公共卫生研究摘要 (2025-12-02)
共收录 56 篇研究文章
1. Cold-Induced Suppression of Myogenesis in Skeletal Muscle Stem Cells Contributes to Delayed Muscle Regeneration During Hibernation.
期刊: FASEB journal : official publication of the Federation of American Societies for Experimental Biology 发表日期: 2025-Dec-15 链接: PubMed
摘要
Mammalian hibernators experience profound cold stress and prolonged physical inactivity during torpor periods; however, it is unclear how skeletal muscle stem cells (satellite cells; SCs) respond to these challenges. In this study, we demonstrated that SCs from a mammalian hibernator, the Syrian hamster, exhibit remarkable resistance to cold-induced cell death, which is associated with intrinsically higher expression of the antioxidant enzyme GPX4, likely contributing to ferroptosis suppression. RNA-seq analysis revealed widespread downregulation of myogenesis-related genes following cold exposure, suggesting suppression of the myogenic program. Consistently, SCs exposed to cold stress exhibited reduced activation and differentiation capacity upon subsequent rewarming, with an increased number of quiescent Pax7-positive/MyoD-negative cells. Muscle regeneration was markedly delayed during hibernation, accompanied by decreased SC activation and macrophage infiltration, suggesting that cold-induced suppression of SC function underlies the limited regenerative capacity in hibernating hamsters. Our results provide insights into the unique physiology of mammalian hibernators: SC viability is preserved, whereas regenerative activity is selectively suppressed during hibernation.
2. Subsistence fishing patterns near food deserts.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-09 链接: PubMed
摘要
Fisheries are critical for sustaining waterfront communities. However, subsistence fishing is not well understood in the United States, despite its potential contributions to health and culture. We piloted a multivariable construct to classify subsistence vs. nonsubsistence fishers, identified the strongest predictor of participating in this practice, and tested for differences in place-based fishing motivations, behaviors, and community sharing. Among shore-based fishers in coastal Alabama, lower household income was the most powerful predictor of subsistence fishing. Subsistence fishers held more fishing motivations, targeted more specific fish groups, were more efficient in catching and keeping fish, and more frequently shared fish across social groups. Informed by these findings, we discussed management strategies to addressopportunities and barriers for shore-based subsistence fishing in coastal Alabama. More broadly, the framework piloted here offers a pathway to integrate subsistence fisheries into management using place-based evidence.
3. An Archean atmosphere rich in sulfur biomolecules.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-09 链接: PubMed
摘要
The abiotic production of sulfur-containing biomolecules under mild and globally relevant conditions has been an elusive endeavor in prebiotic chemistry experiments. As a result, a disconnect has emerged between understanding the origins of life and the later stages of biological evolution; the former potentially occurred independent of sulfur while the latter is universally dependent on it. Here, we demonstrate that planetary organic haze chemistry produces a suite of sulfur biomolecules including cysteine, coenzyme M, taurine, and potentially methionine and homocysteine. These compounds may form high in the atmosphere and subsequently deposit to early surface environments in sufficient amounts to support a budding global biosphere. Our findings thus challenge long-standing assumptions that sulfur biomolecules such as cysteine must have been biological “inventions.”
4. Lineage tracing of both quiescent G0 and active Hoxb5+ LT-HSCs that actively contribute to homeostatic mouse hematopoiesis.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-09 链接: PubMed
摘要
Studying the lineage commitment and differentiation potential of long-term hematopoietic stem cells (LT-HSCs) is important to understand the dynamics of hematopoiesis. A central question concerns which hematopoietic stem and progenitor cell populations are responsible for sustaining steady-state hematopoiesis in vivo without conditioning. Noninvasive HSC fate-mapping strategies to address this question require specific labeling of LT-HSCs only. In this study, we selectively labeled a subset of Hoxb5+ LT-HSCs-excluding short-term HSCs (ST-HSCs) and multipotent progenitors (MPPs)-to track the progeny of these cells. Hoxb5+ LT-HSCs comprise ~1 in 100,000 bone marrow cells. MPPs were not labeled until several months post-induction, indicating their derivation from LT-HSCs. At no time were MPPs labeled and LT-HSCs not, consistent with the origin and maintenance of MPPs from LT-HSCs. Hoxb5+ LT-HSCs are the principal contributors to steady-state in situ hematopoiesis, but only a fraction of LT-HSCs were labeled by the Cre/LoxP conversion to a lineage-tracing color. We tested whether quiescent HSCs could have incised the DNA at loxp sites, but did not finish the rearrangement. Analysis of phosphorylated H2AX (γ-H2AX) revealed that quiescent LT-HSCs retain Cre/LoxP-induced DNA incisions, which are repaired upon cell cycle entry, leading to the appearance of newly labeled LT-HSCs at later time points, mainly of the myeloid-biased HSC. Moreover, most LT-HSCs exhibit marked expansion in response to hematopoietic stress. With the age-related shift of blood formation from balanced to myeloid biased, the myeloid-biased HSCs expand preferentially after 6 mo of tracking.
5. Asheville, North Carolina: The Origin of the American Tuberculosis Sanitarium Movement.
期刊: Annals of internal medicine 发表日期: 2025-Dec-02 链接: PubMed
摘要
The digitization of academic publications and newspapers from the 1800s has permitted identification of several authoritative sources that credit Dr. Joseph W. Gleitsmann with establishing the first successful tuberculosis sanitarium in the United States in Asheville, North Carolina, in 1875, antedating by 9 years the Trudeau Sanatorium in Saranac Lake, New York. The facility used German climatological methods and a defined medical treatment program. Gleitsmann’s Mountain Sanitarium for Pulmonary Diseases had a 30-bed occupancy and published outcomes data from 5 years of clinical experience by 1880. By 1910, Asheville had become a tuberculosis care “colony,” with 25 private tuberculosis sanitaria with a national referral base. Asheville was a key driver of the development of climatotherapy in the treatment of tuberculosis and other respiratory ailments in the preantibiotic era. From 1870 to 1930, medical, mental health, and wellness tourism largely drove the population growth (1500 to 50 000) of Asheville, a previously remote Appalachian town. The stigmatization of tuberculosis sufferers is illustrated by restrictive municipal regulations that led to the demolition of almost all tuberculosis sanitaria within Asheville city limits by the 1920s. The Von Ruck Research Laboratory for Tuberculosis produced more than 50 papers from 1890 to 1930, published mostly in the Journal of the American Medical Association and the Journal of Immunology. These included pioneering immunotherapy studies with tuberculin variants and the first robust description of the antigenic profile of Mycobacterium tuberculosis. Tuberculosis was both incurable and a leading cause of death, and thus perseverance with fractionated tubercle bacillus products and subunits by so many is understandable in the context of the times. By analogy, public health now seems more ready to accept disease-specific immunotherapy agents and vaccines that save lives even if they are substantially less than 100% effective.
6. In healthy older adults, low-dose aspirin for a median 4.7 y did not reduce MACE but increased major hemorrhage at a median 8.3 y.
期刊: Annals of internal medicine 发表日期: 2025-Dec-02 链接: PubMed
摘要
GIM/FP/GP: [Formula: see text] Cardiology: [Formula: see text] Geriatrics: [Formula: see text] Public Health: [Formula: see text].
7. Response by Abdel-Qadir et al to Letter Regarding Article, "Bleeding and New Malignancy Diagnoses After Anticoagulation for Atrial Fibrillation: A Population-Based Cohort Study".
期刊: Circulation 发表日期: 2025-Dec-02 链接: PubMed
摘要
8. Transforming care practice by combining qualitative research and care ethics.
期刊: Nursing ethics 发表日期: 2025-Dec-01 链接: PubMed
摘要
9. Associations Between Both HIV and Metabolic Comorbidity and Self-Reported Mpox Among Men Who Have Sex With Men: Multicenter Cross-Sectional Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Dec-01 链接: PubMed
摘要
Men who have sex with men (MSM) face a disproportionately high risk of mpox infection, and China has recently experienced a rapid increase in the reported cases. This population also has a high prevalence of HIV, which has been identified as a critical factor in understanding the vulnerability to mpox. In addition, metabolic diseases frequently co-occur with HIV and share immunometabolic pathways, raising concerns that they may interact to confer additional risk of mpox infection. This study examines the potential interaction between HIV and metabolic comorbidity in relation to self-reported mpox among MSM in China. A cross-sectional study was conducted among MSM aged 18 to 76 years from October 2023 to March 2024 in 6 representative provincial regions of China. Participants completed an anonymous questionnaire on HIV infection, metabolic diseases (hypertension, diabetes mellitus, and hyperlipidemia), and mpox infection. Metabolic comorbidity was defined as the presence of more than one of these conditions. Logistic regression models were used to examine associations, and additive and multiplicative interactions between HIV and metabolic comorbidity were assessed. Of the 2403 MSM, 56 (2.33%) reported mpox, 199 (8.28%) reported HIV, and 325 (13.52%) reported at least one metabolic comorbidity (hypertension, diabetes, or hyperlipidemia). Both HIV (odds ratio [OR] 4.81, 95% CI 2.29-9.64) and metabolic comorbidity (OR 2.62, 95% CI 1.27-5.14) were associated with higher odds of mpox infection. A dose-response relationship was observed, with the odds of mpox increasing with the number of conditions (per-condition trend: OR 3.03, 95% CI 1.86-4.83). While multiplicative interaction was not statistically significant (interaction term=2.98, 95% CI 0.68-13.70; P=.15), additive interaction metrics suggested a possible excess association (relative excess risk due to interaction=10.80, 95% CI 1.21-37.52; attributable proportion due to interaction=0.74, 95% CI 0.07-0.87; synergy index=4.99, 95% CI 1.19-20.86). Compared to the participants without HIV or metabolic comorbidity, those with HIV and metabolic comorbidity had higher odds of mpox infection (OR 14.51, 95% CI 4.83-40.70). This study suggests that HIV and metabolic comorbidity were each associated with higher odds of self-reported mpox, and exploratory analyses indicated a possible additive interaction. Given the reliance on self-reported diagnoses and the cross-sectional design, the findings should be interpreted with caution due to reporting bias and reverse causation. Further studies are needed to confirm these associations and better understand the comprehensive health needs of MSM with co-occurring conditions.
10. End User and Primary Care Physicians' Perspectives on Digital Innovations in Dementia Risk Detection: Focus on a Digital Sleep Biomarker.
