公共卫生研究摘要 (2025-12-05)
共收录 54 篇研究文章
1. "You got it on you": How the Experience of Community is Influenced by Stigma.
期刊: Journal of community psychology 发表日期: 2026-Jan 链接: PubMed
摘要
This study explores how stigma influences community experiences among individuals with serious mental illness (SMI), using the structural-function-experiential (SFE) model as a guiding framework. Qualitative semi-structured and social network interviews were conducted with 30 participants receiving assertive community treatment (ACT) services in New York state. Modified grounded theory approach guided the analysis. Four themes emerged: (1) “Maybe I’m as crazy as they say I am,” (2) avoiding disclosure and relationships, (3) providers or no one, and (4) longing for connection. These themes illustrate how stigma operates in an ecological framework such as the SFE model consisting of structural, functional, and experiential dimensions of community. Stigma disrupts social relationships, inhibits disclosure, and reinforces social isolation. Applying the SFE model highlights community-level mechanisms through which stigma can be mitigated. Findings inform transformative change efforts to enhance social inclusion and recovery for people with SMI.
2. The Role of Information and Communication Technologies in Social Participation of Older Adults: A Scoping Review.
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Jan-01 链接: PubMed
摘要
Social participation is essential for healthy aging, supporting older adults’ health and well-being. Although information and communication technologies (ICTs) offer promising opportunities, a focused summary of the literature on ICT use for social participation, a distinct aspect of digital engagement, has been lacking. To summarize existing literature on ICT use for social participation among older adults and identify gaps by examining study characteristics, ICT classifications, and associated health variables. PsycINFO, MEDLINE, Embase, and CINAHL were searched for quantitative, nonexperimental studies published from 2016 through 2024. The authors followed the Joanna Briggs Institute scoping review methodology. Of 9,795 screened articles, 85 met the inclusion criteria. The number of relevant publications has increased over time, with nearly half (47.1%) related to the COVID-19 pandemic. Modes of interaction included social media (72.4%), email (64.5%), text messaging (60.5%), and video calls (53.9%). Most studies assessed communication frequency with family and friends (72.9%), whereas fewer explored meeting new people online (7.1%) or the quality of online participation (5.9%). Social well-being (56.5%) and mental health (43.4%) were the most frequently examined health variables. The growing body of research highlights ICTs’ role in social participation in later life but reveals key gaps. Research on underrepresented populations, ICTs’ potential for expanding social networks, and the quality of online participation remains limited. Inconsistent measurement practices hinder ability to draw conclusions. These gaps point to critical opportunities for future occupational therapy research and practice. Plain-Language Summary: Staying socially connected is important for older adults’ health, well-being, and overall quality of life. This review explored how older adults use digital technologies, such as video calls, email, text messaging, and social media, to stay in touch and participate socially. Interest in these technologies has grown in recent years, especially during the COVID-19 pandemic. Most research focused on communication with family and friends; fewer studies examined forming new relationships online or the quality of online interactions. Digital tools can reduce loneliness and support participation, particularly when in-person contact is limited. However, more research is needed to understand usage patterns and the adoption of these tools in daily life, especially among underrepresented groups. This knowledge can help occupational therapy practitioners better support older adults in using technology to promote meaningful social connections.
3. State of the Science of Pediatric Feeding Evaluation, Intervention, and Policy.
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Jan-01 链接: PubMed
摘要
Feeding is a multifaceted process that is frequently disrupted across pediatric populations, in particular among children with medical, developmental, or behavioral challenges. Occupational therapy practitioners possess unique expertise in providing comprehensive evaluations and interventions for feeding and eating skills, child regulation and behavior, mealtime routines, and family-centered goals during this essential activity of daily living. This State of the Science review synthesizes the current state of evaluation, intervention, and policy related to pediatric feeding within occupational therapy; specifically, we identify opportunities for expanded assessment development, intervention research, clinical research partnerships, and policy advocacy. We emphasize the importance of occupational therapy practitioners being part of multidisciplinary teams, consistently being recognized as qualified providers of feeding services, and being reimbursed for service provision across the United States related to pediatric feeding.
4. Challenges in Diagnosis and Management of Complex Regional Pain Syndrome: Insights From a Retrospective 9-Year Review in an Academic Medical Center.
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2026-Jan-01 链接: PubMed
摘要
Complex regional pain syndrome (CRPS) limits self-care, work, and independence due to pain, sensory, and motor dysfunction. Early intervention, including occupational therapy, may reduce long-term disability and support adaptive strategies. To assess CRPS incidence and risk factors after distal limb injuries (primary objective) and evaluate the Budapest Criteria’s effectiveness and identify rehabilitation-focused interventions, emphasizing occupational therapy (secondary objectives). Retrospective cohort study of 556 adults with distal limb injuries (2015-2023). Data were extracted from medical records, including diagnostic codes, clinical notes, and therapy documentation. Descriptive and regression analyses identified risk factors and treatments. Single academic medical center. A total of 556 patients with distal limb injuries, 241 of whom met the Budapest Criteria for CRPS (M age = 48.7 yr; SD = 26.0; 179 were female). Primary measures included injury characteristics, CRPS classification, pain severity, and treatments. Secondary measures were risk factors and therapy involvement within 1 yr of diagnosis. All primary and secondary outcomes were preplanned and queried once from medical records. Among 241 CRPS cases, 69.7% affected the lower limb (CRPS Type 1: 20.3%; CRPS Type 2: 18.7%; unclear: 61%). Diagnostic delays were, on average, 39.7 mo (SD = 63.6). Pain scores averaged 6.7 (for rest) and 7.9 (for activity). Treatments included medications (83%), therapies (66.8%), and injections (17.8%). Occupational therapy participation was significantly higher among accurately classified cases p = .0210). Standardized diagnostic criteria and early occupational therapy engagement were associated with improved documentation. Future research should explore the role of rehabilitation in CRPS care. Plain-Language Summary: This study examined how complex regional pain syndrome is diagnosed and treated, with a focus on its effects on daily activities and how early intervention can improve recovery. Complex regional pain syndrome is a painful condition that can develop after an injury, leading to challenges with movement and participation in everyday tasks. Researchers analyzed medical records to understand how often doctors used the Budapest Criteria, the standard guidelines for diagnosing complex regional pain syndrome, and found that, in many cases, the criteria were not properly documented, which may lead to diagnostic uncertainty. The study also emphasized the importance of rehabilitation, especially occupational therapy and physical therapy, as the first step in treatment, followed by medications if symptoms persisted. These findings underscore the need for consistent diagnostic practices and early occupational therapy engagement to support function and recovery in people with complex regional pain syndrome.
5. Challenges and Opportunities of Cosmeceutical Regulations: A Global Perspective.
期刊: International journal of toxicology 发表日期: 2025-Dec-04 链接: PubMed
摘要
The international cosmeceutical sector has experienced unprecedented expansion, compelling regulatory bodies to enhance and update systems to tackle consumer protection, product effectiveness, and ethical issues. This review critically evaluates and contrasts regulatory settings in key markets, such as the European Union, United States, Canada, Japan, China, India, and Brazil. The examination is concentrated on key features including product definitions, pre-market approval procedures, and ingredient regulation, labeling requirements, post-market surveillance, and integrating ethical and environmental considerations. The outcome shows significant advances in regulatory harmonization, especially in the area of ingredient safety and adverse event reporting; however, there are still considerable challenges. Pioneering among these are the lack of a standard definition for “cosmeceuticals,” highly variable ingredient limitations, and uneven application practice across jurisdictions. The speedy growth of e-commerce and cross-border sales additionally complicates regulatory control, adding to the possibility of non-compliant or counterfeited products reaching consumers. The review also identifies a shortage of empirical evidence to document the actual impact of recent regulatory reforms in the real world, as well as on innovation and market access. The present study recommends the promotion of international harmonization of standards, enhancement of post-market surveillance, convergence of ethical and sustainability dimensions, and targeted support for small- and medium-sized enterprises. Henceforth, while important progress has been achieved, the future of the industry rests on creating nimble, science-informed, and internationally harmonized regulatory systems that can keep pace with changing technologies and consumers’ and public health priorities, ensuring both consumer safety and industry innovation.
6. Tailored ZnCu Conductive MOF as a Floating-Gate in Carbon Nanotube Network FET NH3 Sensors.
期刊: ACS sensors 发表日期: 2025-Dec-04 链接: PubMed
摘要
Ammonia (NH3) is a common and hazardous gas, and monitoring low concentrations of NH3 is crucial for environmental protection and public health. This study reports a synergistically enhanced Zn/Cu bimetallic conductive metal-organic framework (MOF) for room-temperature gas sensing applications and its integration with carbon nanotube network field-effect transistors (CNTFETs). Zn/Cu-HHTP (HHTP = 2,3,6,7,10,11-hexahydroxytriphenylene hydrate) with varying Zn/Cu ratios was synthesized via a solvothermal method and characterized in terms of its structure, morphology, and gas-sensing performance. Cu2+ facilitates efficient charge transfer during sensing, and Zn2+ provides active sites that enhance NH3 adsorption. Gas sensing tests show that Zn1Cu2-HHTP achieves the highest chemiresistive response (|ΔR|/R0 ≈ 4.48%) to 50 ppm of NH3 with excellent selectivity. Kinetic analysis showed that Zn1Cu2-HHTP possessed a 3.45-10.46-fold faster adsorption kinetics rate relative to the monometallic systems. Density functional theory reveals that Zn-Cu synergy optimizes NH3 adsorption at bimetallic sites by balancing adsorption strength. At a gate voltage of 1.0 V, the Zn1Cu2-HHTP floating-gate CNTFET exhibits a response of 91,202.25% to 1000 ppb NH3 within 15 s at room temperature. Sensitivity has been greatly improved from 0.11%/ppm for chemiresistive sensors to 4168.69%/ppm for CNTFET sensors, an increase of nearly 37,500 times. This study presents a novel strategy for developing gas sensors with high performance, low power consumption, and excellent selectivity, offering broad application potential in complex environments for trace gas detection.
7. From Small Ripples to a Sea Change: Elucidating Long-Term and Multi-Level Youth Mental Health Intervention Impacts Using Ripple Effects Mapping.
期刊: Qualitative health research 发表日期: 2025-Dec-04 链接: PubMed
摘要
Ripple effects mapping (REM), a qualitative participatory approach to intervention evaluation, is gaining recognition as a useful method for elucidating the long-term intended and unintended impacts of complex public health interventions. The present study applied an adapted REM approach to capture systems and community change associated with the Agenda Gap program. This population-level youth mental health promotion intervention is embedded in multi-sectoral partnerships with long-term and relational outcomes post-program that are difficult to elucidate using traditional program evaluation methods. Using transcript and mind map data generated through an REM process with former Agenda Gap youth collaborators and adult allies, reflexive thematic analysis supported the construction of three thematic program outcomes: (1) Reimagining Future Possibilities, (2) Systems Integration: Transforming School Practices, and (3) Progressing From Ripple Effects to Sea Change. Spanning socioecological levels (i.e., individual, family, community, and societal), the outcomes and their associated sub-themes captured the meaningful impacts experienced by Agenda Gap participants, as well as those more distal to the intervention, in the years following implementation. These findings demonstrate the substantive, multi-level impacts of the program and also illustrate how qualitative, participatory approaches, such as REM, can complement other forms of evaluation to reveal outcomes that are typically overlooked. Recommendations and implications for future research and applications of REM are offered.
