公共卫生研究摘要 (2025-11-29)
共收录 60 篇研究文章
1. Professional Experiences of Male Nurses With Gender Dynamics, Challenges, and Social Perceptions: A Qualitative Study in Türkiye.
期刊: Nursing inquiry 发表日期: 2026-Jan 链接: PubMed
摘要
Through an in-depth examination of how male nurses experience and overcome gender-based challenges in Turkey, where traditional gender norms and patriarchal values influence social perceptions and professional roles, this study aimed to advance larger conversations on workplace equality. In this respect, a qualitative descriptive design was used to conduct semi-structured interviews with 10 male nurses. The findings showed that most participants selected nursing for job security and financial stability over a career in caregiving. Some nurses advanced faster due to their perceived male authority, even though they often face social skepticism, gender-based discrimination, and isolation at work. The conflict between social acceptance and professional advancement is brought on by these dynamics. To eliminate preconceptions and attain gender equality in nursing, this study highlights the need for inclusive policies and cultural change by examining the experiences of male nurses in a conservative setting where women predominate.
2. The Sounds of Silence: Problematizing Voicelessness in Nursing Practice.
期刊: Nursing inquiry 发表日期: 2026-Jan 链接: PubMed
摘要
A positive healthcare environment and effective nurse recruitment are widely recognized as interconnected factors that improve outcomes for patients, families, and staff. Despite this, frontline nurses and their managers often have conflicting views on workplace issues. Although some hospitals have implemented “speak-up” initiatives, nurses in acute care settings still feel silenced, as interventions designed to improve workplace culture have had limited long-term impact. This underscores the need for a deeper understanding of how nurses are silenced. This qualitative, ethnographic study aimed to improve our understanding of how nurses are silenced in the acute care workplace. Through semi-structured interviews with registered nurses (n = 14) and administrators (n = 9), observational field notes (20 h), and documents (n = 8), we found that although nurses used various channels to voice concerns about patient safety, patient-centered care, and workplace health to their managers, they still felt ignored and unsupported, leading to feelings of vulnerability, anger, and abandonment. Administrators understood staff frustrations but felt powerless, seeing themselves as conduits for top-down directives rather than active participants in organizational initiatives. These findings offer crucial insights for clinicians, researchers, educators, and administrators aiming to create a more inclusive culture that prioritizes collaboration and high-quality care.
3. Learning in the Experiential Continuum: A Philosophically Informed View of Professional Socialisation.
期刊: Nursing philosophy : an international journal for healthcare professionals 发表日期: 2026-Jan 链接: PubMed
摘要
Professional socialisation is a concept that encapsulates the multifactorial and complex learning process through which a person becomes a member of a profession. In the field of nursing, existing literature on professional socialisation has primarily focused on describing students’ key learning experiences during university education. This tendency has been crucial to identifying and characterising the relevance of students’ interactions with faculty, patients, and peers and their engagement with the occupational culture and institutional norms, among other learning experiences. However, few studies have taken a step back to elaborate on the theoretical underpinnings of students’ socialisation, such as the underlying approach to learning or, more fundamentally, what is understood by human experience. We argue that this omission has precluded a more comprehensive view of professional socialisation. Addressing this gap, in this article, we integrate philosophy to develop a framework that intertwines the concepts of experience, learning, and socialisation. In so doing, we propose that learning occurs within an experiential continuum. Ultimately, this framework operates as theoretical scaffolding that offers a deeper understanding of students’ learning during professional socialisation and paves the way for new avenues of empirical research.
4. A novel thermal comfort model for older adults - development and validation of the COMFA-OA model.
期刊: Building and environment 发表日期: 2026-Jan-01 链接: PubMed
摘要
This study presents a population-specific adaptation of the COMFA model, customized to estimate thermal stress levels of older adults. We refer to this index as the COMFA thermal comfort - older adults (COMFA-OA) model. This model incorporates physiological adjustments to enhance accuracy in estimating thermal stress for the older demographic. Key modifications include empirical updates to sweat heat loss, core temperature, and metabolic rate equations to reflect age-related changes in heat regulation and metabolic efficiency. The model was validated using the ASHRAE Global Thermal Comfort Database II and a field experiment assessing thermal sensation of older adults during warm and hot seasons in Texas. Results show COMFA-OA (MAE = 4.03, RMSE = 4.14) outperforms traditional models like PET (MAE = 4.72, RMSE = 4.83), UTCI (MAE = 4.82, RMSE = 4.95), and COMFA (MAE = 4.17, RMSE = 4.29) in accuracy of predicting thermal sensation vote, demonstrating greater multinomial logit model fit (AIC: 4435.3) and achieving competitive computational efficiency (TOPS = 97.54) second only to original COMFA (TOPS = 331.21) and COMFAcourtyard (TOPS = 481.87). Sensitivity analysis identified air temperature, radiant temperature, age, weight, and height as primary contributors to thermal comfort variance in older adults. The COMFA-OA model offers a practical tool for environmental management and public health applications aimed at promoting climate resilience and thermal security for older populations that are vulnerable to heat conditions.
5. Association between physical activity and sleep disorders in Peruvian schoolchildren: A cross-sectional study.
期刊: Sleep medicine: X 发表日期: 2025-Dec-15 链接: PubMed
摘要
Physical activity and sleep are key determinants of child health, yet evidence from low- and middle-income settings remains limited. We examined the association between physical activity and sleep disorders in Peruvian schoolchildren. We conducted a cross-sectional study of 81 children aged 9-12 years from a public school in Callao, Peru (2024). Physical activity was assessed with the Assessment of Physical Activity Levels in Children Questionnaire (APALQ), and sleep disorders with the Tucson Children’s Assessment of Sleep Apnea Questionnaire (TuCASA). Given non-normal distributions, associations between total and dimensional activity scores and TuCASA scores were tested using Spearman’s rank correlation. Most participants showed some degree of sleep disturbance; 45.7 % had mild and 17.3 % moderate sleep disorders, while 37.0 % were normal. Regarding activity, 32.1 % were sedentary, 45.7 % moderately active, and 22.2 % very active. Total physical activity was strongly and inversely correlated with sleep disorder scores (ρ = -0.752, p < 0.001). All dimensions type, frequency, duration, and intensity also showed significant inverse correlations with TuCASA scores (all p < 0.001). Higher physical activity is consistently linked with fewer sleep problems in schoolchildren. Findings support school-based strategies that integrate movement behaviors with sleep health promotion in resource-limited contexts.
6. Psychometric Properties of Intolerance of Uncertainty Scale (IUS-5) in a Sample of Nurses: A Methodological Study.
期刊: Journal of evaluation in clinical practice 发表日期: 2025-Dec 链接: PubMed
摘要
The Intolerance of Uncertainty Scale (IUS-12) is widely used in both clinical and community studies. Due to the length and inconsistent factor structure of the IUS-12, an abbreviated version consisting of five items (IUS-5) has been proposed. However, no study has examined its psychometric properties aside from the preliminary work by its developers. The current study investigated the factor structure of the IUS-5 as well as its reliability and validity. A sample of 315 nurses completed an online self-report questionnaire during the COVID-19 pandemic. Confirmatory factor analysis of the IUS-5 suggested a deletion of one item. The final analysis supported a one-factor solution on the remaining four items (IUS-4) with a McDonald’s omega of 0.77. The validity of IUS-4 was assessed by testing its positive and negative correlations with existing related and contrary measures, respectively. Further, the validity of the IUS-4 was supported through known-group validation. This is the first psychometric assessment of the IUS-5 measure of intolerance of uncertainty in a sample of nurses. Results from the current study supported a shorter measure of four items. However, more work needs to be conducted to examine the IUS-4 and IUS-5 in samples of healthcare providers with different cultural and linguistic backgrounds.
7. Appropriateness Criteria, Insurance Policies, and the Erosion of Clinical Judgement.
期刊: Journal of evaluation in clinical practice 发表日期: 2025-Dec 链接: PubMed
摘要
The American College of Radiology (ACR) Appropriateness Criteria (AC) were designed to guide evidence-based imaging decisions. Increasingly, however, insurers and electronic health record-embedded clinical decision support (CDS) systems use these criteria to determine coverage, shifting their role from clinical guide to gatekeeping tool. This commentary examines the disconnect between policy and practice, driven by low physician awareness, educational gaps, and difficulty navigating the criteria. When applied rigidly, particularly in insurance reimbursement, these shortcomings risk deepening diagnostic inequities. The example of breast cancer screening for patients with dense breast tissue illustrates how restrictive application can limit access to higher-sensitivity imaging and exacerbate disparities. We argue that guidelines should guide, not govern, and that insurer reliance must be paired with physician training, transparent methodology, and adaptability. Policy reform, expanded coverage mandates, and integration of AC education into medical training are needed to align guidelines with both clinical realities and patient needs.
8. Quality of Life in Chronic Heart Failure With Obstructive Sleep Apnea: A Systematic Review.
期刊: Nursing open 发表日期: 2025-Dec 链接: PubMed
摘要
To describe the quality of life in patients with chronic heart failure and coexisting obstructive sleep apnoea, and to examine the effect of common sleep-disordered breathing treatments on quality of life, functional capacity and cardiac outcomes. Systematic review. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered in PROSPERO (CRD42025634352). A comprehensive search was conducted in PubMed, CINAHL, Scopus and Web of Science up to March 2024. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Fourteen studies were included, involving 2048 patients with chronic heart failure and sleep-disordered breathing, including obstructive and central sleep apnea. Sleep-disordered breathing was associated with reduced quality of life, physical capacity and cardiac function. Continuous positive airway pressure improved respiratory events, sleep quality, left ventricular function and exercise performance. Adaptive servo-ventilation reduced central respiratory events but was associated with increased mortality in patients with reduced left ventricular function. Nocturnal oxygen therapy improved some respiratory parameters but did not affect quality of life. Structured exercise programs showed benefits for functional status and quality of life. Obstructive sleep apnea negatively affects the quality of life in people with chronic heart failure. Continuous positive airway pressure is beneficial in selected patients, while adaptive servo-ventilation should be used cautiously. Personalised approaches are needed. Systematic screening and individualised care plans, including nurse-led management, are key to improving quality of life and outcomes in this population. What problem did the study address? The insufficient understanding of how obstructive sleep apnea influences quality of life in chronic heart failure. What were the main findings? Some interventions improved quality of life, while others showed safety concerns. Where and on whom will the research have an impact? The findings guide clinical care for adults with chronic heart failure and coexisting sleep-disordered breathing. We have adhered to the EQUATOR guidelines according to PRISMA. No patient or public contribution.
9. Effects of Soil Moisture and Soil Temperature on Coccidioidomycosis.
期刊: GeoHealth 发表日期: 2025-Dec 链接: PubMed
摘要
Coccidioidomycosis (Valley fever, VF) is a climate-sensitive infectious disease caused by inhaling soil-dwelling fungus Coccidioides, mostly reported in southwestern USA. Although soil moisture (SM) and soil temperature (ST) are known to shape the fungal lifecycle, their effects on coccidioidomycosis remain understudied. Most prior studies have relied on their proxies-precipitation and air temperature-that might not accurately capture soil hydrothermal dynamics. We conducted multivariable negative binomial regressions to estimate seasonal associations between incidence and climate drivers-including SM, ST, and wind speed from the North American Land Data Assimilation Phase 2 (NLDAS-2), and PM10-based dusty-day counts-in Arizona’s hyperendemic counties (Maricopa, Pima, and Pinal) from 2000 to 2022. We found higher incidence in areas with hotter, drier soils and more seasonal dusty days. Multi-year soil hydrothermal cycles-alternating wet-dry and cool-hot periods along with concurrent dry, dusty conditions-significantly influenced incidence. Notably, no antecedent dry-cool seasons were linked to increased incidence, indicating moisture and/or heat are prerequisites for fungal growth and dispersal. SM showed more consistent and widespread effects than ST across seasons and lags, with winter and spring soils most influential. Higher incidence followed wetter winters and monsoons, and dry, hot springs and falls. Our models using NLDAS-2 SM and ST data showed robust performance and generalizability across exposure seasons. Our results support adding multi-year soil indicators-with up to 3-year lead times-into early-warning systems to enhance VF forecasting and better prepare endemic regions for the challenges of a warming, drying, and increasingly variable climate. Coccidioidomycosis is a fungal disease caused by inhaling Coccidioides spores from soils, most commonly in southwestern USA. Soil moisture and temperature likely shape the fungus’s lifecycle, but their roles remain poorly understood because most studies used their proxies—precipitation and air temperature—that might not accurately reflect soil water‐temperature patterns. We examined how current wind, dusty days, and both current and past soil moisture and soil temperature influenced incidence. We found more cases in Arizona regions with drier, hotter soils and more seasonal dusty days. Importantly, alternating wet–dry and cool–hot soil cycles over the past 0–3 years significantly influenced disease occurrence. No past dry–cool conditions were linked to higher incidence, suggesting moisture and/or heat is needed for fungal proliferation and dispersal. Soil moisture had more consistent and extensive seasonal effects than soil temperature. Higher incidence was linked to wetter soils in prior winters and monsoons, and hotter, drier soils in falls and springs, with winter and spring soil hydrothermal conditions most influential. Our models using reanalysis‐based soil data showed robust performance across seasons. Our findings support adding soil data with up to 3‐year lead times into early‐warning systems to improve public health actions in endemic regions.