期刊: JMIR aging 发表日期: 2025-Dec-01 链接: PubMed
摘要
Dementia is a global health priority. Early identification in asymptomatic or mildly symptomatic individuals (ie, dementia risk detection) is proposed as a clinical solution for early intervention and could support researchers to identify novel neuropathological targets and recruit to clinical trials. Digital biomarkers of behavioral or physiological markers, including sleep, are cited as a potential low-cost, noninvasive, and objective method for dementia risk detection. Understanding perspectives on digital biomarkers, particularly acceptability, from potential end users and clinical staff is required when considering implementation within any clinical service. With emerging evidence of sleep as a risk marker for dementia, the efficacy of the Dementia Research Institute Sleep Index (DRI-SI), based on continuous remote monitoring of sleep patterns detected by a digital sleep mat, for dementia risk detection, is currently being explored by the InSleep46 study. This qualitative substudy aimed to explore perspectives of potential end users and primary care physicians regarding the use of a digital sleep mat to measure the DRI-SI and its application towards dementia risk detection. Thirty-one potential end users (age: 31-82 years, 11 female and 20 male) from Newcastle and London, United Kingdom, with personal or caregiving experience related to dementia, participated in qualitative focus group workshops. They shared opinions on integrating the sleep mat into their homes, the DRI-SI’s potential for identifying dementia risk, and the necessary information for engagement with related clinical services. Seven primary care physicians from across England participated in semistructured interviews regarding the potential application of the DRI-SI in dementia risk detection and its integration into current clinical practice. Inductive thematic analysis was conducted to identify key themes. Four key themes emerged from end user focus groups: (1) practical use, (2) prospective acceptability, (3) clinical management, and (4) data concerns. Three main themes came from the semistructured interviews with physicians: (1) prospective acceptability, (2) health care provision, and (3) practical considerations. Common themes were identified in both groups but held differing perspectives. End users were focused on practical aspects of integrating the digital sleep mat within their daily life, the effect of the DRI-SI on clinical care, and privacy concerns regarding data use. Primary care physicians were concerned more broadly with how the DRI-SI and dementia risk detection service would integrate into current clinical practice, the impact on clinical resources and patient well-being, and the need for clinical actionability and guidance on discussing results with patients. End users would find the DRI-SI acceptable as part of their clinical care, but primary care physicians require a more robust evidence base. Future research should explore the integration of the DRI-SI into clinical care/research pathways to enhance clinical acceptability. Five key recommendations have been made for further development of digital biomarkers for dementia risk populations.
11. WhatsApp-Based Intervention for Diabetes Prevention and Care in Argentina: Implementation and Process Evaluation.
期刊: JMIR formative research 发表日期: 2025-Dec-01 链接: PubMed
摘要
In Argentina, diabetes is a growing public health concern, with a prevalence of 14% in 2024 and projections reaching 15.4% by 2050. In this context, a Diabetes Prevention and Care Program was implemented in low-income areas across 3 provinces. A key component of the program was a WhatsApp (WhatsApp LLC)-based intervention aimed at promoting self-care, encouraging healthy behaviors, and supporting follow-up among people with diabetes, those at risk, and pregnant women. This study aimed to describe the implementation and process evaluation of a WhatsApp-based intervention within Argentina’s public health system, using the Carroll Implementation Fidelity Framework, focusing on challenges encountered, implementation strategies used, and lessons learned across the 3 target populations. The intervention was implemented in 40 primary care centers. The population included adults residing in the catchment areas of the selected primary care centers. Participants included adults with type 2 diabetes, people at moderate or high risk based on the Finnish Diabetes Risk Score, and pregnant women. A set of 192 educational and reminder messages was developed and validated through expert input and community feedback. Messages were tailored to each target population and delivered through WhatsApp via Twilio (Twilio Inc) Business API (application programming interface). We assessed implementation fidelity focusing on adherence to the intervention, participant responsiveness, quality of delivery, and contextual barriers. A total of 11,029 participants were enrolled in this study, of whom 9983 (90.5%) had a valid mobile phone number registered in the system. Among these, 32.8% (3276/9983) had a diagnosis of type 2 diabetes, 53.3% (5320/9983) were identified as being at moderate or high risk based on the Finnish Diabetes Risk Score questionnaire, and 13.9% (1387/9983) were pregnant women. Overall, 67.3% (n=5749) opted in to receive messages, with the highest acceptance among those with diabetes (n=2169, 74.3%) and the lowest among at-risk people (n=2935, 62.1%). Message adherence was high: 88.7% (n=5004) of participants received at least the minimum number of educational messages expected, and the mean proportion of messages read per participant was 82.2% (SD 29.8). The dropout rate was low (6.1%) but higher among pregnant participants (14.6%). Message delivery issues mostly included problems with WhatsApp on the mobile phones of participants. Technical challenges, including server overload, were addressed during implementation. The WhatsApp-based intervention was feasible and well-received in public primary care settings in Argentina, particularly among people with diabetes. The experience illustrates how a WhatsApp-based intervention can be leveraged to strengthen service delivery in low-resource contexts, while also highlighting the need for further work on integration with electronic health records, tailoring of content to population needs, and strategies to enhance digital inclusion for underserved populations.
12. Brothers Building Brothers by Breaking Barriers: Protocol for a Pilot Trial of a Telehealth Social Capital Intervention for Young Black Sexual Minority Men Living With HIV.
期刊: JMIR research protocols 发表日期: 2025-Dec-01 链接: PubMed
摘要
Young Black sexual minority men are disproportionately affected by HIV, especially in the Southern United States. To address this, we developed Brothers Building Brothers by Breaking Barriers (B6) intervention with a goal of enhancing social capital and engagement in care among young Black sexual minority men living with HIV. However, we encountered challenges to feasibility in recruiting and engaging for an in-person intervention. The objectives of this study are to iteratively adapt the original B6 intervention for telehealth delivery (Phase 1), and pilot test the intervention through a waitlist-control trial to evaluate its feasibility, acceptability, and safety (Phase 2). In Phase 1, we used the assessment, decision, adaptation, production, topical experts, integration, training, and testing (ADAPT-ITT) framework to structure the iterative adaptation process of B6, working with a diverse study team and a Youth Advisory Board (YAB). After completing the preliminary adaptation process, we conducted initial Telehealth Brothers Building Brothers by Breaking Barriers (Tele-B6) pilot testing with a community partner organization. The result was a 5-week group-level intervention, delivered entirely remotely, consisting of a series of adapted activities to address bonding and bridging social capital, affirm intersectional identities, and engage in resilience-building processes. Following feedback integration from pilot-testing, we conducted Phase 2 with 60 young Black sexual minority men living with HIV recruited over the course of one year and who were randomized at the group level to either the immediate intervention or delayed (waitlist control) intervention group. Various data sources will be used to measure feasibility, acceptability, and safety, including surveys, postsession evaluation data, in-depth qualitative interviews, and review of medical records for HIV clinical outcomes. Phase 1, the adaptation process of B6, began in fall 2022 and was completed in spring 2023. Phase 2, the implementation of the waitlist control trial, began in spring 2023 and concluded in summer 2024. Final follow-up assessments were completed in fall 2024 and the results of the mixed methods evaluation are expected in winter 2025. The adaptation process and telehealth delivery of B6 will add to the knowledge of strengths-based interventions designed to improve care engagement among young Black sexual minority men living with HIV. ClinicalTrials.gov NCT05829759,https://clinicaltrials.gov/study/NCT05829759. DERR1-10.2196/69961.
13. Cocreation of a Mobile App (AYABytes) by Physicians and Adolescents and Young Adults With Cancer to Improve Access to Cancer-Related Resources and Reduce Distress: Protocol for a Single-Arm Feasibility Study.
期刊: JMIR research protocols 发表日期: 2025-Dec-01 链接: PubMed
摘要
Adolescents and young adults with cancer require dedicated and tailored management that bridges adult and pediatric oncology services. At the National Cancer Centre Singapore, 40% of newly diagnosed adolescents and young adults report significant distress due to uncertainty about prognosis, treatment, and disruption of life milestones. A major unmet need is access to reliable, age-appropriate information. Prior studies demonstrate that digital technology can effectively deliver such support. This study describes the protocol for evaluating AYABytes (Adolescent and Young Adult Building Youths, a Technology for Education and Sharing), a mobile app cocreated by patients and health care professionals to improve health-related quality of life for adolescent and young adult oncology patients. An iterative information-gathering process was conducted, including semistructured interviews with 2 clinicians, 3 cancer survivors, and 3 care partners to cocreate this mobile app. AYABytes is an interactive, phone-based intervention designed to engage adolescent and young adult oncology patients with personalized education, mood, and symptom self-management resources with an inbuilt algorithm that responds to patient-reported questionnaires. The app will be evaluated in 2 phases-a pilot test and an implementation test. In the pilot test, the app will be launched to a test group of 20 adolescent and young adult oncology patients aged between 16 and 45 years, selected for representation among the age group and their malignancies. Patients will be allowed to use the app for 1 month. Feasibility and acceptability were assessed via a semistructured survey. In the implementation stage, 200 patients will be allowed to use the app over 6 months and will complete an EQ-5D-5L questionnaire at baseline and at the 1- and 6-month marks. Evaluation of the mobile app was performed via the mHealth App Usability Questionnaire at similar intervals. Funding for the development and trial of AYABytes was awarded in October 2020 through a National Cancer Centre Singapore research grant. Pilot testing was completed in May 2024. The implementation phase began in June 2024 and is currently ongoing. We believe that AYABytes, a novel eHealth mobile app, will be both beneficial and easily used by adolescent and young adult oncology patients. Evaluating the app and its quantifiable impact on improving the quality of life of adolescent and young adult oncology patients will help enrich the evidence for mobile health interventions. It will also validate new digital approaches to help adolescent and young adult oncology patients reduce their distress and address unmet needs and concerns. DERR1-10.2196/69453.
14. Hybrid Modeling of Cercospora Leaf Spot Epidemiology: Integrating Mechanistic and Machine Learning Approaches Using Remote-Sensing and Environmental Data.
期刊: Phytopathology 发表日期: 2025-Dec-01 链接: PubMed
摘要
Despite advances in modeling and sensing, no study has previously integrated mechanistic, meteorological and UAV data into a unified predictive framework for Cercospora leaf spot. From 2020 to 2022, field trials with a susceptible variety under contrasting fungicide regimes and artificial inoculation were monitored for disease severity, airborne inoculum, and yield. Significant treatment differences emerged 44 days after sowing, with incubation lasting 7-12 days and spore peaks occurring from day 77, preceding rapid severity increases. Dissemination showed no prevailing direction but was favored by light, variable winds under conducive microclimates. Yield loss reached up to 0.0123 kg root fresh weight per plant per severity point, and both yield and sugar content decreased with earlier onset and higher final severity. Hybrid models were implemented at multiple levels, integrating multisource data. Severity was best predicted by climatic variables with UAV spectral-structural indices; fructification by humidity-temperature thresholds with stress traits; dissemination by wind-variability metrics with sporulation indicators; and yield and sugar content by UAV indices supplemented with mechanistic covariates. High-level hybridization reduced the RMSE to 0.615 (on a 0-10 severity scale), 0.067 ng C. beticola DNA for actual spores, 2.033 ng for cumulative spores, 1.769° for dissemination direction, 0.015 ng day⁻¹ for dissemination magnitude, 0.235% for sugar content, and 0.051 kg plant⁻¹ for root fresh weight, achieving up to a 39% improvement over lower-level configurations. These results enhance disease prediction, improve the understanding of disease epidemiology, and could support more effective plant-disease management.
15. SmokeBERT: A Bidirectional Encoder Representations From Transformers-Based Model for Quantitative Smoking History Extraction From Clinical Narratives to Improve Lung Cancer Screening.
