公共卫生研究摘要 (2025-12-09)
共收录 53 篇研究文章
1. Association of Cerebral Oxygenation During Prehospital Anaesthesia and Functional Outcome: A Prospective, Observational Multi-Centre Cohort Study of 1014 Patients.
期刊: Acta anaesthesiologica Scandinavica 发表日期: 2026-Jan 链接: PubMed
摘要
Many patients undergoing prehospital anaesthesia may be at risk of inadequate cerebral oxygenation due to underlying conditions or adverse events like hypotension or hypoxia. This study examined whether a decrease in regional cerebral oxygen saturation (rSO2) measured with near-infrared spectroscopy (NIRS) during prehospital anaesthesia associates with worse outcomes. We conducted a prospective, observational study including adult patients anaesthetised by six prehospital critical care teams. A relative cerebral desaturation event (rCDE) was defined as a ≥ 10% decrease in rSO2 for ≥ 5 min from baseline. An absolute cerebral desaturation event (aCDE) was defined as rSO2 < 60% during anaesthesia or lower than baseline if already < 60%. The primary outcome was favourable functional outcome (modified Rankin Scale ≤ 2) at 30 days and secondary outcomes included 30-day survival, 1-year functional outcome, and 1-year survival. Among 1014 patients, 199 experienced an rCDE, with 125 (63%) having supraphysiological baseline. rCDE was not associated with outcomes. Of 182 patients with aCDE, 30-day favourable outcomes were not significantly different (30% vs. 36%, p = 0.14, adjusted OR 0.92, 95% confidence interval 0.62-1.34). However, aCDE was associated with lower 30-day survival (46% vs. 58%, p = 0.006) and less favourable 1-year outcomes (31% vs. 41%, p = 0.043). Adjusted analyses showed no significant associations. An rCDE was not associated with worse functional outcomes. While aCDEs were linked to unfavourable outcomes in unadjusted analyses, these associations were not significant after adjustment, highlighting the complexity of interpreting NIRS in heterogeneous populations. Condition-specific studies are needed to clarify its role. Cerebral oxygen delivery may be jeopardized in critically ill patients undergoing prehospital anaesthesia. This study assessed near-infrared spectroscopy on the forehead in a large number of cases requiring general anaesthesia and subsequent transportation to hospital by helicopter. In unadjusted analysis, patients with an at least 10% decline in forehead saturation had higher survival and better functional outcome, whereas those with a forehead saturation below 60% had lower survival and worse functional outcome. Upon multivariable regression, age, patient category, systemic oxygen saturation and Glasgow Coma Scale score were independent predictors of worse outcomes, but forehead oxygen saturation was not. NIRS-measured forehead saturation decrease appears to associate in a complex fashion with more traditional predictors of patient outcomes. Whether effects of resuscitation interventions like these can be assessed reliably by NIRS is not yet well understood. The study protocol was published beforehand on clinicaltrials.gov (NCT04144803) on 7th October 2019.
2. Recommendations for Improving EHR Transitions: Nursing Perspectives From Three Healthcare Systems.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
Transitions from one electronic health record (EHR) to another are increasingly common yet can be enormously disruptive, affecting patient care and health care worker well-being. Nurses are especially impacted as the largest group of EHR users, and their perspectives are vital for understanding and improving transitions. To identify actionable recommendations for supporting nurses during EHR transitions by learning from nurse experiences at health care systems that have completed EHR-to-EHR transitions. Semistructured interviews were conducted with nurses from 3 health care systems in the United States between September 2023 and March 2024. We used rapid qualitative analysis to understand the nursing experience and actions taken during the EHR transition and identify recommendations for process improvement. We interviewed n=15 participants, including frontline nurses and nurse informaticists across 3 health care systems. We identified ten recommendations across 3 categories: training and support, workflow and usability, and EHR governance. Organizations consistently found that successful transitions required moving beyond vendor-provided support to develop institution-specific guidance, with nurses often taking key roles in developing and disseminating this guidance. Key recommendations included building internal training capacity, staging education to match user readiness, proactively redesigning workflows with nurse input, and establishing shared governance structures for EHR optimization. EHR transitions are challenging and can have a significant and, in some cases, detrimental impact on nursing staff. Input from nurses is critical for improving the transition process and reducing potential negative effects.
3. An Innovative Nurse Navigator Approach to Screen For and Address Social Needs in a Veterans Health Administration Women's Health Clinic.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
Women Veterans are the fastest-growing population in the Veterans Health Administration (VHA), but little is known about how to identify and address their social needs. This program evaluation examined the implementation of a social screening and referral initiative, Assessing Circumstances and Offering Resources for Needs (ACORN), using nurse navigators in a VHA women’s health clinic. (1) Describe the implementation process and outcome measures, (2) assess the prevalence of women Veterans’ social needs, (3) characterize nurse navigators’ perceptions of ACORN, and (4) document implementation challenges and adaptations. Program evaluation with qualitative and quantitative data collected between March 2023 and November 2024. Descriptive statistics were used to summarize sociodemographic characteristics and social needs of Veterans screened. Veterans receiving continuity care at a women’s health clinic in a midwestern VHA hospital. Nurse navigators completed ACORN screens with 291 Veterans, with 67% screening positive. The most frequently reported needs were social isolation/loneliness (49%), utilities (17%), transportation (14%), and digital needs (13%). Nurse navigators and the nurse site champion reported that ACORN enhanced their understanding of patients’ social needs and their ability to address these needs. They also reported seamless integration of ACORN into existing workflows. Findings show early insights into women Veterans’ unique social needs. An innovative nurse navigator approach to social screening in a VHA women’s health clinic was feasible, had high likelihood of sustainment, and improved nurses’ ability to care for their patients. This indicates strong potential for expanding nurse navigator roles both within and outside VHA.
4. Feasibility, Usability, and Satisfaction of a Decision Support Tool to Prevent Community-Acquired Pressure Injuries for Use in the Spinal Cord Injury Clinic.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
Community-acquired pressure injuries (CAPrIs) are common and costly among individuals living with spinal cord injury (SCI). Describe feasibility, usability, and satisfaction of a decision support tool to prevent CAPrIs in individuals with SCI and effect of the Community-Acquired Pressure Injury Prevention-Field Implementation Tool (CAPP-FIT) on CAPrI incidence 6 months post CAPP-FIT implementation. Preparation for the pilot included redesigning clinic workflow and training providers using a simulation with a standardized patient. The CAPP-FIT was piloted with community-dwelling veterans with scheduled in-person and telehealth clinic visits. Processes were assessed using contextual inquiry and monthly provider meetings. Feasibility, usability, and satisfaction were assessed using the mobile application rating scale with veterans and focus groups with providers. CAPrI incidence 6 months post CAPP-FIT intervention was assessed using a propensity match of veterans who did not receive the CAPP-FIT intervention. A modified Poisson regression with difference in differences was used to estimate the incidence rate ratio of CAPrIs. Participants included 7 providers (3 registered nurses, 2 nurse practitioners, 2 physicians). Veteran participants (n=103) had a mean age of 64; 50% White, 33% Black; 56% with paraplegia; and 72% with incomplete injury. Veteran participants were satisfied with the CAPP-FIT, agreed questions were relevant, and improved their conversations with providers. Providers felt the CAPP-FIT was easy to use, improved communications, and promoted preventive care. Participants experienced a lower CAPrI incidence rate compared with a propensity-matched sample at the pilot site, with the decrease among CAPP FIT participants being more pronounced than among non-participants. However, the difference in difference was not statistically significant with IRR: 0.23, 95% CI: 0.048-1.066 (P=0.060). The CAPP-FIT seems to be a useful tool in the SCI Clinic to prevent CAPrIs in veterans with SCI, but further testing is warranted.
5. Quantifying Risk of Exposure to Workplace Violence in Veterans Affairs (VA) Health Care: The Workplace Behavioral Risk Assessment (WBRA).
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
Few health care organizations have structured approaches to assimilate and analyze disruptive behavior data. In 2012, Veterans Affairs (VA) developed the Workplace Behavior Risk Assessment (WBRA), a tool that collects behavioral threat data from multiple systems, consolidates it, and tailors staff training based on the frequency and type of events. This paper provides an overview of the WBRA and how it can inform nurse training. A repeated measures design evaluated trends in workplace violence reporting and event rates across 140 VA health care systems from 2013 to 2024. Data were collected annually using a standardized electronic reporting system and reviewed by multidisciplinary teams. Risk levels were categorized based on the frequency and type of disruptive events, including manual restraint and physical or verbal violence. Descriptive statistics were used to prevalence of incidents and analyze trends, particularly among nursing professionals in high-risk areas. Four VA workplace settings: acute care (psychiatric and medical/surgical), emergency/urgent care, and Community Living Centers (CLC) were consistently classified as high-risk. In FY 2024, nursing staff accounted for over 90% of reports in inpatient and extended care settings and 73% in emergency/urgent care. From FY 2013 to FY 2024, reports involving nurses increased significantly, with the largest rises in CLCs (289%) and Medical/Surgical Units (271%), whereas the proportion of physical violence reports involving nurses rose from 59% to 83%. The WBRA enables health care systems to analyze behavioral risk data to align training with risk.
6. Using Medication Pass Analysis to Examine Longitudinal Changes in VA Inpatient Nurse Staffing and Workload Before and Through the COVID-19 Pandemic: 2019-2022.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
The COVID-19 pandemic resulted in extended disruption to the health care system. National-level data-driven comparisons of inpatient nurse staffing and workload before and during the pandemic have been limited. Assess the extent to which registered nurse (RN) staffing and workload changed from prepandemic levels in a national integrated health care system. Longitudinal descriptive analysis. Medication pass analysis using bar code medication administration data for the peak-time medication pass (PTM) assessing year-over-year changes from 2019 to 2022. To assess significance of year-over-year changes in means we used the Welch 2-sample t test. Staff (N=42,999) administering PTM medications on Veterans Health Administration acute-care inpatient units (643 units; 127 facilities) from January 1, 2019, to December 31, 2022 (3,681,802 staff days). Staffing: unique staff, staff days, staff per day, patients per staff (PPS); workload: patient days, medications, medications per patient, medications per RN, PTM duration. RNs administered 93.6% of peak-time medications. Fewer non-RNs administered medications after the onset of the pandemic. The average number of patients per RN (PPS) in 2022 was 3.3 on medical, 3.2 on mixed medical-surgical, 3.3 on surgical, 2.5 on step down, and 1.5 on critical care units. The greatest increase in PPS from 2019 to 2022 occurred on surgical units (+0.20, P<0.0001). Across nearly all unit types and levels of PPS, medications per RN were greater and duration was longer in 2022 than in 2019. RN staffing and workload fluctuated widely at the onset of the pandemic. In 2022, new patterns began to emerge, showing a higher RN workload than before the pandemic.