10. Correction: Ethical Principles Pertaining to the Care of People With Dementia: Protocol for a Qualitative Thematic Synthesis of Legal Documents.
期刊: JMIR research protocols 发表日期: 2025-Nov-28 链接: PubMed
摘要
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11. Clinical Efficacy of Smartphone App-Based Pulmonary Rehabilitation in Chronic Respiratory Diseases: Randomized Controlled and Feasibility Trials.
期刊: Journal of medical Internet research 发表日期: 2025-Nov-28 链接: PubMed
摘要
Pulmonary rehabilitation improves exercise capacity, dyspnea symptoms, quality of life, and even survival in patients with chronic respiratory disease. Center-based pulmonary rehabilitation programs often face barriers, and alternatives to center-based rehabilitation are urgently needed. This study aimed to evaluate the clinical efficacy of smartphone app-based pulmonary rehabilitation in patients with chronic respiratory diseases, including chronic obstructive pulmonary disease, interstitial lung disease, and bronchiectasis. This randomized controlled trial recruited 90 participants, randomly allocated into intervention (n=60) and control (n=30) groups. The intervention group received a 12-week smartphone app-based rehabilitation program, while the control group received standard outpatient care. The primary outcomes were maximal oxygen consumption via cardiopulmonary exercise test and the chronic obstructive pulmonary disease assessment test (CAT) after a 12-week period. Based on changes in quality-of-life questionnaire index scores, quality-adjusted life years were calculated, and a cost-utility analysis was conducted. A feasibility trial was also conducted in 4 community primary health care clinics. Of the 70 participants (median age 65.5 years) who completed the follow-up visits, 67 were included in the per-protocol analysis. The intervention group (n=43) showed significant improvements compared with the control group (n=24) in CAT score (median 7.0, IQR 4.0-15.0 vs median 10.0, IQR 6.5-18.5; P=.04), and International Physical Activity Questionnaire score (median 1488.0, IQR 1250.3-3027.8 vs median 1164.0, IQR 618.8-2205.0; P=.04), but not maximal oxygen consumption. Clinical outcomes showed more prominent improvements among participants who were physically active or compliant with rehabilitation programs. In the user experience survey, around 80% (35/43) of participants in the intervention group found the app easy to use, and more than 60% (27/43) reported that it helped improve dyspnea symptoms. The mean total health care costs were US $495 in the control and US $523 in the intervention group, with no notable difference in the quality-adjusted life year distribution. In the feasibility trial, 24 participants completed follow-up visits, showing a significant reduction in CAT score (median 8.5, IQR 6.0-18.0 to median 5.0, IQR 2.0-7.5; P<.001) post rehabilitation. No participants experienced disease exacerbation or musculoskeletal injury related to the rehabilitation activities. The randomized controlled trial demonstrated that a smartphone-based pulmonary rehabilitation program improved clinical outcomes, including quality of life, physical activity, and dyspnea, in patients with chronic respiratory diseases. Although physically active and program-compliant participants showed significant clinical improvements, the fact that less than half of the participants demonstrated good compliance warrants more robust strategies to enhance adherence in future programs. Additionally, our feasibility trial demonstrated the potential for rehabilitation programs for older adults with chronic respiratory diseases to be implemented in primary health care settings. This approach represents a novel, scalable model bridging hospital- and community-based care, demonstrating real-world feasibility for digital rehabilitation in chronic respiratory diseases. ClinicalTrials.gov NCT05610358; https://clinicaltrials.gov/ct2/show/NCT05610358.
12. Dental Undergraduate Students' Perceptions of Blended Learning in the COVID-19 and Post-COVID-19 Years: Survey Study.
期刊: JMIR formative research 发表日期: 2025-Nov-28 链接: PubMed
摘要
The outbreak of the COVID-19 pandemic created significant challenges but also a unique opportunity, accelerating the evolution of higher education, including dental education. This encouraged dental education to adopt more flexible modes like blended learning. This study aimed to explore senior undergraduate dental students’ views on blended learning during and after the COVID-19 pandemic and to identify modifiable factors influencing their engagement. A survey was conducted among final-year undergraduate students at a top-ranking dental school in mainland China during the fall semesters of 2020-2021 and 2023-2024. The survey assessed satisfaction with blended learning, preferences for engagement, strengths compared to purely online or offline teaching, and factors influencing engagement during and after the pandemic. Response rates were 75% (85/114) in 2020 and 73% (47/64) in 2023. Blended learning was used in 53% (26/49) of evaluated courses. High satisfaction was reported by 82% (93/114) in 2020 and 59% (38/64) in 2023, with significant differences between high- and low-satisfaction groups (P<.001). Satisfaction with specific course types and learning activities was analyzed. Factors associated with higher satisfaction were evaluated using Pearson correlation. Students acknowledged the strengths of blended learning over online- or offline-only formats. In total, 70% (80/114) in 2020 and 61% (39/64) in 2023 expressed a desire to participate in blended dental education. Factors decreasing engagement included unstable technical support (68/114, 60% in 2020 vs 26/64, 41% in 2023), poor online-offline integration (58/114, 51% vs 34/64, 53%), lack of motivation (51/114, 45% vs 24/64, 38%), and insufficient teacher-student interaction (44/114, 39% vs 20/64, 31%). Factors increasing engagement included high-quality learning materials (76/114, 67% vs 43/64, 67%) and improved technical environments (62/114, 54% vs 35/64, 55%). Final-year dental students were generally satisfied with blended learning and recognized its strengths compared to purely online or offline formats, both during and after the pandemic. More efforts are required to enhance students’ potential engagement in blended learning for the future.
13. Hierarchically Porous Nitrogen-Doped Carbon with High Conductivity for Rapid and Efficient Cr(VI) Reduction.
期刊: Advanced science (Weinheim, Baden-Wurttemberg, Germany) 发表日期: 2025-Nov-28 链接: PubMed
摘要
Carbon-based materials derived from metal-organic frameworks typically exhibit microporous structures and low conductivity, which significantly limit their catalytic activity. Herein, an effective strategy to prepare dodecahedral hierarchical porous nitrogen-doped carbon-based composites (d-PNC) by using ZIF-8 encapsulated with ionic liquid as pyrolysis precursors for efficient Cr(VI) reduction is developed. The encapsulated ionic liquid helps to precisely regulate the hierarchically porous structure in d-PNC. This hierarchically porous structure not only creates a favorable reaction microenvironment, facilitating the mass transfer of Cr species and their interaction with active sites, but also enhancing the conductivity of d-PNC and consequently accelerating the electron transfer of •CO2 - radicals to Cr species, thereby speeding up the reduction process of Cr(VI). Additionally, with the calcination temperature increasing, the content of defective C increases, and N species progressively transforms into graphitic-center N (N3). Density functional theory calculations reveal that the defective C active center substantially decreases the free energy change of the rate-determining step (from Cr(IV) to Cr(III)) through the synergistic effect of N3. Given these outstanding characteristics, the optimized d-PNC material can completely reduce Cr(VI) (333.3 mg g-1) in an oxalic acid solution within 2 min, outperforming its counterparts without a hierarchical structure and those calcined at significantly lower temperatures.
14. Nationwide Epidemiology and Genetic Background of Persistent Nonsyndromic Congenital Hyperinsulinism in Slovakia.
期刊: Hormone research in paediatrics 发表日期: 2025-Nov-28 链接: PubMed
摘要
Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycaemia in children. At least 10 monogenic causes and 28 syndromes have been reported to be associated with CHI. The aim of this study was to evaluate epidemiologic data and genetic background of persistent nonsyndromic CHI in Slovakia. Based on data from the nationwide DIABGENE database of children with persistent hyperinsulinemic hypoglycaemia, 28 children were diagnosed with nonsyndromic CHI during the years 2005 - 2024. DNA analysis of the most common CHI genes was performed. Epidemiology of CHI was calculated using Slovak demographic data. The overall incidence of nonsyndromic CHI in Slovakia over the last 20 years was 1:39,804 live births. In 2024, the prevalence was 1:161,802 children younger than 19 years. A genetic cause was identified in 9 children (32%), the most common was CHI due to mutation in ABCC8 gene (n=4), followed by the KCNJ11 (n=2), HNF4A (n=2) and HK1 (n=1) genes. In diazoxide-unresponsive CHI (n=6), 5 children had a mutation in the ABCC8 or KCNJ11 genes and one in the HK1 gene. Four children had the focal form based on the paternally inherited recessive mutation and underwent pancreatic surgery. Nonsyndromic CHI is a rare disease with nation-wide incidence in Slovakia of 1:39,804. Diazoxide-unresponsive CHI accounts for 21% of all the cases. A genetic cause was identified in 32% (100% in diazoxide-unresponsive) of children; mutations in the ABCC8 gene were the most prevalent. The type of mutation determines the most appropriate management strategy, including pancreatic surgery.
15. False-positive malaria rapid diagnostic tests are prevalent among children under 5 years of age in Uganda.
期刊: The Journal of infectious diseases 发表日期: 2025-Nov-28 链接: PubMed
摘要
Malaria rapid diagnostic tests (mRDTs) are a cornerstone of malaria testing and treatment efforts globally. However, positive mRDT results can occur after treatment due to antigen persistence, even in the absence of malaria parasites. False-negative mRDTs are well-described, but less is known about the prevalence and consequences of such false-positive results. We estimated the prevalence of false-positive mRDTs, defined as mRDT(+)/microscopy(-), using data from the 2018-19 Uganda Malaria Indicator Survey. Children aged <5 years (under-5s) with paired mRDT and microscopy results were included. We estimated the prevalence of false-positive mRDTs among microscopy(-) children using survey weights. We fit bivariate generalized linear models to estimate the prevalence difference (PD) of false-positive mRDTs for pre-specified covariates. We constructed cross-validated weighted lasso regression models to determine which variables best predict false-positive mRDTs among children with recent fever. The prevalence of false-positive mRDTs was 10.7% (849/6786) and was strongly correlated with region-level transmission intensity. Prevalence was higher among children with recent fever (PD: 17.2%; 95% CI: 13.7%, 20.6%), recent antimalarial use (14.7%; 7.1%, 22.3%), and comorbid anemia (8.1%; 5.9%, 10.3%). Prevalence was lower among those with recent antibiotic use (-17.6%; -22.5%, -12.7%). A model with clinical, environmental, and household variables better predicted false-positive mRDTs (weighted AUC = 0.79) than individual models. False-positive mRDTs are prevalent among under-5s in the 2018-19 Uganda MIS and lead to overestimates of community-level malaria prevalence. These results suggest that false-positive mRDTs may also contribute to misdiagnosis and unnecessary antimalarial use in clinical settings.
16. Prevalence of DNA Mismatch Repair Deficiencies in Multiple Solid Tumor Types in China.
期刊: Journal of evidence-based medicine 发表日期: 2025-Nov-28 链接: PubMed
摘要
Microsatellite instability (MSI) as a result of deficient deoxyribonucleic acid (DNA) mismatch repair (dMMR) is a key contributor to the development of tumors with a high mutation rate and cancer-specific neoantigens. dMMR identification can be beneficial for selection of immune checkpoint inhibitor (ICI) therapy-eligible patients. While multiple studies have focused on dMMR prevalence in colorectal cancer (CRC), fewer investigate the prevalence of dMMR in tumor types besides CRC, especially in Chinese patients. In this study, we aimed to determine the prevalence of dMMR in China across five gastrointestinal and gynecological tumor types. Tissue samples from Chinese patients with advanced endometrial, ovarian, cervical, biliary tract, or gastric metastatic or unresectable solid tumors were tested for dMMR status using immunohistochemistry with the Ventana MMR RxDx panel. Data were analyzed to determine the prevalence of dMMR for each tumor type. A total of 748 patients were included in the study, representing five tumor types. Prevalence of dMMR varied across tumor types, with an overall prevalence of 9.4%. Patients with endometrial tumors had the highest proportion of patients with dMMR at 49/164 (29.9%). Patients with cervical tumors had the lowest prevalence of dMMR with 6/221 (2.7%) patients. The prevalence of dMMR was similar across most demographic characteristics. In the dMMR population, co-occurring MLH1 and PMS2 protein loss across all tumor types was observed most commonly, in 48/70 (68.6%) patients. These data highlight the importance of dMMR testing in patients with advanced solid tumors in China to optimize biomarker testing and treatment decisions.
17. Robust Upper Limb Motion Learning and Generalization Using a Hierarchical Neuromechanical Control Model with Deep Reinforcement Learning and Muscle Synergy.
期刊: IEEE journal of biomedical and health informatics 发表日期: 2025-Nov-28 链接: PubMed
摘要
Bio-inspired musculoskeletal robots offer inherent advantages in flexibility, robustness, and compliance. However, achieving efficient and generalizable motion learning while producing natural, human-like movements remains challenging. Neuromechanical mechanisms provide a promising framework to emulate biological motor control and skill acquisition. In this study, we present a biomimetic hierarchical neuromechanical control model (HNCM) that integrates deep reinforcement learning with two distinct lower-level controllers. The model is designed to manage high-dimensional muscle control, enhance robustness to motor and sensory perturbations, generalize to previously untrained tasks, and generate human-like reaching movements. A high-level controller based on the proximal policy optimization algorithm models the supraspinal neural system and generates motor commands. The dual-path adaptive lower-level controller emulates both synergy-based and non-synergy-based motor pathways, preserving the benefits of structured exploration while allowing flexible, task-specific behavioral refinement. Comprehensive evaluations on center-out and random reaching tasks demonstrate that HNCM significantly outperforms baseline methods in control accuracy, learning efficiency, and generalization under noise perturbations, while producing more natural and biologically plausible movement trajectories. This work advances the understanding of neuromechanical control and provides a solid foundation for future applications in musculoskeletal robotics.