期刊: JCO clinical cancer informatics 发表日期: 2025-Dec 链接: PubMed
摘要
Tobacco use is a major risk factor for diseases such as cancer. Granular quantitative details of smoking (eg, pack years and years since quitting) are essential for assessing disease risk and determining eligibility for lung cancer screening (LCS). However, existing natural language processing (NLP) tools struggle to extract detailed quantitative smoking data from clinical narratives. We cross-validated four pretrained Bidirectional Encoder Representations from Transformers (BERT)-based models-BERT, BioBERT, ClinicalBERT, and MedBERT-by fine-tuning them on 90% of 3,261 sentences mentioning smoking history to extract six quantitative smoking history variables from clinical narratives. The model with the highest cross-validated micro-averaged F1 scores across most variables was selected as the final SmokeBERT model and was further fine-tuned on the 90% training data. Model performance was evaluated on a 10% holdout test set and an external validation set containing 3,191 sentences. ClinicalBERT was selected as the final model based on cross-validation and was fine-tuned on the training data to create the SmokeBERT model. Compared with the state-of-the-art rule-based NLP model and the Generative Pre-trained Transformer Open Source Series 20 billion parameter model, SmokeBERT demonstrated superior performance in smoking data extraction (overall F1 score, holdout test: 0.97 v 0.88-0.90; external validation: 0.86 v 0.72-0.79) and in identifying LCS-eligible patients (97% v 59%-97% for ≥20 pack-years and 100% v 60%-84% for ≤15 years since quitting). We developed SmokeBERT, a fine-tuned BERT-based model optimized for extracting detailed quantitative smoking histories. Future work includes evaluating performance on larger clinical data sets and developing a multilingual, language-agnostic version of SmokeBERT.
16. Persistent use of body mass index policies as a barrier to surgery: Prevalence and analysis of policies across England in 2025.
期刊: Journal of health services research & policy 发表日期: 2025-Dec-01 链接: PubMed
摘要
BackgroundIntegrated Care Boards (ICBs) in England are responsible for commissioning healthcare services and setting access policies for procedures such as hip and knee replacement surgery. While the National Institute for Health and Care Excellence (NICE) advises against body mass index (BMI)-based restrictions, many ICBs impose such criteria. This study examines the prevalence and content of these policies to understand their impact on equitable healthcare access.MethodsA qualitative content analysis was conducted to systematically evaluate the policies set by all 42 ICBs in England regarding access to hip and knee replacement surgery for patients living with obesity. Policies were collected from official ICB websites and Google searches, completed in February 2025, and categorised as: no policy, restrictive policy, and non-restrictive policy. The alignment of these policies with clinical guidance was assessed, focusing on their potential impact on equitable healthcare access.ResultsPolicy documents were identified for 41 ICBs: 26 included weight management guidance and 15 imposed BMI-based restrictions on joint replacement referral eligibility. Policies varied in naming, terminology, and specificity, risking inconsistencies in interpretation and implementation. Some ICBs (n = 3) had revoked BMI-based restrictions in recent policy updates, reflecting a shift towards individualised clinical assessments. These findings highlight variability in policy approaches and the evolving stance on BMI-related eligibility criteria.ConclusionsOne third of ICBs still use policies that contradict NICE guidance by restricting access to joint replacement surgery for those with high BMI, while many others apply ambiguous language. These inconsistencies highlight concerns about policies that may influence equitable access to care. Further work is required to evaluate how BMI-related eligibility criteria are applied in practice and their impact on health inequalities.
17. Comment on "Using genomic data and machine learning to predict antibiotic resistance: A tutorial paper".
期刊: PLoS computational biology 发表日期: 2025-Dec 链接: PubMed
摘要
A recent study by Faye Orcales and colleagues proposes a teaching curriculum on supervised machine learning applied to genomics data aimed at predicting antibiotic resistance. The article describes a traditional machine learning pipeline step-by-step in a way that is accessible to anyone, including novices. However, the authors provide a misleading piece of advice in the “Evaluating model performance” section, where they recommend that readers use accuracy and the F1 score for binary classification. We write this short formal comment on that article to reaffirm and explain why accuracy and the F1 score should be avoided in the evaluation of binary classification and why the Matthews correlation coefficient (MCC) should be employed instead. We also take this opportunity to warn readers about the dangers of k-fold cross-validation, which is suggested as a standard method for dividing data into training set and test set, but has several flaws and pitfalls.
18. Walk and Talk: A Randomized Controlled Trial of Multi-Modal Motion-Assisted Memory Desensitization and Reconsolidation Therapy versus Treatment as Usual for Veterans and First Responders with Posttraumatic Stress Disorder.
期刊: Psychotherapy and psychosomatics 发表日期: 2025-Dec-01 链接: PubMed
摘要
Posttraumatic stress disorder (PTSD) presents a significant challenge within the treatment of mental health issues, particularly in veterans and first responders who often experience resistance to standard treatments. This study evaluated the effectiveness of a virtual reality exposure-based treatment with motion as compared to treatment as usual (TAU), as first-line treatment for PTSD within these populations. This multicenter, parallel, single-blind, non-inferiority randomized controlled trial was conducted in three centers across the Netherlands. We included adults diagnosed with occupational or combat-related PTSD, without prior treatment history. Participants were randomized (1:1) to receive either manualized multi-modal motion-assisted memory desensitization and reconsolidation (3MDR) therapy or manualized regular trauma-focused psychotherapy (TAU). 3MDR was applied in fewer sessions than TAU. Primary outcome was self-reported PTSD severity, based on the PTSD Checklist for DSM-5, assessed at baseline, post-treatment, 3 and 6 months post-treatment. Secondary outcomes were clinician-rated PTSD, avoidance, comorbid disorders and symptoms, and functioning. The trial was prospectively registered in the Dutch Trial Register, NL-OMON55588. Between February 15, 2018, and July 22, 2022, 134 participants with PTSD were enrolled, with 67 (50%) randomized to 3MDR and 67 (50%) to TAU of whom 106 (79%) were veterans, and 28 (21%) were first responders. Significant time effects were demonstrated in self-reported and clinician-rated PTSD severity for both groups, as well as in avoidance, comorbid disorders, and functioning. At 6 months post-treatment, 3MDR proved to be non-inferior to TAU in terms of self-reported PTSD (mean difference = -2.91 [95% CI -7.92, 2.10], p = 0.25). 3MDR demonstrates to be an effective alternative first-line treatment for PTSD stemming from occupational traumatic events. Even though it leans on infrastructure with a treadmill and other hardware components, it may offer an alternative over conventional trauma-focused psychotherapies for PTSD that yields savings of a quarter of time spent within therapy.
19. Paramyxovirus matrix protein redirects METTL3 for dual regulation of viral replication and immune evasion.
期刊: PLoS pathogens 发表日期: 2025-Dec-01 链接: PubMed
摘要
N6-methyladenosine (m6A) epitranscriptomic modifications play crucial roles in regulating both host and viral gene expression. Here, we revealed a novel mechanism by which paramyxoviruses exploit host m6A machinery to simultaneously enhance viral replication and suppress host immunity. Our results demonstrated that the viral matrix protein (M) of bovine parainfluenza virus type 3 (BPIV3) binds to the methyltransferase domain of METTL3 in the nucleus and facilitates its translocation to the cytoplasm through an exportin-1-dependent pathway. This mechanism is conserved across multiple paramyxoviruses, including human parainfluenza virus type 3, Sendai virus, Nipah virus, and measles virus, suggesting an evolutionarily conserved viral strategy. The relocated METTL3 catalyzes m6A modification at specific sites within viral nucleocapsid protein (N) mRNA, significantly enhancing its stability and protein expression. Using reverse genetics, we generated recombinant viruses harbouring mutations at these m6A acceptor sites, which exhibited markedly attenuated viral replication, confirming the critical role of these epitranscriptomic marks in the viral life cycle. Rescue experiments demonstrated that the expression of exogenous N protein partially restored the viral titer and concomitant genome/antigenome synthesis in m6A site mutant, indicating that reduced N protein abundance represents a key mechanism underlying impaired viral replication. Furthermore, M protein-mediated depletion of nuclear METTL3 significantly reduces m6A modification of host IFN-β mRNA, resulting in diminished interferon expression and compromised antiviral responses. Supporting this mechanism, infection with viruses bearing nuclear export signal mutations that prevent METTL3 cytoplasmic translocation, maintained IFN-β mRNA m6A modification and resulted in significantly elevated IFN-β expression. These findings provide direct mechanistic evidence that paramyxoviruses utilize M-driven METTL3 relocalization as a sophisticated immune evasion strategy. Our study illuminates how paramyxoviruses strategically manipulate epitranscriptomic regulation to create an environment conducive to viral propagation, thereby advancing our understanding of virus-host interactions and identifying potential targets for antiviral therapeutics.
20. A study of the relationship between physical fitness index and sleep quality in Chinese adolescents.
期刊: Sleep & breathing = Schlaf & Atmung 发表日期: 2025-Dec-01 链接: PubMed
摘要
To explore the relationship between Physical Fitness Index and sleep quality in adolescents and to provide a theoretical basis for improving adolescent sleep quality. A total of 5018 adolescents aged 13-18 years were selected by whole group stratified random sampling method from September to December 2024 in Changzhi, Taizhou, Jishou, Nanchang, Suzhou, Xianyang, and Yulin, China, for the physical fitness test and sleep quality survey. The correlation coefficients between Physical Fitness Index and sleep quality were analyzed using Pearson’s correlation, and the effects of Physical Fitness Index on sleep quality were analyzed using linear regression. The total Pittsburgh Sleep Quality Index score was 5.07 ± 3.03 for male adolescents and 5.79 ± 2.95 for female adolescents, with male adolescents significantly better than females (t = -8.61, p < 0.01). The mean value of Physical Fitness Index was -0.70 ± 3.89 for adolescents with poor sleep quality and 0.02 ± 3.70 for adolescents with good sleep quality in the junior high school level, which was statistically different between the two groups (t = -4.058, p < 0.01). Physical Fitness Index was negatively correlated with sleep quality index (r = -0.062, p < 0.01) and Physical Fitness Index significantly predicted sleep quality (β = -0.04, p < 0.01). There was a significant negative correlation between the Physical Fitness Index and the Pittsburgh Sleep Quality Index in Chinese adolescents.
21. World Health Organization Guideline on the Use and Indications of Glucagon-Like Peptide-1 Therapies for the Treatment of Obesity in Adults.
期刊: JAMA 发表日期: 2025-Dec-01 链接: PubMed
摘要
Obesity is a chronic, relapsing disease affecting over 1 billion people worldwide, driving substantial morbidity, mortality, and economic burden. Glucagon-like peptide-1 therapies (GLP-1 therapies) provide clinically meaningful weight loss and broad metabolic benefits. In response to Member State requests, the World Health Organization (WHO) has issued guidelines for adults living with obesity. The guidelines recognize obesity as a chronic, relapsing disease requiring lifelong care and emphasize early diagnosis and integrated, person-centered approaches combining behavioral, medical, surgical, and other interventions alongside prevention and management of comorbidities. WHO recommends long-term GLP-1 therapies combined with intensive behavioral therapy to maximize and sustain benefits. Both recommendations were graded conditional, reflecting that GLP-1 therapies-with or without behavioral therapy-are effective, but limited long-term data, cost, system readiness, equity, variability in patient priorities, and context-specific feasibility remain considerations. Implementation of these guidelines depends on equitable access to affordable therapies, health system preparedness, and most importantly assurance that care is person-centered, nondiscriminatory, and universally accessible. Given the time required to implement these measures, a priority is a transparent, equitable, evidence-based framework to identify those at highest need while allowing incremental expansion of eligibility as access, capacity, and readiness evolve; this will be the next focus of the WHO guideline. Medication alone cannot solve the global obesity burden. The availability of GLP-1 therapies should galvanize the global community to build a fair, integrated, and sustainable obesity ecosystem. Countries must ensure equitable access not only to comprehensive disease management, but also to health promotion and prevention policies and interventions targeting the general population and those at high risk.