8. Oura Ring Behavioral Feedback Intervention for Alcohol Reduction in Young Adults: User Experience Evaluation of a Pilot Randomized Trial.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-04 链接: PubMed
摘要
Wearable fitness technologies, like the Oura Ring (Oura Health Oy), provide physiological metrics, like sleep and heart rate data, to a growing user base of young adults. However, these technologies and connected mobile apps do not measure young adults’ alcohol use that contributes to these metrics. Personalized feedback on the impact of alcohol on sleep and heart rate may boost motivation to reduce drinking among young adults. For this pilot randomized controlled trial, we evaluated the acceptability, feasibility, and perceived effectiveness of a wearable personalized feedback intervention for alcohol reduction in young adults that integrated physiological and behavioral data. Recruitment took place offline and online via open access websites. Participants (N=60) wore the Oura Ring for 6 weeks and completed daily behavioral smartphone diaries. Only the feedback group (n=30) had full access to the Oura Ring app and personalized feedback reports every 2 weeks, received from the study team. The app included daily feedback on sleep and cardiovascular recovery. Feedback reports combined Oura Ring and diary data to show trends of alcohol use alongside sleep and cardiovascular data. We used artificial intelligence-driven convergent mixed methods to evaluate self-assessed exit surveys and face-to-face exit interviews, including natural language processing and researcher-coded qualitative analyses with interviews. Half of participants (30/60, 50%) were men, 81.6% (49/60) were White, and they had a mean age of 22.02 (SD 1.98) years. Across both groups, the overall program was described as highly acceptable, feasible, and effective. Wearing the Oura Ring was highly acceptable and feasible. The smartphone diaries were moderately acceptable, moderately-highly feasible, and highly effective. The feedback reports were highly acceptable, feasible, and effective. Among feedback group participants, the Oura Ring and app were moderately effective. The feedback group participants also had high adherence using the app daily, and 80% (48/60) read all 3 feedback reports. Per natural language processing, the most common topic in the feedback interviews related to their behavior change due to multiple intervention components (Ɵk=0.18). This contrasted with the most common topic from assessment group participants about prechange learning (Ɵk=0.22). During the researcher-coded qualitative analysis, we identified themes in 3 categories. Most participants described helpful aspects of the Oura Ring and app, smartphone diaries, and feedback report. Most felt that the report had the right amount of information, and a large group reported they learned about their sleep deficits. Curiosity was the most common reason participants joined the study. SMS text messages and usability kept them engaged, and almost none considered dropping out. Commercial fitness wearables that integrate behavioral data may be acceptable and feasible and promote readiness to change drinking in young adults who are generally unconcerned about risky behaviors.
9. Tracking Superbugs in the Digital Era.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-04 链接: PubMed
摘要
10. Assessing Usefulness of the Dashboard Instrument to Review Equity (DIRE) Checklist to Evaluate Equity in Public Health Dashboards: Reliability Study.
期刊: JMIR public health and surveillance 发表日期: 2025-Dec-04 链接: PubMed
摘要
The COVID-19 pandemic was a critical time for public health, and though dashboards remained a source of critical health information for decision-makers, key gaps in equity-based decision support were revealed. The DIRE (Dashboard Instrument to Review Equity) Framework and Checklist tool was developed to be a practical tool for public health departments to use in evaluating equity-based decision support mechanisms in their dashboards. The objective of this agreement and reliability study was to validate the DIRE Checklist tool as a practical and reliable instrument for data practitioners to use in evaluating dashboards. This study was divided into 5 steps to conduct the necessary analysis for agreement and reliability. Step 1 completed the development of the DIRE Checklist tool in Qualtrics (Qualtrics International Inc). Step 2 focused on the parameters required for the selection of the 26 US state-based dashboards. Step 3 was the user testing and assessment process during which each reviewer applied the DIRE tool to each dashboard. Step 4 involved conducting different assessment methods to specifically calculate the comparative analysis, interrater agreement, intraclass correlation coefficients, and the cosine similarity for the Qualtrics, reviewer, and categorical scores. Finally, Step 5 involved conducting any qualitative assessment required on the notes. A total of 26 dashboards were evaluated using the DIRE Checklist tool by 2 reviewers. The overall percentage comparison for the Qualtrics Score was 31.7% (28.24/89) for Reviewer 1 and 41.8% (37.16/89) for Reviewer 2, resulting in a relative percent agreement of 72.7%. Additionally, the categorical scores showed substantial to high agreement across most categories based on percent agreement within each category. The intraclass correlation coefficient scores indicated varying levels of agreement across different categories, with good agreement observed for the Qualtrics score. The reliability and agreement result of the study confirmed strong performance of the DIRE checklist tool. The scores calculated were evaluated consistently and reliably by both raters-demonstrating the DIRE Checklist tool’s ability to robustly evaluate different dashboards across a number of different categories and parameters.
11. Enhancing Access to Family Planning Services in Uganda Through Community Health Extension Workers: Protocol for a Pilot Evaluation.
期刊: JMIR research protocols 发表日期: 2025-Dec-04 链接: PubMed
摘要
In Uganda, 22% of all women of reproductive age have an unmet need for family planning services. Access to contraceptive services, especially long-term reversible contraceptives such as implants, remains a challenge. The number of trained health providers is also not sufficient to address the needs for contraception. The Uganda Ministry of Health implemented a community-based implant provision pilot project where community health extension workers (CHEWs) were trained and accredited to insert implants at community level. This study aims to evaluate the implementation and acceptability of stakeholders toward task shifting the provision of family planning implants to CHEWs in Uganda. The evaluation will use a cross-sectional design using both quantitative and qualitative methods. The quantitative component will use a noninferiority design, whereas the qualitative component will use a descriptive approach. The noninferiority design involves a comparison of the competence of the currently authorized cadre to offer the service to the proposed cadre (CHEWs). Compared with a randomized controlled trial, the noninferiority design is more appropriate for this evaluation because the CHEWs and the authorized cadre are not comparable in terms of level of training and competencies. The authorized cadre has gone through formal training, which is not comparable with the training the CHEWs have received, and so the comparison is such that the competencies of the CHEWs are noninferior or at most equal to the competencies of the authorized cadre. Quantitative data will be collected among 92 CHEWs and 92 qualified health workers using performance assessment checklists and practice-based questionnaires that were developed based on the training manuals. Competency will be measured on a continuous scale and summarized as mean (SD) scores. Qualitative data will be collected through key informant interviews (n=23), in-depth interviews (n=24), and focus group discussions (n=18). Qualitative data will be analyzed using thematic analysis following the framework method for the analysis of qualitative data using ATLAS.ti (version 9). Preliminary findings indicate improved confidence and capacity of community health workers to provide implants despite challenges such as poor waste disposal, record keeping, and data management. By August 2025, training of research assistants had been concluded, and data collection had started. We anticipate that the data collection will be completed by the end of October 2025, the data analysis will be completed by November 2025, and the final results will be published by December 2026. This pilot will generate contextual information that can be used to improve access to family planning services at the community level.
12. Online Clinical Calculator for Predicting 28-Day Mortality in Older Adult Patients With Sepsis-Associated Encephalopathy: Retrospective Study Using MIMIC-IV.
期刊: JMIR medical informatics 发表日期: 2025-Dec-04 链接: PubMed
摘要
Sepsis-associated encephalopathy (SAE) represents a critical complication of sepsis, especially among older adults. Despite its clinical relevance, there remains a lack of accessible and practical tools specifically designed to predict 28-day mortality in this vulnerable population. We aimed to enhance the practical applicability of the model by creating a web-based tool that allows real-time, individualized mortality risk prediction, facilitating early intervention and informed decision-making in clinical practice. Using data extracted from the MIMIC-IV (Medical Information Mart for Intensive Care IV) database, we identified older patients (≥65 years) with SAE (n=2165) and divided them into a development cohort (n=1531) and a validation cohort (n=634). Key risk factors associated with 28-day mortality were identified, and a predictive nomogram was constructed. Model performance was evaluated using the concordance index, integrated discrimination improvement, net reclassification index, and calibration curve analysis. Clinical applicability was assessed through decision curve analysis and benchmarked against traditional intensive care unit (ICU) scoring systems. Furthermore, the nomogram was deployed as a web-based application, enabling clinicians to input data and generate individualized mortality predictions. A total of 2165 older patients with SAE were included, among whom 290 (13.4%) died within 28 days of ICU admission. Multivariable logistic regression identified lower body weight (odds ratio [OR] 0.985, 95% CI 0.975-0.994; P=.001), lower systolic blood pressure (OR 0.972, 95% CI 0.957-0.986; P<.001), lower hemoglobin (OR 0.984, 95% CI 0.974-0.995; P=.005), lower PaO2 (OR 0.996, 95% CI 0.994-0.997; P<.001), and lower Glasgow Coma Scale score (OR 0.825, 95% CI 0.786-0.864; P<.001) as mortality risk factors. Higher respiratory rate (OR 1.083, 95% CI 1.029-1.141; P=.002), increased anion gap (OR 1.081, 95% CI 1.031-1.135; P=.001), elevated blood urea nitrogen (OR 1.045, 95% CI 1.016-1.076; P=.002), prolonged partial thromboplastin time (OR 1.033, 95% CI 1.016-1.050; P<.001), and reduced urine output (OR>0.99, 95% CI 0.999-1.000; P=.002) were also predictive. Patients admitted to “other” ICU types had lower mortality compared with the medical ICU reference group (OR 0.327, 95% CI 0.176-0.609; P<.001). The nomogram achieved concordance index values of 0.899 (development) and 0.897 (validation), outperforming sequential organ failure assessment (0.692), Acute Physiology Score III (0.804), Logistic Organ Dysfunction System (0.771), Simplified Acute Physiology Score II (0.704), and Oxford Acute Severity of Illness Score (0.753), with significant integrated discrimination improvement and net reclassification index improvements (all P<.001). Calibration curves confirmed good agreement between predicted and observed outcomes, while decision curve analysis supported the model’s superior clinical utility. This study presents a novel, validated nomogram for predicting 28-day mortality in older patients with SAE, integrating routinely available clinical data. The deployment of the model as a digital tool enhances its accessibility and usability, providing clinicians with a practical resource for risk stratification and individualized patient management.
13. Exploring the Impact of Perceived Parental Oversight on Problematic Smartphone Use Among Adolescents in the Digital Age: Database Analysis.
期刊: JMIR pediatrics and parenting 发表日期: 2025-Dec-04 链接: PubMed
摘要
The proliferation of smartphones raises worries over their impact on adolescent development, especially problematic smartphone use. This research investigates the intricacies of problematic smartphone usage in adolescents, particularly in light of significant increases in screen time, from a developmental psychology perspective. This study aimed to examine the association between adolescent-perceived parental monitoring strategies and problematic smartphone use in Taiwan, while also exploring variations across age, gender, and socioeconomic status. A nationwide dataset from Taiwan’s annual survey (n=1673; aged 10-18 y) was analyzed using descriptive analysis and moderated multiple serial mediation regression. In total, 3 parental mediation styles-restrictive monitoring, evaluative mediation, and unfocused monitoring-were examined for their effects on smartphone usage. Rigorous surveillance is more beneficial for younger adolescents (aged 10-12 y), significantly reducing smartphone addiction. Conversely, as teenagers mature, the efficacy of restrictive approaches wanes. Adolescents aged 16-18 years benefit more from parental mediation strategies that foster autonomy and encourage appropriate digital conduct. Restrictive monitoring significantly diminishes addiction by constraining internet access; yet, the diverse outcomes of assessment methods highlight the importance of qualitative engagement. Conversely, unfocused surveillance is ineffective, necessitating the use of targeted parental strategies. This study highlights the significance of developmentally suitable parental strategies to mitigate digital addiction and enhance teenage self-regulation. We urge policymakers to implement age-specific, evidence-based methods to improve digital literacy and overall well-being in youth. Future research should investigate the enduring psychological and behavioral impacts of parental mediation and analyze cross-cultural differences in digital parenting methodologies.