7. Understanding Alternate Work Schedules and Their Potential to Improve Work-Life Well-Being for Veterans Affairs Nurses.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
The employee experience of clinical personnel, especially nurses, is increasingly vital for health care organizations and is now part of health care’s quintuple aim, which includes improving patient experience, population health, cost, and health equity. Nurse burnout and turnover intentions have heightened since the COVID-19 pandemic, with high workload and inadequate staffing as key organizational drivers. Flexible work schedules, such as 72/80 (where one works three 12-h shifts per week but receives the pay equivalent of 80 h), have been a longstanding countermeasure, but postpandemic data on their impact are limited. This national evaluation investigates the impact of the 72/80 work schedule on Veterans Health Administration (VHA) nurses. We hypothesized that nurses on a 72/80 schedule experience less burnout, higher job satisfaction, greater work engagement, and lower turnover intentions. We conducted a web-based survey including self-reported 72/80 work status and employee experience measures, alongside existing administrative data on employee outcomes. We analyzed the data using Mann-Whitney U tests, mixed effects, and linear regression models. Eight thousand five hundred forty-five VHA nurses from 170 Veterans Affairs Medical Centers nationwide working in 24/7 bedded units completed the survey. The 72/80 schedule was significantly associated with lower emotional exhaustion and depersonalization, and greater personal accomplishment. In addition, 72/80 status correlated with higher workplace engagement, job satisfaction, organizational satisfaction, and lower turnover intention. The 72/80 work schedule shows significant potential as a transformative workforce strategy, providing substantial benefits in recruitment, retention, and employee satisfaction.
8. Higher Proportions of Baccalaureate-Prepared Nurses in Veterans Affairs Medical Centers Associated With Lower Surgical Mortality.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
Multiple studies have linked higher levels of BSN-prepared nurses to lower odds of postsurgical mortality and failure-to-rescue (FTR; ie, death following the development of a postsurgical complication). The purpose of this national evaluation was 2-fold: (1) to assess the proportion of direct care nurses holding a BSN or higher degree in VA Medical Centers; and (2) to examine the association between the proportion of BSN-prepared nurses in VA Medical Centers and the outcomes of hospitalized Veterans undergoing commonly performed surgical procedures. Across our sample of 117 VA Medical Centers nationally, the mean percentage of RNs with a BSN degree or higher in nursing was 55% (SD=16%) and ranged from 9% to 84%. Every 10-point increase in the percentage of nurses with a BSN degree or higher was associated with a 9% decrease in the odds of 30-day mortality and an 8% decrease in the odds of FTR among a cohort of Veterans undergoing commonly performed general, orthopedic, and vascular surgeries. Higher proportions of nurses with a BSN or higher in VA Medical Centers is associated with lower postsurgical mortality and FTR among Veterans receiving surgery. These findings confirm within the VA what has been shown in non-VA hospital settings for the last 20 years. Ongoing monitoring and improvements, which are both considered foundational to the tenets of learning health systems and high-reliability organizations, are needed to support staffing with higher proportions of frontline BSN-prepared nurses in VA Medical Centers.
9. Strengthening Rural Health Care: A Scoping Review of Nurse Recruitment and Retention Strategies.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
Despite nursing being the largest US health profession, only 16% of registered nurses (RNs) practice in rural areas, where health care access is limited. This significantly impacts rural residents, including over 2.7 million rural veterans receiving care at the Veterans Health Administration, leading to compromised health outcomes. Nurses are vital in primary care, improving coordination and management of chronic conditions. Identify recruitment and retention programs for rural nurses (licensed vocational nurses/licensed practical nurses and RNs), including strategy characteristics and location. We conducted a scoping review of published and gray literature. Eligible studies targeted US rural nurse recruitment and retention strategies. Data were extracted for program characteristics, including strategy type (eg, financial incentive), focus (recruitment, retention, or both), and collaboration levels (single or multi-institutional). Of 1179 unique articles identified, only 60 met the inclusion criteria. An additional 42 programs were identified from gray literature, totaling 102 programs. Twenty-two programs used a multipronged approach (2-14 strategies), totaling 180 strategies. Education (n=85) and personal and professional support (n=54) were the most frequently used recruitment and retention strategies. Of the 102 programs, only 22 used a multipronged approach, with education as the most frequently used strategy. More programs should use a multipronged approach and provide additional incentives and support (eg, financial incentives) to rural nurses beyond education. Only 4 strategies were regulatory, shedding light on the need for more nurse recruitment and retention support at the policy level.
10. Findings and Recommendations From the State of the Art (SOTA) Conference on Nursing Research to Improve Veteran Outcomes.
期刊: Medical care 发表日期: 2026-Jan-01 链接: PubMed
摘要
The Veterans Health Administration (VHA), the largest employer of nurses in the United States, has more than 120,000 nursing personnel providing care to over 9 million Veterans across diverse settings. Despite nursing’s central role in delivering and sustaining care, research on strengthening the nursing workforce and optimizing nursing practice has remained underdeveloped in VHA. To address this gap, VHA’s Office of Research and Development, in partnership with the Office of Nursing Services, convened a State of the Art (SOTA) conference in November 2023 focused on nursing. The Nursing SOTA brought together nurses, researchers, operational leaders, and other stakeholders to review current evidence, identify research gaps, and develop recommendations. Five priority areas were identified: pressure injury prevention and treatment, care coordination models, social drivers of health, nurse staffing and care models, and the nursing work environment. Cross-cutting themes included the need for stronger data infrastructure and expanded support for the VHA nursing science workforce. Conference recommendations were incorporated into VHA’s 2024 Health Systems Research Priorities and are expected to inform future research, policy, and practice aimed at advancing nursing science and improving care for Veterans.
11. The upside and challenge of getting it wrong.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-16 链接: PubMed
摘要
12. PFAS-contaminated drinking water harms infants.
期刊: Proceedings of the National Academy of Sciences of the United States of America 发表日期: 2025-Dec-16 链接: PubMed
摘要
There is evidence of widespread human exposure to per- and polyfluoroalkyl substances (PFAS) but limited evidence of the human health impacts of this exposure. Using data on New Hampshire births from 2010-2019, we show that mothers receiving water that had flowed beneath a PFAS-contaminated site, as opposed to comparable mothers receiving water that had flowed toward a PFAS-contaminated site, had 191% [95% CI: 83-298%] higher first-year infant mortality (611 [268-955] additional first-year deaths per 100k births); 168% [42-294%] more births before 28 wk of gestational age (466 [116-817] additional such births per 100k births); and 180% [57-302%] more births with weight below 1,000 g (607 [192-1022] additional such births per 100k births). Extrapolating to the contiguous U.S., PFAS contamination imposes annual social costs of approximately $8 billion. These health costs are substantially larger than current outside estimates of the cost of removing PFAS from the public water supply.
13. Risk for Cancer With Glucagon-Like Peptide-1 Receptor Agonists and Dual Agonists : A Systematic Review and Meta-analysis.
期刊: Annals of internal medicine 发表日期: 2025-Dec-09 链接: PubMed
摘要
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are used for type 2 diabetes mellitus (T2DM) and overweight or obesity, but their association with cancer is unclear. To investigate the risk for obesity-related cancer associated with GLP-1RAs. PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials from inception to August 2025. Randomized placebo-controlled trials reporting any of the following cancer outcomes: thyroid, pancreatic, colorectal, gastric, esophageal, liver, gallbladder, breast, ovarian, endometrial, or kidney cancer; multiple myeloma; or meningioma. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool, and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Odds ratios (ORs) were pooled using random-effects meta-analysis. The review included 48 trials involving 94 245 participants. GLP-1RAs probably have little or no effect on risk for thyroid cancer (OR, 1.37 [95% CI, 0.82 to 2.31]; 1 fewer to 9 more cases per 10 000 patients treated), pancreatic cancer (OR, 0.84 [CI, 0.53 to 1.35]; 9 fewer to 6 more per 10 000), breast cancer (OR, 0.95 [CI, 0.60 to 1.49]; 10 fewer to 12 more per 10 000), or kidney cancer (OR, 1.12 [CI, 0.78 to 1.60]; 5 fewer to 13 more per 10 000) (moderate certainty). GLP-1RAs may have little or no effect on colorectal, esophageal, liver, gallbladder, ovarian, or endometrial cancer; multiple myeloma; or meningioma (low certainty). The effect on gastric cancer is very uncertain. Results were consistent in sensitivity analyses of trials with low risk of bias and studies of semaglutide or tirzepatide and across subgroups stratified by follow-up duration, population, GLP-1RA class, weight loss profile, dose, and duration of action. The included trials were not designed to evaluate cancer outcomes and had short follow-up. GLP-1RAs may have little or no effect on risk for obesity-related cancers. Longer-term studies are needed to clarify potential risks or benefits. None. (PROSPERO: CRD42024608365).
14. The Incubation Periods of Mpox Virus Clade Ib.
期刊: Annals of internal medicine 发表日期: 2025-Dec-09 链接: PubMed
摘要
Mpox virus (MPXV) clade Ib, first detected in the Democratic Republic of the Congo (DRC) in September 2023, spread internationally within months, prompting an emergency declaration from the World Health Organization. Data on its incubation period, which both shapes outbreak dynamics and informs epidemic response strategies, remain limited. To estimate the incubation periods of mpox clade Ib, examining evidence for differences by route of exposure and demographic factors. Bayesian analysis of clinical surveillance data collected between June and October 2024. South Kivu, DRC, the epicenter of the current mpox clade Ib global outbreak. Clinically attended persons with confirmed mpox clade Ib infection. Demographic characteristics, exposure history, symptom onset, and transmission route. Among 37 polymerase chain reaction-confirmed cases with high viral load (cycle threshold values <34), the median incubation period from exposure to rash was 13.6 days (95% credible interval [CrI], 9.6 to 19.0 days). Five percent of cases are expected to develop a rash within 3.1 days (CrI, 1.3 to 5.5 days) and 95% within 32.3 days (CrI, 22.4 to 45.8 days). The incubation period seemed to differ by putative transmission route: Sexual transmission had a shorter median (10.3 days [CrI, 3.1 to 20.3 days]) than nonsexual transmission (13.5 days [CrI, 9.5 to 19.1 days]), although the CrIs overlapped. Surveillance data lacked detailed exposure histories and a lower bound for exposure periods, but models accounted for these uncertainties, yielding robust median estimates. Evidence from this study suggests that clade Ib may have a longer incubation period than other MPXV clades, and this may vary by transmission route. The shorter incubation for sexual transmission mirrors patterns seen in the predominantly sexually transmitted clade IIb outbreak, highlighting the potential role of exposure route in disease progression. These findings have implications for global recommendations on postexposure monitoring periods and prophylaxis. Gates Foundation and Geneva Centre for Emerging Viral Diseases.