22. Consultations Within School Health Services: A Cross-Sectional Observational Study.
期刊: Journal of advanced nursing 发表日期: 2025-Dec-01 链接: PubMed
摘要
This study aims to (1) describe the content of consultations within school health services, (2) outline school nurses’ assessments, and (3) identify factors that influence the duration of consultations. A cross-sectional observational study was conducted. The data were collected in Norway during November 2023 using a self-report form by school nurses (n = 96). Consultations (n = 382) were registered and analysed using descriptive statistical methods and multiple linear regression analyses to identify factors influencing the duration of consultations. Nearly 30% of the pupils had to wait for a consultation and 29% of the registered consultations were drop-in. School nurses had to prioritise due to limited time in 41% of the consultations. Mental health was the predominant theme. Several adverse factors, such as interruptions during consultations, affected the time spent. This study provides knowledge about the content of consultations within school health services in Norway, contributing to the enhancement of this activity within these services. The insights from this study may serve as a foundation for developing guidelines for consultations, helping to ensure equitable support for all children and adolescents. To our knowledge, this is the first study that gives a broad insight into consultations within the Norwegian school health services. Having enough resources is essential for providing good services. Politicians and central authorities need to consider this when deciding on budgets. This study adhered to STROBE guidelines for reporting cross-sectional studies. No patient or public involvement.
23. Smartphone cognitive behavioral therapy for prevention of depressive symptoms in patients with recurrent pregnancy loss: an exploratory decentralized, parallel-group, multicenter, open, individually randomized, fully factorial trial.
期刊: Psychiatry and clinical neurosciences 发表日期: 2025-Dec-01 链接: PubMed
摘要
The aim was to explore the preventive effects of smartphone cognitive behavioral therapy (CBT) in addressing depression and anxiety in patients with recurrent pregnancy loss (RPL) due to lack of such previous studies. This was an exploratory decentralized, parallel-group, multicenter, open, individually randomized, fully factorial trial. A total of 432 patients with RPL were randomized and patients who completed the psychoeducation component of the app within 2 weeks of consent were included. Five CBT components-namely, self-monitoring, behavioral activation, cognitive restructuring, assertion training, and problem solving-were randomly assigned as present or absent, resulting in 25 = 32 combinations. The primary outcomes were changes in Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scores at weeks 8 and 12 from baseline. A total of 419 patients were analyzed. The presence or absence of specific CBT components did not significantly affect patient outcomes. However, patients experienced a statistically significant overall reduction in depressive symptoms from baseline to weeks 8 and 12. Pre-post effect sizes for overall improvement ranged from -0.30 to -0.38 at week 8 and from -0.22 to -0.33 at week 12. No significant overall reduction in anxiety symptoms was observed. The CBT application significantly reduced depressive symptoms in patients with RPL; however, no specific CBT component showed superior effects. The findings did not indicate efficacy in comparison to the pure treatment-as-usual group. Further research is required to enhance its impact on anxiety and refine the selection and delivery of individual CBT components.
24. The Net Effect of Positive Changes in Alcohol Consumption on Mental Health Among South Korean Adults.
期刊: Substance use & misuse 发表日期: 2025-Dec-01 链接: PubMed
摘要
This study investigates the net effects of positive changes in alcohol consumption-specifically, transitions from high-risk to moderate drinking-on mental health among Korean adults. We analyzed data from 2,238 Korean adults (3,439 person-wave observations) from the 2011-2013 and 2016-2018 waves of the Korea Health Panel Survey. Participants were classified into a transitioned to moderate drinking group (study group) and a continuous high-risk drinking group (control group). To adjust for baseline equivalence between the groups, inverse probability of treatment weighting was applied. Mental health changes, measured using the Korean version of the Brief Encounter Psychosocial Instrument (BEPSI-K), were analyzed using a difference-in-differences (DID) model with multiple regression. A preliminary analysis using independent and paired t-tests examined the treatment effect of moderate drinking on mental health, accounting for group differences, time changes, and their interaction. Results showed overall positive effects, with reductions in psychological and physical stress (-0.064, p < 0.05), frustration (-0.016, n.s.), unmet needs (-0.047, p < 0.1), future uncertainty (-0.101, p < 0.001), and task-related stress (-0.024, n.s.). The overall BEPSI-K score also significantly decreased (-0.051, p < 0.001). In the DID model with multiple regression, controlling for sociodemographic characteristics, moderate drinking had a significant effect in reducing future uncertainty (coefficient = -0.049, p < 0.001). The net positive effect of transitioning from high-risk to moderate drinking suggests meaningful improvements in mental health. These findings offer valuable evidence for refining drinking guidelines, informing mental health policies, and guiding future research.
25. Knowledge-Practice Performance Gap in Clinical Large Language Models: Systematic Review of 39 Benchmarks.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-01 链接: PubMed
摘要
The evaluation of large language models (LLMs) in medicine has undergone a shift from knowledge-based testing to practice-based assessment, representing an evolution in how we measure artificial intelligence readiness for clinical deployment. While LLMs now routinely exceed human performance on medical licensing examinations, their translation to clinical practice remains poorly characterized. This systematic review aims to categorize and analyze medical LLM benchmarks, examining performance patterns across different evaluation paradigms and identifying gaps in current assessment methodologies. The protocol was registered at PROSPERO (CRD420251139729). Four databases (MEDLINE/PubMed, Embase/Ovid, Cochrane Library, and arXiv) were searched from inception to August 31, 2025, using keywords related to clinical medicine benchmarks in LLMs. Studies were included if they (1) investigated clinical medicine benchmarks in LLMs, (2) were published in English, and (3) were available in full-text. Studies were excluded if they evaluated nonmedical domains or lacked benchmark validation. Methodological quality was assessed using the Mixed Methods Appraisal Tool (version 2018) by 2 independent reviewers (κ=0.91). Due to heterogeneity in evaluation metrics preventing meta-analysis, narrative synthesis was conducted using structured categorization of benchmark types. From 3917 screened records, 39 medical LLM benchmarks were identified and categorized into 21 (54%) knowledge-based, 15 (38%) practice-based, and 3 (8%) hybrid frameworks. These benchmarks collectively encompass over 2.3 million questions across 45 languages and 172 medical specialties. Traditional knowledge-based benchmarks show saturation with leading models achieving 84%-90% accuracy on USMLE (United States Medical Licensing Examination)-style examinations, approaching or exceeding average physician performance. However, practice-based assessments reveal performance challenges, with specific benchmarks showing varied results: DiagnosisArena 45.82% (95% CI 42.9%-48.8%), MedAgentBench 69.67% (95% CI 64.2%-74.6%), and HealthBench 60% (95% CI 58.6%-61.3%) success rates, with practice-based benchmarks showing lower performance (45%-69%) compared to knowledge benchmarks (84%-90%). Task-specific analysis revealed differential performance patterns: factual retrieval maintained 85%-93% accuracy, clinical reasoning dropped to 50%-60%, diagnostic tasks achieved 45%-55% success, and safety assessment showed significant gaps at 40%-50% accuracy despite being life-critical. Geographic representation spans 6 continents with 18 (46%) benchmarks, incorporating non-English content. Quality assessment revealed 26% (10/39) of benchmarks had insufficient methodological reporting for complete evaluation. This systematic review provides the first comprehensive analysis quantifying the significant “knowledge-practice gap” in medical artificial intelligence: high performance on knowledge-based examinations (84%-90%) does not translate to clinical competence (45%-69%), with safety assessments at 40%-50%. Our findings provide quantitative evidence for regulators and health systems that examination scores are insufficient and misleading proxies for clinical readiness. This review concludes that autonomous deployment is not currently justifiable and that all evidence-based implementation strategies must mandate practice-oriented validation and robust human-in-the-loop oversight to ensure patient safety. PROSPERO CRD420251139729; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251139729.
26. Surgical Management of Pediatric Muller-Weiss Disease.
期刊: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews 发表日期: 2025-Dec-01 链接: PubMed
摘要
Muller-Weiss disease (MWD) involves the idiopathic collapse and fragmentation of the navicular bone. Patients present with pain and deformity. Pediatric cases are rare, and it is distinct from Kohler disease. Surgical management can include internal fixation of the navicular, calcaneal lengthening osteotomy, and arthrodesis. A healthy 10-year-old boy with a family history of MWD presented with midfoot pain and toe walking. He had hindfoot equinization, pes planus deformity, and forefoot abduction. Imaging revealed a comma-shaped navicular with lateral collapse and fragmentation. He had a short lateral calcaneal column relative to the talus. Following unsuccessful nonsurgical management, he underwent internal fixation of the navicular, calcaneal lengthening osteotomy, and sliding tendoachilles lengthening. Following recovery, he was pain-free with radiographic union of the navicular fragment. We propose he developed MWD through mechanical compression of the lateral navicular, resulting from a short lateral calcaneal column relative to the talus. Our poor understanding of MWD creates challenges in its diagnosis and management. Although rare in children, it is not exclusively a disease of adulthood. Early recognition may allow correction of underlying deformity to prevent progressive fragmentation and degenerative deformity.
27. Dietary Quercetin Mitigates DON-Induced Intestinal Injury via Inhibiting MAPK/NF-κB-Mediated Pyroptosis and Tight Junction Disruption in Chicken.
期刊: Journal of agricultural and food chemistry 发表日期: 2025-Dec-01 链接: PubMed
摘要
Deoxynivalenol (DON), a prevalent food-borne mycotoxin, severely compromises intestinal barrier function. Quercetin (QUE) is a dietary flavonoid with a variety of known bioactivities. Our results demonstrated that QUE significantly ameliorated DON-induced structural damage, functional impairment, and oxidative stress in the small intestine. Mechanistically, DON exposure disrupted the intestinal barrier by downregulating tight junction proteins (ZO-1, Occludin, and Claudin-1) and activating the MAPK/NF-κB signaling pathway. This activation triggered the assembly of the NLRP3 inflammasome, leading to caspase-1 activation and pyroptosis, as evidenced by cleavage of GSDMD and elevated secretion of IL-1β and IL-18. Critically, QUE intervention suppressed the entire cascade, primarily by inhibiting the upstream MAPK/NF-κB activation. Our findings elucidate a novel mechanism by which QUE attenuates DON-induced enterotoxicity via blocking the MAPK/NF-κB-NLRP3-pyroptosis axis, providing a solid mechanistic foundation for its application as a novel nutraceutical or feed additive against mycotoxin contamination.
28. The school lunchbox as a social problem.
期刊: Health (London, England : 1997) 发表日期: 2025-Dec-01 链接: PubMed
摘要
School lunchboxes contain much more than just food. Maternal and paternal moralities, socioeconomic pressures, and the character of contemporary food systems can all be found within them. Lunchboxes, in turn, are microcosms of food system shifts, including the proliferation of highly-profitable, strategically-engineered ultra-processed foods. These commodities, often representing between 40% and 80% of energy intake depending on contexts, are having harmful effects on the health of children and adult populations worldwide. In this paper we examine evolving food system issues as they intersect with school lunchbox dynamics, through in-depth interviews with 34 parents in Australia. The results focus on the affective relations of ‘food parenting’, the fast-paced temporalities surrounding contemporary food cultures, the socialisation of dietary imbalances and governance of food systems and practices. We argue that the school lunchbox is an important example of the individualisation of responsibility for collective, multi-scale, social problems.