14. Artificial Intelligence in Mental Health Services Under Illinois Public Act 104-0054: Legal Boundaries and a Framework for Establishing Safe, Effective AI Tools.
期刊: JMIR mental health 发表日期: 2025-Dec-04 链接: PubMed
摘要
Artificial intelligence (AI) applications in mental health have expanded rapidly, and consumers are already using freely available generative AI models for self-guided mental health support despite limited clinical validation. In August 2025, Illinois enacted Public Act 104-0054, the first state statute in the United States to explicitly define and regulate the use of AI in psychotherapy services, establishing boundaries around administrative support, supplementary support, and therapeutic communication. While the Act clarifies several aspects of AI use in therapy, it also leaves important gray areas, such as whether AI-generated session summaries, psychoeducation, or risk-flagging functions should be considered therapeutic communication. Drawing on the history of empirically supported treatments in psychology, we argue that a framework of evidence, safety, fidelity, and legal compliance could help determine when AI tools should be integrated into clinical care. This approach provides a concrete pathway for balancing patient protection with responsible innovation in the rapidly evolving field of mental health AI tools.
15. Nationwide Prevalence of Cannabidiol Use in Pregnancy and in Women of Reproductive Age.
期刊: Obstetrics and gynecology 发表日期: 2025-Dec-04 链接: PubMed
摘要
Clinical guidelines recommend avoiding cannabinoids, including cannabidiol (CBD), during pregnancy and lactation. Use of CBD is widespread, but prevalence in pregnancy and among women of reproductive age is not well documented. We conducted a cross-sectional analysis using data from the 2022 and 2023 National Survey on Drug Use and Health, with incorporation of survey sampling weights to estimate the prevalence of CBD use. Similar proportions of pregnant women and reproductive-aged women reported ever using CBD in 2022 (353.4 vs 365.1, respectively) and in 2023 (323.4 [95% CI, 259.2-387.6] vs 361.3 [95% CI, 353.6-367.0], respectively) per 1,000 population. More reproductive-aged women had used CBD within the past 30 days compared with pregnant women in 2022 (121.3 vs 43.9, respectively) and in 2023 (113.2 [95% CI, 107.4-118.9] vs 39.3 [95% CI, 16.2-62.4], respectively) per 1,000 population. Due to unknown effects of CBD during pregnancy and prevalent use, clinicians should screen for CBD use to facilitate counseling patients against use in pregnancy and while breastfeeding.
16. Machine Learning-Based Prediction of In-Hospital Falls in Adult Inpatients: Retrospective Observational Multicenter Study.
期刊: JMIR medical informatics 发表日期: 2025-Dec-04 链接: PubMed
摘要
Falls among hospitalized patients are a critical issue that often leads to prolonged hospital stays and increased health care costs. Traditional fall risk assessments typically rely on standardized scoring systems; however, these may fail to capture the complex and multifactorial nature of fall risk factors. This retrospective observational multicenter study aimed to develop and validate a machine learning-based model to predict in-hospital falls and to evaluate its performance in terms of discrimination and calibration. We analyzed the data of 83,917 inpatients aged 65 years and older with a hospital stay of at least 3 days. Using Diagnosis Procedure Combination data and laboratory results, we extracted demographic, clinical, functional, and pharmacological variables. Following the selection of 30 key features, 4 predictive models were constructed: logistic regression, extreme gradient boosting, light gradient boosting machine (LGBM), and categorical boosting (CatBoost). The synthetic minority oversampling technique and isotonic regression calibration were applied to improve the prediction quality and address class imbalance. Falls occurred in 2173 (2.6%) patients. CatBoost achieved the highest F1-score (0.189, 95% CI 0.162-0.215) and area under the precision-recall curve (0.112, 95% CI 0.091-0.136), whereas LGBM had the best calibration slope (0.964, 95% CI 0.858-1.070) with good discrimination (F1-score 0.182, 95% CI 0.156-0.209; area under the precision-recall curve 0.094, 95% CI 0.078-0.113). Logistic regression had the lowest discrimination (F1-score 0.120, 95% CI 0.100-0.143). Shapley Additive Explanations analysis consistently identified low albumin, impaired transfer ability, and the use of sedative-hypnotics or diabetes medications as major contributors to fall risk. In incident report analysis (n=435), 49.2% of falls were toileting-related, peaking between 4 and 6 AM, with bedside falls predominating in high or very high risk groups. CatBoost and LGBM offer clinically valuable prediction performance, with CatBoost favored for high-risk patient identification and LGBM for probability-based intervention thresholds. Integrating such models into electronic health records could enable real-time risk scoring and trigger targeted interventions (eg, toileting assistance and mobility support). Future work should incorporate dynamic, time-varying patient data to improve real-time risk prediction.
17. Involving Health, Technology, and Financial Stakeholders in Co-Designing Digital Pathways for Value-Based Care.
期刊: JMIR medical informatics 发表日期: 2025-Dec-04 链接: PubMed
摘要
18. A Novel Primary Care Planning Informatics Tool Informed by Data-Driven Multimorbidity Grouping: User-Centered Design and Feasibility Testing.
期刊: JMIR formative research 发表日期: 2025-Dec-04 链接: PubMed
摘要
Patients with multimorbidity have complex health care needs and are at high risk for adverse health outcomes. Primary care teams need tools to effectively and proactively plan care for these patients. We developed VET-PATHS (Veteran Panel Management Tool for High-Risk Subgroups), a novel care planning informatics tool for complex primary care patients. VET-PATHS groups patients by chronic condition via latent class analysis of electronic health record data, then jump-starts care planning by suggesting “care steps” based on data-driven high-priority care for the group. The study aimed to iteratively adapt VET-PATHS with user input, then test feasibility and acceptability by frontline primary care teams for empaneled patients at high risk. Three rounds of user-centered design sessions with 17 primary care providers and registered nurses at 5 sites from 2019 to 2021 were conducted to obtain feedback on the VET-PATHS layout, content, and user interface. Feedback was summarized into 4 user experience domains (useful, desirable, credible, and usable), leading to progressively updated prototypes. After the national tool release, we conducted a pilot intervention study in 2023-2024 with 6 primary care teams at 4 sites using VET-PATHS during asynchronous regular meetings. Tool use and resulting care plans were assessed by templated observation during meetings, postpilot chart review, and administrative data. Individual qualitative interviews were analyzed by rapid template analysis for feasibility, acceptability, and utility. User-centered feedback led to updated tool content, context (eg, use in proactive panel management), targeted users (eg, focusing on primary care providers), and display layout. Pilot teams used VET-PATHS over 4 to 8 weekly meetings (mean length 24, range 16-49 min), actively reviewing 80% (280/351) of empaneled patients at high risk visible in the tool. Tool use prompted 127 new actions for 91 unique patients (33% of patients reviewed) and documentation of >1 new care plan for 19% of patients reviewed. Common actions included requests to return to the clinic (n=34, 27%), referrals (n=25, 20%), or vaccinations (n=24, 19%). Of the 127 actions planned, 53 (42%) were received by patients. Difference-in-difference trends for acute hospitalizations declined post pilot, while outpatient utilization was stable or increased for pilot team patients compared to all patients at high risk at pilot sites (per-patient counts: acute hospitalizations -0.15; primary care visits 0.00; mental health visits 0.99). Four generalist teams (n=11 interviews) described higher acceptability. Two “focused” teams with more homogenous panels, for example, substance use disorder (n=3 interviews), found care steps less useful. Teams described how VET-PATHS improved efficiency of care planning through automated patient grouping and identification of care gaps and increased multidisciplinary involvement. User-centered improvements to VET-PATHS were designed to help clinicians process and use complex information about patient multimorbidity to efficiently create new care plans. Subsequently, VET-PATHS was acceptable and feasible to frontline primary care teams, particularly with more general patient panels, and led to concrete changes to clinical care delivery.
19. A Primary Care Program Based on Behavioral Reeducation and Abdominal Massage for Improving the Symptoms of Chronic Constipation: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-04 链接: PubMed
摘要
Chronic constipation is a prevalent and often underestimated gastrointestinal disorder that significantly affects quality of life, particularly among women and older adults. In Spain, it is estimated to affect between 12% and 20% of the population, contributing to increased health care visits, economic costs, and medication dependency. Although pharmacological treatments such as laxatives are widely used, they often offer only temporary relief and may lead to adverse effects or dependency. There is growing interest in nonpharmacological interventions that address the root behavioral and functional causes of constipation, such as dietary habits, physical inactivity, and impaired defecation techniques. However, evidence regarding the effectiveness of such approaches, especially within a primary care setting, remains limited. This study aims to evaluate the effectiveness of a primary care-based structured rehabilitation program that combines behavioral reeducation and abdominal massage therapy in reducing the severity of chronic constipation and use of laxatives. A secondary aim is to assess improvements in quality of life and sustainability of effects over time. This is a randomized controlled trial involving adults aged 18 to 75 years from the counties of l’Anoia and Bages (Catalonia, Spain) who meet the Rome IV diagnostic criteria for chronic constipation. A total of 45 participants will be randomly assigned in a 1:1:1 ratio (approximately 22-23 per center, with 15 per group overall) into 3 groups: a control group, behavioral intervention (BI) group, and behavioral intervention and massage (BIM) group. All participants will complete baseline assessments that include the Rome IV criteria, the Bristol Stool Form Scale, the CVE-20 quality of life questionnaire, and the International Physical Activity Questionnaire. The BI group will receive 2 group education sessions, focused on healthy bowel habits, diet, hydration, physical activity, stress management, and medication use, delivered by a multidisciplinary team. The BIM group will receive the same intervention as the BI group, plus two 30-minute sessions with a physiotherapist to learn abdominal self-massage techniques. The control group will receive usual care. Follow-up assessments will occur at 3 and 6 months after the intervention using the same instruments and a self-recorded calendar of laxative use and massage application. Data will be analyzed using appropriate statistical tests, including the χ2 test, a 2-tailed t test, and ANOVA/Kruskal-Wallis tests, depending on variable type. Participant enrollment concluded in August 2025, and data collection is ongoing and expected to continue until April 2026. This trial will provide evidence on the efficacy of conservative, low-risk interventions for managing chronic constipation in primary care. The findings may support broader implementation of integrative approaches that reduce pharmacological dependence and enhance patient empowerment, with potential public health and economic benefits.
20. Evaluation of a Novel Data Source for National Influenza Surveillance: Influenza Hospitalization Data in the National Healthcare Safety Network, United States, September 2021-April 2024.
期刊: American journal of public health 发表日期: 2025-Dec-04 链接: PubMed
摘要
Objectives. To evaluate the completeness and utility of influenza hospital data reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) from September 2021 to April 2024. Methods. Acute care and critical access hospitals in the United States reported daily numbers of new hospital admissions of patients with laboratory-confirmed influenza to NHSN during voluntary and mandatory reporting periods. To evaluate the completeness of data reported to NHSN, we compared the number of influenza hospital admissions reported to NHSN with data reported to the Influenza Hospitalization Surveillance Network (FluSurv-NET) among 13 states and overlapping counties reporting to both systems from September 2021 to April 2024. Results. During voluntary reporting, about 77% of US hospitals reported daily influenza hospital admission counts to NHSN; during mandatory reporting, this increased to a mean of 94%. These data were highly correlated (r = 0.978; 95% confidence interval = 0.968, 0.985; P < .001) with numbers from FluSurv-NET and in most states (r range = 0.861-0.988) within overlapping surveillance areas. Conclusions. Influenza hospital admissions reported to NHSN demonstrate high levels of complete reporting; overall counts are highly correlated with a high-quality, long-standing influenza hospitalization surveillance system. (Am J Public Health. Published online ahead of print December 4, 2025:e1-e5. https://doi.org/10.2105/AJPH.2025.308282).