15. Integrating Methadone Into Primary Care: Lessons From Ukraine.
期刊: Annals of internal medicine 发表日期: 2025-Dec-09 链接: PubMed
摘要
16. Integrating Methadone Services Into Primary Care in Ukraine: Two-Year Outcomes From a Randomized Trial.
期刊: Annals of internal medicine 发表日期: 2025-Dec-09 链接: PubMed
摘要
Opioid use disorder (OUD) drives high morbidity and mortality, but access to opioid agonist therapy (OAT) is limited in low- and middle-income countries. Integrating OAT into primary care may expand access and improve comorbidity management, although provider discomfort remains a barrier. To compare health care use among persons with OUD receiving methadone in specialty clinics versus primary care centers in Ukraine (January 2018 to December 2023). Two-group randomized controlled trial with 2:1 allocation to intervention and control. (ClinicalTrials.gov: NCT04927091). Thirteen cities in Ukraine: Cherkasy, Dnipro, Kramatorsk, Kropyvnytskyi, Kryvyi Rih, Kyiv, Lviv, Mariupol, Mykolaiv, Odesa, Rivne, Sloviansk, and Zhytomyr. A total of 1459 adults with OUD (950 intervention, 509 control) initiating or receiving methadone. Methadone delivered in primary care aided with telementoring, an Extension for Community Healthcare Outcomes-like model that is adapted to the Ukraine context, versus standard specialty clinic care. Primary outcome: difference in composite quality health indicator (QHI) scores between groups at 24 months, representing access to 17 guideline-concordant services (9 primary care and 8 specialty care) received, assessed through surveys and ranging from 0 to 100. Secondary outcomes: domain-specific QHI scores and methadone treatment indicators. Participants in primary care settings achieved higher composite QHI scores than those in specialty clinics, with a mean difference of 9.1 percentage points (95% CI, 6.9 to 11.2 percentage points) at 24 months. Results were similar for primary care QHI (12.3 percentage points [CI, 9.0 to 15.6 percentage points]) and specialty care QHI (5.2 percentage points [CI, 0.2 to 10.3 percentage points]). Methadone retention among new patients at 24 months was 67.2% in primary care versus 64.7% in specialty clinics. Quality health indicators reflect health care use rather than health outcomes. Quality health indicators were equally weighted despite differing clinical significance. Integrating methadone treatment into primary care settings improves adherence to guideline-concordant health care without compromising methadone retention and treatment quality. National Institute on Drug Abuse.
17. The Legal and Ethical Framework for Artificial Intelligence in Gastrointestinal Endoscopy: A World Endoscopy Organization International Consensus Statement.
期刊: Annals of internal medicine 发表日期: 2025-Dec-09 链接: PubMed
摘要
The OperA (Optimising Colorectal Cancer Prevention through Personalized Treatment with Artificial Intelligence) project aims to transform colorectal cancer care through artificial intelligence (AI) innovations. Recognizing that legal and ethical challenges remain key obstacles to clinical integration, this Delphi study sought to identify and prioritize such concerns in the context of gastrointestinal (GI) endoscopy. Fourteen international experts participated in a 2-round Delphi process. In round 1, the steering committee, with feedback from participants, proposed legal and ethical issues pertaining to AI in endoscopy. Round 2 involved iterative rating and refinement of these issues to achieve consensus on their importance. Consensus was reached on 10 key statements spanning 3 thematic domains: data governance, medicolegal implications, and equity and bias. Experts emphasized the need for robust data protection, transparent algorithmic development, and institutional clarity on data ownership. Liability concerns related to AI-assisted diagnosis and automated reporting were highlighted, alongside calls for guidance from legal and professional bodies. Finally, participants underscored the importance of demographic diversity in training data sets and transparent reporting practices to mitigate bias and ensure equitable AI deployment. As AI tools become increasingly integrated into the clinical practice of gastroenterology, addressing legal, ethical, and equity-related challenges is essential. This expert consensus provides a foundation for developing guidelines and regulatory frameworks to support responsible AI adoption in GI endoscopy.
18. Randomized, Prospective Evaluation of Hemostatic Agents in Robotic-Assisted Laparoscopic Partial Nephrectomy.
期刊: The Journal of urology 发表日期: 2025-Dec-08 链接: PubMed
摘要
Hemostatic agents (HA) are typically used during robotic-assisted laparoscopic partial nephrectomy (RALPN) to minimize perioperative bleeding. However, high-quality evidence supporting their effectiveness is limited. We aimed to determine whether HA reduce perioperative blood loss in patients undergoing RALPN. We conducted a prospective, randomized controlled trial of patients undergoing RALPN. Patients were randomized to HA+, in which HA were assigned, and HA-, no HA. The primary endpoint was mean change in hemoglobin from preoperative baseline to postoperative day 1. Secondary outcomes included major bleeding complications (blood transfusion, reoperation and endovascular intervention), length of stay and 30-day readmission. A total of 208 patients were randomized, and 178 patients were included in the final modified intention-to-treat analysis (88 HA-, 90 HA+). Mean hemoglobin decrease was 1.7 g/dL (95% CI: 1.4-2.0) in the HA- group and 1.8 g/dL (95% CI: 1.4-2.1) in the HA+ group (p = 0.5, 95% CI for group difference: (0.26) - 0.48). The mean estimated blood loss in the HA- group was 116 cc (95% CI: 96-136) and in the HA+ group was 114 cc (95% CI: 88-140) (p-value=0.3). We found no significant difference in major bleeding complications (p-value =0.7, 95% CI for group difference: (-5.4%)-9.8%), as four patients (4.5%) in the HA- group and six patients (6.7%) in the HA+ experienced major bleeding complications. Routine use of hemostatic agents during RALPN does not appear to lower the risk for bleeding following surgery, as measured by the change in hemoglobin levels or major bleeding complications.
19. Critical Appraisal Tools for Evaluating Artificial Intelligence in Clinical Studies: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-08 链接: PubMed
摘要
Health research that uses predictive and generative artificial intelligence (AI) is rapidly growing. As in traditional clinical studies, the way in which AI studies are conducted can introduce systematic errors. The translation of this AI evidence into clinical practice and research needs critical appraisal tools for clinical decision-makers and researchers. This study aimed to identify existing tools for the critical appraisal of clinical studies that use AI and to examine the concepts and domains these tools explore. The research question was framed using the Population-Concept-Context (PCC) framework. Population (P): AI clinical studies; Concept (C): tools for critical appraisal and associated constructs such as quality, reporting, validity, risk of bias, and applicability; and context (C): clinical practice. In addition, studies on bias classification and chatbot assessment were included. We searched medical and engineering databases (MEDLINE, Embase, CINAHL, PsycINFO, and IEEE) from inception to April 2024. We included clinical primary research with tools for critical appraisal. Classical reviews and systematic reviews were included in the first phase of screening and excluded in the secondary phase after identifying new tools by forward snowballing. We excluded nonhuman, computer, and mathematical research, and letters, opinion papers, and editorials. We used Rayyan (Qatar Computing Research Institute) for screening. Data extraction was done by two reviewers, and discrepancies were resolved through discussion. The protocol was previously registered in Open Science Framework. We adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) and the PRISMA-S (PRISMA-Search) extension for reporting literature in systematic reviews. We retrieved 4393 unique records for screening. After excluding 3803 records, 119 were selected for full-text screening. From these, 59 were excluded. After inclusion of 10 studies via other methods, a total of 70 records were finally included. We found 46 tools (26 guides for reporting AI studies, 16 tools for critical appraisal, 2 for study quality, and 2 for risk of bias). Nine papers focused on bias classification or mitigation. We found 15 chatbot assessment studies or systematic reviews of chatbot studies (6 and 9, respectively), which are a very heterogeneous group. The results picture a landscape of evidence tools where reporting tools predominate, followed by critical appraisal, and a few tools for risk of bias. The mismatch of bias in AI and epidemiology should be considered for critical appraisal, especially regarding fairness and bias mitigation in AI. Finally, chatbot assessment studies represent a vast and evolving field in which progress in design, reporting, and critical appraisal is necessary and urgent.
20. Importance of Engaging Partners in Digital Postpartum Depression Prevention: Qualitative Study.
期刊: JMIR pediatrics and parenting 发表日期: 2025-Dec-08 链接: PubMed
摘要
Participants in qualitative interviews designed to optimize the adaptation of a maternal postpartum depression intervention into a novel smartphone app noted that the app could be more useful if were delivered simultaneously to both parents; this calls for additional research on the feasibility and effectiveness of digital dyadic or stand-alone partner interventions to prevent postpartum depression.
21. Associations Among Digital Health Literacy, Lifestyle Factors, and Cardiovascular Health in Black and Hispanic Communities: Cross-Sectional Study.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-08 链接: PubMed
摘要
Black and Hispanic adults in the United States face a disproportionately high burden of cardiovascular disease (CVD). Digital health literacy (DHL) may influence CVD prevention and management, yet its role in these populations is not well understood. This study aimed to examine associations between DHL and cardiovascular-related lifestyle behaviors, CVD, and CVD risk factors among Black and Hispanic adults. This was an exploratory analysis of survey data from a cross-sectional study among adults in Maryland; Virginia; and Washington, DC (March 2024-June 2024). DHL was measured using items from the Digital Health Literacy Instrument, and outcomes included self-reported CVD and risk factor diagnoses and lifestyle behaviors (physical activity and fruit-, vegetable-, and sugar-sweetened beverage intake). Multivariable regression models were used to assess associations, adjusting for sociodemographic and health literacy factors. Among 1221 participants, the mean age was 44 (SD 16) years; most were female (n=766, 62.7%), insured (n=1065, 87.2%), and non-Hispanic (n=840, 68.8%) and identified as Black or African American (n=778, 63.7%). Higher DHL was associated with greater vegetable intake (incidence rate ratio 1.08, 95% CI 1.01-1.15). Contrary to our hypothesis, DHL was positively associated with sugar-sweetened beverage consumption (incidence rate ratio 1.13, 95% CI 1.10-1.25). DHL showed a significant nonlinear association with fruit intake (P=.01). No significant associations were observed with CVD or its risk factors. The relationship between DHL and cardiovascular-protective behaviors was mixed, suggesting that DHL may not be sufficient to promote consistent health-protective behaviors. The findings highlight the need for interventions that strengthen DHL while also addressing broader contextual and structural factors such as targeted digital marketing of unhealthy food and beverages, as well as environmental barriers. Longitudinal and experimental studies are needed to clarify causal pathways and inform equitable CVD prevention strategies.