29. K2MODNP: A Lead-Free Initiator with Excellent Thermal Stability and Promising Energetic Performance.
期刊: Organic letters 发表日期: 2025-Dec-01 链接: PubMed
摘要
Researchers in the field of high-energy density materials are actively exploring toxic metal-free alternatives for traditional primary explosive lead azide due to its well-known environmental and health threats. In this work, dianionic N,N’-methylene-bridged 4-hydroxy-3,5-dinitropyrazole was paired with potassium cations to synthesize dipotassium 1,1’-methylenebis(3,5-dinitro-1H-pyrazol-4-olate) (K2MODNP), a primary explosive with a positive oxygen balance with respect to CO (3.67%), excellent thermal stability (Td = 282 °C), and performance exceeding that of lead azide (LA). Notably, this compound exhibited the highest thermal stability among most reported nitropyrazole-based primary explosives to date. The activation energy was determined using Kissinger’s and Ozawa’s methods, supporting its promising potential as a lead-free primary explosive.
30. Adsorption of Dyes, Pharmaceuticals, and Humic Acids onto Chitosan Biomaterials Doped with Activated Carbon: Colloidal Approaches and Interaction Explanations.
期刊: Langmuir : the ACS journal of surfaces and colloids 发表日期: 2025-Dec-01 链接: PubMed
摘要
Various pollutants affect the hazardousness of wastewater, with organic pollutants playing a main role. Thus, among others, wastewater contains natural organic matter (NOM), pharmaceutical compounds, and various toxic and nonbiodegradable dyes. Removing these hazardous compounds from water is essential since they are harmful to both human health and water quality. Therefore, in this study, we evaluated the removal of humic acids (HA), Diclofenac (DCF), and Reactive Red 120 (RR120) by using chitosan/activated carbon and chitosan/activated carbon/curcumin derivatives as adsorbents. Several derivatives with different composition ratios, such as CS/AC@1:1, CS/AC@1:2, and CS/AC@2:1, were initially synthesized and examined. Furthermore, the addition of curcumin (Cur), which is a natural polyphenolic substance, to the CS/AC@ derivative, i.e., CS/AC@Cur5% and CS/AC@Cur10%, was also examined, in order to scrutinize the possibility of additional enhancement of organic contaminants removal. It was found that at pH 2.0, more than 93% of HA was removed by applying CS/AC2:1 (109 mg/g). In the case of DCF at pH 6.0, 97% was removed by CS/AC@Cur5% (148 mg/g), but CS/AC@Cur10% (112 mg/g) was optimum for RR120 removal (94%) at pH 3.0 and 293 K. The adsorption data were more consistent with the Langmuir isotherm model, whereas the adsorption kinetics followed the pseudo-second-order model in all cases. Thermodynamic analysis confirmed that the adsorption was endothermic and spontaneous for all of the organic pollutants. Adsorption-desorption experiments confirmed that these adsorbents can be used effectively for up to six cycles of regeneration.
31. Two-leaves and many bites: Profiling dog-bites and adherence to rabies prophylaxis in tea-estate communities of Udalguri District, Assam, India.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Dec-01 链接: PubMed
摘要
Dog-mediated rabies disproportionately affects marginalised and socioeconomically disadvantaged communities. Tea estate (TE) communities in India exemplify one such vulnerable population. Despite their vulnerability, limited research has explored rabies epidemiology within TE settings. This retrospective study uses secondary data to evaluate the incidence of dog bite and their determinants amongst the TE communities in the Udalguri district of Assam state of India. Secondary data from 17 to 29 months (January 2022 to May 2024) were retrieved from the hospitals and dispensaries of 11 TE of Udalguri district, Assam. The collected information included dog-bite victims’ demographics and adherence to post-exposure prophylaxis (PEP). Data were analysed using R software, employing descriptive statistics, chi-square tests, odds ratios and mixed-effect logistic regression. Administrative approval was obtained prior to data collection. A cumulative annual incidence of 11.8 bites per 1,000 individuals was recorded across 11 TE in Udalguri. Children aged ≤15 years accounted for 35% of cases, and dependents were the most affected occupational group (32%). Most exposures involved dogs (66%), and 76% of incidents were bites. Less than half (43%) of victims completed the full PEP regimen of five doses, although 71% received at least three doses. Chi-square analysis indicated that males and children aged ≤ 15 years were more likely to be bitten by dogs compared to other animals than females and the older residents. Children aged ≤ 15 years and non-workers had higher odds of receiving any PEP, while females and children aged ≤ 15 years are more likely to receive at least three doses. In multivariable analysis, females were less likely than males to be bitten by dogs compared to other animals (aOR = 0.4, 95% CI: 0.3-0.7), older individuals had higher odds of completing PEP (aOR = 1.8, 95% CI: 1.2-2.8), and children (≤15 years) were more likely to receive at least three doses of PEP (aOR = 1.9, 95% CI: 1.1-3.3). Temporal analysis showed no clear seasonal pattern, although spikes were observed during winter and monsoon months. This retrospective study contributes to build the foundation for community-based approach to control dog-mediated rabies in TE by highlighting key epidemiological patterns, demographic vulnerabilities and limitations of the existing intervention implementation delivery among TE communities. We recommend further in-depth investigations to inform the context specific interventions designed to address the unique vulnerabilities, thereby reducing the risk of rabies specifically in tea -estate populations.
32. "We Don't Always Know What we are Missing." Research Teams' Perspectives on the Recruitment of Adults with Intellectual and Developmental Disabilities in General Population Research.
期刊: Journal of empirical research on human research ethics : JERHRE 发表日期: 2025-Dec-01 链接: PubMed
摘要
Ensuring that research participants accurately reflect patient populations is critical for the equitable distribution of the benefits and burdens of studies; however, many groups experiencing health disparities remain underrepresented in research. This study interviewed research team members (n = 25) interested in inclusive recruitment to understand their perspectives on engaging adults with intellectual and developmental disabilities in general population research. Team-based thematic analysis revealed barriers to the inclusion of adults with intellectual and developmental disabilities including 1) use of direct and indirect exclusionary practices, 2) lack of knowledge and skills, 3) reliance on ad hoc accommodations, 4) perceptions that including adults with intellectual disabilities in research lacks scientific value, and 5) beliefs that people with intellectual and developmental disabilities are not able or willing to participate. However, while team members acknowledged a lack of knowledge and skills to include people with intellectual and developmental disabilities, there was a strong interest in learning.
33. Videoconference-delivered acceptance and commitment therapy for depressed individuals with spinal cord injury sustained within the past 5 years: A pilot randomized controlled trial.
期刊: Rehabilitation psychology 发表日期: 2025-Dec-01 链接: PubMed
摘要
This pilot study examined the effects of videoconference-delivered acceptance and commitment therapy (ACT), supplemented with psychoeducation materials, compared to psychoeducation materials alone, on depressive symptoms and other mental health outcomes in individuals with spinal cord injury (SCI) sustained within the past 5 years. A parallel-group, two-arm randomized controlled trial was conducted in the United States with 34 adults who had sustained an SCI within 5 years and reported at least mild depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores ≥5). Participants were randomly assigned to either the ACT group (n = 15) or the control group (n = 19). The ACT group received eight weekly 1-hr individual ACT sessions via videoconferencing, along with a 1-hr booster session. The control group received only psychoeducation materials. The primary outcome was depressive symptoms measured by the PHQ-9. From pretest to posttest, the ACT group demonstrated significantly greater improvements in PHQ-9 scores (Z = 2.1, p = .04, d = 0.75) and all other mental health outcomes compared to the control group, with medium-to-large effect sizes. These improvements were maintained at the 2-month follow-up for PHQ-9 scores (Z = 2.78, p = .005, d = 0.97) and all other measures, except cognitive fusion. This pilot randomized controlled trial is the first to demonstrate the potential efficacy of videoconference-delivered ACT in improving mental health outcomes among individuals with SCI experiencing depressive symptoms. Larger, more diverse samples and longer follow-up periods are needed to confirm and extend these findings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
34. Associations Between Chronic Conditions and Physical-Cognitive Performance in Middle-Aged Adults: A Cross-Sectional Analysis.
期刊: International journal of aging & human development 发表日期: 2025-Dec-01 链接: PubMed
摘要
The global rise in chronic noncommunicable diseases poses a growing challenge to healthcare systems, particularly in developing countries. This cross-sectional study aimed to investigate the associations between chronic diseases and mobility, balance, and visual memory in middle-aged adults. Ninety-seven participants aged 40-64 were categorized based on the Age-Adjusted Charlson Comorbidity Index. Assessments included the Timed Up and Go Test for mobility, the One-Leg Standing Balance Test for static balance, the Y Balance Test for dynamic balance, and the Rey-Osterrieth Complex Figure Test for visual memory. Individuals with chronic diseases had significantly lower scores in all outcome measures compared to those without (P < .05). However, after adjusting for confounders such as age, body mass index, education, and employment status, group differences were no longer statistically significant. Age, education level, static balance, and right foot dynamic balance were significantly associated with mobility. The results highlight the need for early assessment and preventive strategies targeting mobility, balance, and cognitive functioning in middle-aged individuals with chronic diseases.
35. Does Language Proficiency Affect Completion of Telerehabilitation Video Visits? A Retrospective Study.
期刊: Journal of immigrant and minority health 发表日期: 2025-Dec-01 链接: PubMed
摘要
Telehealth use increased dramatically after the COVID-19 pandemic enabled largely by regulatory changes. Health policy experts recommend telehealth as a viable option for healthcare delivery in the post-pandemic world. As investment in telehealth continues, it is important to ensure that existing health disparities are not exacerbated. One group that is particularly vulnerable to telehealth challenges includes patients with limited English Proficiency. This study aimed to examine whether English proficiency is associated with completion of telerehabilitation visits. Electronic Health Records were retrieved for all patients scheduled for a telerehabilitation visit (physical/occupational therapy) in adult or pediatric outpatient clinics at a large academic medical center between April 1, 2020 and April 30, 2022. Using data from 3,871 video visits involving 1414 patients, binomial logistic regression models were estimated to examine associations between sociodemographic variables (age, gender, race, ethnicity, insurance status, income, language preference) and visit completion rate using multivariable logistic regression models. 6.4% of telerehabilitation visits were conducted in a language other than English. 24% patients had a 0% completion rate, 9% had a completion rate of > 0% and < 100%, and 67% had a 100% completion rate. Being older and publicly insured was significantly associated with decreased odds of 100% completion. Patients with English as their preferred language showed higher odds of visit completion. Age, type of insurance, and language preference were associated with successful completion of telerehabilitation video visits. Future research is needed to reveal specific barriers to telerehabilitation for older patients and those with limited English proficiency.