21. Mobile-Based Ecological Momentary Intervention for Improving Physical Activity in Adults Without Regular Physical Activity: Pilot Randomized Controlled Trial.
期刊: JMIR formative research 发表日期: 2025-Dec-04 链接: PubMed
摘要
The ecological momentary intervention (EMI) is one of the most promising digital-primarily mobile-interventions to enhance physical activity (PA) and other health behaviors. It is a combination of ecological momentary assessment (EMA), in which participants are prompted to indicate their momentary states and ongoing behaviors in daily life, and the just-in-time delivery of interventions tailored to the EMA responses. The EMI has typically been implemented in message-based interventions (eg, activity recommendations tailored to users’ physical locations), but its efficacy and feasibility have not been sufficiently established because of the variability in design and implementation. This pilot, two-arm, parallel-group randomized controlled trial aimed to be an exemplar of EMI for improving PA and establishing efficacy and feasibility among adults without a habit of PA. A total of 40 participants (23 women; mean age 45.40, SD 10.50 years) were recruited from among community dwellers in northeast Japan and randomly allocated to the EMI or control group. Each participant wore an activity tracker to monitor their daily step count and heart rate (HR) for 4 weeks (fully automated). Simultaneously, they responded to EMA questions about the current weather, location, and social context 3 times during the daytime and an additional evening question about motivations for PA each day. Only the EMI group received messages tailored to their responses to EMA, recommending more active alternative behaviors suited to EMA-reported contexts. Participants wore a Fitbit device for 90.3% (21.66/24 hours per day) of the study period (mean 90.3, SD 10.0), and no dropouts were observed. The EMI group showed no significant improvement in the self-reported amount of PA (P=.44), step count (P=.24), or motivation for PA (from P=.11 to P=.91) compared with the control group. However, the EMI group showed a significantly larger increase in the minutes of 40% HR reserve, a measure of moderate or high intensity of PA (mean 16.03, 95% CI 3.76-28.29; Cohen d=0.20-0.41; P=.02 for the follow-up weeks). The intervention was rated as marginally useful and satisfactory, and approximately half of the participants expressed a willingness to continue the intervention. The timing of the EMA prompting was considered inappropriate. These findings suggest that the EMI with messages tailored to EMA-reported contexts was not effective in increasing the amount or motivation for PA but may increase the intensity as assessed by the HR. The intervention aimed to help individuals implement small but slightly more active behaviors in their daily routine, which may not accompany prominent body movements but may be reflected in the increased HR. Marginal feasibility indicates that the intervention has sufficient scope for improvement, particularly in terms of prompt timing.
22. Effectiveness of Different Methods of Interdental Hygiene in Daily Practice Among Young Adults: Protocol for a Randomized, Single-Blind Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-04 链接: PubMed
摘要
Interdental spaces are particularly susceptible to biofilm accumulation and gingival inflammation, which contribute to periodontal diseases and their systemic associations. While interdental brushes (IDBs) are recognized as the most effective method of interdental cleaning, their efficacy depends on proper adaptation to the interdental space. Calibration with a colorimetric probe may enhance their effectiveness and comfort. However, evidence directly comparing calibrated and noncalibrated IDBs, especially in young adults, a key target group for preventive strategies, remains limited. The Hygiene of Interdental Junctions in Adults (HIJA) trial was designed to address this gap. This protocol aims to compare the clinical, microbiological, and acceptability outcomes associated with calibrated versus noncalibrated IDBs in young adults, focusing on interdental inflammation, periodontal indices, and microbiota composition. The HIJA trial is a monocentric, randomized, controlled, single-blind, and parallel-arm study. Overall, 50 healthy, nonsmoking adults aged 18-30 years will be randomized (1:1) to receive either calibrated or noncalibrated IDBs. Participants will perform daily interdental cleaning in addition to conventional toothbrushing for 3 months. The primary outcome will be the reduction in interdental inflammation, expressed as the change in bleeding on probing at 3 months. Secondary outcomes will assess differences in interdental microbiota composition (16S ribosomal RNA sequencing), periodontal indices (plaque index, gingival index, probing depth, and clinical attachment loss), and user acceptability measured through the Theoretical Framework of Acceptability questionnaire at 1, 2, and 3 months. The HIJA trial will generate evidence on whether calibrated IDBs provide additional benefits over noncalibrated brushes in reducing interdental inflammation and improving oral health in young adults. HIJA findings could contribute to the implementation of clinical guidelines and preventive strategies for interdental hygiene in daily practice.
23. Using Virtual Reality to Assess Spatial Navigation Ability in Individuals With Mild Cognitive Impairment and Older Adults: Cross-Sectional Study.
期刊: JMIR aging 发表日期: 2025-Dec-04 链接: PubMed
摘要
Spatial navigation impairment is prevalent in people with Alzheimer disease (AD) and may appear in its initial clinical stage. Detecting this deficit in people at risk may not only help prevent them from getting lost or going missing but also provide a useful clinical aid to accurate diagnosis. Traditional assessments for spatial navigation impairment include questionnaires, paper-and-pencil and maze tests, or video games. While a real-world setting is more valid, direct, and accurate, it is plagued by unpredictable conditions such as weather, obstacles, or accidents. Owing to modern technology, virtual reality (VR) offers a new way to test spatial navigation impairment. The aims of this study were to test the feasibility of a VR setting to assess sense of location in people with mild cognitive impairment (MCI) and the power of VR to discriminate among groups with different clinical conditions. We used the Pai-Jan virtual reality (PJVR) device to test spatial navigation ability in those who were cognitively unimpaired (CU) and those who experienced subjective cognitive decline (SCD) and MCI. The PJVR device is the VR version (VIVE Pro Eye head-mounted display) of the Pai-Jan device, which has demonstrated its power to discriminate among CU, AD MCI, and mild AD dementia. With a map provided and using joysticks or handles, participants were asked to reach 5 points on a 660-m path. Linear deviation (LD; in meters) from each target point and vector deviation (in degrees) from the direction to the start point at each location were treated as the variables for comparison. A total of 113 participants provided informed consent to initiate the study. Of these 113 participants, 93 (82.3%) completed the trials, including 22 (24%) who were CU, 39 (42%) with SCD, and 32 (34%) with MCI. In total, 17.7% (20/113) failed the trials due to cybersickness. The mean LD of the CU, SCD, and MCI groups was 38.2 (SD 39.5), 50.4 (SD 40.7), and 100.4 (SD 46.2) meters, respectively (P<.001). The MCI group showed greater vector deviation (mean 63.2, SD 42.4 degrees) than either the SCD (mean 39.4, SD 33.0 degrees) or CU (mean 38.6, SD 37.4 degrees; P=.02) group. The LD of the PJVR device was correlated with the total scores on the caregiver version of the Questionnaire on Everyday Navigational Ability (P<.001), indicating good ecological validity. The PJVR device is feasible for older adults and participants with MCI. It can detect spatial navigation deficits related to AD pathology, and the results show a close correlation with real-world navigation ability.
24. Evaluation of the 2020 American Urological Association Microscopic Hematuria Guidelines in Clinical Practice: Retrospective Chart Review Analysis.
期刊: JMIR formative research 发表日期: 2025-Dec-04 链接: PubMed
摘要
Hematuria is one of the most common urologic diseases seen within clinical practice, with a prevalence range of 1.7%-31.1%. In 2020, American Urological Association (AUA) guidelines were revised and recommend that following initial evaluation, clinicians should categorize patients into three tiers (low risk, intermediate risk, and high risk) based on various factors. Recent literature has shown that the AUA guidelines have high clinical utility when compared to other international guidelines such as those outlined by the Hematuria Risk Index, Canadian Urological Association, and Kaiser Permanente; however, this guideline remains unvalidated among the population of “well adults” within the United States. We used a retrospective study design to evaluate data abstracted from the electronic medical records of patients seen in the Emory Healthcare Executive Health Clinic from September 29, 2017, to January 29, 2021, to investigate the utility of risk stratification as a tool for clinical decision-making. According to the AUA risk stratification system, patients were stratified into low-risk and intermediate-risk/high-risk groups based on sex, age, smoking history, history of gross hematuria, and red blood cells/high-powered field. The frequencies and percentages of different causes of hematuria across the three risk strata were reported. Of the 882 instances of red blood cells in urine (URBC) ≥3, a total of 368 (41.72%) underwent a repeat analysis within a 6-month time span, 184 (20.86%) within a 12-month time span, and 330 (37.41%) at >12 months. Instances of a URBC <3 (N=1643) were more likely to have no urologic diagnosis-1503 (91.48%) in comparison to 633 (76.27%) for those instances with a URBC >3 (N=830). Ultimately, 23 (100%) participants in the low-risk group had no urologic diagnosis after urinalysis versus 608 (75.62%) in the intermediate-risk/high-risk group (N=804). We found a need for a greater focus on monitoring elevated URBC counts, in accordance with clinical guidelines for managing hematuria in low-risk patients. Future research should examine the impact of risk stratification on clinical decisions and access to care, especially in underserved populations. It should also assess how the new AUA guidelines affect physician referral patterns and explore real-world implementation challenges and facilitators.
25. Phytochemical profiling and cognitive enhancement effects of Astragalus peregrinus extract and its nanostructured lipid carrier in a D-galactose-induced aging rat model.
期刊: Natural product research 发表日期: 2025-Dec-04 链接: PubMed
摘要
One of the primary indicators of mental diseases that cause gradual cognitive impairment is brain ageing. Since the therapeutic effects of medicinal plants on brain ageing have been established, we explored the potential impact of Astragalus peregrinus on brain ageing. We pharmaceutically developed nanoformulation (AP-NLCs) to improve bioavailability and target drug delivery to the brain. Then evaluated the DPPH radical scavenging and AChE inhibitory properties of A. peregrinus crude extract, its fractions and AP-NLCs. The crude extract showed the highest antioxidant activity. We analyse its metabolic profile using UPLC-QTOF-HRMS/MS, which identified thirty-nine metabolites. Crude extract and AP-NLCs potential to prevent and treat D-galactose-induced brain ageing in rats was further investigated compared to Donepezil as a standard drug . They exhibited regression of neurodegenerative features and enhanced brain function and cognitive performance. Additionally, they promoted significant histopathological recovery. The results support using A. peregrinus nano-formulation intranasally, especially when administered prophylactically, to alleviate brain ageing.
26. Modifying Tobacco and Cannabis Waste Perceptions and Behavior Among Young Adults: Protocol for a Randomized Controlled Trial.