22. Health Technologies and Infrastructures for Supporting Home-Based Pediatric Palliative Care: Scoping Review.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-08 链接: PubMed
摘要
Families with children who need pediatric palliative care (PPC) often stay at home to preserve a sense of normalcy. However, families may experience challenges regarding communication and follow-up from health care professionals (HCPs). Health technology is suggested as a way to facilitate communication between families and HCPs, but no previous scoping review has mapped existing studies on health and communication technologies and infrastructures for supporting children who need PPC and their families. The objective of this scoping review was to systematically map the literature on health technologies and infrastructures to support communication in home-based PPC. We conducted a scoping review based on Arksey and O’Malley’s framework with a systematic search for relevant publications in the ASSIA, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science databases in November 2023, updated on August 28, 2025. Eligible publications comprised children (aged 0-18 years) with life-limiting or life-threating conditions requiring PPC and their families; HCPs, social care workers, or teachers caring for children in need of PPC and using any health technologies and infrastructures to support 2-way communication in home-based care; and literature published between January 1, 2018, and August 28, 2025, in Danish, English, Norwegian, or Swedish. Pairs of authors independently assessed eligibility and extracted data, which were summarized using a descriptive approach. This review included 41 publications: 20 empirical papers, 6 protocol papers, 7 abstracts, 3 brief publications, 2 review papers, and 3 case publications. In 29.3% (12/41) of the publications, the researchers applied user-centered phased-design approaches to develop health technology for PPC. Children with cancer were most often studied in the publications. The most frequent delivery of health technology for communication in home-based PPC combined asynchronous and synchronous modes (19/41, 46.3%). Furthermore, the most frequent health technology apps for communication in home-based care were symptom monitoring apps (15/41, 36.6%), video technology (8/41, 19.5%), and health monitoring and video technology (3/41, 7.3%). Smartphones (14/41, 36.6%), internet and Wi-Fi (12/41, 29.3%), computers or laptops (9/41, 22%), and tablets (9/41, 22%) were the most frequently reported infrastructures. Children with cancer and their families are the most frequently reported users of health technology for communicating with HCPs in home-based PPC. However, research on children with diagnoses other than cancer and their families is limited. Combining asynchronous and synchronous modes is the most frequent way to deliver health technology, and children and their families often communicate with HCPs using symptom monitoring apps. Reports of health technology infrastructure for home-based PPC were insufficiently accounted for. Future studies should strive to include the voices of children in the development of health technology to align more closely with their needs. Open Science Framework t9h4c; https://osf.io/t9h4c/.
23. Effects of daily discrimination and microaggressions on alcohol use and related consequences among Latine college students at a predominantly White institution.
期刊: Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors 发表日期: 2025-Dec-08 链接: PubMed
摘要
Latine college students at predominantly White institutions face discriminatory stress, increasing their risk for problematic alcohol use. The specific impact of daily discrimination and microaggressions on alcohol use and related consequences, relative to other college stressors (e.g., academics, finances), remains understudied. This study used an intensive daily longitudinal design to examine whether these experiences independently affect alcohol use and related consequences. The study enrolled 109 Latine student drinkers (Mage = 19.95; 77% female) from a large predominantly White institution in the northeastern United States. Participants completed a baseline survey, an in-person training session, and 28 consecutive daily surveys. Multilevel models analyzed the data, examining within- and between-person effects while controlling for college stress, trauma history, and relevant demographic variables. Participants had an average survey completion rate of 89.1% (∼25 of 28 surveys). Within-person, daily experiences of discrimination and microaggressions were associated with increased alcohol use and consequences. Between-person, these factors predicted alcohol-related consequences but did not significantly affect alcohol use when controlling for college stress, trauma, and demographics. Daily discrimination and microaggressions independently contribute to alcohol use and its consequences for Latine students, beyond other common stressors faced by college students. These findings highlight the need for culturally sensitive interventions addressing discriminatory stress. Predominantly White institutions should also consider policy changes to better support minoritized students and mitigate the negative effects of discrimination on their well-being. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
24. Prevalence and risk factors for work-related musculoskeletal pain among flight attendants: A comparative study.
期刊: Work (Reading, Mass.) 发表日期: 2025-Dec-08 链接: PubMed
摘要
BackgroundFlight attendants (FAs) are subject to unique occupational demands, increasing their risk of developing work-related musculoskeletal pain (WRMSP). WRMSP is influenced by physical, psychosocial, and demographic factors that may change over time due to evolving work environments and practices.ObjectivesCompare the prevalence of FAs’ WRMSP in 2016 vs 2024; Identify key physical and psychosocial predictors of WRMSP in each period; explore implications for ergonomic interventions and health promotion strategies tailored to the aviation work environment.MethodsTwo cross-sectional cohorts of FAs, from 2016 (n = 94) and 2024 (n = 89), completed identical, validated questionnaires using the same sampling frame. Surveys covered demographics, occupational tasks, region-specific pain, and psychosocial factors.ResultsArm and hand pain were less prevalent in 2024. Logistic regressions showed higher odds of neck pain in 2024 associated with stress, attitudes, and satisfaction, but markedly lower odds of arm pain across psychosocial and task factors. Lower back pain was less predicted in 2024 when satisfaction was considered. Across both years, hand pain increased with workload and oven-loading but decreased with age and authority; finger pain rose with effort; upper back pain with BMI and time pressure; shoulder pain with dissatisfaction; elbow pain with standing.ConclusionsTechnological and organizational changes appear to have contributed to reduced arm and hand pain and to lower back pain being less predicted in 2024, while psychosocial stressors were linked to increased neck pain, underscoring the dual impact of ergonomic improvements and persistent organizational pressures on WRMSP.
25. Dose-response associations between leisure-time physical activity, heart age and predicted 10-year cardiovascular disease risk.
期刊: Journal of public health (Oxford, England) 发表日期: 2025-Dec-08 链接: PubMed
摘要
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide. This study aimed to investigate the dose-response relationship between leisure-time physical activity (LTPA) and cardiovascular health, assessed by heart age and predicted 10-year CVD risk, and explore the mediating role of inflammatory regulation. This cross-sectional study included 6658 individuals aged 30-74 years from National Health and Nutrition Examination Survey 2015-2018. Heatmap visualization assessed variable distributions, while generalized linear regression models (GLMs) and restricted cubic splines quantitatively examined the LTPA-cardiovascular health associations. Heatmap visualization revealed that, among the 26 variables evaluated, LTPA was inversely associated with heart age, predicted 10-year CVD risk, and odds ratio for high CVD risk. GLM analyses indicated that each additional hour per week of LTPA was associated with a 0.17-year reduction in heart age, a 0.07% decrease in predicted 10-year CVD risk, and a 5% lower odds for having high CVD risk. Vigorous-intensity LTPA showed stronger benefits than moderate activity. Systemic inflammation biomarkers significantly mediated the associations between LTPA and cardiovascular health. The findings support a dose-dependent cardioprotective effect of LTPA, partially mediated through anti-inflammatory pathways. These results highlight the importance of promoting LTPA, particularly vigorous-intensity activity, for cardiovascular health promotion.
26. Communication Strategies for Tick-Borne Disease Prevention Among US Cattle Producers: Quasi-Experimental Study on Message Framing and Source Credibility.
期刊: JMIR formative research 发表日期: 2025-Dec-08 链接: PubMed
摘要
Haemaphysalis longicornis (Asian longhorned tick) presents a growing threat to cattle health in the United States, causing anemia, weight loss, and even death. Despite the expanding distribution of this tick and the need for prevention, there is limited research on how to effectively communicate tick-borne disease risks to agricultural communities, particularly cattle producers. Social media represents a potentially impactful channel for risk communication; however, its utility and optimal message design for this population remain insufficiently understood. This study aimed to evaluate the effectiveness of various digital communication strategies in influencing US cattle producers’ engagement, risk perceptions, and self-reported preventive intentions regarding tick-borne diseases. A quasi-experimental study with a 2×3 factorial design was conducted with 116 cattle producers in the United States. Participants were randomly assigned to view simulated Facebook posts that varied by message source (extension agent vs cattle producer) and message framing (prevention-oriented, fear-based, or neutral). Participants reported their likelihood of engaging with the post (using an emoji reaction, commenting, or sharing), their perceptions (fear and attitudes), and their intention to adopt preventive behaviors. Data were analyzed using descriptive statistics, ANOVA, and Spearman rank-order correlations. Across all groups, participants showed a clear preference for low-effort engagement, most frequently using emoji reactions rather than commenting or sharing. Descriptive trends suggested that posts from cattle producers, especially those framed as prevention oriented, elicited higher mean engagement. Prevention-oriented messages were also associated with greater concern about tick risks and more favorable attitudes toward prevention. As reflected in the qualitative feedback, fear-based posts were often viewed as exaggerated or less credible. Social media engagement showed moderate correlations with attitudes (ρ=0.52-0.64) and preventive intentions, with attitudes more strongly associated with behavioral intent than fear. This study provides preliminary evidence that prevention-oriented digital messages, especially when shared by credible sources, may foster more positive attitudes and greater willingness to undertake tick prevention among cattle producers, compared to fear-based or neutral content. The findings highlight the need for balanced, context-rich messaging tailored to the preferences and realities of agricultural audiences. By integrating quantitative and qualitative results, this study informs the design of more effective social media-based interventions for tick-borne disease prevention in agricultural settings.
27. Immunogenicity of Adalimumab in Bacterial Molecular Mimicry: In Silico Analysis.
期刊: JMIR bioinformatics and biotechnology 发表日期: 2025-Dec-08 链接: PubMed
摘要
Adalimumab, a monoclonal antibody targeting tumor necrosis factor α, treats autoimmune diseases but induces antidrug antibodies in 30% to 60% of patients, reducing its efficacy. This study aims to investigate molecular mimicry as a mechanism behind this immunogenicity, where bacterial immunoglobulin domains structurally resemble adalimumab’s light chain, triggering immune responses. Using PSI-BLASTp (National Center for Biotechnology Information) and PRALINE (Center for Integrative Bioinformatics), there are 40 bacterial antigens homologous to adalimumab, with 8 clinically relevant strains. Structural analysis revealed 94% amino acid identity between the immunoglobulin domain of Escherichia coli strain B1 and adalimumab’s light chain, and 89.67% similarity with Corynebacterium pyruviciproducens. Root mean square deviation values confirmed strong structural homology. Additionally, 5 cross-reactive B-cell epitopes were predicted, suggesting overlapping surfaces that may promote immune cross-reactivity and antidrug antibody development. This study represents a first step toward identifying a potential microbial factor driving antiadalimumab antibody formation. The predicted cross-reactive regions provide specific candidates for further in vitro validation to confirm molecular mimicry and refine epitope mapping. Understanding these mechanisms may ultimately inform the design of less immunogenic biologics and guide clinical strategies to predict and prevent antidrug antibody formation.