18. Multilevel Estimation of the Relative Impacts of Social Determinants on Income-Related Health Inequalities in Urban Canada: Protocol for the Canadian Social Determinants Urban Laboratory.
期刊: JMIR research protocols 发表日期: 2025-Nov-28 链接: PubMed
摘要
Two decades of research have highlighted persistent income-related health inequities in Canada across municipal, provincial, and national levels. While there is broad consensus among researchers, advocates, and health professionals that social determinants are the primary drivers of health, the empirical foundation supporting this remains relatively limited. A current renaissance in health system data access offers an opportunity to assess the multilevel impact of social factors on health inequalities, yet this potential remains underused. This project aims to examine how social, economic, and political conditions shape health inequalities and investigate how structural and intermediate determinants explain disparities across national, provincial, city, neighborhood, and individual levels. We will create the Canadian Social Determinants Urban Laboratory (CSDUL), a multilevel, longitudinal, virtual data environment that integrates 15 existing databases from Statistics Canada, the Canadian Institute for Health Information, the Canadian Urban Environmental Health Research Consortium, and DMTI Spatial. Guided by the World Health Organization social determinants of health framework, CSDUL will initially cover 2011 to 2015 due to data completeness and expand as additional years become available. CSDUL builds on Statistics Canada’s Canadian Population Health Survey and will link survey data to administrative and health records, including hospital discharges, ambulatory care, mortality, cancer registries, and longitudinal tax files. Area-level indicators will be added using historical postal codes and geospatial boundaries. Organized through a hub-and-node model, CSDUL includes a central hub and 5 research nodes. We will develop and validate area-based indicators to study social determinants at micro (individual), meso (neighborhood, city, and province), and macro (national) levels. A core deliverable is to assess the strengths and limitations of survey and administrative data for health research and derive variables accordingly. After developing CSDUL, we will replicate World Health Organization Regional Office for Europe income-related health inequality analysis for urban Canada and analyze the impact of social determinants on outcomes. We will apply a 2-fold Oaxaca-Blinder decomposition between the lowest and highest urban income quintiles. A major strength of CSDUL is its capacity to analyze how diverse determinants shape health across subgroups (eg, gender), identifying key drivers of health outcomes. The indicators to be used in CSDUL are being developed and validated by the contributing nodes. In collaboration with node 3, we are constructing measures of social capital using DMTI Spatial Points of Interest data. A prototype version of CSDUL incorporating a limited set of indicators has been developed in Statistics Canada’s Research Data Centre. We anticipate receiving the finalized indicators from the nodes by August 2025 to September 2025 and aim to complete the decomposition analysis by December 2025. Multisectoral interventions are most effective when they are customized to meet the unique needs of specific subpopulations using robust and multilevel data sources such as CSDUL. DERR1-10.2196/71929.
19. COVID-19 Pandemic Experiences Among Adults, Youth, and Childcare Providers: Protocol for a Mixed Methods Study.
期刊: JMIR research protocols 发表日期: 2025-Nov-28 链接: PubMed
摘要
The COVID-19 pandemic challenged families, youth, and frontline workers, including childcare providers. Studying lived experiences before, during, and near the pandemic’s end from multiple perspectives provides a more holistic and deeper understanding of its effects and impacts. This study investigated how parental, childcare provider, and youth stress, mental health, and role overload relate to individual coping and family functioning, as well as vaccine attitudes and uptake patterns among youth, parents, and childcare providers. Information learned from this investigation will inform policy and messaging for future public health crises. This study is an explanatory sequential mixed methods study designed to capture the voices of parents of children younger than 18 years of age, childcare providers, and youth aged 12-17 years through surveys and interviews. This retrospective cross-sectional study began with a web-based survey that included demographic questions and validated scales to assess personal well-being, household and family dynamics, behavioral problems, and vaccination-related perceptions, attitudes, and behaviors. Open-ended responses about pandemic experiences for themselves and their families were included. A subsample of parents, youth, and childcare providers was selected for in-depth interviews about their pandemic-related experiences. Descriptive statistics were used to summarize demographic characteristics, and internal consistency was assessed for all survey measures using Cronbach α. Future studies will use inferential statistical techniques to analyze survey measures, thematic analysis for open-ended survey responses and interview data, and mixed methods data integration to synthesize quantitative and qualitative findings. Data collection for the study began in August 2022 and finished in August 2023. Data analysis is currently in progress to address research questions, and study preparation and dissemination efforts are underway. A total of 506 adults and 93 youths answered a study survey, and 45 adults and 21 youths completed in-depth interviews. Among the 506 adults, 166 were childcare providers. The adult sample had a mean age of 42.8 (SD 9.15) years and was predominantly female (467/506, 92.3%), with 9.7% (49/506) identifying as Black, 4.7% (24/506) as Hispanic, and 81.2% (411/506) being parents of children aged 17 years or younger. The youth sample had a mean age of 14.5 (SD 1.63) years, and 55.9% (52/93) were female, 6.4% (6/93) were Black, and 17.2% (16/93) were Hispanic. Several dyads and triads participated. The sample included 42 parent-child dyads, 3 parent-parent dyads, 2 parent-parent-child triads, and 21 parent-child-child triads. These data will be used to understand the diverse experiences of families, youth, and childcare providers during and after the COVID-19 pandemic. This includes successful and unsuccessful adaptations, responses to policies and mandates, and the unmet needs for health messaging, programs, policies, and services. This research aims to guide the development of effective policies and public health communication, fostering scalable and sustainable messaging resources. DERR1-10.2196/77521.
20. Characterizing the landscape of pediatric immunization schedules in the US and Europe.
期刊: European journal of pediatrics 发表日期: 2025-Nov-28 链接: PubMed
摘要
Vaccines are a cornerstone of pediatric medicine and public health. However, no prior. studies have described the similarities and differences between the pediatric immunization schedules of different countries. This study sought to characterize the landscape of general pediatric vaccine recommendations for 32 United States (US) and European, primarily high-income countries. In this cross-sectional descriptive study, pediatric vaccine schedules from 32 countries were collected from publicly accessible government websites. All recommendations for normal-risk, non-pregnant children up to and including the age of 18 were considered. 83.3% (20/24) of vaccines identified were included within at least one country’s general pediatric vaccine schedule. Of these, 9 (45%) were recommended by all 32 countries. The total number of vaccines on countries’ schedules ranged from 11 to 18. Twelve of 32 (37.5%) countries’ schedules included at least one mandatory vaccination, with mandate frequency ranging from 7.1% to 93.8%. Among vaccines with general recommendations, 16 (84.2%) had a consistent number of doses across at least 50% of countries that included them. For most shots, there was general agreement about the age of the first recommended dose. However, numerical differences were noted for the meningococcal, Hepatitis B, and coronavirus disease 2019 (COVID-19) vaccines. Conclusion: While pediatric immunization schedules share broad similarities, including consensus on vaccine inclusion and dosing patterns, differences remain regarding mandates and timing. These findings highlight areas for further research to inform evidence-based immunization policies and national recommendations. What is known: •Pediatric immunizations provide long-term public health benefits, including reductions in infectious disease and infant mortality. •There is a relative paucity of studies comparing entire pediatric immunization schedules across countries. What is New: •This study systematically compared pediatric vaccine schedules across 32 countries, identifying which vaccines, doses, and first-dose ages are consistently recommended. •Although broad consensus was identified for many recommendations, our findings also highlight notable differences that illustrate the diversity of national immunization practices.
21. Digital health interventions for informal cancer caregivers' mental health management: a systematic review.
期刊: Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 发表日期: 2025-Nov-28 链接: PubMed
摘要
With the rising global cancer burden and aging population, informal caregivers are increasingly providing care for cancer patients and playing a critical role in the healthcare system. However, the psychological burden placed on these caregivers has become increasingly pronounced. Digital health interventions have demonstrated considerable potential in alleviating this psychological burden. This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, evaluated the mechanisms of action and the effectiveness of existing digital health intervention strategies and aimed at improving the mental health of cancer caregivers, providing evidence-based policy recommendations. A comprehensive literature search yielded 35 studies from 3449 retrieved articles for descriptive statistics and qualitative analysis. The results demonstrated that digital health intervention strategies, including psychoeducation and psychotherapy delivered through technological avenues such as online courses and websites, were effective in reducing depression and anxiety symptoms among cancer caregivers. This study also provided policy recommendations to promote the implementation of digital health interventions for cancer caregivers. These findings have significant implications for enhancing psychological support for cancer caregivers worldwide.
22. The mediating role of job satisfaction in the impact of quality of work life on organizational commitment and job performance.
期刊: Journal of health organization and management 发表日期: 2025-Nov-28 链接: PubMed
摘要
This study investigates the mediating role of job satisfaction in the relationship between quality of work life, organizational commitment and job performance among nurses - a population often overlooked in mediation-based research models. By simultaneously examining two critical outcomes (organizational commitment and job performance), this study proposes a novel framework that integrates quality of work life and job satisfaction into a unified model of occupational well-being and performance. A cross-sectional survey was conducted with 401 nurses employed at a large healthcare campus. Data were analysed using a two-stage mediation model to evaluate both direct and indirect relationships. In the first stage, the direct effects of quality of work life on organizational commitment and job performance were assessed. In the second stage, the mediating role of job satisfaction was tested using bootstrapped confidence intervals. Findings revealed that job satisfaction fully mediates the relationship between quality of work life and organizational commitment, and partially mediates the relationship between quality of work life and job performance. These results suggest that improvements in nurses’ quality of work life enhance organizational commitment and job performance primarily through increased job satisfaction. This study highlights the importance of healthcare administrators and policymakers prioritizing initiatives aimed at improving workplace conditions such as fair compensation, professional support and a positive work environment. Enhancing these factors can promote greater job satisfaction, organizational commitment and performance among nurses, thereby contributing to the overall sustainability and effectiveness of healthcare systems. While previous studies have typically examined the relationships among quality of work life, job satisfaction, organizational commitment and job performance independently or in isolated pairs, this study makes a novel contribution by positioning job satisfaction as a central mediating mechanism within a comprehensive model. Uniquely, the model simultaneously tests two critical outcomes-organizational commitment and job performance - within a single analytical framework. Moreover, by focusing on nurses - an occupational group often underrepresented in mediation-based occupational research - the study enhances its relevance and addresses a significant gap in the literature. By empirically demonstrating how improvements in quality of work life, via job satisfaction, lead to tangible organizational outcomes, the study offers new insights with direct implications for healthcare management and policy development.
23. Exploring the Types and Causes of Stampede-Related Injuries in Religious Mass Gatherings in Asia: A Systematic Review.
期刊: Journal of religion and health 发表日期: 2025-Nov-28 链接: PubMed
摘要
The present study was conducted to identify the types and underlying causes of human stampede incidents resulting in fatalities and injuries during religious mass gatherings. The PRISMA guidelines were followed to conduct this systematic review. The protocol for this review has been registered in PROSPERO under the code CRD42024529095. Relevant studies were extracted from reliable data sources, including PubMed, Scopus, Web of Science, Science Direct, Google Scholar, ISC, SID, and MagIran. Finally, thematic analysis was used to analyze the obtained data. Among the 842 primary studies identified, 22 aligned with the research objectives following the removal of duplicates and screening procedures. The thematic content analysis delineated principal categories: human factors, physical factors, and environmental factors. These categories were further subdivided into eight subcategories: population characteristics, movement of pilgrims, individual attributes of pilgrims, natural factors, man-made factors, social factors, cultural factors, and political factors. Establishing a global database to document human stampedes and their causes can help identify contributing factors and prevent future incidents. Enhancing our understanding of these events, alongside incorporating religious teachings on self-preservation and assisting others, can reduce their likelihood. Educating pilgrims before their journeys may also be an effective strategy.
24. Unraveling the connection between the Mediterranean diet and sleep health: from biological mechanisms to clinical implications.