期刊: JMIR research protocols 发表日期: 2025-Dec-04 链接: PubMed
摘要
Filtered cigarettes and vaped nicotine and cannabis negatively affect health and create nonbiodegradable, toxic waste from tobacco, e-cigarette, and cannabis waste (TECW). Creating awareness and action to address this public health issue requires expanded knowledge and understanding of TECW harms and more engagement with regulatory policies to reduce tobacco and cannabis use. This is the first study testing an intervention to modify TECW knowledge, perceptions, and behavior, including use of an innovative digital TECW tracking tool. This study tests the efficacy of an intervention to modify TECW knowledge, harm perceptions, attitudes, and behaviors regarding smoke- and vape-free university campus policies among young adults. We aim to develop an evidence-based educational intervention for use in community programs to address TECW. A 6-week randomized controlled trial was conducted at 2 sites representing the 2 public university systems in California from March 2023 to June 2025 with 406 students (aged 18-25 years) and compared brief tobacco, e-cigarette, and cannabis waste education (TECW Ed) plus tobacco, e-cigarette, and cannabis waste education plus motivational and behavioral support (TECW Ed+) with brief education only about TECW (TECW Ed). Participants were randomized 1:1 to each treatment group, stratified by site and tobacco or cannabis use status. Outcome measures include changes in knowledge, harm perceptions, regulatory attitudes, and behaviors regarding TECW, and engagement with smoke- and vape-free policies. Planned statistical analyses include models to assess knowledge, perceptions, and attitudes at weeks 2, 6, and 26 versus group, time, and a group × time interaction, controlling for site, tobacco or cannabis use status, demographics, and baseline level of outcomes. In addition, TECW Ed+ versus TECW Ed group comparison on mean number of Tracker reports between baseline and 6 weeks, and group comparison on mean engagement score at 6 weeks, will be conducted. Data were collected from March 2023 to June 2025. Data analysis is expected to begin in late 2025, with final results anticipated for publication in summer 2026. Results will determine if brief educational videos accompanied by enhanced motivational and behavioral support increase knowledge of TECW’s environmental impact and change perceptions about cigarettes and vape products. We will determine whether such enhanced education increases engagement in smoke- and vape-free regulatory acceptance and improves outcomes of regulatory policies. This trial will be the first to test an intervention to modify tobacco and cannabis waste perceptions and behavior. This trial aims to determine whether additional motivational and behavioral support will change young-adult college students’ current knowledge of TECW and whether such support will motivate them to engage with regulatory policies to reduce TECW. If successful, scaling up this intervention may mobilize a large population of young adults to understand and advocate for policies that protect individual and environmental health. ClinicalTrials.gov NCT05751369; https://clinicaltrials.gov/study/NCT05751369. DERR1-10.2196/79525.
27. Toward science-based conviction criteria to deter wildlife crime.
期刊: Science (New York, N.Y.) 发表日期: 2025-Dec-04 链接: PubMed
摘要
Risk assessment is needed for China’s new conviction standards based on monetary value.
28. Integrating psychiatric rehabilitation into inpatient psychiatric hospitalization to advance personal recovery.
期刊: Psychiatric rehabilitation journal 发表日期: 2025-Dec-04 链接: PubMed
摘要
Psychiatric rehabilitation services (PRS) were developed to facilitate recovery and community integration by addressing psychosocial needs such as housing, employment, illness management, and social inclusion for individuals with serious mental illness. However, PRS are primarily designed for and available in community settings. The objective of this conceptual article is to explore the potential role of PRS during inpatient psychiatric hospitalization and offer a forward-looking vision, identifying trends to guide future efforts. This article presents a conceptual analysis of the potential benefits and impacts of PRS on the recovery process of individuals with serious mental illness if these services were also provided during hospitalization. This critical analysis was coauthored by various stakeholders, including individuals with lived experience, psychiatric, and other mental health providers, and psychiatric rehabilitation researchers. Integrating PRS into routine care during psychiatric hospitalization supports recovery and facilitates postdischarge community connections and outcomes. While PRS were originally conceptualized and designed for community settings, efforts should be made to tailor and adapt them for use in inpatient settings. Shifting staff attitudes toward inpatient recovery-oriented care, developing interventions and training for PRS integration, and securing leadership and institutional buy-in are the next practical steps to make this vision a reality. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
29. Battlefield Triage Technology: Addressing Effectiveness in Far-Forward Combat Casualty Care.
期刊: IISE transactions on occupational ergonomics and human factors 发表日期: 2025-Dec-04 链接: PubMed
摘要
OCCUPATIONAL APPLICATIONSWe identified strategies to support the development or evaluation of technology solutions for a medical response in remote and austere environments. We conducted a systematic analysis of relevant tasks and potential errors within battlefield medical response and communicated the resultant system taxonomy for interdisciplinary application by both engineers and health care practitioners. Our paper contributes to continued advancements of technology support for remote casualty care through detailed insights into remote medical response, identification of system vulnerabilities, and a consolidated system analysis. Background: During mass casualty incidents there is a scarcity of resources relative to the number of casualties. Medics acting in far-forward military settings must manage a mass casualty response and implement casualty care in dynamic, remote environments. Further integration of medical technology may support a medical response and improve casualty outcomes.Purpose: Employ structured systems analyses of the complexity of the tasks, actors, and work domain to inform constraints of a technology intervention in far-forward casualty care.Methods: Seven subject matter experts, drawn from diverse backgrounds and experiences within the Canadian Armed Forces medical trades, participated in the structured workshop. Hierarchical Task Analysis and Human Failure Analysis were applied during a 2-day workshop. Participants analyzed two scenarios considering different organizational units, environments, locations, and types of injuries. Perspectives on select current tools and systems were captured through the system usability score survey. Work Domain Analysis and Worker Competency Analysis were informed by further subject matter expert engagement and protocol documentation.Results: Mass casualty medical response tasks were decomposed and then analyzed to identify sources and risks of human failure. Informational elements of the work domain associated with actions that introduce the most risk from potential human failure focused the worker competency analysis. The resultant system analysis yielded a matrix of skill, rule, and knowledge-based behaviors required of a system designed to support a medic during combat casualty care. This matrix is designed to guide or evaluate the design of a system to support medical field care.Conclusions: Vulnerabilities attributed to information collection, derivation, and communication during field care can be mitigated through technology integration.
30. Ratio of Economy of Motion to Assess Gender Differences in Trainee Autonomy During Robotic Surgery-A Feasibility Study.
期刊: The Journal of surgical research 发表日期: 2025-Dec-03 链接: PubMed
摘要
Gender of trainees and attending surgeons has been shown to influence levels of trainee autonomy (TA) during surgical training. In this study, we evaluated the feasibility of an objective performance indicator, the ratio of economy of motion (rEOM), to assess differences in TA by gender during dual-console colorectal procedures. In this retrospective feasibility study, endoscopic videos from 87 procedures were annotated to identify distinct surgical step visits. Utilizing rEOM, each step visit was attributed to either the attending surgeon or the trainee. TA was compared across six female and four male general surgery chief residents, along with one female and three male colorectal surgery fellows. During 87 procedures, of which 73 were robotic proctectomies and 14 were robotic right colectomies, a total of 2662 step visits were analyzed. Male fellows performed more step visits during all cases (36.8% versus 21.7%; P = 0.019) and right colectomies (34.0% versus 14.6%; P = 0.021). In cases with male attendings, male fellows completed more step visits per procedure (36.8% versus 21.7%; P = 0.034). During right colectomies with male attendings, all male trainees performed a greater percentage of step visits per procedure (35.7% versus 15.0%; P = 0.020). No significant differences were seen in TA between all male and female trainees in surgeries with female attendings. This study demonstrates the feasibility of using rEOM to assess gender differences in TA and/or trainer entrustment. We used rEOM to delineate surgical step ownership, and although our sample size only allows hypotheses-generating inferences, we identified differences in TA between male and female trainees during robotic procedures.
31. Maternal and paternal smoking and offspring antral follicle count in women from an infertility clinic.
期刊: International journal of hygiene and environmental health 发表日期: 2025-Dec-03 链接: PubMed
摘要
The ovarian reserve is established in utero, and therefore may be influenced by parental characteristics such as tobacco smoking. However, the epidemiologic literature on parental smoking and adult antral follicle count (AFC) remains conflicted. Our study included 631 women enrolled in the Environment and Reproductive Health (EARTH) study, a prospective cohort at an academic fertility center between 2005 and 2019. Exposure was assessed by women self-reporting their mother’s and father’s overall and pregnancy specific smoking status. Outcome was assessed via AFC measured using transvaginal ultrasonography day 3 of an unstimulated menstrual cycle or progesterone withdrawal bleed. Adjusted multivariable Poisson regression with robust standard errors was used to estimate associations between participant maternal and paternal smoking exposure and AFC. The women in our study were mostly ≥35 years (55 %), never smokers (74 %), college-educated (92 %), White (84 %), and US born (76 %). The median AFC was 13.5 (interquartile range: 8-18). History of maternal smoking was not associated with AFC (ever vs never smoker: 1.3 %, 95 % CI: 8.4 %, 6.4 %) nor was maternal smoking during pregnancy (smoked during pregnancy vs. never smoker: 4.6 %, 95 % CI: 7.6 %, 18.4 %). History of paternal smoking was associated with lower AFC (ever vs never: 9.9 %; 95 % CI: 16.3 %, -2.9 %). Participants who reported that both their parents were ever smokers averaged 10.9 % lower AFC (95 % CI: 18.6 %, -2.5 %) compared to participants whose parents never smoked. Paternal smoking, including time periods outside the pregnancy window, may negatively influence the long-term ovarian development and function in female offspring. NCT00011713.
32. P16INK4a protein expression associated with Head and Neck Squamous Cell Carcinoma: A perspective of a public health reference service in São Paulo.
期刊: Brazilian journal of otorhinolaryngology 发表日期: 2025-Dec-03 链接: PubMed
摘要
Human Papillomavirus (HPV) may be a predictive biomarker predictor for clinical outcome and influence treatment decisions in patients with Head and Neck Squamous Cell Carcinoma (HNSCC). We evaluated 253 patients with HNSCC from state of São Paulo, Brazil. The influence of p16INK4a expression was analyzed with epidemiological and clinical variables. In total, 32.4% of tumors studied had positive (+) p16INK4a protein expression, and 67.6% had negative. The variables were similar in both groups being the mostly with age under 64-years, male, white race, functional illiterate, smokers and alcoholics. The most affected primary site was oral cavity with T3/T4 tumoral stage, N1/N2/N3 nodals, M0 metastasis and III/IV clinical stage. Patients with oropharyngeal primary site and (+) p16INK4a, clinical staging III and chemotherapy treatment had worse survival. The median time of distant metastasis-free was 38.3-months in oropharyngeal (+) p16INK4a and 15.1-months in negative (-) p16INK4a. In the present study, the epidemiological variables are similar in both groups (Positive and negative p16INK4a expression): age under 64-years, male, white, functionally illiterate, smokers and alcoholics. There is no association of p16INK4a expression with primary site, however, the (-) p16INK4a shows better overall survival, higher frequencies in distant metastasis and less free time of the disease. Although the literature shows a greater survival in oropharynx (+) p16INK4a, our results are contradictory. It is suggested that future studies in different regions and with a larger sample size should be carried out to confirm these findings, because the patients who participated in the present study are only from a specific region of Brazil. 2B.