36. Uranium and thorium levels in urine and hair of coal miners and local residents in Shanxi, China.
期刊: Journal of environmental radioactivity 发表日期: 2025-Nov-30 链接: PubMed
摘要
Uranium and thorium are naturally occurring radionuclides that may pose health risks when released into the environment through coal mining activities. This study aimed to investigate the levels of uranium and thorium exposure among coal miners and nearby residents in Shanxi, China. Urine and hair samples were collected from 51 participants, including 30 coal miners and 21 nearby residents. The concentrations of uranium and thorium were measured using inductively coupled plasma mass spectrometer. Subgroup analysis was performed to investigate the effects of environmental and occupational factors. Both urine and hair samples showed uranium and thorium concentrations higher than typical baseline values, indicating environmental and occupational exposure. Uranium levels in urine were notably higher in coal miners, especially among those with shorter work duration, suggesting recent or ongoing exposure. Thorium concentrations displayed limited variability and did not significantly differ between miners and residents. Uranium exposure appears to be closely linked to mining operations and environmental contamination in the region, whereas thorium exposure remains relatively uniform across groups. These findings underscore the need for further investigation into the long-term health effects of uranium and thorium exposure in coal mining areas and call for targeted interventions to reduce exposure risks.
37. Thrombospondin-1 (THBS1) is dysregulated in preeclampsia.
期刊: Placenta 发表日期: 2025-Nov-27 链接: PubMed
摘要
Preeclampsia involves endothelial dysfunction and impaired angiogenesis. Thrombospondin-1 (THBS1), a pro-thrombotic and anti-angiogenic glycoprotein, may contribute to preeclampsia pathogenesis. This study investigated the role of THBS1 in preeclampsia. THBS1 mRNA expression and protein levels were measured in placentas from early-onset preeclampsia (<34 weeks) and gestation-matched controls. Circulating THBS1 was assessed in early-onset preeclampsia and at 36 weeks’ gestation preceding diagnosis of preeclampsia at term. THBS1 was examined during human trophoblast stem cell (hTSC) differentiation into syncytiotrophoblast and extravillous trophoblast (EVT) and compared to a public hTSC organoid dataset. THBS1 regulation was assessed in hTSCs exposed to hypoxia and inflammatory cytokines. Investigating the source of circulating THBS1, we induced endothelial dysfunction in human umbilical vein endothelial cells (HUVECs) with TNFα and treated them with recombinant THBS1. THBS1 mRNA (P < 0.0001, n = 78 vs n = 30 controls) and protein (P = 0.0039, n = 43 and n = 21 controls) levels were significantly reduced in early-onset preeclamptic placentas. Contrastingly, circulating THBS1 was elevated in early-onset preeclampsia (P = 0.011, n = 35 vs n = 27 controls) and preceding term preeclampsia diagnosis (P = 0.0025, n = 21 vs n = 184 controls). THBS1 decreased during syncytiotrophoblast (P = 0.0028) and EVT differentiation (P = 0.0008), indicating mainly cytotrophoblast expression. Analysis of a public hTSC organoid dataset confirmed this. Hypoxic (1 % O2 vs 8 % O2) and TNFα or IL-6 exposure led to differential expression and secretion of THBS1. We observed no changes in THBS1 with induced endothelial dysfunction. Recombinant THBS1 had no effect on endothelial dysfunction. THBS1 is dysregulated in preeclampsia and may be regulated by hypoxic stimuli. These findings support THBS1 as a potential mediator in preeclampsia pathogenesis.
38. Characterization of Colombian departments based on climatic factors, infrastructure, basic service access, and dengue incidence rate.
期刊: Biomedica : revista del Instituto Nacional de Salud 发表日期: 2025-Nov-27 链接: PubMed
摘要
Dengue is an endemic disease in Colombia, with spatial variations influenced by climatic, socioeconomic, and basic service access factors. Territorial characterization based on these determinants supports a better understanding of disease distribution and enables the design of more effective control strategies. To identify groups of departments in Colombia based on the relationship between dengue incidence rates and climatic, socioeconomic, and basic service access factors in 2023. Data were collected from the Instituto Nacional de Salud of Colombia, the Encuesta Nacional de Calidad de Vida, and satellite sources, such as ERA5 and CHIRPS. Variables related to access to basic services (drinking water, sewage, and waste collection), housing deficit, temperature, precipitation, and the normalized difference vegetation index (NDVI) were analyzed. A multiple factor analysis was applied to reduce dimensionality, followed by hierarchical clustering and self-organizing maps to identify department groupings. Three groups of departments with distinct characteristics were identified. The most vulnerable group (group 3) showed an average incidence rate of 1,046.87 cases per 100,000 inhabitants, associated with extreme housing deficits, limited access to basic services, and climatic conditions favorable for vector proliferation. The analysis identified key territorial patterns in dengue incidence and highlighted the influence of structural factors on disease transmission. These findings provide a foundation to strengthen public policies and design more targeted prevention and control strategies in the most vulnerable regions.
39. Spatial modeling of soil-transmitted helminthiases in Colombia under climate change scenarios.
期刊: Biomedica : revista del Instituto Nacional de Salud 发表日期: 2025-Nov-27 链接: PubMed
摘要
Soil-transmitted helminthiases remain a significant public health burden in Colombia, especially in rural and tropical areas. Climate change is expected to alter environmental conditions that favor the survival and transmission of Ascaris lumbricoides, Trichuris trichiura, and hookworms. To estimate the current spatial distribution of these infections and project prevalence changes by 2035 under climate change scenarios, with and without public health interventions. An ecological study with spatial modeling was conducted, integrating epidemiological, climatic, and biological data. Baseline prevalence data were obtained from the Encuesta Nacional de Parasitismo Intestinal (2012-2014). Climate projections from the ERA5-Land satellite product (2024-2035) were used alongside generalized additive models to estimate environmental suitability. A systematic review defined optimal temperature and humidity thresholds for the development of infective stages. Two scenarios were modeled: one without intervention and another with mass drug administration and improved sanitation. Baseline prevalence was 11.3% for A. lumbricoides, 18.4% for T. trichiura, and 6.4% for hookworms, with highest rates in Amazonia and the Sierra Nevada de Santa Marta. In a no-intervention scenario, projected prevalences increased to 13.6, 21.2, and 8.0%, respectively. The intervention scenario reduced these to 6.8%, 12.7%, and 5.6%. Temperature and humidity were strong positive predictors (p < 0.01), while altitude and forest cover showed negative associations. Climate change may intensify soil-transmitted helminthiases transmission in Colombia by 2035. However, sustained control strategies could significantly mitigate this impact. Spatial modeling offers a valuable tool to guide targeted interventions and inform public health planning.
40. [Incidencia de dengue y su relación con el índice oceánico de El Niño, como variable sensible para anticipar brotes en la región Caribe colombiana].
期刊: Biomedica : revista del Instituto Nacional de Salud 发表日期: 2025-Nov-27 链接: PubMed
摘要
Introducción. El informe Lancet Countdown 2023 para Latinoamérica indica que el aumento de las temperaturas influye en la transmisión del virus del dengue. En la región Caribe de Colombia, se ha identificado una asociación significativa entre la incidencia de dengue y variables climáticas, como la temperatura, la humedad y la precipitación. Analizar la relación entre la tasa de incidencia de dengue y el índice oceánico del Niño en los departamentos de la región Caribe colombiana entre el 2021 y el 2023. Materiales y métodos. Se llevó a cabo un estudio ecológico de serie de tiempo, utilizando modelos de regresión no lineal con desfase y modelos autorregresivos integrados de media móvil en los siete departamentos de la región Caribe. Para los análisis descriptivos y los modelos autorregresivos, se emplearon los programas JASP y RStudio. Para los análisis no lineales y con desfase, se usó el paquete dlnm de RStudio. Se encontró una relación positiva y significativa entre el índice oceánico de El Niño y la tasa de incidencia de dengue en el 2023, año en el que se presentó el fenómeno de El Niño. Los departamentos de Bolívar, Cesar, Córdoba y Magdalena tuvieron correlaciones positivas. También, se observó una relación no lineal entre El Niño o La Niña y la incidencia de dengue, con un mayor impacto durante la fase de El Niño. El índice oceánico de El Niño se presenta como un indicador climático útil para monitorear el aumento de casos de dengue en los departamentos analizados de la región Caribe colombiana.
41. Health effects of wildfire PM2.5 in Latin American cities: A rapid systematic review and comparative synthesis.
期刊: Biomedica : revista del Instituto Nacional de Salud 发表日期: 2025-Nov-27 链接: PubMed
摘要
Wildfire activity is intensifying in Latin America due to climate and land-use changes, but the health impacts of wildfire-derived PM2.5 in urban areas remain poorly quantified and recognized. To assess the evidence on wildfire-related PM2.5 and its association with mortality and morbidity in Latin American cities. We conducted a rapid systematic review and meta-analysis following PRISMA guidelines, using data from PubMed, Scopus, and Bireme. One reviewer independently screened 163 articles and extracted data from 14 eligible studies. A risk of bias assessment was conducted using the Newcastle-Ottawa Scale. Most studies were conducted in Brazil (n = 12) and used time-series or modelling designs to estimate health risks. Wildfire-specific PM2.5 exposure was associated with allcause, cardiovascular, and respiratory mortality. Reported effect estimates ranged from 1.7 to 7.7% increases in risk per 10 μg/m³ of exposure. Other studies assessed preterm birth, COVID-19 outcomes, and site-specific cancers. While two studies provided harmonized RR estimates for all-cause mortality, high heterogeneity and methodological differences prevented formal meta-analysis. Wildfire smoke contributes measurably to premature mortality in Latin America, but current evidence is unevenly distributed across regions, time periods, and population subgroups. Studies rarely capture the disproportionate risks faced by indigenous and rural communities or the intraurban disparities linked to poverty and geography. Future research should focus on the health burden of morbidity linked to wildfire PM2.5.
42. Genomic fragment detection and infectivity evaluation of rotaviruses isolated from wastewater used for irrigation in western Bogotá, D. C.
期刊: Biomedica : revista del Instituto Nacional de Salud 发表日期: 2025-Nov-27 链接: PubMed
摘要
Enteric viruses significantly impact morbidity, mortality, and healthcare. Transmission through wastewater is favoured in highly contaminated areas due to inadequate treatment. To determine the number of rotaviruses and their infectious capacity from wastewater samples used for irrigation in the western part of Bogotá. Concentrations of group A rotavirus were monitored in wastewater using molecular methods. The infectivity of rotaviruses was evaluated in a mouse intestinal villi model. We assessed the feasibility of applying this approach for environmental health surveillance in Colombia, considering findings reported by other authors. The research focused on the La Ramada irrigation network in the western part of Bogotá, specifically the Canal San José. We analysed eighteen wastewater samples using qRT-PCR and detected group A rotavirus in twelve of them. The positive samples contained infectious rotavirus, as confirmed through the mouse villi model. This study shows that contamination by group A rotavirus is frequent in wastewaters from the Canal San José in the La Ramada irrigation network in the western part of Bogotá and reveals high concentrations of rotavirus. The results suggest that villi from mouse intestines serve as a reliable model for isolating rotavirus from wastewaters. These findings provide a new approach for environmental health surveillance in Colombia, based on molecular epidemiology for waters highly contaminated with human enteric viruses.
43. Outbreaks and incidence of vector-borne diseases in Colombia (2007-2024): Impact of climate change and deforestation.