期刊: Sleep & breathing = Schlaf & Atmung 发表日期: 2025-Nov-28 链接: PubMed
摘要
The Mediterranean diet (Med-Diet) is well known for its protective effects against noncommunicable diseases and overall mortality, thanks to its anti-inflammatory, antioxidant, and neuroprotective properties. Simultaneously, sleep is increasingly recognized as a vital modifiable factor that influences health, affecting both physiological and psychological outcomes. This narrative review summarizes epidemiological evidence on how the Med-Diet impacts sleep duration and quality, examines the biological mechanisms behind these effects, and identifies areas for future research. A comprehensive search was conducted using PubMed, Scielo, Web of Science, CrossRef, Google Scholar, and Scopus. A total of 191 articles published between 2015 and 2025 were selected based on specific inclusion and exclusion criteria. Greater adherence to the Mediterranean diet is associated with better sleep outcomes, such as longer sleep duration, shorter sleep latency, higher sleep efficiency, and a lower risk of insomnia and obstructive sleep apnea, particularly among individuals with an overweight. Mechanistically, the Med-Diet promotes better sleep through various interconnected pathways, including modulation of the tryptophan-serotonin-melatonin pathway, reduction of systemic inflammation and oxidative stress, enhancement of metabolic and cardiovascular health, protection of endothelial and brain function, and regulation of gut microbiota and circadian rhythms. Nutrients like polyphenols, omega-3 fatty acids, and fiber influence neurotransmitter balance, neuroendocrine signaling, and microbial diversity, all of which support sleep and respiratory regulation. The Med-Diet offers a promising non-pharmacological approach to improving sleep health. Further longitudinal and intervention studies are needed to establish causality, assess effects within specific populations, and explore integrated lifestyle strategies, expanding the potential for chronic disease prevention and comprehensive health promotion.
25. Underexplored moderating effects of sex in subjective cognitive decline: A systematic review and evidence gap.
期刊: Journal of Alzheimer’s disease : JAD 发表日期: 2025-Nov-28 链接: PubMed
摘要
BackgroundSubjective cognitive decline (SCD) is considered an early symptom of Alzheimer’s disease (AD) and other types of dementia. Establishing differences between males and females in the presentation and risk factors associated with SCD is critical for utilizing subjective cognitive assessments in prognosticating dementia.ObjectiveWe performed a comprehensive review of studies examining the moderating effect of sex on the association between SCD and relevant physical and/or mental health-related outcomes.MethodsThis study was performed following the PRISMA guidelines. We conducted database search in Medline, Cochrane, Web of Science (WOS), and CINAHL. Primary studies including data of the moderating effect of sex on the association between SCD and different outcomes were selected.ResultsA total of 16 studies were included. We found limited evidence for a moderating effect of sex in SCD. Most of the available literature explored sex differences in SCD for risk of dementia, cognitive performance, competing risk of death, AD biomarkers, basal forebrain resting-state functional connectivity, brain volume, among other health outcomes. Among SCD individuals, females showed increased risk of cognitive decline, dementia and other health outcomes, whereas males showed increased risk of death and longer sickness absence compared to controls.ConclusionsOur comprehensive review denotes a lack of studies directly testing the moderating effect of sex in SCD. The available literature points to sex specific associations between SCD and multiple clinical outcomes. However, in line with the current effort of the SCD initiative, further research is necessary within this emerging topic.
26. Community Partner Input: Improving Usability and Feasibility of a Community Physical Activity Intervention.
期刊: American journal of health promotion : AJHP 发表日期: 2025-Nov-28 链接: PubMed
摘要
PurposeAssess how modifications from community partners changed usability and feasibility (U/F) of a pilot physical activity (PA) intervention.DesignMixed-Methods.SettingMichigan communities that are under-resourced.SubjectsPartners from 13 community-based organizations (n = 7 key informant interviews (KII); n = 12 organization survey responses).InterventionRec-Connect™: A Physical Activity Demonstration Playbook, a community-based PA intervention.MeasuresKIIs (2021) and surveys (2023) assessed what ways and/or to what extent modifications to the PA pilot (e.g., guidance, materials, curriculum, partnerships, PA-based policy, systems, and environmental changes (PSE)) improved implementation.AnalysisContent analysis was applied to KII; descriptive statistics were generated from surveys.ResultsThree primary themes were derived from KIIs which explained how modifications improved U/F: (1) effective communication across and within socio-ecologic spheres transformed U/F and illuminated best practices, (2) explicit community engagement guidance made implementation more responsive to PA needs, and (3) stronger and increased collaborations reduced deterrents to PA. Survey results supported themes and explicated modification benefits, which increased communications with entities (44%), identification of community champions (35%), new partnerships (43%), and new PSE changes to address (43%).ConclusionIncorporating partner modifications improved intervention U/F, enhanced facilitation and engagement practices, and strengthened implementation with organizations and champions. Including partner input resulted in a more transformative PA intervention exemplified by increased partnerships and collaborations to address PSE changes.
27. EXPRESS: Differences in Attitudes among Health Professions Students and Educators toward People Experiencing Homelessness: Novel Correlations with Physical Comfort, Prior Experiences, and Interest in Learning.
期刊: Journal of investigative medicine : the official publication of the American Federation for Clinical Research 发表日期: 2025-Nov-28 链接: PubMed
摘要
People experiencing homelessness (PEH) face significant barriers to primary care, compounded by stigma from healthcare professionals. Health professions education offers a critical window to shape attitudes, yet research suggests these attitudes can worsen during training. A cross-sectional survey at a multi-professional graduate institution assessed attitudes toward PEH among students and educators across seven health professions colleges. Attitudes varied significantly by profession, with osteopathic medicine and graduate nursing reporting more favorable views than pharmacy, veterinary medicine, dental medicine, physician assistant studies, and physical therapy. More positive attitudes were associated with greater physical comfort, more frequent prior experiences with PEH, and higher interest in learning about homelessness. Respondents who expressed interest in receiving more information also scored significantly higher on attitude measures. Findings suggest that targeted, profession-specific educational interventions that emphasize meaningful exposure to PEH may improve comfort and reduce bias. Integrating experiential learning alongside didactic content could foster more holistic, equitable care across disciplines.
28. From initial awareness to sustained involvement: using social and behavioral stage models to better understand engagement in HIV cure efforts in the Netherlands, France, Australia, and sub-saharan Africa.
期刊: AIDS care 发表日期: 2025-Nov-28 链接: PubMed
摘要
HIV remains a persistent global health challenge, emphasizing the urgent need for an effective cure. Meaningful engagement of affected communities is essential for advancing HIV cure efforts. Using stage theories of behavior change, this paper investigated engagement as a dynamic process. Engagement was highlighted with five interconnected stages: awareness, perceived relevance, decision-making, participation, and sustained involvement. These stages were used to understand how individuals and communities engage with HIV cure efforts across diverse contexts. Drawing predominantly, but not exclusively, on our own work in the Netherlands, France, Australia, and plans for work in Sub-Saharan Africa, we identified common patterns and local variations in engagement. Previous research underscored the importance of tailoring engagement strategies to lived experiences and sociohistorical contexts, moving beyond one-way information sharing to foster deeper, more meaningful involvement and engagement. Applying social and behavioral stage models in further interdisciplinary research may help pinpoint key opportunities for intervention and promote sustainable engagement with affected communities. Thus, this structured lens of engagement holds potential to advance the ethical and effective development of HIV cure efforts, ensuring that diverse perspectives shape its future trajectory.
29. Comment on "A Streamline Strategy for Indication and Length of Telemetry Monitoring After TAVR".
期刊: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 发表日期: 2025-Nov-28 链接: PubMed
摘要
30. Maternal allergy and neonatal RSV infection synergize via FcR-mediated allergen uptake to promote the development of asthma in early life.
期刊: Science immunology 发表日期: 2025-Nov-28 链接: PubMed
摘要
Allergic asthma arises from complex genetic and environmental interactions. Analysis of a population-wide registry revealed that infants hospitalized for human respiratory syncytial virus (RSV) bronchiolitis who are born to asthmatic parents have a markedly increased risk of developing asthma. To model this interaction, neonatal mice infected with pneumonia virus of mice (PVM), an RSV analog, before house dust mite (HDM) exposure developed amplified type 2 inflammation and asthma-like pathology. Maternal, but not paternal, HDM allergy intensified disease, implicating vertical transmission of an immune risk factor. Mechanistically, neonatal viral infection up-regulated Fc receptors (FcRs) and promoted maturation of type 2 conventional dendritic cells (cDC2s). Maternal allergen-specific immunoglobulin G (IgG), transferred via neonatal Fc receptor (FcRn), enhanced Fc gamma receptor (FcγR)-mediated allergen uptake and T helper 2 (TH2) cell priming. Preventive RSV immunoprophylaxis blocked asthma development in this setting. These findings identify maternal allergy and neonatal RSV infection as converging FcR-dependent causal asthma risk factors, preventable through immunoprophylaxis.
31. Malaria Screening and Treatment in Hematopoietic Cell Transplant Donors and Sickle Cell Disease Candidates/Recipients: A Case Series Using Malaria Polymerase Chain Reaction Testing and a Literature Review.
期刊: Transplant infectious disease : an official journal of the Transplantation Society 发表日期: 2025-Nov-28 链接: PubMed
摘要
Malaria during hematopoietic stem cell transplant (HCT) poses serious risks. Historically, donors with potential exposure were deferred or treated empirically. Malaria PCR, the most sensitive diagnostic tool, is not routinely used. Patients with sickle cell disease (SCD) and their related donors may be disproportionately affected given endemic exposures and potential occult parasitemia. Performed a single-center retrospective review of malaria screening and outcomes in patients with SCD undergoing allogeneic HCT and their related donors. In addition, reviewed the literature on HCT-related malaria cases. Among 57 HCT donors tested for malaria, three asymptomatic cases were identified. Two were identified prior to donation via blood smears and PCRs, while one-initially screened with smears alone-was diagnosed retrospectively after transmitting malaria to the recipient. Retrospective malaria PCR of the hematopoietic cell product was positive, suggesting the donor’s pre-collection whole-blood malaria PCR may have been positive. Among 52 HCT recipients tested for malaria, two developed peri-HCT malaria-one diagnosed and treated pre-HCT, and another with donor-derived malaria. All cases diagnosed before collection and HCT proceeded successfully after treatment and negative PCR. Literature review identified 10 detailed malaria cases in HCT and two additional series lacking case specifics. Asymptomatic HCT donors and candidates with potential exposure to malaria should undergo screening. Malaria PCR offers greater diagnostic sensitivity than conventional methods. PCR utilization may prevent unnecessary donor deferrals and avoided empiric malaria treatment. Moreover, PCR negativity post-treatment may help confirm donor and candidate eligibility. These observations warrant validation in larger studies.
32. Cytomegalovirus Infection After Chimeric Antigen Receptor T-Cell Therapy or Bispecific Antibody Treatment for Hematologic Malignancies.
期刊: Transplant infectious disease : an official journal of the Transplantation Society 发表日期: 2025-Nov-28 链接: PubMed
摘要
Limited data exists on the incidence of CMV infections after chimeric antigen receptor (CAR) T-cell or bispecific antibody (BsAb) therapy for hematologic malignancies. We reviewed medical records of patients with hematologic malignancies treated with CAR T-cells or BsAbs between July 2018 and October 2024 in a tertiary hospital in Seoul, South Korea. CMV infections were detected using CMV DNA qPCR assays performed within 180 days after CAR T-cell infusion or the last BsAb treatment. Secondary outcomes were the occurrence of clinically significant CMV infections (CS-CMVi) and end-organ diseases. Of 179 patients, 76 (42%) received CAR T-cell therapy, and 103 (58%) received BsAb therapy. The incidence of CMV infection was 62% in BsAb recipients, and 43% in CAR T-cell recipients. Two (6.1% of total CMV infections) CAR T-cell recipients had CS-CMVi, and 1 (3.0%) developed possible CMV pneumonia. In the BsAb group, 10 (16% of total CMV infections) patients received antiviral therapy, and 4 (6.3%) had end-organ diseases. Receiving three or more previous systemic chemotherapy regimens in the CAR T-cell group was associated with increased CMV infection risks (HR 4.7, 95% CI 1.88-11.8, p < 0.001), and older age in the BsAb group had a trend toward having more CMV infection (HR 1.02, 95% CI 1.00-1.05, p = 0.06). Approximately 43% and 62% of patients receiving CAR T-cell and BsAb therapy had CMV infection, with 1%-4% developing CMV diseases. Effective strategies for preventing CMV infections in these patients are warranted.
33. Predictors of Atrial High-Rate Episodes and Inappropriate Device Therapy in Implantable Cardioverter Defibrillators.
期刊: Pacing and clinical electrophysiology : PACE 发表日期: 2025-Nov-28 链接: PubMed
摘要
Implantable cardioverter defibrillator (ICD) therapy can prevent sudden cardiac death, but poses a risk of inappropriate device therapy (IDT), which is linked to worse outcomes and reduced quality of life. On the other hand, ICDs can function as an early warning system for atrial arrhythmias. This study aimed to predict which patients are at risk of IDT and who develop atrial high-rate episodes (AHRE) by investigating pre-implant clinical parameters. Patients who received an ICD with an atrial lead between 2010 and 2019 were included in a prospective registry. Over 5.3 ± 3.0 years, 136 of 413 patients received appropriate device therapy, and 36 patients received IDT. Univariate cox regression analyses on 40 parameters were performed, followed by forward multivariate cox regression. The best predictive model (Harrell’s C-index 0.785) included secondary prevention ICD, ischemic CMP (iCMP), CMP not classified as ischemic, hypertrophic or dilated (uCMP), and diuretic use as risk factors, with mineralocorticoid receptor-antagonists (MRA) use and diabetes as protective factors. Surprisingly, AF was not a predictor of IDT. Among 313 patients without prior AF, 136 developed AHRE. Similar cox regressions predicted AHRE development, resulting in a model (Harrell’s C-index 0.663) based on age, left ventricular ejection fraction (LVEF), hypertrophic CMP (hCMP), family history of cardiovascular disease (CVD), and hypercholesterolemia. This study identified six factors that influence the risk of IDT, and five other factors as risk factors for developing AHRE. Pre-implant assessment of these variables can help to better inform patients of the potential benefits and risks.