33. Cancer screening knowledge and health literacy among rural women Aged 30-69.
期刊: Cancer epidemiology 发表日期: 2025-Dec-03 链接: PubMed
摘要
High participation rates are essential for the success of cancer screening programs; however, sustaining consistent engagement is a persistent challenge, especially in rural populations. To investigate the health literacy and cancer screening knowledge levels of women aged 30-69 living in rural areas who are eligible for at least one type of cancer screening, and to identify factors associated with cancer-related knowledge. We conducted a cross-sectional study of 365 rural women aged 30-69 years who attended a Central Public Health Center between February and August 2025, in a province located in the northwestern region of Türkiye. Data were collected via a structured questionnaire, the Knowledge Scale for Cancer Screening, and the Turkiye Health Literacy Scale-32, and analyzed using t-tests, ANOVA, and linear regression RESULTS: Overall, 81.1 % of participants reported having undergone breast cancer screening, 59.7 % cervical cancer screening, and 50.0 % colorectal cancer screening. According to the linear regression analysis, a history of cervical cancer screening (β=0.243; t(10) = 3.235; p = 0.001) and scores on the TSOY-32 subscale for disease prevention and health promotion (β=0.202; t(10) = 2.372; p = 0.018) were significant predictors of cancer screening knowledge. Our study identifies potential factors that may enhance knowledge of cancer screening, which in turn could contribute to increasing the uptake of cancer screening tests. The most significant indicators were high level of health literacy related to disease prevention and health promotion as well as a previous experience with cervical cancer screening. These factors should be considered in the development of targeted interventions to increase cancer screening participation among women in rural settings.
34. Burden and determinants of benign prostate hyperplasia in Africa: Systematic review and meta-analysis.
期刊: Cancer epidemiology 发表日期: 2025-Dec-03 链接: PubMed
摘要
To determine the prevalence and determinants of benign prostate hyperplasia in Africa via a meta-analysis. This report was presented according to the Preferred Reporting Items for Systematic Review and Meta-Analyses checklist. Thirteen articles were searched via PubMed/MEDLINE, EMBASE, Scopus, Google Scholar, Science Direct, and African Journal Online. Data were extracted via Microsoft Excel and exported to STATA 17 for analysis. The data were analyzed via the random effects model. The heterogeneity of the studies was assessed by Cochran’s Q test and I2 statistics. Publication bias was detected via funnel plots and Egger’s test. In 13 studies conducted in Africa, with a sample size of 5619 people between 2011 and 2024, the pooled prevalence of benign prostate hyperplasia was 44 % (95 % CI 31 %-57 %) in Africa. According to the subgroup analysis, the pooled prevalence was greater in studies published from 2011–2018 (56 % (95 % CI: 38–73)) than in those published from 2019–2024 (34 %). The pooled prevalence rates were also greater in those with sample sizes > 500 than in those with sample sizes < 500 (45 % vs 41 %). Family history of BPH (OR = 5.56; 95 % CI; 1.57, 9.55), difficulty in sexual activity (OR = 13.14; 95 % CI: 5.50, 20.77), use of traditional eye medication (OR = 2.27; 95 % CI: 1.68, 2.86), family history (OR = 4.93; 95 % CI: 3.13, 6.72) and inadequate sleeping time (OR = 2.90, 95 % CI = 2.25-3.55) were factors associated with benign prostate hyperplasia among adults. The pooled prevalence of BPH among adults living in Africa was significant. Family history, difficulty in sexual activity and inadequate sleeping time were significantly associated with benign prostate hyperplasia. The greater burden of BPH across the country calls for efforts by health policy makers to pay attention to it.
35. Respirable mineral fibres in leaf surface dust: Micro-characterisation and evidence of a geogenic origin.
期刊: Chemosphere 发表日期: 2025-Dec-03 链接: PubMed
摘要
Naturally occurring fibrous minerals, including erionite and amphiboles, are classified as Group 1 carcinogens, and pose an environmental health risk when inhaled in respirable sizes. In volcaniclastic regions, road cuttings that disturb and expose fibre-bearing formations can release airborne fibres through weathering and human activities. To investigate this process, this study collected surface dust and rock samples from roadside environments in a New Zealand volcaniclastic setting and analysed fibre abundance, characteristics, and the connection between rock sources and airborne fibres. Fibrous particles were detected in surface leaf dust on both sides of the road at all 11 sampling sites, with fibre abundance ranging from 462 to 61,595 fibres/cm2. Of the 338 fibres measured, 93 % were within the respirable size range (geometric diameter <3 μm), and 15 % met the WHO criteria for hazardous fibres (length ≥5 μm, width <3 μm, aspect ratio >3:1). Chemical analysis indicated that most fibres had Si/(Si + Al) ratios consistent with mordenite, while crystallographic data confirmed 84 % mordenite, 13 % erionite, and 3 % amphibole. Mordenite was also the dominant crystalline phase in the rock samples, and fibre abundance in surface dust correlated moderately with mordenite concentrations in the corresponding bulk samples (Kendall’s tau = 0.49, p = 0.04). These findings reveal an under-recognised environmental exposure pathway of respirable mineral fibres from roadside exposed volcanic outcrops, and highlight the need for further monitoring and health risk evaluation in volcanic regions where fibrous zeolite and amphibole minerals are naturally occurring and disturbed.
36. Techniques and outcomes for microsurgical treatment of large and giant cerebral aneurysms in the endovascular era.
期刊: Neurosurgical focus 发表日期: 2025-Dec-01 链接: PubMed
摘要
Large and giant intracranial aneurysms (LGIA) pose significant surgical challenges due to their complex anatomy, high risk of rupture, and severe morbidity and mortality rates. The aim of this study was to evaluate microsurgical treatment techniques and outcomes for LGIA as an alternative to endovascular treatment methods. Intracranial aneurysms treated with microsurgery by a single surgeon from January 2006 to February 2025 were retrospectively analyzed. Demographic data, clinical presentations, aneurysm characteristics, surgical techniques, complications, and outcomes were evaluated. Outcomes were evaluated based on patients’ neurological conditions, with functional recovery levels and predictive factors investigated using multivariate logistic regression analysis. Of 127 patients (80 female, mean age 57.9 years) with LGIA included in the analysis, 99 had large (10-24 mm) and 28 had giant (≥ 25 mm) aneurysms. The mean aneurysm size was 18.4 mm. Aneurysms were most commonly located in the middle cerebral artery (41.7%) and were most frequently treated with primary clipping (72.4%), clip reconstruction (12.6%), and bypass (10.2%). The occlusion rate was 94.5% on postoperative imaging. Surgical complications were observed in 13.4% of patients, while nonsurgical complications were observed in 18.9%. The neurological status of 91.3% of patients improved or remained unchanged. Vasospasm was an independent predictor of poor prognosis (p = 0.019). Microsurgical treatment of LGIA was safe and effective, with high occlusion rates and acceptable morbidity and mortality. Appropriate patient selection, detailed surgical planning, and experienced surgical technique play a critical role in achieving successful outcomes. Despite the increasing use of endovascular techniques, microsurgery remains a fundamental strategy in the management of LGIA.
37. Contemporary adverse event profile of microsurgery for intracranial unruptured aneurysms in high-volume microsurgical centers: the international PRAEMIUM study.
期刊: Neurosurgical focus 发表日期: 2025-Dec-01 链接: PubMed
摘要
Objective values on procedural risk are essential to facilitate informed consent and optimize clinical decision-making in patients with unruptured intracranial aneurysms (UIAs). While robust heuristics, such as the PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage, and site of aneurysm) score, are established for predicting rupture risk, contemporary and granular benchmarks for procedural safety remain scarce. The multinational Prediction of Adverse Events After Microsurgery for Intracranial Unruptured Aneurysms (PRAEMIUM) study aims to comprehensively characterize contemporary adverse event rates following microsurgical treatment at high-volume expert centers, stratified by aneurysm location, morphology, and complexity factors to better inform individual risk/benefit analyses. A cohort study among 20 participating expert centers from 9 countries was established. Patients treated microsurgically for UIAs were included. The authors describe the epidemiology of treated patients and UIAs and a comprehensive adverse event profile using 3 outcomes measured at hospital discharge: 1) poor neurological outcome (modified Rankin Scale score ≥ 3), 2) new sensorimotor neurological deficits, and 3) all-cause adverse events (Clavien-Dindo grade ≥ 1). Subgroup reports were given for aneurysm location, morphology, and complexity factors (prior aneurysm treatment, calcifications, complex angioanatomy involving critical branch vessels or perforators, and thrombosis). The authors purposely chose discharge as the time point to capture early postoperative risks and complications in patients with asymptomatic UIAs, for whom preserving neurological function is paramount. The cohort included 3705 patients (mean age 56 [SD 12] years, 28% male). Overall, at discharge 13.9% of patients (95% CI 12.8%-15.0%) had poor neurological functional outcomes, 14.4% (95% CI 13.3%-15.5%) had new sensorimotor deficits, and 24.1% (95% CI 22.8%-25.5%) experienced all-cause adverse events. Poor neurological outcomes ranged from 8.5% (M1 aneurysms) to 37.4% (posterior circulation aneurysms), neurological deficits from 9.3% (distal anterior cerebral artery [ACA] aneurysms) to 34.2% (posterior circulation aneurysms), and all-cause adverse events from 21.2% (distal ACA aneurysms) to 31.3% (posterior circulation aneurysms). Dissecting and fusiform aneurysms showed notably high rates of poor neurological outcomes (22.0%-33.3%), new deficits (25.4%-26.7%), and adverse events (26.7%-37.0%). Complexity factors significantly influenced outcomes, with prior treatment (22.9%, 19.7%, and 30.1%), calcification (16.3%, 18.1%, and 30.5%), complex angioanatomy (13.1%, 15.9%, and 26.9%), and thrombosis (19.6%, 23.9%, and 39.6%) notably increasing the risks for poor neurological outcomes, deficits, and adverse events, respectively. This large international cohort provides contemporary benchmarks for microsurgical treatment of UIAs, emphasizing variability in outcomes based on aneurysm location, morphology, and complexity. The presented granular and quotable adverse event rates support informed patient counseling and individualized risk/benefit assessments in comparable high-volume centers.
38. Trends in the Incidence of Cancers of the GI Tract in Harare, Zimbabwe, 1990-2019.
期刊: JCO global oncology 发表日期: 2025-Dec 链接: PubMed
摘要
Data on long-term time trends in the incidence of cancer are an invaluable resource for tracking the evolution of the disease in populations, but they are very scarce in Africa. The Zimbabwe National Cancer Registry of Harare can report on the evolution of the cancer epidemic over a 30-year period. Trends in age-standardized incidence rates in the Black (African) population (males and females) are reported for six cancers of the GI tract (oral cavity plus oropharynx, esophagus, stomach, colon plus rectum, liver, and pancreas). There has been a steady increase in the incidence of colorectal cancer, at about 2.5% annually, in both sexes, whereas liver cancer has declined, rather more rapidly in males (3.6% annually) than in females (3% annually). Although the incidence is much lower, cancers of the oral cavity and oropharynx have increased in both sexes (3.5% annually in males, 2.8% [nonsignificant] in females). The incidence of stomach cancer has risen over the period, although significantly so only in the most recent decade (2010-2019), before which there had been a slight decline in rates. While esophageal cancer has declined in incidence in men (1.8% annually), it has increased in women (2.4% annually), with adenocarcinomas comprising an increasing proportion (although still less common than squamous cell carcinomas). There has been no significant trend in the incidence of pancreatic cancer. While some of these trends are related to population-level changes in lifestyles and exposure to environmental factors (such as hepatitis viruses and aflatoxins), the reasons for other changes in incidence are more obscure. While some may be in part due to improvements in diagnostic techniques (endoscopy and imaging), others merit further investigation.
39. Social and health system factors associated with maternal mortality in Eastern and Western China: Population health estimates using provincial-level data.