28. Syphilis: Understanding the disease and the role of dental professionals.
期刊: Community dental health 发表日期: 2025-Dec-08 链接: PubMed
摘要
Syphilis, a resurgent sexually transmitted infection caused by Treponema pallidum, poses significant public health challenges globally. Its varied clinical presentations, especially oral manifestations, position dental professionals uniquely for early detection and intervention. This review synthesizes current epidemiological trends, clinical features, diagnostic approaches, prevention strategies, and management guidelines with an emphasis on the role of dental professionals. A literature review was conducted to assess the clinical presentation of syphilis, prevention and management by dental professionals. Key topics included epidemiology, risk factors, transmission, diagnosis and treatment. A systematic search was conducted across PubMed, Ovid MEDLINE, EMBASE, Scopus, and Google Scholar for studies published in English from 2010 to 2024, supplemented by public health and media reports. A notable increase in syphilis cases was reported globally, including Canada and the United States, with disproportionate impacts on vulnerable populations. Oral lesions, including chancres and mucosal patches, frequently present in early stages, underscoring the importance of dental examination. Rapid point-of-care testing offers opportunities for timely diagnosis in dental settings. Prevention relies on education, routine screening, and structural interventions, while management centres on penicillin-based treatment and coordinated referrals. Dental professionals can play a critical role in mitigating syphilis transmission through early identification, patient education, and referral. Strengthening interdisciplinary collaboration and provider training is essential for improving syphilis outcomes and population health.
29. Azacitidine to treat measurable residual disease in patients with MDS/AML: final long-term results of the RELAZA2 trial.
期刊: Blood 发表日期: 2025-Dec-08 链接: PubMed
摘要
Measurable residual disease (MRD) can predict relapse in patients with advanced myelodysplastic neoplasms (MDS) or acute myeloid leukemia (AML). We report the long-term efficacy and safety of MRD-guided preemptive azacitidine treatment to prevent relapse in the phase 2 RELAZA2 trial. Patients with MDS or AML after either intensive chemotherapy only or consecutive allogeneic stem cell transplantation were prospectively screened for imminent relapse by molecular MRD assessment. Patients who became MRD positive (MRDpos) during screening received azacitidine for up to 2 years to prevent relapse. The primary endpoint was the proportion of patients alive and relapse-free six months after azacitidine start. Of 357 patients screened, 119 (33.3%) became MRDpos, of whom 95 (79.8%) were eligible for azacitidine treatment. The primary endpoint was met; 60 (63%) patients were relapse-free (95% confidence interval 54-71%, P<0.0001) six months after azacitidine initiation with no new safety signals. Of 60 patients achieving MRD response during the first six cycles of azacitidine, 31 (52%) maintained response without hematological relapse for ≥2 years following azacitidine initiation. The median treatment-free duration following azacitidine discontinuation was 20.8 months; the longest ongoing response was 104 months. After a median follow-up of 6.6 years, 15 initial responders (25%) remained alive and in remission. Among screened patients who remained continuously MRDneg, 60-month overall survival and relapse-free survival were 88% and 79%, respectively. Continuously MRDneg patients display a very favorable prognosis. A majority of MRDpos patients can be effectively treated with azacitidine with potential long-term remission even after termination of azacitidine. Clinicaltrials.gov: NCT01462578.
30. Understanding the relationship between eosinophils and chronic obstructive pulmonary disease. A new dawn?
期刊: Expert review of respiratory medicine 发表日期: 2025-Dec-08 链接: PubMed
摘要
Chronic obstructive pulmonary disease (COPD) is a leading cause of global morbidity and mortality. It is a complex and heterogeneous condition defined by the presence of incompletely reversible airflow obstruction. Airway inflammation and remodeling is central to the pathogenesis of this airflow limitation, and eosinophilic or type 2 inflammation has emerged as a measurable and treatable therapeutic target in those patients in whom it is identified. This review addresses the role of type 2 inflammation in COPD pathogenesis as well as current and future therapeutic options. The last 15 years has seen the emergence of a precision medicine, type-2 biomarker directed approach to the use of inhaled corticosteroids in COPD, resulting in better targeting of treatment and an increased benefit/risk ratio. We have also seen the approval of first biological therapy against type 2 inflammation in COPD. There is increasing interest in biomarker directed early intervention to prevent progression or even the development of COPD.
31. Trends of Adolescent Substance Use by Type of Victimization: COVID-19 Interaction Effects in the United States Youth Risk Behavior Survey (2013-2023).
期刊: Substance use & misuse 发表日期: 2025-Dec-08 链接: PubMed
摘要
Adolescent substance use remains a public health concern, particularly among youth exposed to interpersonal victimization. The COVID-19 pandemic has further disrupted social contexts, potentially intensifying disparities in substance use. We analyzed nationally representative data from the Youth Risk Behavior Survey (2013-2023), including 52,679 U.S. adolescents. Substance use outcomes included current cigarette use, alcohol use, marijuana use, and other drug use. Victimization types were categorized as school bullying, electronic bullying, sexual victimization, or multiple. Linear logistic regression models were used to assess temporal trends and victimization-by-year interaction effects. Difference-in-differences (DID) regression tested changes across pre-COVID-19 (2019), COVID-19 pandemic (2021), and post-COVID-19 (2023) periods. Overall, 27.2% of adolescents reported at least one form of victimization. Adolescent with sexual victimization had higher odds of alcohol use (aOR = 2.79) and other drug use (aOR = 3.65) compared to non-victimized peers. Those reporting multiple victimizations had the highest risk across all substances, particularly for marijuana use (aOR = 3.53) and inhalant use (aOR = 6.45) during the pandemic. Victimization-by-year interactions were significant (p < 0.05), indicating widening disparities over time. While marijuana use declined in 2021, it rebounded in 2023 among multiple victimization group (aOR = 1.72). The COVID-19 pandemic exacerbated substance use disparities among victimized adolescents, especially those with multiple victimizations. Findings highlight the need for trauma-informed, targeted interventions beyond universal school-based approaches to address these behavioral vulnerabilities.
32. Azocyclotin Binds CDK4 to Disrupt DNA Methylation in Zebrafish Epigenetic Transgenerational Inheritance.
期刊: Environmental science & technology 发表日期: 2025-Dec-08 链接: PubMed
摘要
Azocyclotin (ACT), a widely used organotin pesticide, poses environmental and health risks due to its endocrine-disrupting effects. While prior studies linked ACT to transgenerational endocrine disruption in zebrafish via DNA methylation, the underlying molecular mechanisms remained unclear. Using zebrafish ZF4 cells as an in vitro model, we elucidated the mechanism by which ACT modulates DNA methylation. ACT exposure induced a 38.03% decrease in global DNA methylation, as determined by 5-mC quantification. Integrated whole-genome bisulfite sequencing (WGBS) and RNA sequencing (RNA-seq) analyses revealed that ACT dysregulated the expression of methylation-related genes, which was subsequently verified at the protein level by Western blotting. These multiomics analyses indicated that ACT disrupts the CDK4/pRb/E2F1/DNMT1 signaling axis and revealed methylation-expression coupling in endocrine-related and imprinted genes. Co-immunoprecipitation and pull-down assays demonstrated that ACT interferes with the formation of the E2F1-DNMT1-Rb-HDAC1 complex. Furthermore, molecular docking and surface plasmon resonance assays confirmed direct binding of ACT to cyclin-dependent kinase 4 (CDK4), a finding validated using CDK4-overexpressing cell lines. These findings establish CDK4 as the primary molecular target mediating ACT’s epigenetic effects. This discovery provides crucial mechanistic insights into the toxicity of ACT in aquatic organisms and its potential environmental risks.
33. Evolution of Multiple Myeloma from a Genomic Perspective.
期刊: Blood 发表日期: 2025-Dec-08 链接: PubMed
摘要
In this review we explore the role of complex interactions between genomic evolution, environmental and genetic predispositions, and immune surveillance in disease progression from precursor conditions smoldering multiple myeloma (SMM) and monoclonal gammopathy of undetermined significance (MGUS) to multiple myeloma (MM). MM is well-described to be universally preceded by precursor states, often decades before it is even diagnosed. Genetic predisposition plays an important role in the initial transformation and is driven by both germline variants and MM-specific loci influencing risk. The reported disparities in occurrence of precursor conditions and MM among racial groups highlights the role of predisposition and the need for broader cohort studies. Early genomic events, such as translocations and hyperdiploidy, are essential in precursor initiation. However, additional factors are usually needed to transform the precursor stages into symptomatic disease, such as positive selection of subclonal populations. This process is impacted by aging, environmental factors such as exposures to Agent Orange and agrochemicals. Therefore, integrating genomic and transcriptomic data and combining them with immune profiling or other clinical features is essential for identifying patients with high risk of progressing into MM. Here, we highlight the complexity of myelomagenesis and underline the importance of state-of-the-art approaches for improved disease prediction.
34. Exploring Perspectives of Health Care Professionals on AI in Palliative Care: Qualitative Interview Study.
期刊: JMIR human factors 发表日期: 2025-Dec-08 链接: PubMed
摘要
The use of artificial intelligence (AI) methods in palliative care research is increasing. Most AI palliative care research involves the use of routinely collected data from electronic health records; however, there are few data on the views of palliative care health care professionals on the role of AI in practice. Determining the opinions of palliative care health care professionals on the potential uses of AI in palliative care will be useful for policymakers and practitioners to determine and inform the meaningful use of AI in palliative care practice. This study aimed to explore the views of palliative care health care professionals on the use of AI for the analysis of patient data in palliative care. This was a phenomenological study using qualitative semistructured interviews with palliative care health care professionals with a minimum of 1 year of clinical experience in a hospice in the North West of England. Data were analyzed using inductive thematic analysis. We interviewed 6 palliative care professionals, including physicians, nurses, and occupational therapists. AI was viewed positively, although most participants had not used it in practice. None of the participants had received training in AI and stated that education in AI would be beneficial. Participants described the potential benefits of AI in palliative care, including the identification of people requiring palliative care interventions and the evaluation of patient experiences. Participants highlighted security and ethical concerns regarding AI related to data governance, efficacy, patient confidentiality, and consent issues. This study highlights the importance of staff perceptions of AI in palliative care. Our findings support the role of AI in enhancing care, addressing educational needs, and tackling trust, ethics, and governance issues. This study lays the groundwork for guidelines on AI implementation, urging further research on the methodological, ethical, and practical aspects of AI in palliative care.