期刊: Biomedica : revista del Instituto Nacional de Salud 发表日期: 2025-Nov-27 链接: PubMed
摘要
Vector-borne diseases pose a public health challenge in Colombia, influenced by climatic and environmental factors. El Niño and deforestation can alter vector habitats, affecting the incidence of dengue, Zika, chikungunya, malaria, cutaneous leishmaniasis, and yellow fever. This study analyzes the relationship between these variables and vector-borne diseases incidence in Colombia (2007-2024). An ecological study was conducted using incidence and outbreak data for six vector-borne diseases, linked to climate information, El Niño, and deforestation. Regression models and random forests were applied to assess associations. Between 2007 and 2024, 3,283,259 cases of vector-borne diseases were reported in Colombia. Of these, 49.9% (1,639,120) were dengue and 39.8% (1,307,351) malaria, accounting for 89.7% of total cases. El Niño was associated with increased incidence of dengue (β = 213.24; 95% CI: 86.05-338.43), chikungunya (β = 26.41; 95% CI: 17.54-70.36), and Zika (β = 14.12; 95% CI: 10.06-89.30). Maximum temperature showed a positive relationship with dengue (β = 5.74; 95% CI: 2.15-13.63) and malaria (β = 17.28; 95% CI: 3.81-30.75). Deforestation was associated with malaria (β = 12.35; 95% CI: 4.62-20.08) and cutaneous leishmaniasis (β = 8.67; 95% CI: 2.21-15.13). Mean precipitation had negative associations with chikungunya and leishmaniasis. Climate change and deforestation impact the epidemiology of vector-borne diseases in Colombia. Integrated public health and environmental conservation strategies are needed to mitigate their effects.
44. [Sistema de alerta temprana para altas temperaturas y olas de calor: la necesidad de una política de salud pública en Colombia].
期刊: Biomedica : revista del Instituto Nacional de Salud 发表日期: 2025-Nov-27 链接: PubMed
摘要
El aumento de la temperatura global, acelerado por el actual cambio climático, requiere la promoción de políticas de salud pública, como la generación de sistemas de alerta para altas temperaturas y olas de calor, para disminuir el riesgo de los grupos poblacionales más vulnerables: niños, mujeres gestantes y adultos mayores. La evidencia científica compilada en esta revisión descriptiva de carácter narrativo respalda que las mujeres en estado de embarazo tienen un mayor riesgo de parto prematuro cuando han estado expuestas a altas temperaturas; los adultos y los niños pueden tener riesgo de deshidratación, y los adultos mayores de 65 años pueden tener un mayor riesgo de padecer enfermedades cardíacas. Se analizaron algunos de los sistemas de alerta temprana de diferentes países para altas temperaturas y olas de calor, considerando un enfoque de disminución del riesgo para la salud de las personas. En Colombia, la normatividad vigente permite la generación de un sistema de alerta temprana para las altas temperaturas. El Plan decenal de salud pública 2022-2031, consignado en la resolución 2367 de 2023, mediante el eje estratégico 5: “cambio climático, emergencias, desastres y pandemias”, invita a desarrollar un trabajo intersectorial para la gestión en salud asociada con estos fenómenos. Este plan tiene como meta estratégica territorial para el 2031 que los diferentes territorios generen sistemas de alerta temprana para disminuir el impacto de las amenazas exacerbadas por el cambio climático. Finalmente, se presenta un marco de referencia basado en el riesgo climático y se invita a las instituciones gubernamentales a liderar este proceso.
45. Regulatory effect of fadR on the inhibition of Aspergillus flavus infection of walnut kernels by Enterobacter ludwigii AA4.
期刊: Microbiological research 发表日期: 2025-Nov-25 链接: PubMed
摘要
Mycotoxin contamination of nuts, frequently attributed to inappropriate storage, causes substantial economic losses and health concerns globally. Biological control using beneficial microorganisms has emerged as an environment friendly method for efficient mitigation of Aspergillus flavus pollution and consequent mycotoxin elimination in foodstuffs. Nevertheless, the exact mechanisms by which these biocontrol microbes protect nuts from this toxigenic fungus remain largely unknown. Using a fungal infection assay, we observed a remarkable inhibitory effect of Enterobacter ludwigii AA4 against the growth of A. flavus colonizing walnut kernels and aflatoxin B1 production. Mutant E. ludwigii AA4 strains, generated by genetically modifying five biofilm-related genes, notably fadR (which encodes a transcriptional regulator), exhibited significantly impaired biofilm development and reduced efficacy in suppressing A. flavus. These results indicated that biofilm establishment is indispensable for the inhibitory effect of E. ludwigii AA4 against A. flavus. We further investigated the kernel colonization of fadR knockout mutant, which exhibited the most pronounced reduction in biofilm formation, via colony counting and laser scanning confocal microscopy. We found that fadR contributed to the suppression of A. flavus by influencing bacterial biofilm production and kernel settlement. Gene expression analysis and site-directed mutagenesis revealed that fadR modulated biofilm development by negatively regulating the transcription of rcsA, an auxiliary protein gene within the Rcs phosphorelay system, potentially by influencing acetyl phosphate-mediated RcsB phosphorylation. These findings highlight the potential of AA4 in the biological control of A. flavus contamination in walnut kernels.
46. Harnessing 3D cultured MSC exosomes through tangential flow filtration for enhanced diabetic wound healing.
期刊: Stem cells translational medicine 发表日期: 2025-Nov-24 链接: PubMed
摘要
Mesenchymal stem cell-derived exosomes have garnered considerable attention in regenerative medicine due to their non-immunogenicity, low infusion toxicity, easy accessibility, straightforward preservation, and minimal ethical concerns. While ultracentrifugation is the prevailing method for high-purity exosome isolation, it is limited by low throughput and the need for specialized infrastructure. This study investigates tangential flow filtration (TFF) as a promising alternative for exosome isolation. This technique offers simpler operation, higher yields, and improved recovery rates compared to ultracentrifugation. Human umbilical cord mesenchymal stem cells (hUCMSCs) were cultured in a 3D microcarrier-bioreactor system, and exosomes were extracted from the conditioned medium using either ultracentrifugation or an automated and enclosed TFF system. Subsequently, we compared the quantity, quality and therapeutic efficacy of the exosomes isolated via both approaches, evaluating their effects in vitro and in a mouse model of diabetic wound healing. Our findings demonstrate that the TFF method effectively isolates high-quality exosomes that meet the standards set by the Minimum Information for Studies of Extracellular Vesicles (MISEV) 2023 guidelines, while achieving a significantly higher extraction yield compared to the traditional ultracentrifugation. Furthermore, both TFF and ultracentrifugation-derived exosomes demonstrate comparable biological activity in vitro and similar therapeutic potential for treating diabetic wound healing, potentially through promoting M2 macrophage polarization and angiogenesis. The results indicate that TFF is a viable method for scalable and efficient exosome production, facilitating advancements in clinical applications for diabetic wound repair.
47. Growth differentiation factor-15 is associated with adverse outcome, malnutrition risk and health deficit in decompensated cirrhosis.
期刊: Clinical nutrition (Edinburgh, Scotland) 发表日期: 2025-Nov-22 链接: PubMed
摘要
Growth differentiation factor (GDF)-15 plays pivotal roles in pathophysiology and is linked to anorexia, wasting conditions, and adverse outcomes. However, its clinical implementation as a biomarker among cirrhosis remains enigmatic; thus, we explored the relationships between serum GDF-15 and diverse endpoints, including nutritional status, all-cause mortality, and health deficit. This observational study analyzed 287 patients hospitalized due to acute decompensating episodes (median age 64 years, 55.8 % male). Malnutrition risk, various body composition, health deficit, and underlying disease severity were assessed by the RFH-NPT scale, CT scans, handgrip strength/frailty index, and CTP/MELD-Na score, respectively. The median concentrations of GDF-15 were 4.75 (Q1, Q3: 3.25, 7.54) ng/mL. Higher GDF-15 levels were related to a more prevalent malnutrition risk and more detrimental disease severity. Patients with increased GDF-15 had more impairment of renal/hepatic function, lower zinc levels, and marked hypoalbuminemia, addressing metabolic imbalance. Moreover, participants with higher GDF-15 also exhibited more significant health deficit like multidimensional frailty. Multivariate Cox analysis indicated that increased GDF-15 independently predicted 1-year mortality after adjustment for coexisting nutritional status and underpinning disease burden (CTP: HR: 1.07, 95%CI: 1.01, 1.13, P = 0.013; MELD-Na: HR: 1.06, 95%CI: 1.01, 1.12, P = 0.044). Serum GDF-15 concentrations were higher in patients with decompensated cirrhosis at risk of malnutrition. Furthermore, this biomarker was closely linked to an increased risk of adverse outcomes and health deficit. It has potential as a complementary biomarker for assessing the prognosis in the context of cirrhosis.
48. Universal maternal testing for group B streptococcus in late pregnancy: process outcomes and alongside qualitative study for the GBS3 trial.
期刊: Early human development 发表日期: 2025-Nov-17 链接: PubMed
摘要
One in five pregnant women/birthing people carry group B streptococcus in the gut or genital tract, and over half of them will pass it to their child during pregnancy, labour (most commonly) or after birth. Most babies exposed to maternal GBS remain well, but 1 in 1750 newborns in the UK and Ireland develop early-onset GBS infection. Introducing routine testing for group B streptococcus (GBS) for all pregnant women and birthing people in late pregnancy may reduce cases of early-onset infection in the newborn but would likely increase the number of women given antibiotics during labour. The GBS3 trial (ISRCTN49639731) is a cluster-randomised trial involving approximately 320,000 women/birthing people from 80 maternity units in England and Wales. It will determine the clinical and cost-effectiveness of routine testing, compared to the current risk-factor based strategy. To obtain details of the timing, coverage and outcome of the testing process and use of IAP, about 130 consecutive maternity records of women who birthed after 32 weeks’ gestation and who were not scheduled for a planned caesarean birth, and the corresponding neonatal records, were scrutinised at each participating maternity unit. We performed a baseline qualitative study to inform the trial design to explore women’s views on the acceptability of different methods of GBS testing in pregnancy, including self-swabbing procedures. We explored the acceptability of different methods of routine testing for GBS colonisation to pregnant women and health care professionals (HCPs), and examined the barriers and facilitators to their implementation. We received detailed demographic data for 9179 women. Overall, in both testing groups, 72 % of women were offered a vaginal-rectal swab for GBS. Of those women offered a swab, 82 % accepted a vaginal-rectal swab. Of the women with a swab taken, 17 % were positive for GBS. 87 % of women had a test result ≥ 4 hours before birth. Our baseline and embedded qualitative studies found that GBS testing is acceptable to most women and HCPs. GBS testing is acceptable to pregnant women and health care professionals in the UK. When GBS testing is offered to eligible women, the offer is accepted, the test performed and a result available to guide the offer of IAP in a timely fashion for the majority of women.
49. African solutions for African medical education: the strategic establishment of the Consortium of Medical Schools in Africa.