期刊: PLoS medicine 发表日期: 2025-Dec 链接: PubMed
摘要
Globally, maternal mortality is off track in achieving the Sustainable Development Goals by 2030. Over the past two decades, China has dramatically reduced maternal mortality in more developed (eastern) and less developed (western) regions. An understanding of the social and health system factors associated with maternal mortality in China may be helpful for countries attempting to meet the 2030 targets and beyond. We analyzed provincial-level data on maternal mortality and social and health system factors from the National Health Statistics Yearbooks and China Statistical Yearbooks from 2004 to 2020. We investigated the factors associated with maternal mortality before and after 2013, the year that a historic national program, Reducing Maternal Mortality and Eliminating Neonatal Tetanus, came to an end. Bayesian kernel machine regression was employed to analyze social and health system factors (urbanization rate, per capita disposable income, average years of schooling, number of health technical personnel in maternal and child healthcare, number of hospital beds for obstetrics and gynecology, local fiscal expenditure on healthcare, prenatal booking rate, antenatal care rate, and hospital delivery rate) as a mixture and identify the factors with larger posterior inclusion probability and a higher value of the exposure-response relationship for the total and cause-specific maternal mortality. In the East, an increase in hospital delivery rate correlated with the decrease in total maternal mortality [posterior mean and standard deviation (SD): -14.8(1.5)] before 2013, and the urbanization rate was negatively associated with total maternal mortality [posterior mean and SD: -3.9(0.6)] after 2013. Hospital delivery, urbanization, local fiscal expenditure on healthcare, and antenatal care were the factors associated with reduced cause-specific maternal mortality in the East. In the West, an increase in antenatal care rate was associated with reduced total maternal mortality, with the posterior mean and SD of -33.8(6.8) and -11.5(4.1) before and after 2013, respectively. Hospital delivery and antenatal care were the factors associated with reduced cause-specific maternal mortality in the West. The main limitation of this study was the data constraints in the national statistics. Coverage of maternal care, health financing, and urbanization were the factors associated with the substantial reduction in maternal deaths in Eastern and Western China during 2004-2020. The improvement of the quantity and quality of antenatal care and hospital delivery may be a viable policy priority in less developed regions worldwide.
40. Gypenoside L inhibits oral squamous cell carcinoma progression by targeting the AKT signaling pathway.
期刊: Bioorganic chemistry 发表日期: 2025-Nov-30 链接: PubMed
摘要
Oral squamous cell carcinoma (OSCC), a prevalent subtype of head and neck squamous cell carcinoma, remains difficult to treat due to limited therapeutic efficacy and high systemic toxicity. Gynostemma pentaphyllum (JGL), a traditional medicinal herb, has demonstrated anticancer potential, but its active constituents and underlying mechanisms against OSCC are not well defined. A network pharmacology approach was used to screen active compounds from JGL. Gypenoside L (Gyp L), a major triterpenoid saponin, was identified as a core bioactive component targeting the PI3K/AKT signaling pathway. Its anticancer effects were validated through cell viability assays, flow cytometry, tumorsphere formation assays, molecular docking, and in vivo xenograft models. Western blotting was performed to evaluate pathway activity. Gyp L significantly inhibited OSCC cell proliferation, induced apoptosis, and caused G0/G1 cell cycle arrest in vitro. Mechanistically, Gyp L reduced phosphorylated AKT levels without affecting total AKT expression. In vivo, Gyp L treatment effectively reduced tumor volume in xenograft-bearing mice, with no apparent systemic toxicity. Gypenoside L is a key anticancer constituent of JGL, exerting its therapeutic effects in OSCC primarily through inhibition of the AKT pathway. These findings support its potential as a natural therapeutic or adjuvant agent for OSCC.
41. Age as a predictor of patient-reported outcomes in anterior cervical discectomy and fusion: analysis of the Michigan Spine Surgery Improvement Collaborative.
期刊: Journal of neurosurgery. Spine 发表日期: 2025-Nov-28 链接: PubMed
摘要
Older patients are increasingly undergoing anterior cervical discectomy and fusion (ACDF). Although studies have examined complication rates in older patients, the correlation between age and achieving specific patient-reported outcomes (PROs) is lacking. The authors sought to determine whether older patients undergoing ACDF are independently associated with lower odds of achieving minimal clinically important difference (MCID) for pain and physical function. The authors queried the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry for patients who underwent 1- to 4-level ACDF (March 2014 to July 2019) for degenerative conditions. PROs were measured at baseline, 90 days, 1 year, and 2 years using the neck and arm numerical rating scale (NRS), Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), EQ-5D, and North American Spine Society (NASS) satisfaction index. Patients were divided into older (≥ 70 years old) versus younger (< 70 years) groups. The authors used univariate analysis to compare demographic characteristics, operative characteristics, and proportions that achieved MCID between the age groups. This study included 7732 patients (6887 [89.1%] < 70 years old and 845 [10.9%] ≥ 70 years old). Unadjusted results demonstrated that older patients had a significantly higher rate of any complication within 90 days (26% vs 19%, p < 0.001), longer length of stay (2.6 days vs 1.7 days, p < 0.001), higher rates of MCID in neck NRS score at any time (76.9% vs 70.3%, p = 0.02) and at 90 days (71.3% vs 60.6%, p = 0.002), and lower rates of MCID in PROMIS-PF score at 1 year (52.7% vs 59.6%, p = 0.044) and 2 years (45.9% vs 57.7%, p = 0.002). Age was not independently associated with any PRO. Independent preoperative ambulation (OR 1.80, p < 0.001) and ambulation at postoperative day 0 (OR 1.25, p < 0.001) were independently associated with significantly increased odds of achieving MCID in PROMIS-PF score. Minor complications within 90 days (OR 0.67, p < 0.001) and lower baseline PROMIS-PF score (OR 0.89, p < 0.001) were independently associated with significantly decreased odds of achieving PROMIS-PF score. For the older subgroup, independent preoperative ambulation (OR 2.11, 95% CI 1.44-3.09, p < 0.001) had significantly increased odds of achieving MCID in PROMIS-PF score. Unadjusted results demonstrated that older patients had significantly longer length of stay and complication rates within 90 days. Adjusted analyses demonstrated that advanced age was not independently associated with PROs in patients undergoing ACDF. However, independent early postoperative and preoperative ambulation were associated with significantly increased odds of improved PROs following ACDF.
42. Rapid diagnosis of tuberculosis using a three-dimensional nanofiber paper-based electrochemical sensor.
期刊: Diagnostic microbiology and infectious disease 发表日期: 2025-Nov-28 链接: PubMed
摘要
Tuberculosis (TB) is the leading cause of death caused by a single infectious pathogen. Currently, a variety of conventional methods are widely used for detecting Mycobacterium tuberculosis (Mtb) or diagnosing TB, which have made significant contributions to controlling the TB epidemic. However, these existing TB diagnostic methods still face some difficulties and cannot provide rapid, low-cost, high-sensitivity, and high-accuracy diagnostic results simultaneously. Therefore, it is imperative to develop new TB diagnostic methods that are rapid, cost-effective, and sensitive through rigorous evaluation of potential biomarkers and new detection methods. In this study, a three-dimensional nanofiber (3D NFs) paper-based electrochemical sensor was prepared using electrospinning technology, and Mtb secretory protein Ag85B was utilized as a biomarker to achieve point-of-care detection of TB clinical samples. The 3D NFs paper-based electrochemical sensor can achieve a wide range of Bacillus Calmette-Guérin detection of 101-108 CFU/mL with good specificity. When the clinical bronchoalveolar lavage fluid samples were diluted 103 or 104 times, the 3D NFs paper-based electrochemical sensor could detect TB clinical samples with a sensitivity of up to 92.9 % and a specificity of 60 % within 5 min. 3D NFs paper-based electrochemical sensor has the advantages of low cost, high sensitivity, and fast response speed, and can realize rapid preliminary screening of TB patients.
43. Environmental noise, air pollution, and momentary stress: A context- and mobility-based approach.
期刊: Social science & medicine (1982) 发表日期: 2025-Nov-24 链接: PubMed
摘要
Air pollution and noise exposure adversely affect individuals’ physical and mental health. Static environmental exposure measurement methods lack accuracy and introduce estimation bias in the relationship between environmental exposure and health outcomes. Contextual factors and temporal effects play a significant role in influencing this association due to non-stationary effects. However, few studies have considered mobility-based exposure, contextual factors and temporality together in environmental health research. This study investigates the associations between noise and PM2.5 and momentary stress level (MSL) using a mobility-based measurement method, considering both contextual and temporal effects. It collected real-time exposure data from participants using mobile sensing technologies (e.g., GPS tracking) and geographic ecological momentary assessment (GEMA). The results show that daily routines and interactions with family or friends are linked to the highest PM2.5 exposure, whereas work/study contexts and settings spent with colleagues are associated with the lowest PM2.5 and noise levels. Travel is associated with the highest noise exposure. Further, travel and work/study contexts and being with colleagues are significantly and positively related to MSL compared to daily routines and being alone separately, while being with family members is related to lower MSL. The association between noise and MSL is significant (effect size: 0.003-0.008, temporal range: 1 minute-2 hours), particularly in entertainment, work/study, daily routines, when alone, with friends, or with family. PM2.5’s association with MSL becomes non-significant when contextual factors are included. This study highlights the importance of addressing temporal and contextual uncertainty in mitigating the uncertain geographic context problem.
44. Consistency of outcomes of studies on rectal cancer from the NCDB and SEER databases: A systematic review.
期刊: American journal of surgery 发表日期: 2025-Nov-20 链接: PubMed
摘要
The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) Program are major national cancer databases. While widely used, it is unclear if studies from each yield consistent conclusions on similar questions. This study compared findings from NCDB and SEER studies on rectal adenocarcinoma care to assess concordance. This PRISMA-compliant systematic review included studies evaluating rectal adenocarcinoma care using NCDB or SEER data. The main outcome was concordance or discordance between studies with overlapping topics. Of 310 screened studies, 30 addressed overlapping questions, with nine areas of overlap, and major disagreements in four. SEER studies showed a survival benefit of neoadjuvant radiation therapy (NRT) in mucinous adenocarcinoma, unlike NCDB studies. Other differences involved adjuvant therapy for stage T3N0 and stage II disease, and lymph node yield cutoffs. Most NCDB and SEER study conclusions were consistent, with discrepancies limited to controversial areas.
45. Interventions for promoting physical activity and/or reducing sedentary behaviour in older workers: a scoping review.
期刊: Occupational medicine (Oxford, England) 发表日期: 2025-Nov-01 链接: PubMed
摘要
To present the available evidence for interventions aimed at promoting physical activity and/or reducing sedentary behaviour in older workers and identify their key components. A scoping review was conducted to provide an overview of the available literature on interventions for increasing physical activity and reducing sedentary behaviour in older workers, identify gaps in the literature base and inform future research. Intervention Component Analysis (ICA) was conducted to identify the components of interventions that appear important for encouraging physical activity and reducing sedentary behaviour, thus facilitating health-promoting behaviour change in older workers. Thirty-eight articles were included in this review. Twenty-two studies were eligible for inclusion in ICA. Findings suggest that ‘Planning for change and/or addressing barriers to change to achieve goals’ and ‘Social support from a professional, family member or organised group’ appear to be key components within interventions that positively impact the physical activity and sedentary behaviour of older workers. This is the first review to employ ICA to identify potentially important components of interventions that target sedentary behaviour and physical activity in older workers. A gap in the literature remains for interventions targeting older workers who work from home. Further work is needed to develop suitable interventions for older workers, given the increase in economic inactivity in this employee group due to ill health.
46. Global burden of gastroesophageal reflux disease, 1990-2021, with projections to 2040: an update from the global burden of disease study 2021.