34. Complete genome sequences of two Cressdnaviricota viruses identified in respiratory tract samples from forest musk deer in China.
期刊: Microbiology resource announcements 发表日期: 2025-Nov-28 链接: PubMed
摘要
We identified two circular single-stranded DNA viruses from forest musk deer in China through metagenomic analysis. Phylogenetic results suggest they represent unclassified Cressdnaviricota lineages. This study highlights the diversity of the deer’s respiratory virome and underscores the importance of wildlife virus surveillance for conservation and public health.
35. An Open-Road Driving Performance Task to Examine Long-Term Medical Marijuana Use and Prescription Opioid Positivity Among Adults Aged 50 Years and Older: Protocol for an Observational Trial.
期刊: JMIR research protocols 发表日期: 2025-Nov-28 链接: PubMed
摘要
Driving performance involves multiple underlying components of psychomotor functioning, such as attention, executive functions, and vehicle control. While the effects of acute medical marijuana and prescription opioid intoxication are known, how long-term use of medical marijuana under real-world conditions affects driving performance is unknown. Additionally, there are numerous ongoing physical and cognitive changes that affect driving performance with age. Given the proliferation of medical marijuana and prescription opioid use in adults aged 50 years and older, the prevalence of polypharmacy, and declining functional abilities, it is imperative to understand the long-term effects of daily medical marijuana use. Further, we need to understand how co-occurring use of medical marijuana and prescription opioids, in the presence of comorbidities such as chronic pain, affects real-world driving outcomes. This study aims to document the observational trial protocol. The primary goal of this study is to identify the effects of daily long-term (ie, use for >12 months daily or most days of the week) medical marijuana use on driving performance outcomes using an open-road driving performance task under real-world conditions in adults aged 50 years and older who endorse chronic or severe nonmalignant pain and to examine the combined effect of daily long-term medical marijuana use and prescription opioid use on driving outcomes. A secondary goal is to qualitatively explore self-regulation of medical marijuana and prescription opioid use in this population. We plan to test medical marijuana use as the exposure variable in adults aged 50 years and older on an open-road driving task performance as the primary outcome. The study will detail tetrahydrocannabinol exposure through ecological momentary assessment and urinalysis and will compare performance with a race-sex-matched group of non-marijuana users. This study is funded by a grant from the National Institute on Drug Abuse (5R01DA057965). Recruitment began on May 19, 2025. As of November 2025, a total of 30 participants had been enrolled. Recruitment is anticipated to be completed by 2029. Publication of the complete results and data from this study is expected by 2030. Data from this study will identify the effects of long-term medical marijuana use and the combined effect of that use with prescription opioids to develop risk screening protocols and intervention targets for this population. The development and dissemination of screening and intervention guidelines will be the next step in this work. ClinicalTrials.gov NCT06995937; https://www.clinicaltrials.gov/study/NCT06995937. DERR1-10.2196/77944.
36. Overview of the prevalence of job satisfaction and turnover intention among emergency medical services personnel: a meta-analysis.
期刊: Journal of global health 发表日期: 2025-Nov-28 链接: PubMed
摘要
Emergency medical services (EMS) personnel, including paramedics, emergency medical technicians (EMTs), and firefighters are subjected to substantial occupational stressors that diminish job satisfaction and increase turnover rate, ultimately affecting efficient delivery of pre-hospital emergency care. Therefore, we performed the first meta-analysis to determine the prevalence of job satisfaction and turnover intention among EMS personnel, including paramedics, emergency medical technicians (EMTs), and firefighters. We comprehensively searched Web of Science, PubMed, Cochrane Library, Embase, and EBSCOhost until March 2025. The pooled prevalence of job satisfaction and turnover intention was analysed using the Freeman-Tukey double-arcsine transformation model in R software. Cochran’s Q and statistics assessed heterogeneity and subgroup analysis explored moderator variables. A total of 25 studies with 59 562 EMS personnel were included. The pooled prevalence of job satisfaction was 63% (95% confidence interval (CI) = 53%, 72%), with estimates of 71% for EMTs, 62% for firefighters, and 54% for paramedics. Job satisfaction was 56% during the COVID-19 pandemic and 65% in the pre-pandemic period. The pooled prevalence of turnover intention was 29% (95% CI = 24%, 36%), with estimates of 28% for paramedics, 22% for EMTs, and 17% for firefighters. Turnover intention was 34% during COVID-19 pandemic and 27% in the pre-pandemic period. Approximately, 63% of EMS personnel report job satisfaction, while 29% express intent to leave the profession. Mental health support, workload management, and professional development opportunities should be promoted among EMS personnel to further enhance job satisfaction and mitigate turnover intention. PROSPERO: CRD420251027283.
37. The blue nexus unveiled: Interlinking marine pollution, circular economy, and the blue economy in ocean sustainability.
期刊: Marine pollution bulletin 发表日期: 2025-Nov-27 链接: PubMed
摘要
The circular economy has emerged as a transformative framework in environmental research, promoting resource efficiency, waste reduction, and sustainable production-consumption cycles-crucial for addressing marine pollution challenges. The growing urgency of marine environmental degradation and the global shift toward a sustainable blue economy have driven interdisciplinary research linking ocean health and economic development. This study conducts a bibliometric analysis of 3261 Scopus-indexed publications (1990-2025), focusing on the thematic convergence of marine pollution and blue economy discourses. Using keyword co-occurrence mapping, the analysis identifies major research clusters related to marine contaminants, wastewater treatment technologies, circular economy practices, environmental economics, and marine governance. Results reveal three dominant thematic domains: (1) marine and coastal pollution, including plastic debris, oil spills, and harmful algal blooms; (2) sustainability and life cycle approaches tied to economic valuation and waste management; and (3) ocean policy, ecosystem services, and climate resilience. Central cross-cutting terms-such as sustainability, monitoring, and ecosystem valuation-highlight the field’s integrative nature. A thematic literature review further synthesised interdisciplinary insights. This study proposes an Integrated Marine Sustainability Framework (IMSF) linking marine sustainability outcomes to key drivers-pollution, technology, and policy-moderated by governance and stakeholder engagement. It underscores circular economy and blue economy strategies to minimize marine pollution, ensuring environmental protection, economic growth, and effective, integrated ocean management for sustainable development. This study contributes to a deeper understanding of the knowledge structure and priorities in marine environmental science, offering insights for policy alignment, academic collaboration, and future research on sustainable ocean development.
38. Feasibility of the Social Media-Based Prevention Program "Leduin" for German Adolescents on Instagram: Mixed Methods Pilot Study.
期刊: JMIR formative research 发表日期: 2025-Nov-27 链接: PubMed
摘要
Digital platforms, particularly social media, including Instagram, present unique opportunities for health promotion among adolescents due to their widespread use with interactive features supporting high user engagement. However, the feasibility of effectively utilizing platforms like Instagram for health interventions requires careful consideration of adolescent engagement patterns. This pilot study evaluated the leduin program-designed to foster essential life skills and functional social media use among adolescents-while also exploring the broader feasibility of using Instagram to deliver complex social and psychological interventions in this population. The study adapted the feasibility framework by Bowen et al and used a mixed methods approach. Quantitatively, Instagram interaction metrics of 99 participants (women: 62/99, 63%; men: 37/99, 37%; aged 14-18 years; mean age 15.2, SD 0.74 years) were analyzed descriptively (means, medians, SDs) and inferentially (Welch ANOVA, Kruskal-Wallis, Pearson and Spearman correlations, linear and segmented regression analyses) using RStudio. Metrics included story views, retention rates, feature engagement (eg, polls, question stickers, quizzes), and drop-off rates. Recruitment efforts were also analyzed descriptively. Qualitatively, 13 postprogram semistructured interviews were conducted with 11 women (11/13, 65%) and 6 men (6/13, 35%; mean age 15.29, SD 0.99 years). Participants were sampled to reflect varying engagement levels (6 high, 5 medium, 6 low). The mean interview duration was 25 minutes 11 seconds (SD 6 minutes 34 seconds). Content analysis, with high intercoder reliability (κ=0.90), comprehensively explored participants’ experiences and the program’s impact. Quantitative results indicated that the recruitment process was challenging, with 101 schools and 10 youth centers contacted, resulting in a participation rate of 12.8% (99/775 students). On Instagram, story views ranged from 34 to 81 per post, with an average daily retention rate of 87.7% (SD 7.8%). By week 4, 76% of the total drop in views had occurred (mean views declined from 66.1 to 53.4); by week 6, 97.3% of the drop had been reached (declined from 66.1 to 49.9 views), indicating sustained viewer interest over the 14-week program. Features requiring minimal user effort, including polls (mean 56.8%-54.4%), quizzes (mean 56.6%), and sliders (mean 51.2%), showed significantly higher interaction rates than more demanding features such as challenges (mean 21.7%) and question stickers (mean 20.6%; P<.001). Qualitative findings revealed that adolescents valued the program, its design and methods for its relevance to their daily lives, and its support in developing essential life skills. Suggestions for improvements were made. The study underlines the potential of various Instagram features and content posting schedules for health interventions to meet adolescent preferences and interests. Challenges with reaching the target group effectively emphasize the need for targeted recruitment strategies and optimizing initial content to boost engagement, underscoring the critical implications for prevention research and policy in leveraging digital platforms to enhance adolescent health.
39. Anchoring single-atom iron sites onto carbon spheres for boosting electrochemical sensing of bisphenol A.
期刊: Talanta 发表日期: 2025-Nov-27 链接: PubMed
摘要
Bisphenol A (BPA), a common endocrine-disrupting chemical, poses serious threats to both ecological systems and human health even at trace concentrations. However, the accurate detection of BPA in complex matrices remains challenging due to the low sensitivity and poor selectivity of conventional electrochemical sensing platforms. The saturated N4-coordinated single-atom sites derived from metal phthalocyanines exhibit high catalytic specificity and atomic utilization efficiency, enabling selective recognition of BPA. These characteristics enhance adsorption and electron transfer processes, potentially overcoming the limitations of traditional sensing materials and offering a feasible route for the ultra-sensitive detection of trace BPA in complex environments. In this study, we have developed a highly efficient electrochemical sensor for BPA by anchoring saturated N4-coordinated single-atom sites of metal phthalocyanine onto carbon spheres (MPc/CSs, where M = Fe, Co, and Ni). The carbon spheres (CSs) serve as substrates to support the metal phthalocyanine molecules, improving the stability of the active sites and preventing aggregation. Among the materials tested, FePc/CSs exhibited the highest sensitivity (0.53 μA μM-1) and the lowest limit of detection (0.031 μM), exhibiting better performance than other modified electrodes, including CoPc/CSs, NiPc/CSs, and metal-free phthalocyanine-loaded CSs (H2Pc/CSs). Structural analysis revealed that the Fe-N4 single-atom sites possess higher charge density than the Co-N4 and Ni-N4 single-atom sites, resulting in their superior catalytic activity. Practical validation of the FePc/CSs modified glassy carbon electrode (GCE) in real samples, such as supermarket receipts and plastic products, yielded satisfactory recovery rates (97.5-103.4 %), confirming the sensor’s reliability in complex matrices. These results demonstrate that electrodes based on CSs-supported single-atom iron sites can serve as highly sensitive, selective, and cost-effective electrochemical sensors for BPA. Overall, this work provides an efficient strategy for designing high-performance environmental sensors based on engineered electronic microenvironments and offers valuable insights for the sensitive analysis of environmental pollutants.
40. Polycyclic aromatic hydrocarbons in the surface sediments of China's Eastern Beibu gulf: Unveiling distribution patterns, tracing sources, and evaluating risks.
期刊: Marine pollution bulletin 发表日期: 2025-Nov-27 链接: PubMed
摘要
This study focuses on the eastern Beibu Gulf in Guangxi, China, aiming to deeply analyze the pollution status of polycyclic aromatic hydrocarbons (PAHs) in the surface sediments of this sea area. During the research, surface sediment samples were collected from 12 stations, and the contents of 16 PAHs in them were determined. Diagnostic ratio methods, principal component analysis (PCA), sediment quality benchmark method, toxicity equivalent factor (TEF) method, and risk quotient (RQ) method were comprehensively applied to conduct a comprehensive study on their distribution characteristics, sources, and risks. The results show that the pollution degree of PAHs in this sea area is at a low-to-medium level. The total concentration range is 82.05-98.63 ng·g-1, with an average value of 91.46 ng·g-1. In terms of composition, it is mainly dominated by three - and four - ring PAHs, resulting in a relatively low overall toxicity risk. Through source analysis, it is found that PAHs mainly come from biomass and coal combustion, and there is also a small contribution from petroleum and its combustion processes. Through comprehensive analysis by multiple risk assessment methods, the ecological risk of PAHs in this sea area is at a low level. The results of this study provide crucial data support and scientific basis for environmental management, pollution prevention and control, and ecological protection in the eastern Beibu Gulf, and are of great significance for promoting the sustainable development of this area.
41. Exploring the types of assistive devices and methodological issues in children with developmental coordination disorder: A scoping review.