期刊: BMJ global health 发表日期: 2025-Aug-17 链接: PubMed
摘要
50. Cost-effectiveness of Zvandiri, a community-based support intervention to reduce virological failure in adolescents living with HIV in Zimbabwe: Results of a decision analytical model.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Improving antiretroviral therapy (ART) adherence among adolescents living with HIV (ALHIV) improves outcomes, but with resource implications. We conducted a cost-effectiveness analysis extrapolating the costs and benefits of a community-based peer-support intervention (Zvandiri) among ALHIV in Zimbabwe. We used a de-novo multistate Markov decision-analytic model that simulated Zvandiri lifetime costs and benefits on viral suppression, death rates, life-years (LY) and quality-adjusted-life-years (QALYs) gained from the healthcare system perspective. We estimate the incremental cost-effectiveness ratio (ICER) per LY and QALY gained and compare the ICER to proposed cost-effectiveness thresholds of $500 and $700 per LY or QALY gained. We explore parameter uncertainty using probabilistic sensitivity analyses. Cohort-microsimulation suggests that after 40 years under SoC, 21% of 280 ALHIV will have undetectable viral-load (VL), 12% will have low VL (<1000 copies/mL), 10% will have high VL (≥1000 copies/mL) and 57% would have died. With Zvandiri, ART adherence improves, decreasing annual probability of virological failure or death. After 40 years, 65% will have undetectable viral load, 23% low VL, 3% high VL and 9% would have died. Zvandiri results in 1,345 LYs gained at incremental cost of $500,587, yielding a discounted ICER of $372 per LY gained. Zvandiri also results in 1,246 QALYs at incremental cost of $123,645, yielding a discounted ICER of $99 per QALY. The ICER is highly sensitive to programme costs, health-related utilities, and the discount rate. Zvandiri is a cost-effective intervention for reducing virological failure and death in ALHIV. Our analysis likely underestimates the full benefits of the intervention by not accounting for reductions in HIV transmissions resulting from higher virological suppression observed in full transmission models.
51. A data-driven analysis of patient selection for xenotransplant human clinical trials.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
The demand for transplant organs far exceeds the available supply. In the United States alone, more than 90,000 patients are currently on the kidney transplant waitlist, yet only about one third of them will ever receive a transplant. Xenotransplantation, organ transplants from gene edited pigs, offers a potential solution to this shortage. Successful investigational transplants of pig kidneys into brain-dead recipients and expanded access cases involving living human recipients have resulted in the green-lighting of the first human clinical trials. Using the benchmark of 2-year survival of non-human primates in pre-clinical studies, we developed a tool that can identify individual wait-listed patients predicted to have a shorter life expectancy than with a xenotransplant, utilizing Random Survival Forest, DeepSurv and Cox Proportional-Hazards models. We found that it is hard to identify patients that reach clinical equipoise unless the expected xenograft survival exceeds two years, with the Random Survival Forest model identifying less than 5% of such patients. Few patients would benefit based on survival alone and potential beneficiaries are spread across more than 200 transplant centers. Several incentives could allow more patients to reach equipoise. At the same benchmark of 2-year xenograft survival, keeping patients inactive on the waitlist while they have a functioning xeno-kidney increases the percentage achieving equipoise by up to 1.7% across cohorts. Granting patients with failed xenografts the same priority as prior living donors increases this by up to 17.9%, while assigning them the highest priority raises it by up to 28.5%. We are able, however, to identify phenotypes that have a high mortality and low transplant rates in the current allocation system that could serve as acceptable candidates; while not achieving equipoise, they would enjoy the benefits of being dialysis free.
52. Demographic trends and disparities among NIH-funded medical school faculty in the US, 1970-2022.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Although gender and racial/ethnic trends and disparities are well documented among recipients of National Institutes of Health (NIH) research grant funding, little is known about the demographic trends and disparities within a critical subpopulation: NIH-funded medical school faculty. This paper analyzes a rich dataset of full-time medical school faculty and their NIH grants from 1970 to 2022 and examines temporal trends in the demographic distribution and relative representation (representation index) of NIH-funded medical school faculty by gender, race/ethnicity, and their intersections. This paper reports that, while the gender gap in NIH funding has narrowed, a gender gap remains, particularly among highly funded faculty. Further, trends disaggregated by both gender and race/ethnicity demonstrate the particularly low relative representation of Black and Hispanic NIH-funded faculty, specifically Black and Hispanic women, that persists over time. Notably, although Asian men and women are represented at similar rates among medical school faculty overall, a gender gap in favor of Asian men has become more pronounced over time among NIH-funded Asian faculty. Although there are efforts to recognize a broader set of metrics for a successful research career, research grant funding remains key for establishing research independence, tenure, and promotion. Thus, our findings of ongoing disparities underscore the urgent need to identify effective strategies to advance gender and racial/ethnic equity within NIH-funded medical school faculty.
53. Exploring spatial variation and multilevel modeling of malaria prevalence among children aged 6-59 months based on RDT in Niger: Insights for public health decision-making.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Malaria is a life-threatening infectious disease caused by parasites of the genus Plasmodium transmitted through the bite of infected female Anopheles mosquitoes, which act as vectors of the disease. It affects approximately 219 million people globally and results in 435,000 deaths each year. Fever, chills, and exhaustion are among of the signs of this illness. If left untreated, these symptoms can develop into serious problems like anemia, respiratory distress, and even organ failure. By identifying determinants related to malaria prevalence, this study supports evidence-based national malaria prevention and control initiatives. The results help improve decision-making for malaria control efforts and guide focused public health initiatives by identifying areas with a high malaria burden. Data from the 2021 Niger Malaria Indicator Survey (NMIS) is used, focusing on RDT-confirmed malaria cases in children aged 6-59 months. The dataset includes individual, household, and community-level variables, such as age, household income, education, healthcare access, and geographic coordinates. Spatial distribution of malaria prevalence is first visualized through maps and hot spot analysis to identify areas with high and low malaria rates. Random effects are incorporated to capture unobserved heterogeneity between regions and communities, allowing for more accurate estimates of malaria prevalence by adjusting for spatial clustering. Multilevel logistic regression models are applied to account for the hierarchical structure of the data. Model fit is evaluated using standard criteria (AIC, BIC and DIC), and diagnostics are performed to ensure reliability. 1121 (23.7%) of the 4724 children aged 6 to 59 months who were examined had positive RDT results for malaria. Malaria prevalence in Niger among children aged 6-59 months is significantly clustered (Moran’s I = 0.434, p < 0.001), revealing distinct hotspots and cold spots unlikely due to chance. Model III provides a better fit for RDT prevalence among children aged 6-59 months with malaria, as indicated by the smallest AIC, BIC, and deviation statistics compared to other reduced models. Malaria prevalence was associated with factors, including child age, anemia levels, maternal education, the number of children sleeping under bed nets, the use of insecticide-treated nets, the number of children aged 5 and under, as well as residence and region. The findings show that malaria prevalence among children aged 6-59 months in Niger is significantly influenced by factors such as child age, anemia levels, maternal education, and bed net usage, emphasizing the need for improved coverage of insecticide-treated nets and tailored interventions based on local conditions.
54. From safety commitment to safety behavior: The mediating role of safety awareness.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
To deeply analyze the mechanism of workplace safety climate on employee safety behavior, a conceptual model of employee safety behavior was constructed based on the theory of stimulus-organism-response (SOR). Structural equation modeling was used to test the model and hypotheses. The results show that safety communication and safety regulation have a significant positive impact on employees’ safety commitment and, consequently, on their safety compliance behavior. However, safety communication has no significant impact on employees’ safety awareness. Safety regulation can significantly improve employees’ safety awareness, which in turn enhances their compliance behavior. Employees’ safety compliance behavior directly affects their participation behavior and plays a completely mediating role in the influence of safety commitment and safety awareness on safety participation behavior.
55. Analysis of PM-bound polycyclic aromatic hydrocarbons exposure among motorcycle taxi drivers in six central provinces in Thailand in winter.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Motorcycle taxis are popular transportation in areas with heavy traffic in Thailand. In this study, we recruited motorcycle taxi drivers in six central provinces in Thailand between January and March 2023 and measured their particulate matter (PM) and PM-bound polycyclic aromatic hydrocarbon (PAH) exposures using personal air sampling. We found that the PM10 and PM2.5 concentrations measured by personal air sampling were independent of those monitored at air quality monitoring stations or by area air sampling devices. Among the six provinces, motorcycle taxi drivers in Pathum Thani were exposed to the highest mean concentration of PM10 (224.9 µg/m3), PM2.5 (410.9 µg/m3), PM10-bound total PAH (38.4 ng/m3), and PM2.5-bound total PAH (36.9 ng/m3). Four workstations (PTT-1 to PTT-4) using 22 samples of PM₁₀ and 25 samples of PM₂.₅ personal air samplers showed unexpectedly higher PM₂.₅ than PM₁₀, likely due to route-specific environmental factors, as drivers follow variable routes determined by passenger destinations and daily demand. The incremental lifetime cancer risk of PM10-bound PAH and PM2.5-bound PAH in Pathum Thani were 4.5 × 10-8 and 7.8 × 10-8, respectively, which were acceptable levels. None of the individuals’ lung function parameters was significantly correlated with the individuals’ concentrations of PM10, PM2.5, PM10-bound total PAH, or PM2.5-bound total PAH. However, province averages of PM10-bound total PAH exposure of motorcycle taxi drivers were positively correlated with the proportions of participants who answered symptoms of chronic bronchitis in the province. The causal relationship between motorcycle taxi drivers’ PM and PM-bound PAH exposure in Pathum Thani and their respiratory symptoms needs to be further investigated.
56. The EQo-Mental project: A protocol for a mixed-methods study on occupational balance and mental health in parents of children with developmental delays.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Parents of children with developmental delays (DD) often face significant challenges that affect their mental health and occupational balance. While early intervention services traditionally focus on child development, the occupational needs and well-being of parents remain underexplored. The EQo-Mental project aims to examine the association between parental mental health, occupational balance, and meaningful activity engagement, and to co-develop family-centred strategies that promote well-being in early intervention contexts. This sequential mixed-methods study includes two phases. The quantitative phase will involve approximately 700 parents of children aged 0-6 years attending early intervention centres in Alicante, Spain. This phase comprises two components: (1) the psychometric validation of the Spanish versions of two occupational measures-the Occupational Balance Questionnaire (OBQ-E) and the Engagement in Meaningful Activities Survey (EMAS)-and (2) a cross-sectional analysis examining associations between occupational and mental health outcomes. Participants will complete a sociodemographic questionnaire along with validated self-administered instruments assessing occupational balance, meaningful activity engagement, stress, anxiety, depression, and psychological well-being. In the qualitative phase, participatory sessions and focus groups will be conducted with a subsample of parents and key stakeholders to explore perceived occupational and mental health needs and to co-design actionable strategies for improving occupational balance and family well-being. Participant recruitment began in November 2023 and is ongoing; data collection is expected to be completed by October 2025. Psychometric analyses will first be conducted to evaluate the validity and reliability of the OBQ-E and EMAS. Next, descriptive analyses and multiple regression models adjusted for potential confounders will be used to explore associations between occupational and mental health variables. Phase 2 consists of a participatory-action research process, including discussion groups and a multi-stakeholder focus group. Qualitative data will be analysed using reflexive thematic analysis. Findings from EQo-Mental will inform the design of evidence-based, family-centred strategies that support occupational balance, parental well-being, and engagement in meaningful activities. By addressing the occupational needs of parents, the project seeks to foster more resilient families and strengthen early intervention services through an inclusive, occupation-focused approach.