期刊: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 发表日期: 2025-Nov-01 链接: PubMed
摘要
Gastroesophageal reflux disease (GERD) imposes substantial global burden. Its recent trends and long-term projections have not been reassessed since the Global Burden of Disease (GBD) 2019 cycle. Using GBD 2021 data, incident and prevalent cases, years lived with disability, and age-standardized rates (ASRs) were estimated for 204 countries from 1990 to 2021. Decomposition analysis categorized changes into population aging, population growth, and epidemiological change. Projections to 2040 used a Bayesian age-period-cohort model, with Nordpred and ARIMA used to assess robustness. From 1990 to 2021, incident cases increased from 180.0 million to 324.1 million (+80.1%), and prevalent cases increased from 450.8 million to 825.6 million (+83.2%). The global age-standardized incidence rate (ASIR) reached 3882 per 100,000 with a peak at ages 30-39 years. ASRs varied by Socio-demographic Index (SDI) levels and exhibited a non-linear negative association overall: decreases at SDI <0.4 and > 0.6, with modest increases at 0.4-0.6. Decomposition analysis indicated population growth contributed most to the incidence increase (+95%), with smaller contributions from aging (+3%) and epidemiological change (+2%). Projections suggest that ASIR will increase to approximately 3939 per 100,000 and ASPR to approximately 9990 per 100,000, whereas ASYR is projected to increase only slightly. Projections were consistent across models. The global burden of GERD continues to rise, primarily associated with demographic expansion and modifiable lifestyle factors. In the absence of enhanced prevention, equitable diagnostic access, and obesity control, incidence and prevalence are anticipated to increase further through 2040. These findings provide region-specific evidence to inform resource allocation and targeted interventions.
47. Predictors of adverse events and recurrence of esophageal food bolus impaction: a systematic review and meta-analysis.
期刊: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 发表日期: 2025-Nov-01 链接: PubMed
摘要
Esophageal food impaction (EFI) is a gastrointestinal emergency that often requires urgent endoscopy. Predictors of recurrence and adverse events remain understudied and inconsistently reported. We conducted a systematic review and meta-analysis to identify predictors of recurrence and adverse events in EFI. We systematically searched PubMed, Embase, and the Cochrane Library on March 1, 2025. We included any observational studies or clinical trials that evaluated EFI outcomes in adults. The primary outcomes were EFI recurrence and adverse events, assessed according to underlying esophageal pathology, biopsy practices, follow-up, and timing of endoscopy. Effect sizes were evaluated using odds ratios (ORs), and a random-effects model was applied. A total of 14 studies were included with 3116 patients. Male gender was modestly associated with a higher risk of EFI recurrence (OR 1.45; 95% CI 1.01-2.10; P = 0.05), and patients with eosinophilic esophagitis (EoE) had a markedly increased risk of recurrence (OR 3.28; 95% CI 2.09-5.14; P < 0.001). No significant associations with recurrence were observed for biopsy (OR 1.44; 95% CI 0.98-2.11; P = 0.06), those who underwent follow-up (OR 1.10; 95% CI 0.37-3.32; P = 0.74), gastroesophageal reflux disease (GERD) (OR 1.22; 95% CI 0.46-3.23; P = 0.68), or hiatal hernia (OR 1.84; 95% CI 0.51-6.65, P = 0.35). For any adverse events, neither a history of prior EFI (OR 1.80; 95% CI 0.26-12.26) nor the timing of endoscopy (OR 0.89; 95% CI 0.49-1.64) was significantly associated with increased risk. Similarly, gender, EoE, and GERD were not associated with increased risk of adverse events. Only the male gender and EoE were significantly associated with a higher risk of EFI recurrence. Other factors, including GERD, hiatal hernia, follow-up, and biopsy status, were not. Delayed endoscopy and prior EFI were not associated with increased adverse events. Large-scale studies are needed to define risk factors better and strengthen the risk-stratification guide for preventive strategies.
48. The C19-YRSm questionnaire for Long COVID.
期刊: Occupational medicine (Oxford, England) 发表日期: 2025-Nov-01 链接: PubMed
摘要
49. AOTA 2025 Occupational Therapy Code of Ethics.
期刊: The American journal of occupational therapy : official publication of the American Occupational Therapy Association 发表日期: 2025-Nov-01 链接: PubMed
摘要
The 2025 Occupational Therapy Code of Ethics (the Code) of the American Occupational Therapy Association (AOTA) reflects the dynamic and inclusive nature of the occupational therapy profession, the evolving health care landscape, and the impact of emerging technologies that may present ethical considerations in practice, research, education, and policy. AOTA members are dedicated to fostering inclusion, equity, participation, safety, and well-being for all individuals, across diverse identities, abilities, and life circumstances. AOTA members are committed to empowering every person, group, family, organization, community, or population they serve to help them achieve their occupational goals and meet their unique needs.
50. Non-muscle myosin IIC predominantly expressed in the slow-twitch skeletal muscles impedes age-related muscle weakness.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Skeletal muscle expresses three types of non-muscle myosin (NM) II in addition to skeletal type myosin. While immature myoblasts have been reported to express NMIIA and NMIIB, playing roles in cell morphology, the specific localization and function of NMIIC in skeletal muscle cells remain unclear. In this study, we aimed to investigate the expression pattern and the physiological role of NMIIC in skeletal muscle. NMIIC was specifically expressed in the slow-twitch muscles such as soleus, which primarily consists of type I and type IIa fibers, and its expression increased as muscle differentiation progressed. To explore the function of NMIIC in skeletal muscle, we used whole-body NMIIC knockout (KO) mice. Myofiber size was slightly but significantly decreased in the soleus of young (18-20-week-old) NMIIC KO mice. However, contractile force of the isolated soleus muscle in the NMIIC KO mice did not differ from that of wild-type mice, suggesting that the slight reduction in fiber size has limited physiological significance at this age. Interestingly, in 81-week-old NMIIC KO mice, soleus contractile force was significantly reduced despite no difference in fiber size between aged wild-type and NMIIC KO mice. Notably, NMIIC expression levels were higher in aged than young mice. These findings suggest that while NMIIC has minimal impact on skeletal muscle function under young and healthy conditions, it may play a crucial role in maintaining muscle function when muscle is compromised at age.
51. Multi-scale dynamic graph neural network for PM2.5 concentration prediction in regional station cluster.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Accurate prediction of PM2.5 concentrations is crucial for public health and environmental management. However, effectively capturing complex spatiotemporal dependencies across multiple time scales remains a persistent challenge for existing methods, particularly in regions with sparse monitoring stations. This study proposes a Multi-Scale Dynamic Graph Neural Network (MSDGNN) for PM2.5 forecasting in station clusters. The model incorporates multi-scale temporal modeling (hourly, daily, weekly) to capture both short- and long-term dependencies. A learnable mapping matrix dynamically groups stations to strengthen spatial correlation learning. Furthermore, MSDGNN employs multi-head attention and spatiotemporal graph attention mechanisms to construct dynamic graphs, utilizing adaptive adjacency matrices and Chebyshev graph convolutions for effective feature propagation. We evaluated MSDGNN on 22 air quality monitoring stations in the Chang-Zhu-Tan region. Results demonstrated that our model reduces MAE by 6.77% and RMSE by 8.67% compared to the best baseline, validating its capability to learn complex dependencies and deliver accurate predictions under diverse spatiotemporal conditions.
52. Perspectives of racially minoritized youth with disabilities on addressing ableism and other forms of discrimination.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Racially minoritized youth with disabilities often encounter more extensive forms of discrimination. However, little is known about youth perspectives for addressing disability-related and other forms of discrimination, which is important for enhancing the participation and inclusion of youth with disabilities. This study explored the recommendations of youth with disabilities for addressing barriers and multiple forms of discrimination. This study involved in-depth interviews with a purposive sample of 20 youth with disabilities. We applied an inductive thematic analysis to the transcripts. Our findings highlighted the following key themes: (1) addressing barriers in healthcare, education, employment and the legal system; (2) community, social supports and resources; (3) advocacy; and (4) inclusive policies and youth involvement. There is a critical need for more inclusive services and support for youth with disabilities, especially those with multiple minoritized identities, to foster safe environments and quality of life.
53. Who gets included? A scoping review protocol of digital health interventions for older adults with heart failure through an equity lens.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Heart failure is a common and progressive condition that significantly impacts older adults, leading to increased morbidity, reduced quality of life, and healthcare utilization. As its prevalence continues to rise, there is a need for effective management strategies tailored to this population. Digital health interventions (DHIs) have emerged as promising tools for managing chronic conditions like heart failure, potentially improving accessibility and personalizing care. However, there is limited understanding of the inclusivity and effectiveness of these interventions across diverse subgroups of older adults, particularly those differentiated by age, cognitive status, socioeconomic status, sex/gender, and race/ethnicity. This protocol outlines a scoping review to assess the extent of literature on DHIs for managing heart failure among older adults, focusing on the representation of diverse subgroups and the characteristics of the interventions. Specifically, the review will explore which populations are included in current DHIs, how they are represented, and how intervention characteristics influence participation and outcomes. This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews, using the PROGRESS-Plus framework to assess equity-related factors such as socioeconomic status, race/ethnicity, geographic location, and cognitive status. The review will focus on randomized controlled trials published between January 1, 2005, and the present, in high-income countries. The forthcoming scoping review will provide a comprehensive mapping of the existing literature on digital health interventions for heart failure management in older adults, focusing on the inclusivity of diverse subgroups. By identifying gaps in the representation of key demographic factors such as age, cognitive status, socioeconomic status, sex/gender, and race/ethnicity, the review will highlight areas for future research and inform the development of more equitable, effective digital health solutions for heart failure. The findings will be valuable for healthcare practitioners, policymakers, and researchers seeking to improve the accessibility and impact of DHIs in managing heart failure among older populations.
54. Violent deaths following disasters: A retrospective analysis.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Negative mental health outcomes associated with disaster exposure can increase risks of interpersonal and self-directed violence. However, the link between disaster exposure and increased incidence in violent deaths is not clearly established. The objective of this work is to assess the incidence of violent deaths in non-disaster and disaster periods across five distinct disaster events. This study uses an ecological, quasi-experimental design to assess violent deaths in pre-disaster and disaster periods across five U.S. states (e.g., North Carolina, Oregon, Oklahoma, Wisconsin, and Colorado) with federally declared disasters resulting from natural hazards (e.g., flood, wildfire, tropical cyclone, storms). Deaths recorded in the National Violent Death Reporting System were used to describe violent deaths with injuries occurring three-months prior to and after disaster onset. Poisson regression with population offsets and fixed effects was used to calculate incidence rate ratios for disaster affected and unaffected counties within the same state, comparing violent death rates in disaster periods with non-disaster periods. Most of all deaths were White (80.75%), male (76.87%), and unmarried (65.03%); the median age of decedents was 41.5 years (IQR: 28-55). Overall, the incidence of violent deaths was consistent between disaster and non-disaster periods for both affected (IRR: 0.985; 95% CI: 0.760-1.276) and unaffected counties (IRR: 1.062; 95% CI: 0.975-1.158). Rate ratios were heterogenous but not significant across individual disasters, with only non-suicide and all-cause violent deaths increasing significantly following severe storms and flooding in Wisconsin for counties ineligible for public assistance. The results of this study are consistent with the heterogenous findings on violent deaths and disasters throughout literature. As disasters become more frequent and severe, it is important to further consider the relationship between disaster impacts and negative mental health outcomes, including violent deaths.