35. Bridging the AI-Literacy Gap in Health Care: Qualitative Analysis of the Flanders Case Study.
期刊: Journal of medical Internet research 发表日期: 2025-Dec-08 链接: PubMed
摘要
Building on the assertion that nearly every clinician will eventually use artificial intelligence (AI), this study provides a triangulated qualitative analysis of the requirements, challenges, and prospects for integrating AI into routine health care practice. This skills gap contributes to cautious and uneven adoption across clinical settings. Despite advancements, many health care professionals report a self-perceived lack of proficiency in comprehending, critically evaluating, and ethically deploying AI tools, which contributes to cautious adoption in clinical settings. While addressing key research questions, the study investigates the necessary prerequisites, barriers, and opportunities for AI adoption and specific training priorities that medical staff require. The study is uniquely focused on the health care workforce, moving beyond the predominant emphasis in the literature on medical students. Situated in Flanders, Belgium, a recognized innovation leader but with moderate lifelong learning participation, this research combines 15 semistructured expert interviews, a regional survey of 134 health care professionals, and 3 co-interpretive focus groups with 39 stakeholders, all conducted in 2024. The results expose small generational and mainly occupational divides. For instance, 85.07% (114/134) of survey respondents expressed interest in introductory AI courses tailored to health care, while 80% (107/134) of them sought practical, job-relevant AI skills. However, only 13.8% (19/134) of clinicians felt that their training adequately prepared them for AI integration. Notably, younger professionals (<30 years of age) were most eager to engage with AI but also expressed greater concern about job displacement, while older professionals (>50 years of age) prioritized reducing administrative burden. Physicians and dentists reported higher self-assessed AI knowledge, whereas nurses and physiotherapists showed the lowest familiarity. The survey also revealed differences in preferred learning formats, with doctors favoring flexible, asynchronous learning and nurses emphasizing the need for accredited, employer-supported training during work hours. Ethics, though emphasized in academic literature, ranked low in training interest among most practitioners, except for younger and palliative care professionals. Focus group participants confirmed the need for clear regulatory guidance and access to accredited, practically oriented training. A significant insight was that nurses often lacked institutional support and funding for training, despite their pivotal role in AI-enabled workflows. Taken together, these findings indicate that a one-size-fits-all approach to AI education in health care is unlikely to be effective. By triangulating insights across research stages, this study highlights the need for occupation-specific, accessible, and accredited AI training programs that bridge gaps in digital literacy and align with practical clinical priorities. The qualitative insights obtained can inform policy and training priorities in light of the European Union (EU) AI literacy mandates, while highlighting persistent gaps in workforce preparation.
36. Revisiting the stressor-burnout relationship: Evidence for reverse causation and conditional change.
期刊: Journal of occupational health psychology 发表日期: 2025-Dec-08 链接: PubMed
摘要
The assumption that work stressors cause burnout is central to many occupational health theories. In this study, we addressed three limitations in prior research: (a) the limited understanding of how within-person increases in work stressors drive increases in burnout (the stressor hypothesis), including the consideration of whether the reverse effect (the strain hypothesis) offers greater predictive value; (b) the limited research on varying long-term time lags in the development of burnout; and (c) the limited evaluation of the effects of multiple work stressors. We applied random-intercept cross-lagged panel models with different time lags to analyze data from 2,131 German-speaking employees, collected across five time points over 24 months. Our findings showed stronger support for the strain hypothesis, suggesting that an increase in burnout over 6 months results in a subsequent increase in work stressors. This finding remained consistent across three types of stressors (i.e., work overload, social stressors, and organizational stressors) and when accounting for additional longer term time lags. We found limited evidence for the stressor hypothesis, particularly when disregarding stable between-person differences. However, cross-level moderation analyses showed that work stressors resulted in increased burnout for individuals who experience chronically lower levels of job resources (i.e., job autonomy and social support) or higher levels of work stressors. Our findings challenge the unconditional applicability of the stressor effect. They emphasize the theoretical importance of considering reverse causation, the timing of effects, and a clearer distinction between within-person changes and between-person differences to advance the understanding of burnout development processes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
37. The association between trunk flexion and low back pain in blue-collar workers: A systematic review.
期刊: Work (Reading, Mass.) 发表日期: 2025-Dec-08 链接: PubMed
摘要
BackgroundTrunk flexion has been considered as an important risk factor for low back pain (LBP) in blue-collar workers. There is controversy about this claim, and prior reviews mainly included studies assessing trunk flexion with questionnaires and/or outside of the work setting.ObjectiveIn this systematic review, we aimed to investigate the association between objectively measured trunk flexion at work and LBP in blue-collar workers from epidemiological studies.MethodsLiterature searches were performed in PubMed, Embase and Web of Science until June 2024. Cross-sectional and longitudinal cohort studies were included if they objectively measured trunk flexion (amplitude and duration) under normal working conditions in blue collar workers. Two reviewers independently performed study selection, data extraction and risk of bias assessment, and studies were described narratively.ResultsFrom 800 references, four studies with 2013 participants in total were included. There was no evidence for an association between trunk flexion amplitude/duration and increased LBP prevalence, incidence and/or intensity. One study showed an association between higher duration of trunk flexion above 30° and reduced risk of LBP (hazard ratio 0.87, 95%CI: 0.78-0.97).ConclusionsThese results suggest that trunk flexion is not associated with LBP development or aggravation in blue-collar workers. However, based on the limited number of studies and lack of geographical diversity, the certainty of evidence is low and more evidence is needed from studies with objective measures of trunk flexion at work.
38. Adsorption/desorption between nanoparticles and aerobic granular sludge: influences of sludge concentration, granule size, aeration/mixing intensity.
期刊: Journal of environmental management 发表日期: 2025-Dec-07 链接: PubMed
摘要
The global concern regarding nanopollutant pollution stems from its long-term threat to ecosystems and public health. This study systematically investigated the effect of key parameters on nanoparticles (NPs) adsorption in aerobic granular sludge (AGS) systems, such as mixed liquid suspended solids (MLSS), granule size, aeration/mechanical mixing intensity, and the fate of NPs in Nereda® process were also investigated. The results showed that NPs adsorption by AGS followed the first-order kinetics during aeration, the NPs adsorption capacity was negatively correlated with MLSS and granule size (r = -0.510, r = -0.405), but positively correlated with mechanical mixing intensity (r = 0.320). Fourier-transform infrared spectroscopy analysis revealed that the outer and inner surface of AGS mainly consisted of lipid and protein groups, which affected the adsorption performance. When the NPs were adsorbing by sludge mixture, the flocs and small granules would take the adsorption effect firstly, but the final adsorption performance was not affected. When the influent NPs was 143.79 μg L-1, 94.60-98.67 % NPs would be adsorbed by sludge mixture in each Nereda® cycle, and desorption efficiencies were smaller than 5.0 % during both plug-flow feeding and aeration phases. This study revealed how operational parameters affect NPs adsorption by AGS and evaluated the interception rate of NPs in Nereda system, providing insights into NPs management for further wastewater treatment.
39. Effects of atmospheric particle deposition from coal combustion on heavy metals accumulation and growth responses of wheat (Triticum aestivum L.).
期刊: Journal of environmental management 发表日期: 2025-Dec-07 链接: PubMed
摘要
Atmospheric particulate deposition has increased heavy metal(loid)s (HMs) input into cropland ecosystems, posing a potential risk to food safety and human health. However, its contribution to HMs accumulation and physiological stress in the soil-wheat (Triticum aestivum L.) system by the pathways of foliar and root uptake still remains unclear. In this study, we simulated atmospheric dry deposition of environmental levels using fly ash from coal combustion to assess its effects on HMs absorption and physiological responses of wheat. In a 6-month pot experiment (from November to May), three deposition fluxes of 0.143, 0.286, and 0.572 g·m-2·d-1 (low, moderate, and high) were applied at different growth stages (early, late, and entire period), respectively. Results showed that high deposition levels suppressed photosynthetic activity and chlorophyll content, while enhanced antioxidant defenses, with superoxide dismutase (SOD) and catalase (CAT) activities elevated by up to 249 % and 90 %, respectively. Atmospheric particulate deposition showed a strong bioaccumulation capacity for Cd, Pb, and As, contributing 41.2 %, 18.7 % and 42.7 % to the grain concentrations, respectively. Late dustfall exposure caused higher wheat grain HMs than early exposure, and grain Cd contents were raised by 35-70 % under deposition during late exposure. The correlation analysis indicated that Cd accumulation in grains derived from both directly foliar uptake and indirectly root absorption under atmospheric particulate dry deposition, whereas Pb and As were predominantly contributed by foliar pathways. It was confirmed that atmospheric deposition significantly contributes to HMs accumulation and physiological stress in wheat, particularly via foliar uptake. Therefore, besides soil pollution remediation, preventing airborne HMs input especially from the directly foliar contamination is also urgent to protect agricultural food safety. Our study is also novel in simulating dry deposition of coal-combustion fly ash across multiple wheat growth stages using realistic fluxes through a controlled exposure chamber, providing quantitative precision that cannot be achieved in smelter-based field observations.
40. Pfas bioaccumulation, depuration, and associated energetic costs in the Eastern oyster Crassostrea virginica.
期刊: Environmental toxicology and chemistry 发表日期: 2025-Dec-06 链接: PubMed
摘要
Per-, and polyfluoroalkyl substances (PFAS) are a class of man-made chemicals that are widespread and persistent in the environment. Impacts of PFAS on the health of oysters are an emerging concern to conservationists and oyster farmers alike. Depuration of contaminants has been shown to be energetically expensive in some bivalves and there is concern that this metabolic cost may have a negative effect on organismal health. To address bioaccumulation concerns, eastern oysters (Crassostrea virginica) were exposed to a mixture of PFAS (PFOS, PFOA, PFHxA, PFPeA, PFBS) at a nominal concentration of 2 µg/L per compound for 28-days and then transferred to clean water for 5-days. Concentration of PFAS in soft tissues was measured on a subset of oysters seven times throughout exposure using an ultra-high performance liquid chromatography coupled to triple quadruple mass spectrometry (UHPLC-QqQ-MS) to determine PFAS bioaccumulation and subsequent depuration. Bioaccumulation factor was higher for >6 carbon chained compounds compared to <6 carbon chained compounds and PFAS tissue concentration was below detection limits within 24-hr of transfer to clean water. To determine metabolic cost of PFAS exposure and depuration, an additional group of oysters were exposed to either a mixture of PFOS + PFOA (5 µg/L each) or a mixture of PFOS, PFOA, PFHxA, PFPeA, PFBS (2 µg/L each) for 10-days and optical respirometry was used to assess changes in mass-specific oxygen uptake (MO2). There was no significant difference in MO2 between treatment and control oysters during exposure or during depuration. There was no evidence that exposure and depuration of PFAS mixtures at concentrations higher than measured in coastal environments adversely impacted oyster metabolism.