期刊: Research in developmental disabilities 发表日期: 2025-Nov-27 链接: PubMed
摘要
To comprehensively map the types of assistive devices implemented for children with developmental coordination disorder (DCD), regardless of setting, and clarify the methodologies used in these interventions. Specifically, we sought to answer the following questions: (1) What types of assistive devices are available for children with DCD? (2) What is known about the targeted participants, the purpose of using assistive devices, programs implemented, evaluations and results? (3) What are the current limitations of assistive devices, such as lack of tools for fine motor skills, limited focus on daily activities, and insufficient consideration of DCD pathophysiology? This study’s methodology was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. We screened articles, including RCTs, before-and-after comparisons, and single case studies published by May 10, 2024, using PubMed, Web of Science, Medline, and Cochrane Library databases. We identified 546 English-language articles, of which 51 were included in the final eligibility criteria. We found that active video games, virtual reality, personal computer games, tablets, electronic pens, and robots served as assistive devices that can be used at home. Upon categorizing assistive devices based on their target symptoms (gross motor, fine motor, cognitive, and psychological), we observed that few types of assistive devices related to fine and coordinated movements, and none was designed based on the neurodevelopmental characteristics of DCD, such as impairments in motor planning, internal modeling, or brain function. We identified assistive devices used in DCD interventions, including several applicable to home settings. However, most devices targeted gross motor skills, with relatively few addressing fine hand motor movements. In the future, it is necessary to develop assistive devices that consider intervention models focusing on DCD pathophysiology and daily life.
42. Quantification and visualization of micro- and nano-plastics transfer from maternal to fetal: A rat model study.
期刊: Journal of hazardous materials 发表日期: 2025-Nov-26 链接: PubMed
摘要
Micro- and nano-plastics (MNPs) are emerging pollutants, with growing evidence suggesting the presence of MNPs in human tissues. However, there is a notable lack of quantitative data regarding the maternal-embryonic transfer of MNPs. In this study, rats were utilized as model animals and were orally exposed to europium-labeled nanoplastics (Eu-NPs, 0.2 μm) and microplastics (Eu-MPs, 2 μm) over 18 days, from gestation day 0.5 to day 18.5. High-angle annular dark-field scanning transmission electron microscopy and inductively coupled plasma mass spectrometry were employed to qualitatively and quantitatively track the maternal-fetal transfer of MNPs. The results indicate that the transfer of MNPs from the placenta to the fetus exhibits size-dependent. Specifically, the transfer rate from the placenta to fetus reached 0.48 %, significantly higher than that of Eu-MPs. Notably, MNPs underwent deformation and fragmentation during in vivo transfer. The study also demonstrated that MNPs primarily accumulated in the rat decidua, where they compressed capillaries, potentially impairing fetal growth. These findings provide new insights into the maternal-fetal transfer of MNPs and offer a novel perspective for further investigating the impact of MNPs on maternal and fetal health.
43. The Effectiveness of AI Chatbots in Alleviating Mental Distress and Promoting Health Behaviors Among Adolescents and Young Adults: Systematic Review and Meta-Analysis.
期刊: Journal of medical Internet research 发表日期: 2025-Nov-26 链接: PubMed
摘要
The prevalence of mental distress and health risk behaviors among adolescents and young adults has emerged as a pressing public health concern. Artificial intelligence (AI) chatbots have been increasingly recognized for their potential to provide scalable and accessible mental health support and health education; however, questions remain about their effectiveness in addressing the unique challenges faced by adolescents and young adults. This study aimed to synthesize evidence from randomized controlled trials (RCTs) on the effectiveness of AI chatbots in alleviating mental distress and promoting health behaviors among adolescents and young adults. Eight databases (PubMed, PsycINFO, Cochrane Library, CINAHL, Embase, Web of Science, Scopus, and IEEE Xplore) were searched for RCTs published in English between January 1, 2014, and January 26, 2025. Eligible studies assessed the effects of AI chatbots on mental distress and health behavior outcomes among adolescents and young adults (15-39 years). Extracted data were synthesized narratively or meta-analyzed as appropriate; subgroup and meta-regression analyses were performed to explore moderators of chatbot effectiveness. Risk of bias was evaluated using the revised Cochrane risk-of-bias 2 (RoB 2) tool for randomized trials. Evidence quality was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Out of 2495 records retrieved, 31 RCTs were included, comprising 29,637 participants; 26 studies were eligible for meta-analysis. Overall, AI chatbots demonstrated small-to-moderate effects in mitigating mental distress (standard mean difference [SMD] -0.35, 95% CI -0.46 to -0.24; P<.001) and promoting health behaviors (SMD 0.11, 95% CI 0.03 to 0.19; P=.006) in adolescents and young adults. Significant improvements were observed for depressive (SMD -0.43, 95% CI -0.62 to -0.23; P<.001), anxiety (SMD -0.37, 95% CI -0.58 to -0.17; P<.001), stress (SMD -0.41, 95% CI -0.50 to -0.31; P<.001), and psychosomatic symptoms (SMD -0.48, 95% CI -0.82 to -0.14; P=.006); negative affect (SMD -0.27, 95% CI -0.53 to -0.01; P=.04); and self-ambivalence and appearance distress (SMD -0.25, 95% CI -0.34 to -0.17; P=.01). While AI chatbots contributed to modest enhancements in life satisfaction and well-being, their impacts on positive affect and self-efficacy were limited. The effectiveness of AI chatbots varied depending on target samples, control conditions, and design features such as dialog system methods, deployment formats, and the use of reminders. User engagement emerged as a critical factor for success, with repetitive content and technical issues noted as primary barriers to adherence. This systematic review and meta-analysis highlights the potential of AI chatbots to address mental health challenges and promote health behaviors among adolescents and young adults. Retrieval-based dialog systems demonstrated consistent and reliable effects, while generative systems showed promise, but their overall effectiveness was inconclusive. Future research should prioritize developing safety protocols and evaluation frameworks for generative systems and validating their long-term impacts on mental health and behavior change in adolescents and young adults.
44. Digital Health Technology Adoption Among Chinese Physicians: Latent Profile Analysis and Cross-Sectional Study.
期刊: Journal of medical Internet research 发表日期: 2025-Nov-26 链接: PubMed
摘要
Digital health technologies (DHTs) are transforming global health care delivery, yet physician adoption remains highly variable and influenced by a complex interplay of individual, institutional, and technological factors. In China, despite national initiatives such as the “Healthy China 2030” strategy promoting DHT integration, understanding physicians’ heterogeneous perceptions is essential for effective implementation. This study aimed to identify distinct latent profiles of Chinese physicians based on their perceptions of DHT benefits, barriers, and behavioral intention, and to examine the demographic and occupational factors associated with profile membership. A cross-sectional survey was conducted among 4851 physicians (female, n=2994, 60.69% ; mean age 38.4, SD 8.7 years; 51.58% (n=2502) with more than 10 y working experience) from 46 hospitals in Shaanxi Province, China, between October and December 2023. Assessment included nine indicators across three domains: Perceived Benefits (4 items), Adoption Barriers (4 items), and Behavioral Intention (1 item). Latent profile analysis was used to identify distinct subgroups of physicians based on their response patterns. Multinomial logistic regression examined predictors of profile membership, and results were reported as odds ratios (ORs) with 95% CIs. The latent profile analysis identified 5 distinct profiles: Reform-Adaptable (n=516, 10.64%; 95% CI 9.76%-11.52%), Negative (n=1003, 20.68%; 95% CI 19.50%-21.86%), Neutral (n=2276, 46.92%; 95% CI 45.50%-48.34%), Reform-Conservative (n=545, 11.23%; 95% CI 10.33%-12.13%), and Positive (n=511, 10.53%; 95% CI 9.66%-11.40%). Significant intergroup differences were observed in demographic and occupational characteristics. For instance, compared with the Negative profile, male physicians were less likely to belong to the Neutral (OR 0.76, 95% CI 0.64-0.90; P=.001) and Reform-Conservative (OR 0.67, 95% CI 0.54-0.84; P=.001) profiles. Compared to the Neutral profile, physicians with a master’s degree or above were less likely to be in the Reform-Conservative profile (OR 0.75, 95% CI 0.59-0.96; P=.052). Those working in tertiary hospitals were less likely to belong to the Positive group (OR range 0.56-0.66, P=.001). High-income physicians were more likely to be in the Reform-Conservative group (OR range 1.83-2.38, P=.001). In addition, higher occupational stress was associated with a greater likelihood of Positive profile membership (OR range 1.12-1.26, P=.001), while better work satisfaction predicted higher odds of Positive profile membership (OR range 1.04-1.16, P=.001). This study introduces a novel, person-centered approach by identifying five distinct perceptual typologies among physicians, moving beyond traditional variable-centered analyses. This typology provides an evidence-based foundation for tailored interventions. For instance, the Reform-Adaptable group may need barrier reduction, while the Reform-Conservative group may require clearer value demonstrations. This nuanced understanding can help healthcare systems enhance the impact and scalability of digital health technologies in real-world clinical practice.
45. Prenatal exposure to PFAS, associations with child cognitive ability and modification by maternal Vitamin D status: The MABC study.
期刊: Journal of hazardous materials 发表日期: 2025-Nov-24 链接: PubMed
摘要
Prenatal per- and polyfluoroalkyl substances (PFAS) exposure may adversely influence neurodevelopment. However, few studies have considered whether cumulative PFAS exposure over the entire course of pregnancy impacts child cognitive development and whether nutritional factors modify these associations. To investigate whether Vitamin D status modifies the association between maternal PFAS exposure during pregnancy and child cognitive ability. This analysis used 728 mother-child pairs in the Ma’anshan Birth Cohort (MABC), a population-based Chinese birth cohort enrolled from 2013 to 2014. We measured and averaged serum PFAS and Vitamin D concentrations during the first, second, and third trimesters of pregnancy. Child cognitive ability was assessed at age 2.7-6.0 years using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition. We used linear regression, Bayesian kernel machine regression, and quantile g-computation to estimate covariate-adjusted associations of individual PFAS concentrations and their mixture with child cognitive scores. Analyses were stratified by sex to examine sex-specific associations between PFAS and child cognitive scores, with further stratification by categorizing maternal Vitamin D levels into deficient (<20 ng/mL, n = 636) and non-deficient (≥ 20 ng/mL, n = 92) groups. Overall, the pregnancy average of br-PFOA concentrations was inversely associated with VCI scores (β = -1.72, 95 %CI: -3.43, -0.02), 8:2 Cl-PFESA was inversely associated with VSI scores (β = -1.21, 95 %CI: -2.30, -0.11), and n-PFHxS was inversely associated with WMI scores (β = -2.19, 95 %CI: -4.35, -0.03). Generally, PFAS were associated with lower cognitive scores in boys, but not girls. Further, the PFAS mixture was negatively associated with boys’ total cognitive scores (β = -1.94, 95 %CI: -3.69, -0.19), with br-PFOA and n-PFHxS having the greatest weights; in contrast, PFHpS was the major contributor to the positive association of the PFAS mixture with cognitive scores in girls. After stratifying by maternal Vitamin D status, adverse associations were primarily observed in the deficient group among boys, whereas positive associations were present only in the deficient group among girls. Specifically, associations of cognitive scores with n-PFOA, br-PFOA, PFNA, n-PFHxS, and br-PFHxS were significantly stronger among boys born to women with Vitamin D deficiency (Range of betas=-4.73 to -2.04, P < 0.05) than those with sufficient levels of Vitamin D (Range of betas=-3.81-1.52, P > 0.05). The PFAS mixture was negatively related to child cognitive ability in boys, where each quartile increase in the mixture was associated with boys’ VCI, VSI, WMI, and FSIQ scores decreased by 2.77, 2.21, 2.57, and 1.94 scores, respectively (all p-FDR < 0.05). We observed sex-specific adverse associations between prenatal PFAS and cognitive ability. Our findings suggest that prenatal Vitamin D may modify these associations, potentially mitigating the neurotoxic effects of prenatal PFAS exposure.
46. Predictors of primary postpartum hemorrhage among middle eastern postpartum women with vaginal delivery: A retrospective matched case-control study.
期刊: Midwifery 发表日期: 2025-Nov-24 链接: PubMed
摘要
Primary postpartum hemorrhage (PPH) remains a major contributor to maternal morbidity and mortality globally. Despite improvements in maternal healthcare across the Middle East, the burden of PPH persists, and regional data on its predictors remain limited. This study aimed to examine the maternal and health service-related predictors of primary PPH among Middle Eastern women with vaginal delivery in Oman. A retrospective matched case-control study was conducted among 483 postpartum women who delivered vaginally at three hospitals in Oman between May 2022 and May 2024. Cases (women with PPH, ≥500 mL blood loss) were matched 1:2 with controls based on maternal age, parity, and pregnancy type. Demographic, maternal, and health service-related factors were obtained from medical records and standardized forms in collaboration with unit head nurses.” Data were analyzed using descriptive statistics, univariate analyses, and logistic regression (p < 0.05). The prevalence of primary PPH was 10.4 %. No significant sociodemographic differences were observed between cases and controls. Logistic regression identified six significant predictors, including retained placenta (OR = 6.484), cervical tears (OR = 48.058), perineal tears (OR = 1.473), episiotomy (OR = 2.056), anticoagulant use (OR = 2.193), and mode of delivery (OR = 1.412). The highest PPH incidence occurred at the AXXX Hospital (28.58 %), which may reflect differences in service capacity and staffing. This multi-center case-control study strengthens evidence on PPH predictors in this under-researched region. Both maternal and health service-related factors were associated with increased risk of primary PPH. Emphasis on targeted postpartum assessments, preventive measures such as selective episiotomy and perineal support during delivery, and improved clinical documentation is warranted. Policy-level actions, including investments in workforce capacity and service delivery, may further reduce PPH and improve maternal outcomes in Oman and comparable contexts.
