a four-stage modified Delphi process involving a large group of international stakeholders who assessed outcomes relevance through online surveys, followed by consensus meetings with a subgroup of stakeholders to finalize the COS. The objective of this study is to evaluate the acceptability of the full MNH-EPI-COS among key stakeholders who participated in the first two round of the Delphi process, to identify anticipated barriers to its adoption, and to assess agreement on the inclusion of individual outcomes, their definitions, and the perceived feasibility of data collection. An online consultation was conducted using an electronic semi-structured survey targeting senior clinical and public health experts and civil society representatives who had contributed to earlier phases of MNH-EPI-COS development but did not participate in the final consensus meetings. Of the 118 invited stakeholders, 100 completed the survey. The majority (95%) agreed that the MNH-EPI-COS captures the most important outcomes, is likely acceptable to key stakeholders (94%), and facilitates timely evidence generation (92%). Additionally, 75% expressed intent to use it. Over 80% of participants agreed with the individual outcomes and their definitions, except for “skin-to-skin contact” and “breastfeeding,” which were acceptable to 67% and 74%, respectively. Concerns were raised about the feasibility of measuring specific outcomes across diverse settings due to the substantial effort and resources required. Key barriers to adoption include knowledge, skills, and understanding gaps and the lack of practical resources. The MNH-EPI-COS, including its outcomes and definitions, was highly acceptable to the larger group of stakeholders involved in the early stages of its development. However, feasibility concerns remain. Successful implementation will require effective dissemination, targeted training, data collection resources, and real-world evaluation.
56. Self-reported prevalence of hand eczema and associated factors among hair dressers of Debre Berhan City in North Eastern Ethiopia.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The prevalent condition known as hand eczema has been associated with substantial decreased quality of life, as well as considerable social and occupational expenses. Even though hairdressing is a significant source of wealth, it is linked to several kinds of medical problems mainly skin conditions. Limited studies conducted in Ethiopia to assess self-reported prevalence of hand eczema and associated factors. This study aims to assess self-reported prevalence of hand eczema and associated factors among hairdressers of Debre Berhan city. A cross-sectional study was conducted among 435 hairdressers of Debre Berhan city in North Eastern Ethiopia from January 10 to February 20, 2025. A simple random sampling technique was used to select hair dressers. Data was collected using a structured questionnaire adapted from Nordic occupational skin questionnaire and observational checklist through face to face interview and observation. Multivariable binary logistic regression was employed to identify associated factors of hand eczema. Prevalence of hand eczema among hairdressers of Debre Berhan city was 56.9%. Poor knowledge (AOR = 2.89, 95% CI: 1.199-4.963), not utilizing personal protective equipment consistently over the years (AOR = 3.8, 95% CI: 2.183-7.012), low hand washing frequency per day (AOR = 3.4, 95% CI: 1.399-6.433) and not taking OHS training (AOR = 4.8, 95% CI: 2.617-8.709) were identified factors of hand eczema. Prevalence of hand eczema among hair dressers in Debre Berhan city was high. Poor knowledge, not utilizing personal protective equipment consistently over the years, low hand washing frequency per day and not taking OHS training were identified factors. Hair dressers should utilize proper type of personal protective equipment before starting any activities in the work place. Inclusion of hand eczema education in Technical and Vocational Educational and Training (TVET) or policy-level interventions would enhance occupational health awareness, early prevention strategies and long-term skin protection practices among hairdressers.
57. Knowledge, attitudes, and barriers to HIV testing among youth in Kumba, Cameroon: A cross-sectional qualitative community-based focus group study.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Human Immunodeficiency Virus (HIV) remains a major public health concern in sub-Saharan Africa. In Cameroon, young people are disproportionately affected but underrepresented in HIV testing statistics. To explore knowledge, attitudes, and behaviours related to HIV testing among youth in Kumba, Cameroon, and to identify barriers to inform community-based interventions. A cross-sectional qualitative study was conducted using nine focus group discussions (FGDs) with 75 youth (52 females and 23 males) aged 18 - 35 years across four quarters in the Kumba II municipality. Participants were purposively sampled to reflect diverse educational and occupational backgrounds. Data were thematically analysed using Braun and Clarke’s framework with NVivo Version 14. Participants demonstrated high awareness of HIV testing services (90.7%) and transmission via sexual contact (96.0%), though knowledge gaps remained regarding non-sexual transmission and testing procedures. While 93.3% had previously undergone HIV testing, 57.3% reported stigma and 46.7% raised confidentiality concerns as ongoing barriers. Female participants feared being labelled as promiscuous, while males cited social norms that discourage help-seeking. Most participants supported school-based or youth-centred community testing, emphasising the need for privacy and youth-friendly environments. Key motivators for testing included the desire to know one’s status (82.7%), symptom appearance (28.0%), and unprotected sex (17.3%). Despite strong awareness and high testing uptake, stigma and confidentiality concerns persist among youth in Kumba. To enhance HIV testing rates, community-based strategies should prioritise mobile clinics, peer outreach, and confidential youth-centred services. Strengthening education about HIV transmission and demystifying the testing process may further reduce barriers.