41. Normative Data for Physical Activity and Heart Rate Metrics of Recreational Football Among the General Male Population-The Football Cooperative Initiative.
期刊: Journal of strength and conditioning research 发表日期: 2025-Dec-05 链接: PubMed
摘要
Everard, E, Carroll, P, Doherty, S, Harrison, M, and Krustrup, P. Normative data for physical activity and heart rate metrics of recreational football among the general male population-the Football Cooperative initiative. J Strength Cond Res XX(X): 000-000, 2025-Owing to established benefits associated with recreational football, there has been increased focus on developing the concept of Football is Medicine. This is leading to the development of more formalized and larger scale recreational football initiatives in general populations, such as the Football Cooperative (FC) in Ireland. The aim of this study was to determine the physical activity and heart rate (HR) metrics of FC games and to compare these metrics between the 2 FC game sites. One hundred two men (age: 37.4 ± 8.5 years, height: 176.2 ± 18.2 cm, body mass: 90.6 ± 21.5 kg) volunteered for this study. The games were 9 vs. 9 and 30 minutes per half on an astroturf pitch (36.5 × 27.5 m). Global Positioning Systems and chest-strap HR monitors were used to measure physical activity and HR metrics, respectively. Subjects ran an average of 6,632 m with 32 accelerations per session. Furthermore, subjects had a HRmean of 77% of their peak HR achieved during matches (Match-HRpeak) and played 81% of the time above 70% Match-HRpeak, 52% above 80% Match-HRpeak, and 23% above 90% Match-HRpeak. Despite a mean age difference of 10 years between the 2 sites, the only significant physical activity differences between sites were maximum speed and high-speed running. This was the first study to provide normative data for HR and physical activity metrics related to a 9 vs. 9 recreational football initiative. The results show recreational football provides a training stimulus in relation to HR metrics and distances covered that is to the upper ranges of recommended exercise guidelines.
42. One Dose Versus Two Doses of Intravenous Tranexamic Acid in Revision Total Joint Arthroplasty.
期刊: Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews 发表日期: 2025-Dec-01 链接: PubMed
摘要
Tranexamic acid (TXA) is often used to reduce the amount of blood lost during total joint arthroplasty (TJA) and decrease the incidence of postoperative transfusion. Despite its extensive use, the ideal dosing regimen is still widely debated. The primary aims of this study were to compare single-dose and two-dose regimens on postoperative hemoglobin levels, transfusion rates, and 30-day complication rates in patients who underwent revision TJA. This retrospective study included patients who underwent revision total knee arthroplasty or revision total hip arthroplasty between April 2014 and November 2020 at a single academic institution. Patients were divided into two groups: One group received a 1 g bolus of intravenous TXA just before incision and another intravenous 1 g bolus during wound closure (n = 151), and the second group received a single, 1-g, intravenous bolus of TXA just before incision (n = 189). No notable statistical differences were found between the two cohorts when evaluating postoperative hemoglobin levels (b = -0.18, 95% confidence interval [CI]: -0.39 to 0.03; P = 0.09), transfusion rates (odds ratio [OR] = 0.74, 95% CI: 0.39 to 1.38; P = 0.34), length of hospital stay (rate ratio = 0.95, 95% CI: 0.84 to 1.08; P = 0.43), and 30-day postoperative complication rates (OR = 1.30, 95% CI: 0.54 to 3.15; P = 0.56) even after controlling for patient characteristics and surgical factors. In this study, no association was found between a single dose of perioperative TXA during revision TJA and increased rates of post-operative complications when compared with two-doses, suggesting comparable efficacy.
43. Faculty-Initiated Burnout Interventions for Undergraduate Nursing Students: A Systematic Literature Review.
期刊: The Journal of nursing education 发表日期: 2025-Dec 链接: PubMed
摘要
Burnout in student and professional nurses contributes to academic attrition, decreased academic success, turnover, and poor quality of care. This study aims to determine which educational interventions are successfully being used to prevent burnout and promote resilience in undergraduate nursing students. This systematic literature review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Faculty-initiated practices aimed at preventing burnout and promoting resilience in undergraduate nursing students are identified and evaluated. A total of 406 articles were identified as relevant to the research question, and 10 studies were ultimately included in the systematic literature review. Narrative synthesis was used to group interventions into the following five common themes: mindfulness, stress education, psychological skill building, social support, and exploring professional identity. The findings provide guidance for nurse educators to reference when incorporating burnout prevention and resilience promotion activities in curriculum.
44. Integrative Spectral-Graph Learning With CNN Features for the Classification of Circle of Willis Anatomical Variants.
期刊: IEEE journal of biomedical and health informatics 发表日期: 2025-Dec 链接: PubMed
摘要
Many cerebrovascular diseases are related to morphological variations in the Circle of Willis (CoW), an arterial network located at the base of the brain. Early detection of these structural abnormalities can result in effective treatments and helps to prevent the progression of the diseases to more advanced stages. This necessitates the need for developing a computer-aided model capable of automatically identifying anatomical variants of the CoW using a standardized classification framework, such as the Lippert and Pabst system. However, there are no reported studies that have applied the Lippert and Pabst classification in the context of computer-assisted analysis of CoW variants. Due to the small size and high class imbalance often present in medical datasets, it becomes challenging for standard CNNs to effectively capture CoW variants in classification tasks. To address this, we developed a novel graph-based method that incorporates spectral analysis with a hybrid Convolutional Neural Network and Graph Neural Network architecture to capture the complex morphological structures of the CoW. We conducted a detailed study comparing the performance of the proposed method in classifying anterior and posterior CoW variants across various configurations of VGG and ResNet networks. The proposed method attains a balanced accuracy of 0.69 for anterior and 0.71 for posterior CoW classification, indicating that the proposed framework significantly improved CoW classification performance across both anterior and posterior classes.
45. Proteomic profiles of Lissachatina (Heterobranchia) and Pomacea (Caenogastropoda) snails infected with Angiostrongylus cantonensis using 4D label-free quantitative analysis.
期刊: PLoS neglected tropical diseases 发表日期: 2025-Dec 链接: PubMed
摘要
Angiostrongylus cantonensis, the causative agent of human eosinophilic meningitis, utilizes terrestrial and freshwater gastropods as intermediate hosts. However, the molecular mechanisms underlying these host-parasite interactions remain unclear. We applied four-dimensional label-free quantitative (4D-LFQ) proteomics to examine proteomic alterations in infected versus uninfected specimens of two intermediate snail hosts, Lissachatina fulica and Pomacea canaliculata. Differentially expressed proteins (DEPs) were identified, followed by Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. In infected Lissachatina, 36 proteins were upregulated and 104 downregulated, while in infected Pomacea, 94 were upregulated and 364 downregulated. GO analysis revealed 111 enriched terms linked to 71 DEPs in Lissachatina and 484 terms associated with 389 DEPs in Pomacea. KEGG pathway enrichment (Level 3) showed predominant downregulation, including 12 of 20 pathways in Lissachatina and 18 of 20 in Pomacea. Both species shared downregulation in essential pathways: ribosome, proteasome, aminoacyl-tRNA biosynthesis (genetic information processing); glycolysis/gluconeogenesis, pyruvate metabolism, sulfur metabolism (metabolic); and phagosome formation and endocytosis (immune-related). Protein-protein association (PPA) analysis identified conserved hub proteins, Tr-type G domain and T-complex chaperonins, indicating coordinated disruption of translational and proteostatic processes in both groups. Our findings suggest that A. cantonensis can modulate host immunity and metabolism, suppressing key protective responses in both gastropod hosts. This proteomic data may serve as a foundation for discovering biomarkers and designing interventions to disrupt the parasite’s life cycle.
46. Nursing and Disability: Examining the Equity of Nurse Practice Acts.
期刊: The Journal of nursing education 发表日期: 2025-Dec 链接: PubMed
摘要
Many individuals with disabilities face challenges in education and employment despite having legal protection. This study examined laws governing nursing and education, focusing on how they affect individuals with disabilities pursuing nursing careers. Using the READ document analysis approach, we reviewed state nurse practice acts across the United States. Ten states included accommodations or anti-discrimination language. In comparison, 34 states had language that could exclude persons with disabilities without any mention of accommodation, and 10 states had no laws with language about disabilities or accommodations. The lack of specific language in laws may lead to discrimination for persons with disabilities attempting to enter nursing education due to various interpretations of the law. Nursing education should adopt inclusive standards for admission and outcome measures for nursing students. Regulatory bodies should adopt more specific and inclusive language in their laws.
47. Urinary Reflux Mimicking Seminal Vesicle Invasion on 99mTc-HYNIC-PSMA SPECT/CT: Clarification by Concurrent Bone Scintigraphy.
期刊: Clinical nuclear medicine 发表日期: 2025-Nov-19 链接: PubMed
摘要
A 67-year-old man with lower urinary tract symptoms underwent transurethral resection of the prostate (TURP), revealing prostatic adenocarcinoma. Staging with 99mTc-HYNIC-PSMA SPECT/CT demonstrated focal uptake at the prostate mid-to-base and left seminal vesicle, initially suggesting miT3b disease. However, a subsequent bone scan revealed an identical uptake pattern inferior to the bladder, confirming a urinary artifact rather than true PSMA-avid tumor involvement. This case underscores a recognized pitfall of PSMA imaging following TURP and highlights the value of correlative imaging in preventing false-positive interpretation and ensuring accurate staging.