47. Prevalence and associated plasmid resistant genome of ESBL and AmpC producing commensal E. coli isolated from lactating cows and pre-weaned calves on dairy farms in Western Australia.
期刊: Preventive veterinary medicine 发表日期: 2025-Nov-24 链接: PubMed
摘要
This study aimed to determine the prevalence and associated plasmid resistant genome of extended spectrum β-lactamase (ESBL) and Ambler class C cephalosporinase (AmpC) producing commensal Escherichia coli, using a targeted pDNA approach, from lactating cows and pre-weaned calves on dairy farms in Western Australian (WA). Following culture and modified double disc diffusion, ESBL and/or AmpC producing commensal E. coli were isolated from faecal samples and phenotypic antimicrobial resistance (AMR) determined. Plasmid DNA (pDNA) was extracted, amplified, and sequenced to identify the AMR and replicon composition. Phenotypic analysis of 1117 faecal samples from 26 Western Australian dairy farms revealed a low overall prevalence (7.3 %) of ESBL and/or AmpC-producing commensal E. coli, with 3.2 % in cows (n = 633) and 12.8 % in calves (n = 484). All isolates were classified ‘non-wildtype’ for ampicillin and ceftiofur, with 95.1 % classified as ‘non-wildtype’ multidrug resistant (MDR). While blaTEM was common in the pDNA (total: 60.6 %; cow: 76.9 %; calf: 57.7 %), a total of 13 AMR genes were identified across 126 plasmids (cow: n = 30; calf: n = 96) isolated. Multiple correspondence analysis (with chi-square-based 95 % confidence ellipses) showed variation in pDNA AMR genes and replicons by farm, with generally distinct plasmid profiles, though some clustering suggests possible farm-to-farm plasmid transmission. In conclusion, though low in prevalence, ESBL and/or AmpC producing commensal E. coli having high phenotypic AMR, MDR, and pDNA diversity were isolated from dairy cattle on 65.4 % of screened farms.
48. pH-switchable vortex-assisted liquid-liquid microextraction using hydrophobic eutectic solvents for the extraction of phthalate esters from water, fruit juice, and milk samples.
期刊: Food chemistry 发表日期: 2025-Nov-24 链接: PubMed
摘要
Phthalate esters (PAEs) are widely used in the plastic industry, but their accumulation in living organisms raises concerns, necessitating ongoing monitoring. This study explores the application of switchable hydrophobic eutectic solvents (HESs) for the sustainable extraction of PAEs. Among different HESs tested, an equimolar thymol: octanoic acid mixture demonstrated the highest potential in extracting PAEs from water, fruit juice, and milk samples, achieving recoveries of 91 % to 108 %. Calibration was linear over the concentration range of 1-300 μg/L, with detection limits of 0.3-1.0 μg/L under the extraction conditions optimized using Box-Behnken design. The method provided enrichment factors in the range of 138-152. We also evaluated the interactions between the selected HES and the target PAEs using quantum chemistry. The environmental impact of the proposed method was evaluated using the GREENness metric tools, including AGREE and AGREEprep. The results revealed that this microextraction method can be a sustainable alternative for determining PAEs.
49. Acute toxicity, behaviour, metabolism, and transcriptomic points of departure in embryo-larval zebrafish exposed to nine different PFAS.
期刊: Journal of hazardous materials 发表日期: 2025-Nov-24 链接: PubMed
摘要
Most per- and poly-fluoroalkyl substances (PFAS) lack toxicity data, and the hazards associated with different PFAS chemical structures have not been systematically assessed using in vivo models. To address this gap, we compared the toxicity of nine PFAS in embryo-larval zebrafish, an emerging alternative to conventional in vivo models. Exposures were conducted from 0 to 5 days post-fertilization with semi-static renewal. We then evaluated three apical toxicity endpoints (developmental toxicity (mortality/malformation), swimming behaviour, and metabolic activity) alongside gene expression changes using high-throughput transcriptomics. These data were used to derive apical and transcriptomic points of departure (aPODs and tPODs, respectively). Transcriptomic benchmark concentration modeling in BMDExpress v3.2 was performed to derive tPODs using multiple approaches. Overall, PFAS potency increased with longer fluorinated carbon chain lengths and was greater for PFAS containing sulfonic groups. tPODs were generally the most sensitive endpoints, typically falling within a 10-fold range below aPODs. Our results support previous findings that tPODs provide suitably conservative PODs for chemical toxicity assessment. Our results contribute new data on PFAS early-life stage toxicity and demonstrate an economical and ethically viable high-throughput platform for systematic evaluation of chemical hazards and potencies for risk assessment applications.
50. Hepatotoxicity of Huangdujuangen mediated by mTOR/p53/FOXO pathways in zebrafish; insights from Integrated multi-omics and network pharmacology.
期刊: Phytomedicine : international journal of phytotherapy and phytopharmacology 发表日期: 2025-Nov-23 链接: PubMed
摘要
“Huangdujuangen (HDJG)”, composed of the roots of Rhododendron molle G. Don, is a traditional Chinese medicine that is widely known for its promising therapeutic potential for a wide range of diseases. Nevertheless, the potentially hepatotoxic properties of this substance have raised considerable public health concerns and warrant more in-depth investigation. Currently, the specific toxic constituents and the underlying mechanisms are still poorly understood. This experiment aimed to investigate the potential mechanisms underlying hepatotoxicity induced by HDJG. Zebrafish at 4 days post-fertilization were employed as an experimental model, wherein water extracts (WE) and alcoholic extracts (AE) of HDJG were administered at varying concentrations. Hepatotoxic effects were evaluated through a comprehensive assessment of liver phenotypes, histopathological alterations, and biochemical parameters. To unravel the principal chemical constituents, potential targets, and associated signaling pathways related to hepatotoxicity, a combination of Ultra-high performance liquid chromatography coupled with quadrupole electrostatic field orbitrap mass spectrometry (UHPLC-Q-Exactive Orbitrap MS) and network pharmacology approaches was systematically employed. Moreover, integrated transcriptomic, proteomic, and molecular biological techniques were harnessed to explore the underlying toxic mechanisms at both the gene and protein expression levels. The findings of acute toxicity studies revealed that the AE of HDJG exhibited markedly greater toxicity than its water-based counterpart. This heightened toxicity was predominantly manifested through elevated mortality rates, pronounced morphological changes, abnormal fluctuations in liver enzyme levels, and substantial alterations in tissue architecture. A total of 169 bioactive constituents were identified within the AE. Of these, 103 compounds were confirmed to be absorbed into the circulatory system, where they interacted with 558 molecular targets and influenced 204 distinct signaling pathways. Multi-omics in-depth analysis indicated that HDJG primarily perturbed the mTOR signaling pathway, the p53 signaling cascade, and the FOXO signaling network, ultimately inducing significant hepatic cellular injury. This study demonstrated that HDJG has the notable capacity to activate the mTOR/p53/FOXO signaling pathway, thereby intricately disrupting key biological processes such as autophagy, apoptosis, and oxidative stress, which collectively contribute to the development of hepatotoxic effects. These findings offer a solid theoretical foundation and meaningful reference for the safety evaluation and appropriate clinical application of HDJG.
51. Infectious morbidity associated with early amniotomy during labor induction.
期刊: European journal of obstetrics, gynecology, and reproductive biology 发表日期: 2025-Nov-20 链接: PubMed
摘要
This study’s purpose was to determine if an early amniotomy increased the risk of maternal and neonatal infectious morbidity when compared with late amniotomy. This was a single-center retrospective cohort study performed between 1/1/2010 and 3/31/2018. It assessed the relationship between eligible term women undergoing labor induction with early amniotomy, defined as artificial rupture of membranes (AROM) performed less than 12 h from start of cervical ripening, compared with women who do not have an early amniotomy. The primary outcome was a composite of chorioamnionitis and/or neonatal sepsis. Secondary outcomes included isolated maternal fever, composite maternal morbidity, cesarean delivery, amnioinfusion, any transfusion, length of labor induction, cord prolapse, NICU admission, and Apgar score. Among the 1200 patients, the rate of chorioamnionitis or neonatal sepsis was lowest at 0.4 % for patients with early amniotomy <12 h, increased to 3.5 % in both the interval to AROM 12 to <18 h and 18 to <24 h, and further increased to 5.9 % when AROM occurred after 24 h from start of cervical ripening (p = 0). For the secondary outcomes, the rate of cesarean was significantly lower in the early AROM group <12 h at 13.9 % compared to all other later periods of AROM, with the highest rate in the >24 h group (34.9 %, p = 0). The mean time from amniotomy to delivery was increased across each time interval, lowest at 11.5 in the <12-hour interval and highest at 44.6 h for the interval with AROM at 24 h and beyond (p = 0). Composite maternal morbidity also increased across each time interval, lowest in the <12-hour group at 17.6 % and highest in the group that had AROM occur after 24 h at 31.2 % (p = 0). There were no significant differences in neonatal secondary outcomes. When amniotomy is performed <12 h after initiation of cervical ripening, there does not appear to be an increased rate of infectious morbidity. When performing amniotomy in a closer time interval to end of cervical ripening, it appears infectious morbidity may be reduced with shorter duration from amniotomy to delivery while decreasing cesarean and maternal morbidity rates.
52. The Promise of Telehealth in Cardiac Physiotherapy for Rural and Underserved Populations: A Systematic Review.
期刊: Telemedicine journal and e-health : the official journal of the American Telemedicine Association 发表日期: 2025-Nov-20 链接: PubMed
摘要
Background: Cardiovascular diseases remain a leading cause of global morbidity and mortality. Cardiac rehabilitation (CR), particularly cardiac physiotherapy, is crucial for secondary prevention; yet access is suboptimal, especially for patients in rural and underserved populations due to logistical and socioeconomic barriers. Telehealth offers a promising solution to address these disparities. Objective: This systematic review aimed to synthesize evidence on the effectiveness, feasibility, and acceptability of telehealth-delivered cardiac physiotherapy interventions in rural and underserved populations and identify the associated barriers and facilitators. Methods: A comprehensive search was conducted across multiple databases. Studies investigating telehealth-delivered cardiac physiotherapy in rural/underserved populations were included. Due to heterogeneity in study designs, interventions, and outcomes, a narrative synthesis was performed. Qualitative and quantitative data were extracted on effectiveness, feasibility, acceptability, barriers, and facilitators. Results: Nine studies were included, employing diverse designs (randomized controlled trials, multimethod, feasibility, qualitative, codesign, and mixed methods). Telehealth-delivered cardiac physiotherapy demonstrated effectiveness in improving exercise capacity, cardiac risk profiles, weight management, and quality of life. It also enhanced CR attendance and completion rates. High feasibility and acceptability were reported, with patients valuing convenience and home access. Key facilitators included personalized support, staff adaptability, and codesign approaches. Persistent barriers included digital literacy, technological infrastructure limitations, socioeconomic factors, staffing issues, and potential patient isolation. Conclusion: Telehealth-delivered cardiac physiotherapy holds significant promise for expanding access and improving outcomes for rural and underserved populations. While effective and acceptable, successful implementation requires addressing digital, technological, and socioeconomic barriers. Leveraging identified facilitators and designing patient-centered interventions are crucial for equitable cardiovascular care.
53. Preparation of a novel fluorescent material ZIF-8@ZIF-8 and its application strategy in the detection and stripping of the tetracyclines residue in food.
期刊: Food chemistry 发表日期: 2025-Nov-17 链接: PubMed
摘要
The substantial presence of tetracyclines (TCs) and their resistant degradation properties have rendered them prevalent residues in animal-sourced foods. This paper introduced a novel metal-organic framework (AuNCs@ZIF-8@CDs@ZIF-8) that encapsulated carbon dots (CDs) and gold nanoclusters (AuNCs). This framework synergistically combined fluorescence emission with the porous characteristics of multi-shell metal-organic frameworks, facilitating the development of sensors and adsorbents specifically designed for tetracycline antibiotics. The fluorescence intensity ratio (F0/F) showed a good linear relationship with the concentration of TCs in the range of 0-100 μmolL-1, with a detection limit of 0.0903 μmolL-1. Additionally, AuNCs@ZIF-8@CDs@ZIF-8@SA/CMC hydrogel sensors were constructed and visualized for TC detection using a smartphone. The hydrogel demonstrated a TC loading capacity as high as 551.137 mg/g. The research provided a new strategy for developing the integrated technology of quantitative detection, rapid visualization detection, and adsorption removal of pollutant residues in food.