48. SpaTM: topic models for inferring spatially informed transcriptional programs.
期刊: Briefings in bioinformatics 发表日期: 2025-Nov-01 链接: PubMed
摘要
Spatial transcriptomics enables the contextualization of gene expression with spatial organization, advancing our understanding of development, disease, and tissue architecture. However, existing analysis pipelines require multiple tools to explore spatial domains, and few methods can jointly analyse spatial data from annotation-free and annotation-guided perspectives with high interpretability. We therefore propose the Spatial Topic Model (SpaTM), a topic-modelling framework capable of annotation-guided and annotation-free analysis of spatial transcriptomes. SpaTM can learn gene programs that represent histology-based annotations while also inferring spatial domains with an annotation-free approach if manual annotations are limited or noisy. In benchmarking experiments, SpaTM achieves competitive performance at spatial label prediction and clustering when compared with existing state-of-the-art methods. We demonstrate SpaTM’s interpretability by using topic mixtures to capture transcriptional programs in dorsolateral prefrontal cortex and ductal carcinoma samples and show how its intuitive framework facilitates the integration of spatial transcriptomics tasks. Finally, we showcase how SpaTM can extend the analysis of large-scale snRNA-seq atlases in human brains with Major Depressive Disorder. Overall, SpaTM provides a unified and interpretable analysis framework for spatial transcriptomics, enabling competitive performance in multiple tasks while inferring biologically informed gene programs.
49. Timing of BRCA Genetic Testing and Surgical Decision-Making Among Young Black Women With Breast Cancer.
期刊: Cancer control : journal of the Moffitt Cancer Center 发表日期: 2025 链接: PubMed
摘要
IntroductionGenetic testing for hereditary cancer syndromes, particularly BRCA1 and BRCA2 (BRCA) germline pathogenic or likely pathogenic variants (GPVs), is critical in informing surgical decisions for women with breast cancer. Young Black women are historically underrepresented in genetic testing and research, making it essential to understand how testing timing influences treatment choices. We evaluated how the timing of BRCA testing affected surgical management among young Black women with breast cancer.MethodsParticipants were drawn from a population-based cohort of Black women diagnosed with invasive breast cancer at age 50 or younger, recruited via Florida and Tennessee cancer registries. Data were collected through structured questionnaires, electronic health records, and lab reports, including information on genetic testing, BRCA status, and treatment. Participants were categorized by timing of BRCA testing (pre-surgical vs post-surgical) and GPV status. Chi-squared tests assessed associations between testing timing, BRCA status, and surgical treatment.ResultsAmong 633 participants, people with a BRCA GPV who were tested before surgery (n = 29) were significantly more likely to undergo bilateral mastectomy (82.8%) than those tested after surgery (40%). Timing of testing and BRCA status were both strongly associated with surgery received (P < 0.0001).ConclusionBRCA testing at diagnosis and prior to surgery is significantly associated with surgical management in young Black women with breast cancer. These findings highlight the importance of timely genetic testing, especially in populations with historically lower testing rates. Many women with breast cancer receive genetic testing to find out if they have inherited mutations that increase their risk for future cancers. This information can help guide decisions about surgery, such as whether to remove one or both breasts. However, young Black women are less likely to receive genetic testing early in their treatment. This study examined how the timing of genetic testing affected surgical choices in young Black women with breast cancer. We found that women who received testing before surgery were more likely to choose a more aggressive surgery that could lower their future cancer risk. These findings suggest that offering genetic testing earlier in the treatment process may help women make more informed decisions. This research highlights the need to improve access to timely genetic testing, especially for Black women who have historically faced barriers in cancer care.
50. Decolonizing infectious disease programs: A mixed methods analysis of a novel multi-country virtual training for Female Genital Schistosomiasis.
期刊: PLOS global public health 发表日期: 2025 链接: PubMed
摘要
Existing medical curricula and continuing professional development for infectious diseases have been largely driven by materials from higher-income countries and exclude teaching about FGS. In 2023, The Geneva Learning Foundation’s peer learning-to-action model was used to create a multi-country virtual training program to address this gap and empower local healthcare workers in endemic countries. During Phase 1, participants learned about FGS and developed an action plan to address it. In Phase 2, participants received support in implementing their action plans. To explore the learning approach and its ability to reach a diverse set of health care workers, we conducted a mixed methods study framed in the theoretical lens of connectivism. Quantitative and qualitative data were collected through online surveys, analyzed separately, and then integrated. Healthcare workers from 19 Francophone African countries, representing all levels of the health system, participated in Phase 1. Over two-thirds of Phase 1 participants reported an increase in FGS technical knowledge and trained 2,675 colleagues. About 85% of the Phase 1 participants found the peer review process beneficial, generating new ideas that strengthened their action planning. Phase 1 course completion was not significantly associated with profession or organization where a participant worked. Social/external connections led to personal growth and high-level professional impacts. The networks formed created valuable support systems for participants, and training certification led to opportunities for role expansion and promotion. 255 and 71 participants completed Phase 1 and 2, respectively. All participants reported engaging and teaching 49,088 community members about FGS. Peer connections and local knowledge exchange addressed immediate educational needs across health system levels and promoted local action. The virtual peer learning-to-action model successfully reached diverse learners, equipping them with knowledge they directly applied to challenging problems in their contexts, effectively decolonizing the approach to FGS.
51. Contribution of xpert MTB/RIF assay and Urine LF-LAM for the diagnosis of tuberculosis in children aged 5 - 14 years, at selected health facilities in Ethiopia, 2016 - 2019.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Childhood tuberculosis (TB) remains under-reported and undiagnosed. A full complement of diagnostic tests is oftentimes unavailable in resource limited country like Ethiopia. This study assesses the contribution of Xpert MTB/RIF assay and urine LF-LAM for childhood TB diagnosis using sputum and urine samples. A facility based cross-sectional study was conducted in children between 5 and 14 years of age. Sputum and urine samples were collected from children with presumptive TB. The samples were tested for TB using LF-LAM, Xpert MTB/RIF assay, concentrated smear microscopy, and culture. Diagnostic performance of Xpert MTB/RIF assay was analyzed and compared against culture, which was used as the gold standard. Urine LF-LAM test result was compared to a composite reference standard. Of 576 participants with presumptive TB enrolled in the study, 519 (90.1%) had complete clinical data and bacteriological laboratory test results. Active TB was diagnosed in 14.1% (73/519), and bacteriological confirmation was made in 10.1% (52/515) of children with presumptive TB. The odds of being diagnosed with a bacteriologically confirmed TB are significantly higher in children who have household contact history with TB patient (aOR 2.27, P = 0.03) and age above 10 years (aOR 3.67, P < 0.001). Xpert MTB/RIF test had sensitivity of 79% using culture as the gold standard. Compared to smear microscopy, the sensitivity of the Xpert MTB/RIF assay increased by 50% for children aged 5-9 years and by 40% for children and adolescents living with HIV (C/ALHIV). All bacteriologically confirmed (n = 2) and clinically diagnosed TB children (n = 2) who live with HIV were tested positive for urine LF-LAM. The overall sensitivity of urine LF-LAM was 27.6% when using the composite reference standard, compared to 17.9% when the bacteriological reference standard was applied. Pulmonary TB diagnosis was greatly improved with the use of Xpert MTB/RIF assay, particularly in children aged 5-9 years and C/ALHIV who typically have difficulty producing good quality sputum. Urine LF-LAM performed well in children/adolescents who tested positive for HIV, but it performed poorly in the other variables, which suggests that urine LF-LAM testing did not play a critical role in TB diagnosis in children with negative HIV status.
52. Co-infections of Schistosoma mansoni and Helicobacter pylori in school-aged populations and implication for management and control practices in Niger State, Nigeria.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Helicobacter pylori and Schistosoma mansoni are two important pathogens that infect the gastrointestinal tract, could be acquired earlier in childhood, and can remain asymptomatic for a long period. While S. mansoni is been controlled within routine primary healthcare program, there are no control guidelines for H. pylori. Here, we investigate the co-infection pattern of both pathogens to support improvement of management strategies. Fresh stool samples were obtained from 299 school-aged children between ages 6-17 years and analyzed using real-time and conventional polymerase chain reaction (PCR) for the direct detection of S. mansoni and H. pylori respectively. An overall prevalence of 19.7% (4.5% - 24.1%) was recorded for H. pylori, and 34.4% (0% - 42.1%) for S. mansoni, while co-infection of both was 7.0% (0% - 8.1%). Infections were significantly different across the study communities for S. mansoni (p = 0.00) when compared to H. pylori (p = 0.38). There were, however, no significant association between infection and gender (p > 0.05), with the following odds of infection for S. mansoni (OR=0.69, 95% CI: 0.42, 1.12), H. pylori (OR=1.33, 95% CI: 0.75, 2.36), and combination of both infections (OR=1.31, 95% CI: 0.83, 2.09). By age category, children below 14years were twice likely to be exposed to the combination of both infections; age 12-14 years (OR=1.9, 95% CI: 1.06, 3.44), and age 9-11 years (OR=1.96, 95% CI: 1.11, 3.48). But they were also less likely to be exposed to S. mansoni; age 12-14 years (OR=0.52, 95% CI: 0.27, 0.97), and age 9-11 years (OR=0.43, 95% CI: 0.23, 0.79). Our study highlights an unexpectedly high prevalence of S. mansoni, moderate prevalence of H. pylori, and very low coinfection prevalence for both. Our findings on S. mansoni are particularly concerning, suggesting potential challenges in control programs. It is therefore important to consider integrated interventions, including chemotherapy and improved water, sanitation, and hygiene (WASH) services.
53. Associations between refugee camp living and duration lived in refugee camps with health outcomes: A cross-sectional analysis of the Annual Survey of Refugees, 2021-2022.
期刊: PloS one 发表日期: 2025 链接: PubMed
摘要
Refugees represent a growing, marginalized population who experience significant health disparities. Approximate 20% of refugees live in refugee camps. Quantitative studies examining the health effects of refugees living in refugee camps are limited. We examined whether living in camps (and duration) is associated with worse health among U.S. refugees. We used two years of cross-sectional data from the Annual Survey of Refugees (ASR 2021 and 2022), involving refugees ≥ 16 years old who entered the U.S. between FY 2016 and FY 2021. We tested for associations of living in a refugee camp (and duration) with self-reported physical and mental health using separate logistic regression models. In this national sample of 3,005 refugees (mean age = 39.0 years, SD = 12.4 years; 46% women, 30% White, 31% Black, 18% Asian), more than one in three (37%) reported living in a refugee camp - of whom, over 88% lived in a refugee camp for a year or more or their whole life. Living in refugee camps was highest for refugees from Democratic Republic of Congo (75%), Somalia (58%), and Burma (44%). In adjusted analyses, compared to those who did not live in camps, those who lived in camps for ≥1 year had 27% greater odds of poor physical health (aOR: 1.27 [95% CI: 1.02, 1.60]). Association of camp living with mental health became insignificant when adjusted for socio-demographic characteristics. Refugees who lived in refugee camps, and for longer duration, may require targeted interventions to mitigate health harms from their refugee camp experience.