54. A new multitracker device for rapid, in-field detection of multiple water contaminants.
期刊: Talanta 发表日期: 2025-Nov-17 链接: PubMed
摘要
Accurate and selective detection of multiple water contaminants over a wide range, from parts per billion (ppb) to parts per million (ppm) is crucial, since contaminant levels vary over time. A new ‘Multitracker’ device was developed to this end. It is conceptually designed, 3D-printed and assembled in-house, featuring three vertically aligned LED-phototransistor pairs to minimize optical interference and enable detection of multiple species, quantified by optical measurements using contaminant-specific reagents. It also includes a microcontroller, enabling measurement of four contaminants, namely arsenic, chromium, iron and fluoride, across the visible and infrared spectrum. Multitracker can measure contaminants both below and above the permissible limits for drinking water, set by the World Health Organization. It’s detection ranges are: As (2.5 ppb-1 ppm), Cr(VI) (3 ppb-2.5 ppm), Fe(II) (69 ppb-15 ppm) and F- (160 ppb-8 ppm). Environmental testing with the device has revealed no interference from other species, except for arsenic, where Amberlite IRA-96 resin is used to mitigate phosphate interference. Validation against standard instruments, including ICP-MS, ICP-AES, UV-visible spectrophotometer and ion-selective electrode, confirms Multitracker’s accuracy, even with water samples from diverse natural sources. The device maintains reliable performance across varying temperature and humidity too. It offers several advantages of cost-effectiveness ($22.5), compact size (19 × 11 × 8 cm), lightweight (920 g), rapid detection (1-15 min, depending on contaminant), with operation using just two rechargeable batteries. Thus, Multitracker offers a novel compact optical arrangement for multi-species detection, unlike existing devices, suitable for field deployment and rapid measurement.
55. Efficacy and safety of Tan Yin Wan in preventing acute exacerbations of COPD: A multicenter, randomized, double-blind, placebo-controlled, phase Ⅳ clinical trial.
期刊: Phytomedicine : international journal of phytotherapy and phytopharmacology 发表日期: 2025-Nov-17 链接: PubMed
摘要
Recurrent acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose disease deterioration and economic burden. Tan Yin Wan (TYW), a traditional Chinese medicine (TCM) formulation, has shown promise in COPD management, but robust clinical evidence is lacking. We aimed to evaluate the efficacy and safety of TYW in delaying AECOPD onset, with subgroup analyses exploring the TCM principle of “Treating Winter Disease in Summer” (Dongbing Xiazhi, ), which advocates reinforcing physiological resilience in low-risk seasons to mitigate exacerbation and severity of disease in high-risk seasons. In this multicenter, randomized, double-blind, placebo-controlled, phase Ⅳ clinical trial, participants with moderate-to-severe COPD and high exacerbation risk received TYW or an identical placebo, in addition to standard therapy for 52 weeks. The primary outcome was time to the first AECOPD. Secondary outcomes included the severity of the first AECOPD, annualized exacerbation rate, proportion of AECOPD cases, symptom scales (Breathlessness, Cough, and Sputum Scale (BCSS), COPD Assessment Test (CAT), and modified Medical Research Council Dyspnea Scale (mMRC)), 6-Minute Walk Distance (6MWD), pulmonary function and safety. A total of 342 patients were recruited from 18 centers between July 13, 2021, and June 5, 2023, with 308 patients in the full analysis set (FAS) and 297 in the per-protocol set (PPS). TYW significantly prolonged the time to the first AECOPD vs. placebo after adjustment for baseline confounding (adjusted HR = 0.55, 95% CI = 0.35 - 0.87, p = 0.01), and the restricted mean survival time difference (ΔRMST) was 30.45 days (95% CI = 4.68 - 56.23, p = 0.02). Improvements were demonstrated in BCSS, CAT, mMRC, and 6MWD at multiple timepoints (all p < 0.05), though lung function showed no significant differences. Exploratory subgroup analysis indicated a numerical trend toward a prolonged time to first exacerbation by 40.29 days in summer-enrolled participants (June - August) compared to non-summer-enrolled participants. This observation is tentatively consistent with the TCM principle of “Treating Winter Disease in Summer” as a proactive preventive strategy, though formal statistical significance was not achieved. Safety profiles were comparable between groups. TYW adjunct therapy might delay AECOPD onset and improve symptom burden, representing a preventive intervention that embodies TCM’s “Treating Disease Before Onset” (Zhi Wei Bing, ) philosophy, potentially through “Treating Winter Disease in Summer”, as a proactive seasonal strategy in long-term COPD management. This trial was registered at the Chinese Clinical Trials Registry (ChiCTR2100048801).
56. Global emergence of Acinetobacter baumannii International Clone 12 predominantly found in the Middle East.
期刊: Microbial genomics 发表日期: 2025-Nov 链接: PubMed
摘要
Infections caused by carbapenem-resistant Acinetobacter baumannii (CRAB) are of great concern, as mortality is high, and treatment options are very limited. Despite having among the highest rates reported worldwide, scarce genomic data are available on CRAB strains from the Middle East. Here, we report the global emergence of a novel International Clone (IC), designated IC12, based on the epidemiological, phenotypic and genome sequencing data (short reads and long reads) of a set of 60 A. baumannii isolates belonging to multilocus sequence type 158 (Pasteur scheme). IC12, prevailing in the Middle East since 2007, has also been found in Europe, Asia and South America. Alleles OXA-65 and ADC-117, coded by the bla OXA-51-like and bla ADC A. baumannii-intrinsic genes, respectively, were hallmarks shared by all the isolates. Plasmid pIC12-2 (80,000 bp), which carries a repAci6 replication initiator (RP-T1) and a type IV conjugative transfer system, played a major role in the antimicrobial resistance profile of 54/60 of the IC12 isolates. This resistance was mediated by three mobile genetic elements, namely Tn2008, MITEAb-IC12 and TnaphA6. All four Peruvian IC12 isolates lacked pIC12-2 and carried a different set of plasmids. Two of the Peruvian isolates carried a chromosomal resistance island of 79,396 bp long (designated IC12-RI) marked by the occurrence of tet(X3). The global spread of IC12 is worrying and calls for further studies on the virulence features and clinical impact of this clone.
57. Cumulative and variable depression symptom exposure and incident dementia: Panel data analysis of four longitudinal cohort studies.
期刊: Alzheimer’s & dementia : the journal of the Alzheimer’s Association 发表日期: 2025-Nov 链接: PubMed
摘要
Late-life depression symptoms are implicated in dementia. We examined how cumulative burden, duration, trajectory, and variability of depression symptoms are associated with incident dementia. A prospective cohort analysis of 23,305 dementia-free adults from four population studies (English Longitudinal Study of Ageing [ELSA], Health and Retirement Study [HRS], Survey of Health, Ageing and Retirement in Europe [SHARE], China Health and Retirement Longitudinal Study [CHARLS]) with repeated Centre for Epidemiologic Studies of Depression scale (CES-D)/Euro-Depression scale (EURO-D) assessments across three waves and a pooled median follow-up of ≈10.8 years. Exposures included CumSD/cumulative average depression symptom score (CumADS), high-symptom exposure duration, visit-to-visit variability (Standard deviation [SD], coefficient of variation [CV], variation independent of the mean [VIM]), and time-course patterns. Associations were analyzed using multivariable-adjusted Cox regression. Each 1-unit increase in cumulative score was associated with a 3%-8% higher dementia hazard across cohorts. Highest versus lowest cumulative quartiles showed markedly elevated risk. Sustained high exposure for 4 years conferred ≈2.7-3.9× greater risk. Higher variability and worsening trajectories were also linked to higher incidence. Associations were robust across subgroups. Persistent and unstable depression symptoms independently predict higher dementia risk, supporting longitudinal mood monitoring and sustained management. Multi-cohort study of 23,305 adults (ELSA, HRS, SHARE, CHARLS). Cumulative depression burden shows a dose-response with dementia risk. Highest versus lowest quartile: dementia hazard up to 18× (HRS). Sustained high symptoms (4 years) linked to ≈2.7-3.9× greater risk. Visit-to-visit variability independently associates with higher dementia risk.
58. Laparoscopic versus open liver resection in patients aged at least 80 years: retrospective propensity score-matched cohort study.
期刊: BJS open 发表日期: 2025-Oct-30 链接: PubMed
摘要
Laparoscopic liver resection has been associated with less morbidity than, and similar global outcomes to, open liver resection. There is no robust evidence that these outcomes lead to similar clinical outcomes in patients aged over 80 years. The aim of this study was to analyse the short-term outcomes between open and laparoscopic liver resection in patients over 80 years old. A retrospective analysis was undertaken. The study population comprised patients aged ≥ 80 years who underwent laparoscopic or open liver resection between January 2014 and December 2019, and who presented with resectable malignant tumours. The primary outcome was postoperative morbidity, according to Dindo-Clavien grading. Cox regression models were used to compute hazard ratios and 95% confidence intervals. Propensity score matching (1 : 1) was performed to balance the two groups according to independent prognostic factors for morbidity. A total of 988 patients were analysed from 34 centres (16 from Asia, 14 from Europe and 4 from America): 487 in the open group and 501 in the laparoscopic group. Independent risk factors associated with severe morbidity were the open approach (hazard ratio 1.59, 95% confidence interval 1.19 to 2.11; P < 0.001), Charlson Co-morbidity Index score > 7 (HR 1.69, 1.26 to 2.27; P < 0.001), more than one resected tumour (hazard ratio 1.55, 1.13 to 2.11; P = 0.006), major hepatectomy (hazard ratio 1.86, 1.22 to 2.83; P = 0.003), and Iwate score ≥ 7 (hazard ratio 1.43, 1.02 to 2.01; P = 0.03). Before propensity score matching, severe morbidity, length of intensive care unit stay, 90-day mortality, length of hospital stay, and readmission were better in the laparoscopic group (P < 0.050). These observations were confirmed after propensity score matching. The laparoscopic approach is a safe procedure for elderly patients, with better morbidity and mortality outcomes than the open approach, and should be considered as a default option.
59. Specific educational strategies using the Anatomage table for physical and occupational therapy students: a questionnaire-based survey.
期刊: Frontiers in medicine 发表日期: 2025 链接: PubMed
摘要
Anatomy and physiology are important basic medical sciences and foundational subjects in rehabilitation courses. As an educational tool, the Anatomage table, a virtual dissection table, can help medical and allied health science students to improve their academic motivation and gain a deeper three-dimensional (3D) understanding of human anatomy, to train them as future healthcare professionals. However, specific educational strategies using this tool are unclear. This study therefore aimed to identify specific educational strategies for students enrolled in rehabilitation courses using the Anatomage table, guided by Kolb’s Experiential Learning Cycle (ELC). This study involved conducting six neurophysiology lectures, after which the participating physical and occupational therapy students attempted two tasks (report and quiz assignments), specifically designed for this study. After completing the assignments, the students provided the necessary feedback by completing a questionnaire. Qualitative content analysis and correspondence analysis were subsequently conducted. Our findings revealed that the assignments left a positive impression on many students, enhanced their understating of the human body’s 3D structure, and promoted peer collaboration. The report assignment, which was associated with “Concrete Experience” and “Reflective Observation” in the ELC, was generally perceived as more engaging than the quiz. However, it also revealed that students found both assignments difficult without the required prior knowledge or preparation. The clear instructional videos and stable system performance improved usability, whereas scheduling constraints and limited foundational knowledge were perceived as challenges. These findings suggest that the assignments conducted using this tool support the visual learning preferences typical of early-year rehabilitation students. The sequential use of report and quiz tasks may enhance experiential learning by linking reflection and active experimentation. Integrating such technology-enhanced strategies within a pedagogical framework can suggest complement traditional lectures and cadaver-based anatomy education.
60. Patient characteristics associated with elective shoulder surgery cancellation: focus on socioeconomic factors.
期刊: Frontiers in public health 发表日期: 2025 链接: PubMed
摘要
This study aimed to examine the factors associated with the cancellation of elective shoulder surgeries, focusing mainly on socioeconomic aspects, and to explore these associations stratified by rural and urban areas. A retrospective cross-sectional analysis was conducted using the electronic medical records of 1,001 adult patients scheduled for elective shoulder surgery under general anesthesia at a tertiary hospital in South Korea between April 2018 and December 2024. Surgery cancellation was defined as any procedure recorded as “canceled” before the scheduled surgery date. Sociodemographic, clinical, and surgery-related factors were analyzed using chi-squared tests and multivariate logistic regression models. Stratified analyses were also conducted based on residential area. The overall surgical cancellation rate was 11.5%. Older age (≥65 years), severe disease, rural residence, manual labor, and complex surgical procedures were significantly associated with higher odds of cancellation. The multivariate analysis showed that patients aged 65 years or older (adjusted OR = 2.20, p < 0.001), those with severe disease (adjusted OR = 4.29, p = 0.004), manual laborers (adjusted OR = 2.93, p < 0.001), and rural residents (adjusted OR = 1.87, p = 0.006) were at a greater risk of cancellation. Stratified analysis revealed that Medical Aid coverage significantly increased the risk of cancellation in rural areas (adjusted OR = 5.76, p = 0.025). Elective shoulder surgery cancellations are influenced not only by clinical factors but also by socioeconomic and geographical disparities. Patient-centered surgical planning that incorporates individual socioeconomic circumstances is essential for reducing cancellation rates and promoting equitable surgical care.